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The news continues to alarm me as multiple outlets from the world over report sharp increases in incidences of mental health issues and diagnosed eating disorders among adolescents. This week in Ontario it was reported that admissions to their teen eating disorders ward has jumped to 223% capacity, an increase of over 100% of what was reported in January. In fact, one of the heads of the eating disorders program there revealed that this is the worst and most dire situation that she has ever seen in over 30 years, no question.

Another finding by the University of Michigan reports significant increases in medical admissions among adolescents with existing or newly developed eating disorders during the pandemic. In fact, the hospitalizations in their hospital among children aged 10-23 for eating disorders this past year has more than doubled than what it was for the years of 2017-2019. Even more concerning however, is that the numbers may represent only a fraction of those with eating disorders affected by the pandemic as only those with severe illness that actually led to hospitalization were included in the count. Some figures suggest that as many as 77% of people with an eating disorder never receive treatment, 77%. That is huge!

England too is reporting a sharp rise in number of children that are seeking help for eating disorders as well as increasing struggles for them to access the help that they desperately need. The National Eating Disorders Association reported a 41% increase in messages to phone and online help lines in January 2021, as compared with January 2020. A recent study from the International Journal of Eating Disorders found that symptoms worsened across the board for people with anorexia, bulimia and binge-eating disorders nationwide since the pandemic began. This is both worrying and alarming as we have discussed the issues with eating disorder treatment and outcome.

I am personally hearing stories about more and more stories of young girls struggling with eating disorders every week.

With numbers so compelling I struggle to understand why we are not making prevention a clearer, more pressing, accessible priority.  Why are prevention programs so difficult to implement in our schools? Why aren’t we talking about this more for our educators and parents? Prevention programs have been both tested and proven to improve self-esteem, self-confidence, overall body positivity, measures of shape and body concerns, as well as reducing internalization of the thin-ideal, determinants of body dissatisfaction, and eating disorders overall.

Let’s talk to our schools, our educators, and our fellow moms and push the need for these critical, lifesaving programs! I am here to help. Message me anytime.

I’ve been reading through a curriculum addressing body image, eating, fitness, and weight concerns called Healthy Bodies by Kathy J. Kater. In it, the various costs of negative body image for girls were discussed. Negative body image refers to an over or hyper-focus on comparing one’s size and shape to unrealistic or unattainable social ideals.

In the book, four specific consequences of negative body image were highlighted:

1. A drain on time, energy, self-esteem, and motivation for self-care.
2. A serious disconnection from self
3. Reduced and unbalanced nutrition/diet as well as overall weight gain
4. & Last but certainly not least, the possibility of eating disorder onset

Each of these costs individually are significant and worthy of discussion, but today I would like to examine the second consequence, that of disconnection from self, as this is a very serious and alarming adverse result of negative body image. Disconnection from self is when a child is not comfortable in his or her own skin and/or in his or her own physical body. Ultimately, this is detrimental and damaging to the child’s formation of their personal identity. Children experiencing this disconnection from self, struggling with their body image tend to value themselves looking from the outside in, rather than from the inside out. The outcome of this type of thinking results in the “how I look” taking precedence over the “who I am” question. This struggle is not only heartbreaking but preventable and unnecessary.

Unfortunately, our culture tends to focus on a person’s “outside packaging” as the primary way in which to pass judgement on them. Children struggle to reconcile this contradiction with their own personal values, body confidence, and self-esteem. Instead of looking inward to find their self-worth as they should, they feel compelled to look to external cues as a measure of their value. This “dissociative crisis” as Ms. Kater calls it, allows adolescents girls to risk both their physical and emotional health in order to secure the physical outward appearance they perceive as critical to their acceptance and value in society. This confusing and complicated struggle takes a real and measurable toll on the girls, often barring the child’s true, authentic self to be recognized.

Over and over studies find that at least 70% of adolescent girls and 45% of adolescent boys don’t like their bodies. These are massive numbers.

According to berealusa.org:

These negative body image statistics are alarming. How can we help our children? Body confidence, self-esteem, and body positive programs are proven to create measurable, quantifiable effects on those who participate in them. In fact, they lead to better general mental health, increased classroom participation, reductions in negative mood, less unhealthy weight control behaviors, and even some risk reduction for future eating disorders.

We help our children with any problem or issue they encounter, why not give them the tools they need to support their physical bodies, their body image, and their self-esteem? We must implement these crucial programs in our schools. Contact me to find out more.

What does it mean to have healthy self-esteem?

Healthy self-esteem is being consistently able to value yourself for who you are, having overall positive feelings about yourself, and realistic expectations of yourself. Healthy self-esteem is about acting in ways that demonstrate self-respect and faithfulness to your values.  People with healthy self-esteem recognize the positive qualities they possess, but also accept that they are not perfect, that no one is, and that they will inevitably experience some disappointment and setbacks at various times throughout their life. The key is to keep things in perspective and not constantly berate themselves over their perceived flaws and imperfections.

People with healthy self-esteem trust their own judgement and can express how they feel and what they believe without fear of judgement. They are able to withstand the pitfalls of peer pressure and can avoid destructive behaviors and dangerous patterns. They understand that self-esteem comes from within and that external validation or approval does not have a bearing on their belief in themself. Easier said than done, right?

Why is healthy self-esteem valuable?

One of the most beneficial aspects of healthy self-esteem is about learning how to feel comfortable in your own skin. It is when you are able to rely on your ability to think, to reason, and to decide. And while you will still need advice and input, you will feel comfortable to reflect, mull, and ultimately decide for yourself. There is less second guessing and guilt over your decisions. You will become less paralyzed if you think that you made a mistake, as you accept that mistakes are inevitable and critical to your growth. Healthy self-esteem will give a positive balance between independence and dependance, will allow you to like yourself, and go through life with a healthier, happier sense of security in who you are. Healthy self-esteem is also protective against eating disorders.

Why is healthy self-esteem a particular challenge for adolescents?

During adolescence there is an exorbitant amount of pressure to fit in with friends and be accepted by them. Adolescents need to be well-liked, respected, and admired. There are challenges as they navigate their need for independence with their inability to be completely self-sufficient just yet.  Adolescents are confused about what they are going through and often don’t have the words to describe how they feel. Sadly, low self-esteem often goes hand in hand with anxiety and/or depression and it makes it especially challenging for teens to cope. Low self-esteem has been empirically proven time and time again to lead to self-harm behaviors, drug and alcohol abuse, and disordered eating behaviors.

So how can I promote my teens healthy self-esteem?

There are many, many books written on the subject and this can be a daunting topic to navigate, but there are some things you can implement immediately. First, start to notice any negative self-talk your child engages in, any distorted messages or irrational thoughts. This can include black and white thinking, minimization, assuming responsibility for anything that goes wrong, jumping to conclusions, or assigning themselves negative labels or names. If this is an issue, it is important that you help your child understand where these thoughts are coming from and how they can reframe them. Help them reframe their “I should” to “I could” or I’d like to” or “I choose to”.

Next try to notice if your child suffers from perfectionism, constantly striving to be perfect in the hopes that a lack of mistakes will give them validation and/or improve how they feel about themselves. This will always backfire at some point and will ultimately make your child feel bad about themselves. Speak with her, explore what might happen if things weren’t perfect, what that might look like, and discuss how each of us has our own unique talents and abilities. Explain that none of us are perfect, nor are we expected to be, and no amount of external validation will make us feel better about ourselves deep down. Instead, work to find some positive qualities that she can to focus on and perhaps, some positive affirmations she can practice.

I know these are some very high-level ideas and concepts, but they can be extremely helpful for anyone struggling with self-esteem issues, are beneficial for all of us, and are especially effective and valuable for heading off eating disorders of all kinds.

I am looking to put together a group of women with adolescent daughters who would like to meet to discuss strategies for supporting our daughters throughout their teenage years. Please pm me if interested.

F.E.A.S.T. or Families Empowered And Supporting Treatment for Eating Disorders, is an organization dedicated to supporting parents and caregivers of those struggling with an eating disorder. They are unique as all members of this incredible organization have experienced what it is to have a son or daughter develop an eating disorder. They are intimately aware of the intense worry, fear, and frustration that accompanies these devastating disorders.

I was honored to be asked to write a guest post for their blog. It is entitled My Journey, My Passion.

Just read an extremely compelling, poignant, well-written, compassionate, sad, but very important book on the seriousness of eating disorders, as well as the serious holes in our medical systems treatment of them. Linda and John Mazur, in their book entitled, Emilee, The Story of a Girl and Her Family Hijacked by Anorexia, recount the painful journey of their beautiful daughter and her unrelenting eating disorder. Raising awareness, supporting, and educating people about these serious mental illnesses is so critical to our treatment of them.

In prior posts we’ve looked extensively at eating disorders and risk factors. This week I’d like to focus on a pervasive issue/bias that may seem tangential but is actually a negative behavior deeply associated with disordered eating and many negative health effects. I’m referring to weight stigma.

What is weight stigma? Weight stigma is defined as the social rejection and/or devaluation of those who do not meet or comply with the prevailing acceptable social norms of body weight and shape by other members of society. Weight stigma refers to any biased or discriminatory acts that are targeted towards individuals specifically because of their weight and size.

Why is weight stigma so dangerous? Those who experience weight stigma and suffer from an eating disorder or any mental or physical health issue are less likely to be diagnosed and get the help they need, especially when they have a higher BMI or are considered obese. That is scary. In fact, patients experiencing weight stigma have been documented to have been denied the testing, therapies, and surgeries provided to thinner patients with the same health conditions, leading to poorer health outcomes.

What are some consequences of weight stigma? According to multiple empirical studies, weight stigma is tied to increased mortality, as well as increases in certain diseases and chronic conditions. People who are obese experience poorer healthcare. Further, people who experience weight stigma have more psychological distress with documented higher levels of disordered eating, low body-image, emotional distress, low self-esteem, and depression. Weight stigma also leads to greater levels of stress and all the unpleasant consequences that accompany it. Often individuals who experience weight stigma are stereotyped as being lazy, lacking self-discipline, weak willed, and/or non-compliant. Sadly, in a study that just came out June 1, weight stigma experiences worldwide were found to be most frequent in childhood and adolescence, and any associated distress due to them was found to be highest during these time periods as well once again highlighting the age of adolescence as a particularly stressful and precarious time.

How is weight stigma perpetuated? When society regards obese people as architects of their own ill health as well as being personally responsible for their weight problems due to their own laziness and overeating, weight stigma is established. Additionally, weight stigma is often viewed as a beneficial incentive for weight loss and an acceptable method for producing change by many healthcare practitioners, including doctors, nurses, health coaches, nutritionists, dietitians, etc. Further, the $72 billion that Americans spend on the diet industry each year adds considerably to the weight stigma struggle many experience.

How then can we stop the weight stigma? This is a harder question to answer. We need to work at eradicating the diet culture that is so pervasive and insidious in our society. We have to be so careful how we speak to people, the language that we use, the messages we espouse. Especially when it comes to our children who are so impressionable and vulnerable, we must teach them the value of treating all people with dignity and respect, regardless of their size or build. We must educate ourselves, our healthcare workers, as well as our educators about weight stigma. We all have our own paths to forge in life. Forcing others to conform to a certain mold does not help or support anyone’s mental or emotional health and is more often than not, unsuccessful.

I recently came across an article titled “Pandemic has fueled eating disorder surge in teens, adults”.  I was dismayed to read about how eating disorder diagnoses and needs have increased exponentially since the start of the pandemic. Wait times for treatment can be months and there is a shortage of beds in inpatient facilities as well as appointments with therapists. The Alliance for Eating Disorders Awareness, which started offering virtual therapist-led support groups for adults during the pandemic, have also seen a huge surge. Since January more than 7,000 people from every state and 32 countries have attended their support groups and hospitalizations have increased greatly as well. The article above reports that medical records data from 80 US hospitals found a full 30% eating disorder patient increase since March 2020, that was compared with data from the 2 previous years. I was disheartened to hear that among girls aged 12 to 18 there were 1,718 admissions in these hospitals alone – interestingly however, there were no increases among boys.

Sadly, there have been large surges in all types of mental health illness since the onset of Covid-19. According to the Kaiser Family Foundation (KFF), a nonprofit organization focusing on national health issues, since the pandemic onset there has been a fourfold increase in symptoms of anxiety or depressive disorder. People are reporting difficulty with sleeping, difficulty with eating, and increased alcohol and substance use. Children and teens have been hit particularly hard as this is a time when they struggle with their emotions and how to express them. As parents and educators, we must inform ourselves about the signs and symptoms of stress and strain on our children to best help them cope and to reduce the possibility of turning into something more serious.

Different people cope in different ways and so their signs of stress will vary. Young children might struggle with their sleep schedule, develop more separation anxiety, be more aggressive with siblings and friends, may have more stomach discomfort, or crying more than usual. For older children and adolescents though, things such as changes in mood, changes in behavior including stepping back from personal relationships, any loss in joy or interest from activities that were previously enjoyed, changes in eating patterns or appetite, reduced effort or interest in academics, any risky or reckless behaviors, or appearance changes such as decreased personal hygiene or taking less care of themselves, are all warning signs that your child could use some help.

We have to work to keep the lines of communication open with our children. We have to notice how they are acting and reacting. Encourage them to speak with someone if they are struggling. We must keep an eye out for any changes in behavior of any kind and not delay in speaking to a professional if you have any concerns. Eating disorders are much easier to address and treat when they are discovered early on, but even better, of course, is if they do not develop at all. Educating ourselves on the risk factors for them as well as their symptoms has been scientifically proven to help reduce their onset.

And while I do not have any specific numbers for how the pandemic has affected our community specifically, it is a good reminder that although we always need to pay attention to the signs and symptoms, it is even more important to be diligent in times of acute stress. Let’s keep working together to eradicate these devastating illnesses.

As of late there has been a lot written and talked about regarding the Health at Every Size (HAES) approach to weight control. I was fascinated at the prospect of an approach to health and wellness that does not directly advocate the frustration and potential dangers of dieting, restricting, abstaining, etc. As I work to better understand HAES and how it can help people better approach their health and wellness, I wanted to share my thoughts and ask others for theirs as well.

HAES helps to reduce weight stigma and bias by shifting from a weight-focused to a health-focused paradigm, thereby challenging some of the key assumptions of traditional approaches to weight management ultimately allowing us to better accept our bodies wherever they are and have compassion for our shape and size.

The HAES approach does not claim that everyone is at a healthy weight, as some have come to believe. Rather, it is a paradigm that seeks to support and help people in the body that they currently have, whether or not they are at their optimal weight. HAES seeks to increase body respect, to shift from the focus that a person’s value is based solely on their weight and size, while increasing self-care and self-acceptance behaviors. This allows peoples weight to fall where it may based on intuitive eating, while recognizing that lifestyle is one risk factor for disease, but not the only one. Behaviors encouraged include eating a healthful diet (but not restricting intake), physical activity, getting the proper amount of sleep, stress management, finding joy in life, along with intuitive eating. Intuitive eating encourages an individual to respond to internal cues of hunger and satiety rather than external cues of specific meal times or events, and is thought to prevent negative body image and the disordered eating that often accompanies it.

The HAES approach is important as it supports the idea that physical presentation and weight should not be the primary way that people are looked at or judged. This is a critical first step to achieving body acceptance and body positivity. And since some studies show that up to 70% of an individual’s weight can be dictated by genetics, 90% of people fail on diets, and 60% of them end up gaining more weight than they lost, we have to find a way to be comfortable in our bodies, even while we work to keep them healthy.

That said, there are those who misinterpret this approach to mean that it is ok to let yourself go and not care about your weight and what you eat. Those practitioners who use HAES and intuitive eating have found that it can only work in conjunction with a significant amount of education and understanding. HAES then can be considered a tool to help us achieve body positivity, but, like all tools, must be implemented in a mindful and thoughtful way in order to properly benefit from it.

Please share your thoughts on HAES and any personal experiences, whether positive or negative, with me. Thank you!

I came across a devastating statistic this week which stated that by age 13, 53% of girls are unhappy with their bodies and this number grows to 78% by the time girls are 17! How can we, as mothers, grandmothers, sisters, aunts, and teachers work to reduce these numbers and replace these negative thoughts and beliefs with ones that support body image and overall self-esteem?

As we’ve established previously, our own attitudes and beliefs about our bodies, our appearance, our weight, and our shape can influence the way our children and anyone who looks up to us as role models, think about and see their own bodies. Understandably, it can be very difficult to always be positive about how we look, but it is nevertheless critical that we try not to criticize our appearance. For example, saying things such as “I’m so fat” or “I feel fat” or “this makes me look fat”, etc. when around young girls only reinforces the misconception that our physical presentation is what is most valuable. Rather, trying to find something else about ourselves or our bodies that we can praise on occasion can go a long way to helping girls feel more comfortable in their bodies. Negative speech, attitudes, and behaviors only breed more negativity in both behavior and emotion.

Further, it is also essential to praise things about ourselves and our daughters that are NOT related to appearance in any way. Through the use of these kinds of comments, our daughters understand that there are many ways to be valued and that our appearance is not the only way or even the most important way, for us to appreciate our bodies. We must instead recognize our bodies for all the wonderful and important things they do for us, not just for how they outwardly look. Our bodies carry us, carry our children, build muscle, build endurance, heal themselves, provide signals when we are in danger or in need of food or drink, store our memories, store our emotions, and give us so much more. Focusing instead on all these amazing things our bodies can do, removes appearance related stress and pressure.

Another way to create body positivity is to work to create an atmosphere in our homes that is one where negative body and appearance comments are discouraged and unwelcome. It is important to not greet people with comments about how they look, but instead with things that are not appearance related. Some examples might include saying things such as how nice it is to see someone as it’s been so long, or commenting on something you’ve missed specifically about that person, or perhaps something you’re excited to hear about that they’ve experienced.  Sadly, it has been ingrained in us from a very young age that when we see someone often the first comment we make is about appearance. We say things such as, “you look so lovely” or “you look so thin” or “your outfit is so slenderizing”, etc. While there is no malice or ill intent in saying these things, they nevertheless reinforce the importance of physical appearance and its value above all else.

Ultimately though, we need to teach our children that a person’s worth is tied to their personal qualities, middos if you will, and not their physical appearance. Complimenting others for non-appearance related qualities in front of our children while also promoting healthy, strong bodies over thin or skinny ones, can go a long way in increasing body and self-image, as it is no longer the yardstick by which their value is measured. Children who are confident and have good feelings about themselves are less likely to develop body dissatisfaction and eating disorders. Helping your child build good general self-esteem is also likely to help your child be resilient to pressures from others and maintain healthy eating patterns.

Stay tuned for more practical and usable strategies for helping our children develop better body image and greater self-esteem.