Eating Disorders in Schools by Robyn Hussa

A Strategic, Tiered Approach to Eating Disorder Awareness In Schools

For the seven years that we have been developing and delivering more than 14 programs into schools to educate about eating disorders, mental health and stress management (now in collaboration with Harvard School of Public Health), we have found the "tiered" approach overwhelmingly favorable (versus coming into a school and teaching the students directly, right off the bat).

The tiers include: teaching the leaders (school clinicians, administrators, coaches and educators), teaching the parents, then teaching the students.  The goal is to create a "blanket of support" for the entire school community -- especially when it comes to teaching about these topics in grade schools, middle schools and high schools.  In fact, in grade schools, we don't even teach about eating disorders themselves.  We train the teachers and parents about these issues, but not the students themselves.  Instead, we focus on body image, healthy coping and stress management training for children under the ages of 12.

In a recent survey that we conducted for our ThinkEatPlay program to optimize health in female athletes, we learned how very little athletic coaches know about issues of disordered eating, eating disorders and related health complications facing young athletes.  Similarly, we have learned that school clinicians in each district may not know about the illnesses, nor where (exactly) to refer or send students if they are found to be struggling with a serious, life-threatening eating disorder.

For these reasons, we have developed several tiers of learning and strategic roll-out for each.  In particular, the "Train the Trainer" model is highly popular, whereby in-depth trainings with qualified specialists in the field of eating disorders directly teach "Trainers" from each district. 

Afterwards, those "Trainers" return to their district to instruct the other leaders, coaches and counselors.  Finally, after the "Train the Trainer" model has been completed, we instruct parents. 

Only after the above, will we actually teach students about eating disorders.

Examples of programs we use for each "Tier" include:

Tier 1 and 2 -- Train the Trainer and Train the Parents: Speaking Out About Eating Disorders film, ED 101 film, ThinkEatPlay (for coaches), Be -- Stress Management and Wellness Curriculum, Beneath The Floorboards (documentary film about the mental health side of obesity), as well as an array of live seminars and talks with qualified specialists in the field of eating disorders.

Tier 3 -- Teach the Students -- NORMAL THE MUSICAL, ED 101 film, Stress Management Curriculum, Healthy Selfitude, Soar! Body Image Seminar, Self Esteem Stomp, Inside Out (live arts event), Real Deal body image blog universe, YouTube Channel of films, etc.

Examples of a 3 Tiered Initiative:

Tier 1: Train the Trainers with Speaking Out About ED film and seminar with qualified eating disorders specialists.  During this training, leaders in the schools are linked to QUALIFIED eating disorders providers, hospitals and resources in their community.

Tier 2: Train Parents with ED 101 film and seminar with qualified eating disorders specialists.  During this training, parents learn about all types of eating disorders and how to speak to a child who may need help.  They learn about support and the importance of early intervention to a full recovery.

Tier 3: Train the students with the ED 101 film and follow up with the Stress Management and Mindfulness curriculum.  We focus on teaching the students that these are biologically based illnesses that are not a matter of will, how to help a friend who may be struggling, that full recovery is possible, and -- most important -- we provide trainings about healthy ways to manage stress and cope with difficulty.

Programs to Teach About Eating Disorder Awareness in Schools

Need programs to raise awareness about eating disorders in schools? Here's an update about NORMAL's latest and greatest projects.

Choose from one of our 14 programs today!

Body Image and Self-Esteem

Though many educators are aware of the importance of healthy body image, often we don't realize how they relate to self-esteem and to the myriad of mental health issues facing students.

As this brief clip featuring Cynthia Bulik, PhD, FAED will show, individuals with a healthy sense of self find a balance between focusing on the confidence they feel from their abilities, their work, their hobbies, their personal relationships, their charity and outreach efforts and -- a tiny portion -- is from their body image or body esteem.

We run into trouble when our mind is overly focused on body, shape and weight. When this happens, individuals from all demographic backgrounds, from all genders and walks of life can experience complications.

This is why it is so crucial to help individuals evolve a strong sense of body esteem or body image. Programs and resources for promoting strong body image, include:

Reflections Body Image Program

We Are The Real Deal blog

Lauren Fleshman blog

Body Image Health.org

Self-Acceptance Through Arts and Yoga

Olympic.org

30+ Other Body Image Blogs and Resources

Turning Negative Thoughts into Positive Actions

photo from livingambitiously.com

Start your new year with an exercise that can enhance positive thinking in students. Teaching students how to change their negative thoughts is a powerful step toward conscious living and stress-management... we also use these techniques continuously in eating disorder recovery.  In particular, learning how to write and incorporate affirmations into daily life can literally turn those negative thoughts into positive beliefs and actions.  Affirmations stem from ancient yogic traditions (such as Ananda yoga) and train our autonomous, healthy Self to emerge louder, more clearly than ever before.  But most people don't know what affirmations are, nor how to employ them. 

Below is an exercise that will help students learn HOW affirmations are made, why they are necessary, and how to incorporate them into daily life as a stress-management and coping skill.

This exercise can be taught to students ages 12 and up in a classroom setting.  Supplies needed are: Negative Thoughts & Postive Statements (chart)* (one copy of the chart per student), a pen or pencil for each student and a stack of note cards** (about 5 per student).

Please ensure that each student has the supplies needed, then begin the exercise.

Instruction / Instructor cues are in italics:

1.  Begin in the left column and make a list of everything negative that you believe about yourself (or a fear that you have).  Try to focus only on writing in the left column – don’t worry about the right column for now.  Write down whatever comes to mind.  Listen to the negative thought from a place of gratitude and from a child's curiosity and simply write it down.  You can always erase or keep adding more later.  Once you have written down 4 or 5 fears or negative beliefs about yourself, then you are ready to move on.

2.  In the second column, next to each negative belief or fear, write the new positve statement -- a new belief you’d like to replace the old belief with.

After all students have finished filling out both columns.

3.  Once you have completed filling out each column, fold the piece of paper in half lengthwise so that the column with the negative thoughts gets folded underneath the column with the positive statements.

From this column, students will write some affirmations.

4.  Please take one note card and write one positive statement (or affirmation) onto each note card. 

When the students have transfered four or five positive statements onto each note card (like flash cards), they can put down their pens to signal they are ready for the next step.

5. Sitting with both feet on the floor, breathing calmly and slowly, gently pick up the stack of cards and slowly flip through each affirmation.  Simply noticing them.  Reading them.  Paying attention to what happens in your body as you read each card.  Make sure to flip through the stack of cards at least twice.  

The process of not only taking a negative thought and turning it into a positive statement, but LIFTING that positive statement off of a list and onto a flash card or affirmation card, is incredibly powerful.  The symbolism of "folding away" the negative thoughts and actually using them to derive helpful, positive statements is equally impactful.  The concepts to teach, here, are that negative thoughts or fears are not things we should be afraid of: they often help guide us to reach our higher potential.

There are several ways to experience or practice affirmations.  First, they can be experienced by creating or writing the affirmation – as in the above exercise.  This is the sureset way to find an affirmation that really resonates with where a student is right now in their process or journey.  The act of writing the affirmation is the first step in practicing it.  The reading through of the cards is the second step.  I recommend that students keep the stack of cards near their bed and reach for them every morning.  They will want to add affirmations to the stack – and to throw away any affirmations that are no longer feeling resonant or like they are working.  We have to believe in the affirmation in order for it to work, so if it isn’t resonating, then students should be encouraged to move on to another affirmation.

Affirmations can also be experienced through movement and voice.  Students can be encouraged to create a physical gesture or posture that symbolizes their affirmation -- this helps "seal" the affirmation into the body and muscle memory.  In addition, students can be taught to speak the affirmation 3 times out loud or until they actually believe the words.

--

*This chart is inspired by Barbara Stanny's "Replacing Beliefs" exercise in her book, Overcoming Underearning.

**Keep in mind that the types of paper used for the affirmation cards can add to the fun of the exercise. Try shiny or sparkly paper, or other interesting types of card stock!

New Mindfulness Program for Schools

The NORMAL nonprofit is launching a new mindfulness curriculum and is seeking teachers to teach the exercises to students in middle and high school and provide feedback.  If you are interested, please contact me directly at rhussa@normalinschools.org.

What is Mindfulness?

According to Jon Kabat-Zinn of the Center for Mindfulness at University of Massachusetts, “Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgmentally."*

When I teach students about mindfulness I explain that it is an important part of living consciously.  It is important to be aware - awake - alert.  Without paying attention, our life flies by.

Mindfulness is also a crucial part of stress management.  A healthy option to offer students, so they can build an arsenal of coping skills to support their life.  Practicing mindfulness doesn't have to be a long meditation or yoga or other practice.  There are an array of "daily" things that deliver the same impact -- and they are user-friendly and teacher accessible, to boot.

For starters, there is journal writing.  In my book, Healthy Selfitude, I discuss the benefits of journal writing -- namely -- how journaling can help us cultivate mindfulness.  Writing is a proven stress management technique that we can use to instantly calm us down and unite our body, mind and spirit.  The physical act of writing physically connects the brain to the body and allows emotions and feelings to flow onto the page.  The act of writing and journaling is also something that brings us into the present moment, where we can live more consciously and in a state of mindfulness.  Through journaling we can begin to observe the conscious and unconscious choices we make in life.  According to the American Psychological Association, expressive writing offers physical benefits and improves immune functioning.** 

I recommend that teachers from all disciplines encourage students to journal or free-write at least 2 minutes per day.  In doing so, we are showing students HOW to cope with stress, we are showing them how the act of writing brings them directly in contact with the present moment, and -- because journaling has clinically shown to reduce anxiety and enhance immune system functioning -- we are providing students with a quick and easy point of entry to mindful living.

What is meditation?

Jon Kabat-Zinn tells us in his book Wherever You Go, There You Are that "Meditation is synonymous with the practice of non-doing.  We aren't practicing to make things perfect or to do things perfectly.  Rather, we practice to realize the fact that things are perfect -- as they are.  This has everything to do with holding the present moment in its fullness without imposing anything extra on it, perceiving its purity and the freshness of its potential to give rise to the next moment."*

One of the tools we have to access mindfulness and meditation readily is actually contained within our own body.  Our breath allows us to become mindful (almost immediately) and is a crucial aspect of meditation.  In fact, in ancient traditions, breathing is referred to as "life force" or "prana."  According to Thich Nhat Hanh in his book Breathe, You Are Alive, "Breathing is a way of awakening and maintaining full attention in order to look carefully, long, and deeply, see the nature of all things and arrive at liberation."

Most every yoga, movement and meditation practice is centered around a breathing technique.  In yoga, we call these techniques "pranayama" which translates to mean life-force lengthening.  Our breath is our life force.  It connects our bodies, our  minds and our spirits to all things.  Our breath can tie us to the present moment, it can calm us, it can reduce our heart rate during anxious times, it can help us find peace.

When students are stressed, it is so helpful to know that everything they need to calm down is inside of their own bodies.  One of the breathing exercise that is most calming and centering, is called Nadi Shodhana or "alternate nostril breathing."  For a demonstration, watch this video.  

Often students ask me what they should be thinking about as they breathe.  Truly -- the goal is to think about the breath.  It is that simple (and yet complex).  To simply follow the breath in and out without judgment or negativity.  There are a few poems or mantras that can help.  For example, "breathing in a long breath, I know I am breathing in a long breath.  Breathing out a long breath, I know I am breathing out a long breath." or "Breathing in, I calm my whole body.  Breathing out, I calm my whole body."***

Naturally, minds will wander, so is important to reinforce to students that they are to simply observe their thoughts without judgment, in a state of loving-kindness and see if they can direct their thoughts back to the present moment.

Mindfulness and conscious living isn't easy to do, which is why it takes practice -- and why we call these exercises a "practice" -- they take time for everyone to learn and to feel comfortable with.  

--

*Kabat-Zinn, J., Wherever You Go, There You Are p. 19-25.

** Gortner, E.M., Rude, S.S., & Pennebaker, J.W. (2006, Sep). “Benefits of expressive writing in lowering rumination and depressive symptoms.” Behavioral Therapy, 37 (3), 292-303.

***Nhat Hanh, T., Breathe, You Are Alive p. 25-82

Students Need Their Sleep!

photo courtesy of Townsquare Media

When I interviewed Dr. Craig Johnson of the Eating Recovery Center in Denver in 2010, he told me a surprising statistic:

"The average adolescent patient coming in for eating disorder treatment is reporting an average of 4.2 hours of sleep per night."

According to the National Sleep Foundation, teens need about 9.25 hours of sleep each night to function at their best.  Yet most teens do not get enough sleep.  One study found that only 15% reported sleeping 8 1/2 hours on school nights.*

In addition, recent studies at Mayo Clinic show that getting more quality sleep may also have a positive effect on the body's glucose and insulin levels.  In fact, researchers are suggesting that lack of sleep is also linked to weight gain in some cases.  In such a fast-paced, over-worked society it is difficult to find five hours to slow down -- let alone 9 or 10.  But research is starting to show that proper sleep could help resolve complications like obesity, diabetes and hypertension.

One thing is clear, sleep is one of the most overlooked ways ways to nourish our bodies.  “Ninety-nine percent of people who think they only need five hours of sleep a night are actually hurting themselves,” said Dr. Lee Green of the department of family medicine at the University of Alberta in Canada.**

Students who struggle with insomnia or restless sleep can employ a few mindfulness and meditation techniques before bedtime.  Pranayama or breathing techniques have a calming effect on the brain and have been shown to reduce anxiety.  For sample exercises, visit my yoga for recovery blog -- updated regularly.

And if breathing or yoga techniques aren't working, the Mayo Clinic offers 7 steps to better sleep.***

If these resources don't help you or your students enjoy a more peaceful sleep, it may be time to find help and professional guidance.  In many local universities, free resources are available. Many sleep programs offer free treatment in exchange for participation in research studies.  Harvard University's Division of Sleep Medicine is currently recruiting participants, as is the Johns Hopkins Sleep Disorders Center, among many others.

 

*http://www.sleepfoundation.org/article/sleep-topics/teens-and-sleep

** Courtesy of ABC News: http://abcnews.go.com/blogs/health/2012/10/16/lack-of-sleep-linked-to-weight-gain/

***Courtesy of Mayo Clinic: http://www.mayoclinic.com/health/sleep/HQ01387/NSECTIONGROUP=2

Another Side of Obesity Education in Schools

Teachers, coaches and leaders in schools know all too well the devastating effects of bullying.  In particular, those kids who are living in bodies that are larger are under incredible pressure -- from friends and also from leaders -- to lose weight, embrace a healthy lifestyle and to learn nutritional balance.  Yet the incredible shame that is caused by this type of bullying could have long-term, damaging effects on children.  Researchers are concerned that if dieting and exercise are so greatly emphasized with children as young as 6 years old, as as is now the case in many school wellness programs, we may end up with greater psychological and emotional damage in our children.*  The main thing to remember, here, is that for some of the children who are obese -- they may ALSO be struggling with an eating disorder.  This means that -- like all eating disorders -- focusing on dieting and exercise is NOT the optimum way to intervene.  School leaders must try to find the balance and remember to address the behavioral and psychological aspects of these conditions (for example, WHY are the kids eating this way?  Is it because they are stressed?  Is it because they don't know other ways to manage their feelings?  Are some students binge eating or over-exercising to manage their stressful lives?), as well as the physical and nutritional aspects. 

An important addition to the amazing work that many wellness programs are teaching in schools, such as Michelle Obama's "Let's Move" campaign, is to ALSO instruct about mindfulness, mindful eating, healthy coping and stress management strategies, as well as teaching compassion toward those who are struggling with obesity.  In particular, it is crucial to instill empathy toward those who are living in bodies that are larger, rather than encourage or endorse any kind of shaming, stigma or negativity toward them.  Weight bias is so ubiquitous, it has become socially acceptable.  We need to join together to broaden our compassion towards individuals who suffer from these debilitating conditions and effect a cultural paradigm shift that embraces weight diversity... Every body is not meant to be the same size.

This week, the National Association of Anorexia Nervosa & Associated Disorders (ANAD), Binge Eating Disorders Assocation (BEDA) and NORMAL nonprofit (NORMAL) announce the launch of a united initiative to end bullying due to weight stigma.  The project hopes to bring a crucial supplemental programming element to the wellness programs that exist in schools.  One of the first aspects of the program is the documentary Beneath The Floorboards, which is based on the true story of Chevese Turner and her life long struggle with binge eating disorder. "I hope that in sharing my journey, others can find hope and strength. It is time that we shift the way we look at health and weight and recognize that years and years of shaming people for their body size has never worked to motivate individuals to lose weight and, in fact, has contributed to weight gain and eating disorders.” 

Watch the trailer, here:

Laura Discipio, Executive Director of ANAD states “Our society is falling short in the way we look at health; the film showcases the importance of having a societal shift in the way we think about bodies and weight." For more details about the project and important resources, please visit www.BeneathTheFloorboards.org.

*For an array of short films and resources by the leading researchers in these topics, please visit NORMAL nonprofit's ShareCare page on Dr. Oz's and Oprah Winfrey's ShareCare website.

For School Coaches, Trainers and Female Athletes

The NORMAL nonprofit is creating a survey with Harvard University's School of Public Health to determine what middle school and high school athletic directors, coaches and trainers would like to know when it comes to nutrition, female athlete triad, body image, eating disorders, stress-management and wellness.

We are doing this as part of our new Female Athlete Triad Awareness project which will produce programs, resources, apps and films and distribute them to schools nationwide.  If you would like to participate or pilot these programs, please e-mail us today!

For the latest facts, resources and information on the Female Athlete Triad (and Tetrad), visit us here.

Mindfulness in Schools

To help center your students I highly recommend teaching a few simple breathing, meditation or mindfulness exercises that encourage the kids to "slow down" and embrace self-care.  Below is an example of a breathing exercise I lead in almost every class I teach.

And when I say "class" -- I don't mean yoga class.  I mean in a school classroom setting.

I have led these kinds of simple centering exercises in 2nd grade classrooms and higher (through graduate level) and the result is always the same... students are relaxed, centered and ready to take on the day.

Resources:

• Efficacy of yoga
• Meditation and Mindfulness Resources

 

 

Obesity vs. Eating Disorders

With the start of school just around the corner and with MANY a campaign out to combat obesity in schools, I thought I might share a few stats and facts.  With gratitude to my colleague, Joanna Poppink, MFT, who graciously allowed me to re-post her article which was featured in the August issue of Case In Point (p. 33).  While this article is intended for clinicians, I think that it could offer some important insights to teachers as well.

Obesity and Eating Disorders: Causes, Diagnoses, Treatment Options

by Joanna Poppink, MFT

If you take one thought from this article to apply to your work, let it be this: If you can relate to the unique person within the frame of obesity, you can know in your mind and heart that before you stands a human being worthy of respect, appreciation and caring. Such sensitivity and compassion equips you to be more effective as you relate to your patients, explore how obesity relates to eating disorders, recognize effective treatment options and access trustworthy resources for information, support and clinicians. I interviewed eight highly qualified eating disorder professionals on these issues and offer their perspective as well as my own.

Noneating Disorder Causes of Obesity

Obesity is a physical condition, not an illness or a character description. The causes are many and can relate to illnesses like Cushing’s disease or diabetes. It can be the result of emotional eating, poor eating habits, drug reactions, limited nutritional knowledge or yo-yo dieting. Several risk factors exist for both obesity and eating disorders, such as history of dieting, low self-esteem, trauma, childhood abuse, high media exposure, problems with affect regulation, body image dissatisfaction and weight-related teasing (Albers). Weight alone is not enough to make an accurate diagnosis or determine a treatment approach. Correct diagnosis made by a mental health professional or physician based on the DSM-IV TR is essential. If weight doesn’t define an eating disorder, what does?

Types of Eating Disorders

Eating disorders are serious illnesses that affect an individual’s body, mind and spirit. They have the highest mortality of any mental illness. No race, age, gender or socioeconomic status is exempt. The weight of a person with an eating disorder can fall within a normal range, be dangerously low or reach obese levels. Let’s explore some of the top disorders.

Anorexia: symptoms are primarily starvation, fear of food, obsession with body appearance and occasional ravaging binge/ purge episodes. Symptoms can reach emaciation, organ failure, loss of menses, loss of hair, dental problems and vulnerability to stroke and heart attack.

Bulimia: symptoms are primarily binge/ purge behaviors, i.e., vomiting and laxative use after uncontrollably eating massive amounts of food in a short time. The person can be underweight, normally weighted or overweight. Purging disrupts the endocrine and electrolyte systems and puts the person at risk for stroke and heart attack. Both involve an intense fear of gaining weight or becoming fat, regardless of their actual weight. Sufferers have a distorted body perception and determine their selfworth by their weight and appearance. They often deny the existence or seriousness of their disorder.

Binge eating disorder (BED) is similar to bulimia except without purging. The sufferer eats until painfully full and eats when not physically hungry. She often binges in secret.

Eating Disorders Not Otherwise Specified (EDNOS): A majority of people with eating disorders fall into this category. These are disorders that partially qualify for the above diagnoses. It’s helpful to understand the EDNOS classification because people can rationalize their behaviors, saying they don’t have an eating disorder because they don’t have all the symptoms of an anorexia, bulimia or BED diagnosis. All these eating disorders disrupt a person’s life, cause devastating emotional pain, damage bodies, undermine personal and professional relationships and limit a person’s ability to progress in educational or career pursuits. The sufferers are wracked with shame and self-disgust, which is often hidden from others.

Obesity and Eating Disorders

A person suffering from any eating disorder may or may not be obese. Their weight can range from emaciation to underweight, normal weight, overweight and obese. Obesity itself is not diagnostic. For example, an obese person can diet drastically or go through weight reduction surgery, like gastric bypass, live as an anorexic woman for months or even years, and return to an obese state. A person recovering from anorexia may gain weight that reaches obese proportions before her metabolism adjusts to a new way of eating.

Treatment Psychotherapeutic methods including EMDR (Shapiro) are effective when obesity is related to eating in order to feel safe and soothed. The obese person may need guidance and support in nutrition and exercise. A correct diagnosis is needed because putting a focus on nutrition and exercise, which can be helpful to non-ED patients, can exacerbate symptoms if a person has an eating disorder. Different levels of treatment exist to match the needs of the eating disorder patient, i.e., outpatient, intensive outpatient programs, partial hospitalization, residential and hospital programs. Finding the right match depends on correct diagnosis, the patient’s willingness to do recovery work, availability of therapeutic resources, and availability of adequate funding. Intense and comprehensive treatment often includes a team of professionals: psychotherapist who specializes in eating disorders; dietitian; physician; and psychiatrist. While this kind of treatment addresses the multidimensional aspects of the disorder, it also contributes to the high cost of treatment, all too often a barrier to recovery work. While cognitive behavioral psychotherapy has been the standard for treatment, it isn’t effective for everyone. I and other professionals in the field are on the constant lookout for promising new information, research and treatment methods that will help us help the people in our care. Fortunately, ongoing research and clinical exploration offers us more treatment options. Such options include: Mindfulness practices, EMDR, journal practices, guided imagery, art, dance and movement therapies, yoga, equine therapy, life skills teaching, stress management, attachment theory informed psychotherapy, psychodynamic oriented psychotherapy, internal family systems therapy (IFS), dialectical behavior therapy, and acceptance and commitment therapy. Leigh Cohn said, “The greatest advancements I see are related to diagnosing ED in males. The standard assessment tests were written for women, and men are often underscored on them. New tests are in development that use language that is sensitive to how males and females react differently to certain words. For example, the traditional phrase, ‘I think my thighs are too large,’ would more commonly be answered in the affirmative by women than men, who might react more forcefully to a phrase such as, ‘I check my body several times a day for fatness.’ The new assessments for men place a larger consideration on exercise, muscle dysmorphia, and on the terminology in discussing questions about body dissatisfaction and binge eating.” Each person who seeks treatment or is in treatment is in a particular stage of their eating disorder while also in a particular stage of their own human development. As they progress in both, levels of care and treatment methods change and adapt to the always current needs of the patient in the present. Regardless of the treatment methods, I’ve come to know that a sense of despair is a common thread running through the experience of a person with an eating disorder. To meet this despair the experienced clinician offers kindness, compassion and empathy as well as knowledge of the disorder and treatment methods. When a person is at home with harsh internal criticism and self attack, learning to recognize and respect kindness is a major element in recovery. Weight Loss as a Goal? All my colleagues interviewed for this article agree that reaching a healthy weight is the result of good self-care. Effective healing methods reinforce the individual’s ability to be present for who she truly is and what she needs to be whole and well. Then the emaciated person gains and the obese person loses. Losing weight is a side effect, not the goal of treatment My belief is that as a clinician I need to keep learning as much as I can about effective treatment methods so I can use them in my work with patients or establish solid referrals for treatments beyond my scope of practice. At the same time I try to forget it all when I am first with a new patient. I let the person lead me to the treatment approach that is best for them at the time. In this way the person can move gradually and with sense of security into the new territory of healing, a path that requires courage.

Author’s Note

Thank you to colleagues interviewed for this article: Susan Albers, PsyD, psychologist at the Cleveland Clinic and author Eating Mindfully, 50 Ways to Soothe Yourself. Web: www.eatingmindfully.com. Leigh Cohn, MAT, CEDS, publisher, Gurze Books, editor in chief, Eating Disorders: The Journal of Treatment and Prevention. Web: www.bulimia.com. Jean Fain, LICSW, MSW, Harvard Medical School-affiliated psychotherapist and the author of The Self-Compassion Diet. Web: www.jeanfain.com. Robyn Hussa, MFA, E-RYT, author, CEO of NORMAL, source of eating disorder educational materials. Web: www. robynhussa.com. Karen R. Koenig, LCSW, M.Ed, eating coach and author of What Every Therapist Needs To Know About Treating Eating and Weight Issues. Sarasota, Fla. Amy Pershing, LMSW, ACSW, clinical director, The Center for Eating Disorders, Ann Arbor, Mich. Web: www. center4ed.org. Dr. Nina Savelle-Rocklin, Psy.D., private practice, Sherman Oaks, Calif. Web: www.NSReatingdisorders.com. Francine Shapiro, Ph.D., senior research fellow at the Mental Research Institute in Palo Alto, Calif., director of the EMDR Institute, author www.emdr.com

Joanna Poppink, MFT, is a psychotherapist specializing in eating disorders, speaker, consultant and author of Healing Your Hungry Heart: Recovering From Your Eating Disorder. Member of AED, IAEDP. Contact: www.eatingdisorderrecovery.com | Joanna@poppink.com

Nutritional Education Do's and Don't's

There's a great deal of information available on the internet that pertains to nutrition -- so much that it is actually tough to keep it all straight.  With so many teachers genuinely interested in communicating helpful messages to kids, I thought I'd put a few resources together to outline a few Do's and Don't's of nutritional education.  With gratitude to Karen Sossin, MS, CDN with whom I consulted to offer these helpful tips.

How should we define healthy eating?  

Sossin offers her favorite definition, which comes from Ellyn Satter's "Normal eating":

"Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it -not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.  In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings." ~Ellyn Satter

How many times a day should a person eat?

Sossin tells us that the classic response is that individuals should eat 3 meals a day plus 2 snacks, but not everyone's schedule allows for this structure.  Some students rely on 5 smaller meals throughout the day.  Sossin also pointed out that some studies do suggest that skipping meals may lead to over-compensating later on.  She said that when we allow ourselves to become 'starving' -- we tend to eat more than we need and grab whatever is available.

"Learning to stabilize glucose levels is the key to peak performance in the classroom, on the athletic field and throughout the day.  The best way is to combine quality protein (nuts, seeds, poultry, fish, beans) and quality carbohydrate (unrefined grains, vegetables and fruits) at all meals and snacks.  This combination will have a stabilizing effect on glucose levels." ~Karen Sossin, MS, CDN

How do you define a full, balanced meal?

According to Sossin, a full meal is well-balanced with any combination of three or more food groups including: vegetable, fruit, lowfat dairy, protein, whole grain.  More information is available in the resources section below.

What are examples of healthy snacks?

Things like:

• yogurt with strawberries and walnuts
• dried tart cherries and raisis with almonds and sunflower seeds
• a pita stuffed with chopped egg, shredded carrots and peppers
• cheese sticks and an apple

Sossin cautions that eating on the go is the opposite of being aware and mindful of the foods that we choose to eat.  If we eat on the run we are less likely to be aware of the foods we are consuming, nor as mindful as we should be.

Nutritional Education Don't's:

A classroom teacher should NEVER:

• NEVER discuss a student's weight
• NEVER encourage any type of diet or weight loss regardless of the student's size or shape
• NEVER discuss foods in terms of good versus bad -- placing a moral value on foods can lead to feelings of guilt when the “bad” food is eaten
• NEVER use food in any form as a reward or incentive
• NEVER comment on their own weight

Nutritional Education Do's:

A classroom teacher SHOULD:

• BE a role model -- students observe and are influenced by the opinions of their teachers; therefore, teachers should eat nutritiously and emphasize health and not weight for yourself
• DISCUSS the importance of eating a well-balanced diet to support an active and healthy lifestyle
• PROVIDE an understanding of intuitive eating -- learning to listen to internal cues that drive hunger and fullness
• TEACH about the development of a healthy body image despite the reality of our thin-ideal media
• ENCOURAGE goal setting in order to make healthy behavioral choices
• ADDRESS the physical and emotional dangers of dieting
• HELP students understand that we are all born with genetic predispositions that affect our own unique body size

"Consider your own food habits and ideas about weight. Your own comments about appearance can have tremendous influence on what your students think is acceptable or desirable. The goal for you and your students is to be at a healthy weight and have a positive self-image, based on more than a number on a scale." ~Karen Sossin, MS, CDN

"It is not enough to just teach WHAT to eat, an understanding of the emotions and circumstances under which one eats is just as important." ~Karen Sossin, MS, CDN

Resources for classroom teachers:

• With so many fad diets, obesity information it is really hard to know what we should be eating.  A great resource for classroom teachers is the Choose My Plate site (www.choosemyplate.gov).
• Download Department of Health and Human Services "Eat for the Health of It" Brochure
• American Dietetic Association "Eat Right" Food and Nutrition tips
  

Karen Sossin has both undergraduate and graduate degrees in nutrition. Her graduate degree has a concentration in Exercise Physiology. She has a certification in Health and Fitness from the American College of Sports Medicine. Karen is a member of the American Dietetic Association, American Diabetes Association and the American College of Sports Medicine. She has held various leadership positions in these professional organizations. Karen serves as the Nutrition advisor to the New York State Public High School Athletic Association, which focuses on student-athletes. She has been published in several journals, newsletters as well as reference books in the field of nutrition. A national, inspirational and motivational speaker, Karen has more than 20 years of experience working with schools and communities.