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What is Healthy _Final

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>> Welcome back. We've talked a lot about risk factors, populations, and eating disorders in general, but let's get down to actual practice. First and foremost, it's important to always be aware of what your scope of practice is. Be the amazing Health Coach that you are and don't try to be the psychologist that you're not. That said, people are going to talk about things with you that are emotional and that bring up feelings. And feelings can, for many people, lead to emotional eating. And emotional eating can happen in eating disorders, but they're not the same thing. So let's flesh that out a little bit, shall we? High-stress levels can lead to emotional eating. We know that carbohydrates can increase serotonin levels, and we know serotonin is one of the feel-good neurotransmitters. We also know that certain fats can increase endorphin levels and that endorphins are our body's natural painkillers. Self-medicating through food happens and can feel effective for a lot of people. Think about it for a minute. When I ask you what's your comfort food, what comes to mind? Most people will have an answer right away. It might be carbs, ice cream, mashed potatoes, or bread. We all know that, to some degree, food can bring comfort. Food can also be a distraction for painful emotions. Plenty of people have sought comfort from ice cream and cake after breakups, and plenty of people have crunched away their anger with a bag of chips, and plenty of people have celebrated promotions and awards with decadent meals at their favorite restaurants, plenty of kids have been rewarded for good behavior with candy, and plenty have been punished for bad behavior by losing dessert. Let's face it. In our culture, food is inextricably linked to emotions. As such, we've learned to cope with emotions using food to such a degree that a lot of people don't even know what normal hunger cues are. Some believe you're hungry only when your stomach growls. I know many a dietitian who posit that if your stomach growls, you've waited too long to eat. Most don't know that being tired, lightheaded, and irritable are also bonafide hunger cues. They also don't know what full it. Is being full so stuffed that you can't breathe? Is it just not being hungry anymore? Is it, "I could have dessert, but then I might not be able to breathe" or is it "Do I still have room for jello?" In a culture where food and emotions are so in mesh, teaching people what physical hunger is is no small task. And here's the kicker, eating in response to emotions isn't necessarily wrong. What is wrong is when people always eat in response to emotions and they have no other coping skill in their bag. What's wrong is when people never eat in response to emotions, even though they crave it on occasion because their rule is to always only eat in response to their stomach grumbling. Moderation is key. Eating in response to emotion sometimes is okay. It's okay to celebrate with cake, it's okay to treat yourself when you're down sometimes as long as there are other times where you soothe yourself in other ways too, maybe a lavender infused epsom salt bath instead? Then there's the all-important topic of what constitutes a healthy body. Let's chat about BMI for a minute. In general, the Health at Every Size and Size Acceptance Community will tell you that BMI is a crap measure, a made-up ratio of height to weight that's supposed to signify health and often misses the mark by an awful lot. But the one place that I do use BMI is with people who have been diagnosed with anorexia. In general, most physicians will consider a BMI of 18 or 19 to be healthy if not fantastic. Well, for someone who has been underweight and diagnosed with anorexia, we know statistically that if they don't restore weight to somewhere between a BMI of 20 to 22 or sometimes even more, their chances of long-term recovery are slim and they will most definitely relapse. Studies have shown that much. It can be really hard when you're trying to help someone restore to that range when someone else on the team is telling them that a BMI of 18 is normal and healthy. That said, that's about the only time BMI has been helpful. The real answer to what is healthy is found in the Health at Every Size community, where a healthy relationship with food and flexibility around food choices abound. It's not about the weight or the number on the scale. In fact, you know, true health is never about those things. If you're eating normally, eating according to your body's cues, eating intuitively, your body will find where it wants to be. Bodies are diverse. Some are tiny, some are big, there's a whole array in "normal," thin, fat, short, tall, round, pear-shaped, and square-shaped. The idea that everyone needs to look like the fictitious airbrushed Kelly Clarkson we saw before is absolutely absurd. We're working to get people to be in tune with their bodies, to listen to their bodies, to eat when they're hungry, to stop when they're full, to rest when they're tired, to play when they have energy, to express their feelings when they have them, and to use their voices not their bodies to communicate. That is health, and health truly comes at every size. But you may be wondering, "Well, how do I tell the difference between a healthy eater and something like orthorexia?" It's actually a lot easier than you might think. You know, the first thing you want to look at is flexibility. A person who is a healthy eater has the ability to be flexible. They may prefer organic farm-to-table foods. But if they're on the road and the only thing available is a processed sub, they'll eat it. Someone with orthorexia most likely will not, and if they do, it will be done with great anxiety, a ton of guilt, worry, fear, and dread. They will undoubtedly be preoccupied with the thought, "What is this food going to do to my body?" That is a worry that virtually everyone with an eating disorder has. However, it's really not a worry of a healthy eater. A healthy eater knows that variation is fine and deviation is fine. Someone with an eating disorder generally won't deviate from foods that they're willing to eat. They simply won't eat if those foods aren't available. If they're traveling, you'll notice most will bring their food or they simply won't eat when it's time to stop and get something, believing that restaurant food is going to do something bad, make them gain weight, for example, or hurt their health in some other way, when, realistically, it will do nothing but provide energy and a source of nourishment. Looking at the beliefs they have about food is another way to distinguish this. If foods are categorized as good and bad and as a result, you feel or you become good and bad for eating them, you have a problem. That's not normal or healthy. Well, it's not uncommon in American culture to hear someone say, "Oh, I'm going to be bad tonight and order something bad for me. I'm going to have nachos." We all know that nachos aren't actually bad. The person will have nachos, enjoy them, and resume their regular eating habits without an issue. Someone with orthorexia or another eating disorder may say the exact same thing, but they will be highly preoccupied after the meal. They might disappear into the bathroom for a long period of time as they try to get rid of it or they may simply be distracted by the worry in their head or the complex mathematical formulas they're trying to calculate to figure out how to atone for what they just ate. Or they may be fidgeting and checking their body a lot while they're waiting for the offending nachos to pop out of their thighs in an extra few pounds. Yep, totally impossible, defies the laws of physics, but they still worry that it's going to happen. Another clue is if you see that food shapes their core identity. There's an excessive amount of energy and pride that goes into their food choices. They might say something like, "I'm a clean eater" or "I'm a vegetarian" and brag that they never deviate. This person is never flexible and that feeling of this is who I am can be indicative of a problem. You know, whereas a person who identifies themselves by saying something like, "Yeah, I'm a vegetarian. I'm a skier, hiker, avid reader, friend, mom, daughter, computer whiz, etcetera," is likely healthy. In the latter example, being a vegetarian is part of who the person is versus all of who the person is, like in the first example. This concept is so common that I've written a lot about it over the years. In my book Anorexia Nervosa: A Guide to Recovery, there's a chapter called Who Am I without Anorexia. I wrote that because people literally lose their identity to their eating disorder and you don't find that in healthy eaters. What about overeating versus binging? Binge is a highly overused word. People use it to say that they ate a little larger than normal meal, that they ate dessert, or that they ate a little more than they normally would. None of those things constitute a binge. A binge is characterized by three or more of the following. Ready? Eating more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of being embarrassed by how much one is eating, and feeling disgusted with oneself, depressed, very guilty, ashamed and/or embarrassed after eating. Overeating on the other hand is simply eating a little too much. It's eating dessert your grandmother made when you're already full because it's the polite thing to do and it's your favorite dessert. Overeating is taking a second helping of something that tastes particularly good even though you're already satisfied. It's taking more than usual of something you don't eat very often because it's good and you like it. It's also something that doesn't typically happen with regularity. Both binging and overeating may happen in response to emotions. What about compulsive eating? What is that? Compulsive eating is mindless and frequent eating throughout the day, and it's different from binging. If someone's approaching food more than six times a day, he or she could very well be dealing with compulsive eating. There's also something called night eating syndrome. This is when someone gets up in the middle of the night and eats. Sometimes, they remember it, and sometimes, they don't. They struggle mightily and it's really challenging to treat, they'll often go through measures to prevent themselves from eating in the middle of the night. I actually once consulted with a woman whose family members locked her in her room at night in an attempt to prevent her from eating at night. It's not the same thing as being upset and fatigued in the evening and eating to quell that emotion. So how, as an Integrative Nutrition Health Coach, can you support your clients? Well, first it's important to understand and remember that disordered eating habits are coping mechanisms. They help someone make order out of chaos and they give someone a concrete goal to focus on and achieve in a life that feels otherwise pretty out of control. Let's face it. We all need to feel like we can create effective change in our lives. When you feel really powerless, food and weight concerns are a way to feel in control and empowered. You can't make your spouse be faithful, but you sure can lose 10 pounds or you sure can bury your sadness in cake. Be mindful of your client's eating patterns. What's underneath their eating behaviors? Can you find the emotion that they react to and have trouble coping with? I once had a client who quite honestly said she had no idea why she binged and purged, not a clue. I had to keep a log, and after about 10 instances, it was pretty clear that she binged and purged every time she saw her mother. She was angry every time she saw her mother. And initially, it looked like it was her mother who triggered the behavior, but in reality, it was anger. She had no idea what to do with her anger, and she felt really unsafe every time she was angry. For her, that happened to be linked to her history and some experiences she had that made her believe anger was unsafe. When it comes to eating disorders, it helps to know what works and what doesn't. In reality, there's little evidence to support self-help modalities where Alcoholics Anonymous is touted as highly effective in addiction communities, there's nothing to suggest that it helps eating disorders. Cognitive behavioral therapy or a CBT and dialectical behavioral therapy, which is a form of CBT that blends in mindfulness from Zen Buddhism and uses an irreverent skills training style have been highly effective. Those suffering need a model to understand what urges and triggers are. And there's something called urge surfing that essentially likens an urge to use a behavior to a wave and urge surfing is a little more complex. But basically, what we do is teach them to surf their "urge" to use a behavior much the same way you would surf a wave. In my over 20 years of experience, the thing that really makes the most difference in true healing and recovery is a development of self-compassion and self-love. At the core of every person with an eating disorder lies questions around self-worth. Most feel worthless, like they have no value. While realizing their value can initially make all the challenges in their lives feel really painful, it's walking through this pain, and no, I didn't say sitting through this pain, that helps them heal and fully recover. Once you truly love someone, you can't hurt them, even when that person is yourself. People who have struggled with eating disorders have had far too much pain in their lives already and truly deserve only gentleness and compassion from here on in. Many find a great deal of solace in spirituality, a feeling like they're part of something bigger than them and being a part of "all there is" has tremendous healing power. It gives people a lens through which they can begin to understand and let go of suffering, and it helps people feel connected and empowered. I'm a huge fan of the Stone Center's relational model that posits that humans healing connection. You know that feeling where you share something really important, maybe super painful, and the person you're talking to just gets it. In that moment where they just get it and you feel that they get it, healing begins. Be the person who gets it for your clients. Develop the ability to put yourself in their shoes and see the world from their perspective so that you can connect in that important healing moment. Then step back out into your world so you can also offer choices and options from another perspective. Remember, we're made up of body, mind, and spirit, and we need to connect with and nurture all three. Helping our clients be truly connected on all three levels is where the magic happens. So I'll leave you with six tips. Be flexible in your approach and encourage flexibility in your clients. If something isn't working, try something else. Your modeling of flexibility will go a long way in your clients' learning to be flexible. All foods are fine in moderation unless of course the person has a legitimate allergy or intolerance. If you're teaching something else, you're fostering eating disorders. Normal eating means making healthy choices most of the time, but there needs to be room for fun foods too. Demonizing foods only fosters disordered eating, guilt, shame, and uncontrolled cravings. Moderation is key, especially in a society that doesn't even know what that is anymore. Don't be afraid to use humor. Sometimes clients have behaviors and views that can be really skewed, rigid, and stuck. It can be easier to break through that using humor. I once had a client tell me that her body did not require more than 800 calories per day. She had a whole list of reasons why that was so and scientific fact based on her mind. I in turn noted that 800 calories per day was the perfect amount for a 30-pound cocker spaniel. And I really wished that she had told me that before we started working together. If she was really a cocker spaniel, and I'd known that before, it would have saved us both a whole lot of trouble. We both had a pretty good laugh out of it, but it really made the point that 120-pound woman definitely needed more calories than a 30-pound cocker spaniel. And it helped break through her rigid thinking without shaming her. Be comfortable using some emotion yourself. It's okay to express sadness, compassion, and concern. It builds rapport and helps clients feel like the relationship is real. Be compassionate and encouraging at all cost and know with every fiber of your being that recovery is available to everyone. Be really clear about your own feelings about food and body image. You can't help someone get over being fatphobic if you're fatphobic yourself. You also can't help someone incorporate complex carbs in their diet if you believe carbs are the devil. Clients are radar and they know when you aren't being authentic. If you're not authentic, you can't be effective. Be a great role model. Lastly and maybe most importantly, meet your clients where they're at, take cues from them. For example, if you're coaching an LGBT or genderqueer client, start by asking them what they want to be called. I've had a genderqueer client who wanted to be called they or them. I've had trans with differing preferences about which pronoun to call them based on where they are in their transition. It's respectful to ask and then use the pronouns they select no matter what their sex or gender preferences are. Your ultimate goal is to provide health coaching that's appropriate for your client's individual body, and that's not something that's determined by a group, it is individual. Let's briefly recap because we covered a lot today. As an Integrative Nutrition Health Coach, it's important to remember that emotional eating is not the same thing as an eating disorder. In our culture, food is inextricably linked to emotions. So what is healthy? Healthy eating includes flexibility, not labeling foods as good or bad, lack of compensatory behaviors, and not having food shape core identity. Again, look for severity, marked distress, and how the eating patterns affect daily functioning. And remember the six tips I gave you before. Be flexible and encourage flexibility, encourage moderation, don't be afraid to use humor, be comfortable using some emotion yourself, be really clear about your own feelings about food and body image, and perhaps, most importantly, meet your clients where they're at. That's all for today. Bye for now.

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Duration: 18 minutes and 3 seconds
Language: English
License: Dotsub - Standard License
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Views: 5
Posted by: integrativenutrition on Aug 30, 2018

What is Healthy _Final

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