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Many people are surprised to hear that I often eat with my clients. They think it is odd to ask a client to bring a snack or a meal to a nutrition appointment or silly that we might complete a meal together one-on-one or in a group setting. The reality is that some of the most valuable information about one’s food intake and eating behaviors is gathered by eating with them. During this snack or meal time the food rules, fear foods, and/or eating disorder behaviors can be addressed in the moment in an encouraging and supportive way. Meal time can be very stressful for a person with a poor relationship with food and/or for those individuals with disordered eating or an eating disorder so providing meal support as part of treatment can be a game-changer.

Meal support is common at the residential, partial hospitalization, and intensive outpatient levels of care but is may not be offered as commonly in an outpatient setting. I’ve found that adding meal support as part of the treatment plan at the outpatient level can be monumental to achieving nutrition-related goals. Some outcomes of meal support may include:

  • Improved ability to complete a meal or snack
  • Acceptance and tolerance of  a variety of foods and beverages
  • Confidence in portioning and eating appropriate amounts of food for one’s needs
  • Practicing normal eating behaviors and while decreasing eating disorder behaviors
  • Challenging and reducing food rules and rituals
  • Practicing distress tolerance while feeling emotionally supported
  • Improved confidence around self-regulated food intake
  • Recognition of  hunger and fullness cues
  • Improved mindfulness at mealtime

Incorporating meal support into practice is useful not only for clinicians but also for the client’s community of support, if appropriate. I recommend that a team approach (dietitian, therapist, support persons, client, etc.) is used in planning and preparing for the meal and that meal support goals and the experience is individualized for each client.  For example, person A might set a short term goal to practice eating a meal mindfully with the ultimate goal of identifying hunger and fullness cues while person B may set a short term goal of eating 100% of the meal to help achieve the long term goal of re-nourishing their body. Goals will evolve and change as appropriate throughout the journey. Seek out a registered dietitian that specializes in eating disorder treatment to help identify appropriate meal support goals and to assist in planning meals and giving guidance and tips for before, during and after the meal.

Chrysalis Center offers meal support 3 times a week as part of their Intensive Outpatient Program and once a week for those partaking in outpatient services. Talk to your treatment team if you think this would be beneficial for you!

 

Courtney is a registered dietitian who specializes in sports nutrition and eating disorder treatment. She incorporates HAES and non-diet principles into her practice. In addition to nutrition consultations, Courtney leads IOP and outpatient meal support group and IOP nutrition group.



I thought that I would change up my tune a little bit and write about something seasonal. No matter how much I want to believe that the summer is still here, the Christmas decorations at Cotsco tell me otherwise. Sigh. But I’m not going to talk about Christmas or any other winter holidays today. Confused? So was I when I saw those fake Christmas trees in September. I digress… Today I am writing about something very… Fall: Pumpkins. Pumpkin patches have popped up all over Wilmington and I thought I’d provide some ideas of what to do with these stinkers other than paint, carve or smash them.

Eating pumpkin is underrated.

Growing up I was taught to scoop out the pulp and seeds and throw those away (which I never minded since it was all kind of smelly.) We would occasionally toast the seeds, but my pillowcase full of candy always won over the Ziplock bag of dry seeds and I never would have considered taking a bite out of Jack (O’Lantern). Yet, I wish I would’ve been taught that pumpkin pie wasn’t the only way to enjoy pumpkin. In adulthood I learned to be open minded and curious about pumpkin – well about all food in general – and I’ve found out that I like it…a lot.

For a little background: pumpkins are a Fall veggie and if you are selecting one it should feel firm and heavy for its size. One serving of pumpkin provides 130% of the average person’s Vitamin A needs for the day and 15 % of their Vitamin C needs. Talk about vitamin packed and a clever way to add some variety into your meals!

Canned pumpkin or whole pumpkin can both be used in a multitude of ways.

  • If you use canned pumpkin please you double check if you are need pumpkin puree (only pumpkin) or pumpkin pie mix (sweetened and spiced for convenience). Depending on what you are making this could make a significant difference for your end product.
  • If you have a whole pumpkin on hand, spoon out the seeds and stringy pulp and cut the pumpkin into large pieces. Roast it until fork-tender (about 350 for 45 minutes) and then remove/peel the skin off. You may need a knife for this. Next, mash the pumpkin flesh up with a potato masher, put it in your blender or food processor. Voila. Fresh pumpkin puree that you can use or freeze.

I am a big proponent of eating a variety of foods and of adding foods, not taking foods away. I hope that these ideas help you branch out and see if pumpkin is something you enjoy in your meals and/or snacks! Pumpkin (Spice) up your life!

Pumpkin Smoothie:

1 cup milk, 1 medium banana, ¼ cup pumpkin, 1 dash of cinnamon, maple syrup to taste, 4 ice cubes. Blend. Drink. Yum.

Turkey Pumpkin Chili:

Courtesy of www.WholeFoodsMarket.com *

Ingredients:

  • 2 tablespoons extra-virgin olive oil
  • 1 small yellow onion, chopped
  • 1 green bell pepper, chopped
  • 2 jalapeño peppers, seeded and finely chopped
  • 2 cloves garlic, finely chopped
  • 1-pound ground white or dark meat turkey
  • 1 (14.5-ounce) can diced tomatoes, undrained
  • 1 (15-ounce) can pumpkin purée
  • 1 tablespoon chili powder
  • 1 teaspoon ground cumin
  • 1/2 teaspoon fine sea salt
  • Ground black pepper, to taste
  • 1 (15-ounce) can kidney beans, rinsed and drained

Instructions:

Heat oil in a large pot over medium high heat. Add onion, bell pepper, jalapeños and garlic and cook, stirring frequently, until tender, about 5 minutes. Add turkey and cook until browned. Add tomatoes, pumpkin, 1 cup water, chili powder, cumin, salt and pepper and bring to a boil. Reduce heat to medium low and add beans. Cover and simmer, stirring occasionally, for 30 minutes more. Ladle chili into bowls and serve.

Pumpkin Apple Doggy Treats:

Courtesy of http://munchkinsandmilitary.com/2016/10/pumpkin-apple-dog-treats.html *

Ingredients:

  • 4 – 4.5 cups oatmeal, plus additional
  • 1 medium apple
  • 1 egg
  • 1 cup canned pumpkin

Instructions:

Preheat oven to 400 degrees F. Grind the oatmeal down in a food processor or blender. Transfer to mixing bowl. Core apple, being sure to remove all of the seeds. Grate apple, and add to bowl with oatmeal. Add egg and canned pumpkin to bowl and mix well to combine. The mixture will be thick and slightly sticky. On a surface dusted with oatmeal (ground or not, your choice) roll the dough out to approximately 1/2″ thick. Use a doggy bone cookie cutter to cut dough into shapes, and transfer to a lined baking sheet. Bake for approximately 12-15 minutes, or until golden and crispy. Allow to cool to room temperature, then store in an airtight container for up to a week.

 

* I am not endorsing these sites, I just like the recipes! I posted the full recipes here to filter out any diet talk or mention of numbers.  But please be aware that these sites may include this information.



These days one can’t go anywhere without hearing nutrition chatter. You’ve probably heard things like:

  • “Don’t eat gluten.”
  • “Eat more coconut oil.”
  • “Fat is bad.”
  • “Bananas are too high in sugar.”
  • “Eat clean”
  • “(Insert food rule here).”

These and many other rigid suggestions are being tossed around casually and though each statement might seem a bit different they all portray the same underlying message that what you are eating is wrong and you should be doing it differently.  Harsh, isn’t it? Consider yourself introduced to diet mentality and the diet paradigm. More formally, the diet paradigm includes patterns of eating that are:

Inflexible, quantitative, prescriptive, rigid, perfection-seeking, good or bad foods, rules, deprivation, time-based, fear-driven, guilt-inducing, shaming, body hatred, hunger, struggle, rationalising, temptation, thought-consuming, punishing (Willer, 2013).

If the way you are eating and your relationship with food feels like the above, then it is diet behavior. You are not alone in thinking the above is what you should do to “be healthy.” We live in a diet culture where dieting to lose weight or change body shape has been normalized. Our society promotes weight loss diets, puts thinness on a pedestal and advocates the belief that weight loss is the way to improve self-esteem, become respected, feel effective and in control, and avoid criticism (Mehler, 2010).  The messages, strict weight loss strategies, rule driven diets, and marketing that saturates us with these ideas come from a 60 billion dollar industry. You read that correctly, the diet industry is worth sixty billion dollars. The pushers of  “Weight is the problem and dieting is the answer” are making bank off of our insecurities and drive for thinness. That doesn’t sit well with me.

Furthermore, while this industry rakes in the dough and promotes the diet paradigm as the “norm,” clinical practice and research tell us that these messages and eating patterns are dangerous. Eating disorder specialist, Phillip Mehler, MD, and Psychiatrist, Arnold Anderson, MD, (2010) state that dieting is the most common contributing factor to eating disorders. Wow. Dieting also leads to being obsessed with food, nutritional deficiencies, increased psychological stress, impaired social functioning, increased intake of substances, food and body preoccupation and distraction from other personal health goals, reduced self esteem, weight stigmatization, discrimination, weight gain, and – because it is worth mentioning again – an increase in the risk of developing disordered eating.

You haven’t failed your diet, diet culture has failed you!

For more information check out the links below and stay tuned for Courtney’s future follow-up posts including topics such as non-diet nutrition and the Health at Every Size approach.  If you are looking to further explore your relationship with food and your body seek out a non-diet dietitian or therapist that specializes in eating disorder treatment.

Resources:

https://daretonotdiet.wordpress.com/

http://www.healthnotdiets.com/for-the-public

https://www.intuitiveeating.org/

http://www.unh.edu/health/ohep/nutrition/non-diet-approach-health-every-size-haes

 

References:

Mehler, P. S., & Anderson, A. E. (2010). Eating disorders: A guide to medical care and  

     complications. Baltimore, MD: The John Hopkins University Press.

Tribole, E., & Resch, E. (2017). The intuitive eating workbook: 10 principles for nourishing a

     healthy relationship with food. Oakland, CA: New Harbinger Publications.

Willer, F. (2013). The non-diet approach guidebook for dietitians: A how-toguide for applying the non-diet approach to individual dietetic

     counseling. Raleigh, NC: Lulu Publishing Ltd.



Throughout my years of practice I have heard too many individuals talk about exercise as something they hate, something they dread, or most commonly, as something they only do when they are dieting. To some, the mere thought of incorporating exercise brings along a dark cloud of self judgement, shame and fear. When exercise becomes a ‘have to’ instead of a ‘want to’ – Houston, we have a problem!

Strict and rigid exercise routines and exercise performed solely to change one’s body, weight, or dependent on food intake may bring one to dangerous grounds. Quite often this results in inadequate fueling for what is being asked of our bodies, leaving one feeling fatigued, irritable, having difficulty concentrating, and more prone to illness, injury or further medical complications. These side effects may lead one to eliminate exercise all together, often creating guilt which challenges mental, emotional, and physical health. Evelyn Tribole, MS, RD and Elyse Resch, MS, RD, FADA, CEDRD in their book Intuitive Eating use the analogy of comparing exercising for weight loss to a time card being punched by a bored assembly-line employee, emphasizing that weight loss will not motivate exercise for long and will become discouraging when the results are not happening quick enough or are not what was pictured or promised. These authors recommend “decoupling exercise from weight loss,” and I couldn’t agree more.

You may be asking, what does exercise look like if it is not weight, calorie, or food focused?

First off, the definition of exercise is: planned, structured, and repetitive bodily movements; while the definition of  physical activity is: body movement produced by contractions. Takeaway: whatever you want to call it, it is about moving your body. I like to keep it simple. So instead of categorizing and labeling movement, see what happens when you just call it movement. Does that take some of the pressure off?  Refraining from strictly defining movement allows us to move away from unrealistic expectations. Other names that I like equally as much are: enjoyable movement, mindful movement, and intuitive exercise.

Secondly, identify the type of body movement that you like or enjoy that makes you feel good. This might be a bike ride with your children, a yoga class with your best friend, paddle boarding with your dog, or a walk on the beach at sunset. The music at the yoga class, your dog’s tongue flapping in the wind, or the salty beach breeze might make that experience rewarding and enjoyable enough to want to do it again! Unsure of where to begin, try to think about what you used to enjoy doing as a child, chances are these activities may still be something you have fun doing now. Did someone say kickball?

Lastly, consider what the benefits of movement are that you personally connect to. These may include: increased strength, flexibility, endurance, a more cheerful outlook, improved mental functioning, feeling of vigor, greater bone density, improved sleep, stimulation of immune function, improved circulation and lung function, reduced risk of chronic disease. Try to think of exercise as self care and health promoting instead of punishing, stress inducing, or negatively interfering with your health or well-being. I challenge you to focus on how moving your body is part of you taking care of you and know that it is okay to feel good about any movement that achieves this.

How can movement be part of your full life?

References

Sizer, F.S ., & Whitney, E . (2014) Nutrition concepts & controversies. Belmont, CA: Wadsworth, Cengage Learning.

Tribole, E., & Resch, E. ( 2012). Intuitive eating: A revolutionary program that works. New York, NY: St. Martin’s Press.

Willer, F. (2013). The non-diet guidebook for dietitians. Raleigh, N.C: Lulu Publishing, Ltd.

 

Courtney is a registered dietitian who specializes in sports nutrition and eating disorder treatment. She incorporates HAES and non-diet principles into her practice. In addition to nutrition consultations, Courtney leads a weekly meal support group. Meal group provides a safe space to challenge food rules and behaviors that prevent one from enjoying food or feeling comfortable in their body.


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