Hightlights from the January TK Eating Disorder Conference: Juliet Zuercher, RD

So 2013/2014 was a year of professional growth for me, despite the fact that I haven't worked in my field in 2 years! I started my CBT certification course, started attending workshops, conferences and trainings held by my local CAMFT organisation and actually committed to reading the books I had previously labelled "reference material". (haha)

Yesterday's conference on Eating Disorders was wonderful, I know that's an odd statement - but it was hugely informative and unlike many trainings went so far beyond theory and actually discussed the research and application to treatment (hallelujah!). My two favourite speakers were: Juliet Zuercher, RD and Margaret Nagib, Psy.D. all the speakers were enjoyable and brought new insight and resource information, but as Bridget would say "WOW-WEE" was my reaction to a few of the presentations.

Juliet Zuercher, RD as a dietician and nutrition therapist discussed feeding difficulties, health and wellness and the ways in which we have a responsibility to demonstrate professional integrity and authenticity in our own lives (so brave to say to a room full of counselling professionals!).

Zuercher referenced Ellyn Satter, MS, RD, LCSW, BCD extensively through out her presentation and based on what she had to say about her work I could barely make it through the night without googling her! I loved what she had to say about the parent-child feeding relationship, about the division of responsibility:
The division of responsibility for infants:

• The parent is responsible for what
• The child is responsible for how much (and everything else)

Parents choose breast- or formula- feeding, help the infant be calm and organized, then feed smoothly, paying attention to information coming from the baby about timing, tempo, frequency, and amounts.

The division of responsibility for older babies making the transition to family food

• The parent is still responsible for what, and is becoming responsible for when and where the child is fed.
• The child is still and always responsible for how much and whether to eat the foods offered by the parent.

Based on what the child can do, not on how old s/he is, parents guide the child’s transition from nipple feeding through semi-solids, then thick-and-lumpy food, to finger food at family meals.

The division of responsibility for toddlers through adolescents:

• The parent is responsible for what, when, where
• The child is responsible for how much and whether

Fundamental to parents’ jobs is trusting children to decide how much and whether to eat. If parents do their jobs with feeding, children do their jobs with eating:

Parents' feeding jobs:

• Choose and prepare the food
• Provide regular meals and snacks
• Make eating times pleasant
• Show children what they have to learn about food and mealtime behavior
• Be considerate of children’s food inexperience without catering to likes and dislikes
• Not let children have food or beverages (except for water) between meal and snack times
• Let children grow up to get bodies that are right for them

Children's eating jobs:

• Children will eat
• They will eat the amount they need
• They will learn to eat the food their parents eat
• They will grow predictably
• They will learn to behave well at mealtime

Her main point on this issue was that family meal times are a necessity and must be made a priority at least (she says) 3 times per week. These meal times should not make food the focus on the time spent together, but rather the connection and communication between family members sharing a meal together.

I loved the image created regarding this point- that our joy in eating together should be about the experience as well as satiating hunger, we should also be feeding our minds and hearts as much as we are feeding our bodies. The meal should not be about how long it took to cook, how many grams of fat are in each item or how quickly we can woof it down before returning to alternate pursuits.

 "Time spent with families at meals is more related to the psychological and academic success of preadolescents and adolescents than time spent in school, studying, church, playing sports, or doing art activities"

Hofferth, S.L. (2001) How American children spend their time. Journal of Marriage and the Family. 63, 295-308

Making mistakes myself... passing them on, already!

This reminded me greatly of two experiences of eating that I have hated in recent years - firstly, silent meals! When I worked on the residence at Family Life Center, all meals (apart from a short moment after breakfast) were completely silent, residents and staff communicated to pass water, etc only through hand signals, there was no eye-contact, smiling, laughing, touching - no communication of any kind. I HATED IT. It ran so much against the grain of my enjoyment of meal times and communicating in general! I hated it so much so, that when I ran the Orchard house of 6 girls, our dinner times were well known for being more than a little rambunctious, loud and full of laughter!

The lesson I learned in these experiences of silence, was what it feels like to deprive others of interaction and solely focus on the food, what I was eating, that I had to eat everything on the plate, likes, dislikes or would rather die than eat (say hello to my first experience of Corndogs), with no conversation to distract, I found there were a great many things I disliked intensely!

The second experience of eating I hated in recent years was also silent. Back in November I attended a Mindfulness retreat through CAMFT, I wasn't sure about going - as I do struggle with the more Zen-Buddist/ Somatic/ Eco-Vegan therapists, my need for empirical evidence and structure really runs against the grain of their ideology and sometimes I can't help myself thinking uncharitable thoughts. For example, 'no Wanda, I'm afraid that even if we all meditate in the park focusing our energy on peace and love there will still be crime in the 2 block radius that surrounds us, we are not all powerful and able to annihilate the choices of others through our trained thoughts! Personally Wanda I'd like to string you up by your toe rings until you manage to meditate yourself back down through the power of positive thinking and putting it out to the universe'... and other such compassionate things.
That said, I went. I thought most of it was a crock, but a day out in which no one was allowed to talk to me, at least cut down on the number of unusual people I had to be friendly to (ha,ha). Our task at lunch during the retreat was to eat in silence (I'm a pro after my FLC days) and to be truly mindful about our eating. That was a useful experience. Mindfulness in eating is without doubt a skill, and a useful and necessary component of healthy eating and living.
Mindfulness sounds so impressive, but really when you break it down to the task of eating all it means is, what can you make yourself aware of? What are the colours on your plate, can you notice the shades and textures and interactions between the food items on your plate. Can you pay attention to the sound, the feel as you cut through green beans and hear the squeak as you chew them? Can you notice what you like about a taste? Can you discern what you dislike about a taste, texture or smell? Can you examine it? Treat each meal like an exploration, delving into new territory of understand can you be fully present with your mouthful, and fully present with your surroundings, the people, the conversation, the world the surrounds your experience of eating? Mindfulness in eating - that is worthy pursuit!

I'll admit, I've been reading Satter's work, her book: 'Child of Mine: Feeding with Love and Good Sense' is very clear and does prescribe a lot of behaviours that are rigid and a little uncomfortable for me, but surely that's the point! If I don't really know what I'm doing, if my boundaries with food are unhealthy - structure and limits are going to sound very restrictive and unpleasant! I think my reaction to the structure imposed on eating says more about my disordered eating than it does about the research itself! If you equate food with love, food with reward, food with achievement, food with success, food with nurturance, food with happiness, the idea of limiting access, of prescribing exposure - it feels like deprivation, it looks like rejection, it smells like fear - fear of the feelings, thoughts and experiences that food masks, soothes and replaces.
In short - my revulsion at her work - is probably all I really need to know about it's effectiveness because it challenges my own distortions and dysfunction - eating for every reason... you know, apart from actual hunger!
I've ordered "Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook". I expect to hate it - really hate it from a place of recognition of what must be done... like I hate opening the boot of the car full of shopping, knowing what must be done!


The Ellyn Satter Institute http://ellynsatterinstitute.org
There is incredible basic information available on the website - with free pdf copies of feeding and eating advice for each age group and a few on healthy eating and feeding picky eaters. She also has released some webinars on youtube, I've watched the first one, what I'd say is the information is good, but dynamic they are not!
Preventing Child Overweight and Obesity: Raising Children to be Competent Eaters by Ellyn Satter. January 12, 2012. Session 1.


Zuercher discussed our responsibility (as clinicians, but also as parents and caregivers) to be role models demonstrating personal integrity in our own food and living choices. How can we sit with a client who purges after meals as a compensatory behaviour for eating more than their imaginary ingestion rules permit - and challenge the cognitive distortions or the body shame experienced while going home to a 6 mile run and plate of carrot sticks and salad to reach our own imagined ideals of body beautiful?
Can we say to our binge eating clients - eat small meals, never get hungry enough to trigger a binge, make healthy choices in food and exercise, moderation and acceptance are key - then plonk ourselves down in front of the TV and eat a pint of Ben & Jerry's ice-cream instead of cooking dinner as a means of rewarding ourselves for a days' hard work and avoiding feelings stress or sadness? I think the answer is no. Maybe, just maybe - we could be effective with clients without dealing with our own disordered eating patterns or unhealthy lifestyle choices, if we maintain the 'Tabula Rasa' or blank slate (impossible in my opinion) but we have absolutely no chance of pulling off this con with our own children and families!

Zuercher talked about making choices from a place of freedom - not allowing ourselves to be motivated by fear. This I think is particularly true of dieting, which Zuercher could not have been more scathing about had she burned The South Beach, 5:2 Fasting, Atkins and Vegan books in effigy in the middle of the room! She said that diets are about fear, fear of not being good enough, not being attractive, not being accepted, fear of being unable to control our lives and choices, fear of being perceived as lazy, fear of making choices that are not prescribed by others, fear of taking responsibility for our own destiny. What ever the fear that motivates our dieting, Zuercher advocates for this approach:

Linda Bacon - Health at Every Size

Linda Bacon - Health at Every Size - Youtube

Fat isn't the problem.
Dieting is the problem.

Health at Every Size - Linda Bacon 

HAES acknowledges that well-being and healthy habits are more important than any number on the scale. Participating is simple:
1. Accept your size. Love and appreciate the body you have. Self-acceptance empowers you to move on and make positive changes.
2. Trust yourself. We all have internal systems designed to keep us healthy—and at a healthy weight. Support your body in naturally finding its appropriate weight by honoring its signals of hunger, fullness, and appetite.
3. Adopt healthy lifestyle habits. Develop and nurture connections with others and look for purpose and meaning in your life. Fulfilling your social, emotional, and spiritual needs restores food to its rightful place as a source of nourishment and pleasure.

• Find the joy in moving your body and becoming more physically vital in your everyday life.
• Eat when you’re hungry, stop when you’re full, and seek out pleasurable and satisfying foods.
• Tailor your tastes so that you enjoy more nutritious foods, staying mindful that there is plenty of room for less nutritious choices in the context of an overall healthy diet and lifestyle.

4. Embrace size diversity. Humans come in a variety of sizes and shapes. Open to the beauty found across the spectrum and support others in recognizing their unique attractiveness.

Read more: Health at every size - Excerpts & Downloads

More than anything else in this presentation from Zuercher, I thought about how healthy behaviours - truly healthy behaviours to body, mind and spirit are counter-culture. We actually have to swim against the current to carve out a self that is permitted to be and feel good. From everything that was shared in this presentation here are the top 10 take away messages I appreciated:

Top 10 Tips for Parents Who Want to Raise Healthy Children

1. Be a good role model: don't follow fad diets for weight loss, eat mindfully (intuitively). Choose from a variety of food that are tasty and satisfying, eat when hungry, stop when not hungry.

2. Promote size acceptance: All bodies are shaped differently. This is part of the natural, genetic variety of our species! Fostering an environment of size acceptance for diverse shapes promotes a child's self acceptance and well being. Body differences should be welcomed, not feared.

3. Use positive body language: Are you constantly talking about the weight you want to lose or how much better you think you would feel if you could just shed 10 more pounds? Do you comment often on others' appearance and make judgments about them based on weight? Instead of these negative expressions, talk positively about your own body and you will model a healthy self-concept for your children.

4. Allow for freedom of choice within structure: Children have not learned the social definition of good and bad foods. They eat what they like and what looks good to them, provide options of whole grains, fruits and vegetables along with other foods, children will sometimes choose the grains, fruits and vegetables. So provide food options for children with reason: one snack may be an apple with peanut butter or graham crackers with milk, another may be a cereal bar or two cookies.

This is supposed to show balance - Fruit (Watermelon) & Ice-cream

5.Create a positive food environment: children excel both emotionally and academically in environments where they feel safety and love. The dinner table is perhaps the best venue for providing this environment. So, make it a rule for the family to eat at least one meal together per day. Keep the conversation positive - children will associate the context of the meal with the positive feelings, promoting a healthy rather than a conflicted relationship with food.

6. Be aware of food allergies: Not all childhood food allergies will last a lifetime, most will be outgrown, provide opportunities to develop immunity to the proteins in allergenic foods by testing with small doses. Unnecessary food restrictions may inadvertently contribute to disordered eating or an eating disorder.

7. Be active: Limit "screen time" (TV, computers, texting etc) build in family times that encourage an active lifestyle. Plan holidays that include enjoyable active activities hiking, biking, swimming, roller-blading. Set clear expectations regarding chores for children and take time to invent games while doing chores so that even routine activities become associated with fun and closeness.

 8. Involve the child in menu planning: ask about children's preferences when planning your weekly menu, shopping and meal preparation, include them where possible. These are teaching moments that foster empowerment around food choices rather than passivity.

 

9. Eat the same meal at dinner time: resist the urge to make a special plate for the child who refuses to eat what is served. The parent decided what will be served and when, the child decides if they will eat and if so, how much. This encourages children to make good choices around food and increase variety.

10. Eat with balance, variety and moderation: Do not require children to finish the food on their plate. Provide a variety of flavours, colours, textures and aromas in food to expand children's food repertoire. Allow children to portion their own meals when old enough, small frequent meals and snacks allow the body's metabolism to work most effectively.

 Find joy... in the small things, be mindful of the pleasure in each moment, and accept yourself now, just as you are... oh and no more diets!