Order of the Chocolate Fish

It is always my honor to bestow the Order of the Chocolate Fish upon members of the UNC Center of Excellence for Eating Disorders team for going beyond the call of duty in service of our mission. On this occasion, I am so pleased to induct two of our highly dedicated clinicians, Kate Cardoza, MSW, LCSW and Rachel Finholt, MSW, LCSW into the Order of the Chocolate Fish.

Kate and Rachel are both Clinical Social Workers with the UNC Center of Excellence for Eating Disorders. They work tirelessly spanning both inpatient and partial hospitalization levels of care to provide family based therapy for patients and family members throughout their time in treatment. In 2011, Kate and Rachel identified a need for additional family programming to provide even more support for family members and to offer a new opportunity for meal support. Out of this idea was born the Multi-Family Meal Program. This monthly program provides a place for family members to come together, learn more about eating disorders and treatment, and support their loved ones through a community meal.

Kate and Rachel have been instrumental at every step in the process of coordinating this program, including securing the funding needed to make these meals possible, coordinating with hospital catering to ensure we have enough food for our families each month, working with both the inpatient and partial hospitalization treatment teams to arrange for the necessary staff support at each dinner, organizing a schedule of speakers throughout the year to speak with patients and families, and overseeing every step of the meal from set-up to clean-up! A little over one year after the start of these meals, our families have benefited immensely from the efforts put forth by Rachel and Kate.

The UNC Center of Excellence for Eating Disorders is grateful for Rachel and Kate’s dedication to our patients and their families, and we are very excited to see the Multi-Family Meal Program continue to grow!

It is my honor and pleasure to bestow the Order of the Chocolate Fish onto Kate and Rachel. Congratulations and thank you!

Eating Disorders on Popular TV Shows

Glee fans have spent this season getting to know a new character named Marley. Marley is a sophomore who falls prey to the cruel torment of a fellow Glee club member, Kitty. Kitty convinces Marley that, in order to succeed in auditions, she needs to lose weight. Succumbing to Kitty’s pressure, Marley begins purging and abusing laxatives—both symptoms of bulimia nervosa. Catherine Weingarten recently wrote an article, “Glee’s Harmful Portrayal of Eating Disorders,” in response to this new plotline. She discusses how Glee downplays the seriousness of eating disorders and fails to provide any type of statement to highlight the associated dangers at the end of the episodes. The show represents bulimia nervosa as a choice that Marley makes for a short time, instead of being a very dangerous, all-encompassing psychological disorder.

Although I am not the biggest Gleek, I am guilty of catching up on Gossip Girl episodes during my breaks from school. Reading Weingarten’s article made me remember that Gossip Girl also addressed the topic of eating disorders. Blair (a New York socialite, played by Leighton Meester) suffered from bulimia nervosa during several of the show’s seasons, and viewers are told that she was treated. Blair’s eating habits (including overeating during stressful time periods) and weight concerns are mentioned in various episodes of the program. Characters with disordered eating, eating disorders, and body-image issues have definitely been the topic of other popular television programs as well. This trend makes me worried for the impression that these characters will have on younger girls and the likely lack of awareness they may have regarding the severity of such disorders. I agree with one of Weingarten’s other points: without being particularly sensitive to how these topics are addressed, television shows may misrepresent these disorders.

The topic of eating disorders likely strikes a chord with many viewers who may be struggling personally or know someone who is struggling with an eating disorder. Knowing that such a vast audience watches Glee, I am disappointed that the production staff did not carefully consider how they addressed the topic prior to airing the episodes. I would assume teachable moments on television programs intended for entertainment purposes are probably few and far between. Choosing to include the topic of eating disorders could have been an excellent opportunity for the show to teach its viewers about the seriousness of the eating disorders and to encourage viewers to help any affected friends or family members to seek help. When TV producers want to include sensitive subject material in their scripts, I would hope that they would want to embrace their power to reach (and possibly teach!) such a wide audience. My gut feeling is that the production team is misinformed or unaware of the nature of eating disorders. I hope that Glee and other television programs will learn from responses to the show’s depiction of eating disorders and will exercise mindfulness during their portrayal of sensitive topics in later shows. If you would like to call attention to this or other harmful (or beneficial) messages in the media concerning body image and beauty, please report to the NEDA media watchdog program. Go to this link!

http://www.nationaleatingdisorders.org/get-involved/media-watchdog

If you would like to contact Fox about this issue, we suggest that you leave a message on Fox Broadcasting’s viewer comment line. The number is 310-369-3066. You can also write a letter to: Fox Broadcasting Co., P.O. Box 900, Beverly Hills, Calif., 90212.

Use your voice to create change!

By: Annie Altschul

When It Comes to Public Health, Not All Publicity Is Created Equal

The amount of media coverage related to obesity is staggering. Today, one can hardly watch the morning news without hearing stories about the latest predictor of excessive weight-gain or seeing shocking b-roll of the “average” overweight American.  While this increased attention has made weight-related disease a major societal concern, evidence suggests it has simultaneously augmented the prejudices toward obese individuals.

The Yale Rudd Center for Food Policy and Obesity recently completed a content analysis of videos that accompany online news to observe how overweight individuals are currently portrayed by the media. Out of 371 videos from five major news stations, 65% were found to stigmatize overweight/obese adults. Specifically, videos tended to show obese persons gorging on junk food or being inactive, and the camera usually focused in on only their lower bodies. In addition, obese individuals were less likely to be shown in business attire (or even fully-clothed, for that matter) in comparison to non-overweight adults. Peterson, Depierre and Luedicke (2013) argued that these unflattering angles and the videos’ narrow depiction of stereotypical behaviors both dehumanize overweight individuals and fuel connotations associated with obesity.

Considering peoples’ tendency to equate seeing with believing, Peterson et al. make a valid point. These visuals presented by reputable news sources are thought to be accurate and unbiased. Of course, as Peterson et al. divulge (2013), this is often not the case. Unfortunately, people might view the media content as a reliable representation of all obese individuals without recognizing possible framing effects that overgeneralize and dramatize the disease. In such a way, some news stories become a vehicle for spreading obesity stereotypes—ingraining assumptions like individuals are overweight because they are lazy and lack self-control (Puhl, Schwartz, & Brownell, 2005) and in extreme cases, inciting discrimination. In order to eradicate this increasing stigmatization, the Rudd Center has compiled a database of images and videos that show overweight individuals in a variety of settings (e.g., in the workplace, out with friends, gardening, or taking a walk through a park). Databases like these may not only redefine how others perceive obese individuals, but also encourage more supportive behavior during every day social interaction and treatment.

After reading this content analysis, I find myself further questioning the benefits of media attention for public health crises. There is a part of me that feels that the public health impact of the obesity epidemic, in particular, demands approaches that grab attention when provoking a nation to take action. So perhaps using these shocking images is just a way for the networks to make the signal stand out from the noise of the other news headlines? In the end, it appears that the shock publicity backfires. If there is a potential for viewers to take a victim-blaming approach in response to dehumanizing and stereotypical visuals, there needs to be just as much concern for maintaining a fair representation of story subjects as there is for trying to gain an audience’s attention.

On a personal note, as a former radio reporter, I always saw news as a tremendous community outlet and an especially valuable tool for communicating recent science to the general public. Our radio station often highlighted compelling research on the perils of snacking or the prevalence of Type II diabetes within the local school system. While these pieces were intended primarily to inform, I never considered how startling leads or accompanying photos may have intentionally casted a negative stigma over a group of individuals especially in need of community encouragement. I believe in the powerful impact other people have on our decisions and self-perception. Thus, due to the media’s ability to dictate cultural opinion, journalists covering societal weight issues should make a conscious effort both to invoke empathy and concern within the population while assuring a more humanistic portrayal of the individuals affected by this disease.

Puhl, R. M. Peterson, J. L, Depierre, J A. Luedicke, J. (2013). Headless, hungry and unhealthy: A video content analysis of obese persons portrayed in online news. Journal of Health Communication, 0:1-17.

Brownell, K.D., Schwartz, M.B., Puhl, R.M. & Rudd, L. (Eds.), Weight bias: Nature, consequences, and remedies (pp. 165-174). New York: Guilford Press.

By: Elise Hartley

PAS Project and Latino Health Fair in Chapel Hill

A successful Latino Health Fair was held on March 4^th, 2013. It was organized by UNC Center for Latino Health (CELAH) in partnership with St. Thomas More Catholic Church. Many UNC Clinics and community programs collaborated in the event. It was a one-day, outreach event that gave the Latino community free access to basic health screenings and health resources. With the initiative from CELAH Clinic and St. Thomas Moore Church, the fair made valuable health information available to the Latino community. Bilingual staff was available to provide guidance and help members of the Latino community feel at home. Health screenings available included blood pressure, cholesterol, blood sugar, and dental examinations along with many other health services. The UNC Center of Excellence for Eating Disorders was represented by Dr. Mae Lynn Reyes-Rodríguez and her PAS Project research staff. We educated Latinos about the importance of healthy eating habits and spent a great deal of time explaining healthy foods and portion sizes. We also provided information about PAS Project and the free treatment being offered to Latina adults who are suffering from eating disorders. Monica Gulisano, RD, LDN, the dietitian on the PAS Project, offered an orientation to the impact of healthy eating patterns on chronic medical conditions such as diabetes and hypertension.

One critical feature of this Health Fair event was that there was no language barrier. This made it an attractive and user-friendly venue for the Latino community to receive basic health information on preventing and treating a range of health conditions. The attendees were grateful that professionals were on hand who could answer their questions and concerns in Spanish. Without the language barrier, the Fair created a comfortable atmosphere that allowed the attendees to open up and express any doubts or questions related to their health issues. The attendees left more knowledgeable about general health issues, their own health status, and where they can seek treatment in the community. We can’t wait to participate again next year in the Latino Health Fair event!

By: Marissa Garcia (PAS Project)

An Important Reminder For All Eating Disorder Providers

Clinicians who work with eating disorders are highly dedicated professionals. Since eating disorders revolve around some very fundamental human experiences—eating to survive and how we feel about our bodies and ourselves—the work can stir up one’s own personal feelings about eating, body weight, and self-esteem. Taking time for physical and psychological self-care can be overlooked when working with patients who have eating disorders.

Warren, Crowley, Olivardia, and Schoen (2009) conducted a study of 43 individuals that explored treatment providers’ experiences of working in the field of eating disorders. Most providers reported experiences in which patients asked questions or commented on the provider’s weight and shape, or if they felt monitored, examined, or evaluated by their patients. In some ways, this is no surprise. Providers are also role models, and patients will be curious about whether their providers practice what they preach. When asked if their view of food has changed since working with patients with eating disorders, 70% of providers said yes, and 54% admitted to actually changing their own eating behaviors since working in the field (Warren, Crowley, Olivardia, & Schoen, 2009). So working in the field clearly has an effect on clinicians’ own behavior. For example, clinicians in the study reported an increased awareness about food as a fuel and source of nutrition and attempt to eat more mindfully.

The authors provided advice for therapists who are new to working with patients with eating disorders. Three important recommendations were: having a supervisor and working as part of a multidisciplinary team; maintaining social support; and maintaining a realistic perspective that some eating disorders are chronic conditions.

Supervision provides all therapists (both new and seasoned) with someone to talk with about the experience of treating eating disorders. Being part of a multidisciplinary team allows for feedback on any questions or concerns from a wide range of providers. Different perspectives invariably lead to a richer conceptualization of what is happening with each patient. Working as part of a team can help buffer providers from shouldering too much responsibility and can help you focus on your strongest realm of influence. Most participants in Warren et al.’s study stated that the best form of self-care was engaging in conversation with other colleagues about any emotions or triggers.

A few years back, we sponsored the Caring Is Caring program that encouraged parents and partners to look after themselves as they were caring for a loved one with an eating disorder. We emphasized that the best way to care for someone with an eating disorder was to ensure that you were also caring for yourself. The same philosophy holds for providers. They too need to monitor their own wellbeing and to take time for self care. Balance, self-care, and sharing the challenges of your work with other professionals are critical to optimizing how helpful we can be in providing the best possible care for our patients.

Warren, C., Crowley, M. E., Olivardia, R., & Schoen, A. (2009). Treating patients with eating disorders: An examination of treatment providers’ experiences. Eating Disorders, 17(1), 27-45.

By: Brie Shelly

My Dream

I truly believe that we have to learn to transform frustrating experiences into positive reflections and action. However, sometimes personal reflections are not enough to lead to change, and collective reflections are needed in order to produce transformation in the system. During the past months, the nation has been immersed in an immigration legislation process giving hope to the Latino population that something will change for the better. Meanwhile, other transformations are needed in the eating disorders field. For many years, we have had to struggle with the misconception that eating disorders just affect white females from the upper-middle class, which has contributed to the lack of awareness and services for those who suffer from eating disorders in the Latino population and other racial and ethnic minorities. Although small steps have been taken to decrease health disparities in the Latino population, much work remains to be done. When I moved from Puerto Rico to North Carolina in 2008, I was surprised by the lack of awareness about eating disorders among mental health providers who serve the Latino population.

During the past five years I have devoted my efforts to educating the Latino community in North Carolina about the importance of exploring and assessing eating disorders in Latinos, and although the effort has been successful, we are now facing the challenge of finding adequate services. The fact is that, with the exception of the PAS Project, which is a research study providing treatment for adult Latinas with eating disorders, there are no dedicated eating disorders services for adolescent or adult Latinos with eating disorders. Eating disorder clinics around the area do not have bilingual therapists and sliding scales are rarely provided for those with no health insurance with the exception of the UNC Psychology Clinic. On several occasions, I have struggled with the impact of raising awareness when adequate resources for treatment are not available. I especially struggle when I talk with Latina mothers who are desperately seeking the best services for their daughters and sons. During my formative years in graduate school, I was taught that I was ethically bound to provide the best care for everyone in need, regardless of their status, condition, race, or ethnic background. Our current healthcare system challenges us to live up to those principles. Latinas with eating disorders in the United States have to be bilingual and have health insurance in order to receive the best care for their condition. Is this a health disparity? From my point of view, it is and something that should be changed in order to guarantee the human and civil rights of everyone in need in the community.

Even more than awareness about eating disorders, we have to improve our current access to the healthcare system. So the question is what we can do about it in our roles as researchers, clinicians, family members, or as citizens of a community? We need more research that focuses on culturally sensitive treatment development for Latinos with eating disorders. PAS has initiated training in eating disorders to bilingual therapists who serve the Latino population, but more bilingual services are still needed. We also have to educate the Latino community about how to recognize eating disorder symptoms but furthermore, we have to educate them about how to advocate for the services that they need. The Worldwide Charter from the Academy for Eating Disorders has as its mission to increase eating disorders awareness and to stimulate legislation for equal access and better services for patients suffering from these conditions. Everybody deserves the best care, not because of their economic status, race or ethnic background, or language, but because they are human beings. This is my dream—equal access to services for eating disorders for all. I hope this is your dream too and the American dream.

By: Dr. Mae Lynn Reyes-Rodriguez

Breathing into awareness

In the hustle and bustle of our daily lives, our minds can become tangled up in some pretty tricky traps. Think of the traps like nets. The more nets our minds get caught in, the more net we’re carrying around. The more net we’re carrying around, the more likely they are to get tangled, making it really difficult to see what is happening right in front of us. When we can’t see and we feel the weight of the nets bearing down on us, distressing emotions can start to build in our bodies—frustration, anger, sadness, fear, exhaustion, loneliness. And there we are, entangled in heavy nets, feeling exhausted, frazzled and not being able to see where we’re walking.  It’s not a fun situation, but we’ve all been there—for one reason or another, our minds love taking the bait.

Removing the net is the goal, but often this process can cause the nets to get even more tangled and increase the distress of the moment. Some approaches that tend to tighten the knots are pretending that you can see accurately through your entanglements, judging and criticizing yourself for falling into the traps, and walking around blindly, which usually results in getting caught in more nets.

A great place to start to loosen the grip of the nets and begin to see clearly again is with our breath.  We have a constant, soothing ocean that is moving in and out of us at all times. Turning to the breath with mindfulness can give us a moment to calm down, recognize what we’re feeling because of the tangled mess that our minds are in, and formulate a wise plan for how to get out from underneath it all. Think of it as a platform that will allow you to get a bird’s eye view on the gnarly mess that has come to shade your vision, so that you can figure out which knot to tackle first.

Finding this platform takes practice. Our breath is constantly going in and out, but our minds aren’t readily trained to tap into the wise ways of our bodies. The more we practice finding the platform, the better we’ll be at finding it in moments when we really need it.

So…let’s practice…

Breathing Into Awareness Audio File

By: Colie Taico, LCSW