By: Leigh C. Brosof
​
​This year’s fifth-annual Louisville National Eating Disorder Association (NEDA) Walk was held a few weeks ago on September 15 at Bellarmine University. From the speakers to the attendance (497 people registered!), it is clear that the community rallying around eating disorder awareness and advocacy only continues to grow in Louisville. This growing sense of community is imperative in Louisville to increase resources devoted to eating disorder treatment, decrease stigma, and letting individuals in recovery or recovering from eating disorders know that they are supported and that there is hope.
 
Ken Fleming, a Kentucky State Representative, who helped spearhead legislation recognizing an eating disorder awareness week in Kentucky, spoke about the steps being taken in Frankfort to help address legislation surrounding eating disorders. I was lucky enough to attend one of these meetings in Frankfort and got to see the legislative process in action!
 
Dr. Andrea Krause, a pediatrician in Louisville, spoke about the seriousness of eating disorders and how professionals work with families and individuals with eating disorders to treat these disorders and work toward recovery.
 
Megan Ward gave an inspiring speech about her personal struggles with an eating disorder and how she ultimately was able to get the help she needed to reach recovery. She also spoke powerfully about how eating disorders come in all shapes and sizes and do not discriminate based on age, race, ethnicity, gender, or anything else.
 
This message was echoed by the last speaker of the day, former MLB catcher and NEDA Ambassador Mike Marjama, who battled with an eating disorder while playing professional baseball and now works to increase awareness about eating disorders in all individuals. This was truly an important message for everyone to know that eating disorders do not “look” a certain away, that they can affect anyone, and that everyone is worthy of treatment.
 
Ultimately, all of the money raised through NEDA goes directly back to clinical resources, awareness about eating disorders, research endeavors, and to help our local community continue to fight eating disorders. Fundraising efforts for the Louisville NEDA Walk continue through October 15.
 
To donate, go to: https://nedawalk.org/louisville2018. It was a powerful day to remind our community that we continue to get stronger in the fight against eating disorders, and that if you struggle, there are others around you to support you, and there is help and hope available for a full recovery.
 
If you or a love one is struggling with disordered eating, there is help available. NEDA offers a helpline to speak to someone about seeking help, and a screening tool to help identify if any eating concerns you are having may be an eating disorder.
Screening Tool:
https://www.nationaleatingdisorders.org/screening-tool
 
NEDA Helpline to speak to someone over the phone:
https://www.nationaleatingdisorders.org/help-support/contact-helpline
1-800-931-2237

​Upon hearing about the experiences my lab had at the 2018 International Conference on Eating Disorders in Chicago, Illinois, we discussed the controversial nature that exists when researchers use “triggering,” terminology. Audience members became upset with certain researchers who used words such as “overweight,” and “obese,” which were used to describe study participants. These words have been part of the terminology present in fat-shaming, fat discrimination, and micro aggression towards a population that society has deemed to have above average weight. Furthermore, these words become associated with individuals that society has frequently labeled as “lazy” or “incapable” as dictated by their portrayals in films, television, and other media outlets. However, this begs the question: Should researchers use these words if they are so triggering in the public domain? The answer is complicated.
 
“Obese,” comes from the latin “obesus,” which means “fat, stout, plump.” It was believed that Hippocrates recognized obesity as a medical condition as it gave rise to the onset of other diseases (Christopoulou-Aletra & Papavramidou, 2004). The modern term “obesity,” one that became stigmatized by society today, took shape in 1942, when The Metropolitan Life Insurance Company began to determine mortality rates based off of age and weight. For the first time, individuals were standardized and the notion of what an individual “should” weigh was popularized (Statistical bulletin of the Metropolitan Life Insurance Company). While initially designed to determine “desirable weight” dependent on age, height and mortality values, the insurance company changed the medical term into one that society was able to pass medical judgment on, completely discounting the innate nature in which all bodies are different.
 
Researchers Meadows and Danielsdottir (2016) said it best, “Part of the problem is that the very act of labeling is a process of othering, one that creates a distinction between us and them; which raises the question: who is entitled to do the labeling and why, and in what conditions is such a distinction needed?” Within research, othering is needed in order to determine differences between two groups of individuals. However, when presenting research, the two groups must be labeled in order for other researchers to understand what populations the research is being done on. The questions Meadows and Danielsdottir (2016) raise are both legitimate and further contemplation could give rise to an ethics paper worth developing.
 
However, I argue, researchers ought to be allowed to use the triggering word, upon critical consideration, as long as its intent is to use the word as it originally appeared in the dictionary and not one that was shaped from societal norms. I recognize this statement contains many caveats, like “what if the word in the dictionary was created offensively in the first place?” It is the responsibility of researchers to develop a common word that can be used for research purposes.
 
Let’s say for instance, researchers were to change the word of a specific demographic every time social norms dictate it as “triggering.” Not only would this be a disservice to the population in which the research was presented on, but also could have a negative impact on the research itself. For example, if researchers cannot come up with a common language for the subject in which they are communicating, then the ability to share research will be dependent on how long the terminology within that research is deemed “acceptable.” For this reason, when reporting on demographics, researchers ought to be careful in the first place of the terms they do use.
 
In the end, I believe that “obese” as a research term ought to continue to be used, reporting results unbiased without regard to social norms. Further, if new information comes to light, for example if it was discovered that Hippocrates used “obese” as a derogatory term, then it is the ethical responsibility of researchers to utilize different terminology for this demographic.

​While the culture in the United States has come a long way in terms of normalizing and destigmatizing mental illness, particularly with respect to depression and anxiety, there are still a lot of misconceptions and stereotypes surrounding other mental illnesses, such as eating disorders and obsessive-compulsive disorder. Eating disorders, and mental illness in general, is still a taboo topic in a lot of communities, specifically among people of color.
 
As an Indian-American, I have witnessed the culture surrounding mental illness within my community. Rather than being seen as a real illness that warrants the same attention and level of care as a physical ailment, mental illness is often dismissed and not legitimized. Even when one’s mental illness is acknowledged, their family might try to explain it by giving it a biological cause, such as rationalizing it as a thyroid dysfunction. Due to a myriad of sociocultural factors, South-Asians face unique barriers to seeking treatment for eating disorders.    
 
One issue is that eating disorders are still stereotyped as an issue that only affects young, affluent, White women. In reality, eating disorders affect people of all genders, ethnic groups and ages (Marques et al., 2011).
 
While extensive research on eating disorders has been conducted in European-American populations, and some research has been conducted in African, Latin-American, and Hispanic populations, eating disorder research has been historically sparse in Asian populations (Soh & Walter, 2013). Research has suggested that referrals to eating disorder services from South-Asian populations are under-represented (Abbas et al., 2010), despite evidence suggesting that rates of disordered-eating behaviors are similar to the rest of the population (Wales et al., 2017). Studies have also shown that there is a high prevalence of disordered eating behaviors in minority populations in general (Solmi et al., 2014), and research in South-Asian populations have suggested that the incidence of certain eating disorders, specifically bulimia nervosa, is higher in South-Asian populations than White populations (Mumford et al., 1991).
 
Eating disorders are particularly relevant in the South-Asian community due to role that food plays in the culture. Any large gathering of family or friends usually involves a lot of sugary, fatty food, and people are encouraged to socialize and eat, and those that do not partake are seen as asocial. However, it is also a common occurrence in the South-Asian community to have various relatives or family friends comment on various aspects of one’s life, including one’s physical appearance. In the Indian community, being light-skinned and thin are seen as not just sufficient, but necessary to be considered attractive, if you are a woman. Societal pressure in the form of comments or suggestions are often made if a woman does not match this ideal body type, conditioning individuals to go to extremes pursuing this ideal. Research has found that this is a common theme in the South-Asian community that can prime individuals to develop disordered eating habits and behaviors (Wales et al., 2017). Much of this pressure is faced by young women and adolescent girls, as patriarchal norms dictate that they are expected to look attractive to find an ideal husband. Men in the South-Asian community also face the same societal pressures, but generally to a lesser extent. Older women often note that they do not face the same pressures after marriage, though some pressures still exist. This dual pressure to eat in social settings and yet maintain a thin figure may be one reason why there is a higher than average prevalence of bulimia nervosa in South-Asian women, and why anorexia nervosa might not be as common (Mumford et al., 1991; Abbas et al., 2010). Klump and Keel (2003) also provide other explanations on cultural differences in eating disorders, and their research has found that bulimia nervosa has greater variability cross-culturally than other eating disorders, such as anorexia nervosa.
 
Additionally, women who are part of the South-Asian diaspora, but who live in the Western world face experience many conflicting messages about food and weight, as they are exposed to more traditional South-Asian influences from their family, as well as being exposed to various Western disordered eating triggers such as peer pressure, pictures of thin celebrities and pro-anorexia websites.
 
Not only do South-Asians face unique sociocultural pressures that may contribute towards disordered eating, but they also face barriers to seeking treatment. One of the biggest barriers to accessing services is lack of knowledge – while younger South-Asians tend to be more aware and exposed to ideas about mental illness, they may be dismissed by elder family members or friends. The lack of communication and understanding of the seriousness of eating disorders can keep younger South-Asians from accessing care, particularly if they are dependent on family members to assist with paying for treatment (Wales et al., 2017). This goes along with the general stigma surrounding mental illness in the South-Asian community – seeking treatment involves acknowledging the mental illness, and many South-Asians do not want to admit that there is a “problem” in their family or community.
 
While South Asian populations face these unique barriers to accessing care for eating disorders, progress is still being made. Mental health is being discussed in a serious way in South-Asian media, such as in Bollywood movies, reshaping the way it is viewed by the general population. However, increasing eating disorder research on this understudied population is important, as it could contribute towards reducing barriers to treatment and improving quality of care to the South-Asian population. Moreover, eating disorders may present differently in Eastern populations versus Western populations, so more research needs to be done to parse out if such differences exist. Additionally, normalizing topics within these communities is essential, as stigma can keep South-Asians from accessing mental health services, even when readily available.
 
References
 
Abbas, S., Damani, S., Malik, I., Button, E., Aldridge, S., & Palmer, R. L. (2010). A comparative study of South Asian and non‐Asian referrals to an eating disorders service in Leicester, UK. European Eating Disorders Review, 18(5), 404-409.
 
Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological bulletin, 129(5), 747.
 
Marques, L., Alegria, M., Becker, A. E., Chen, C. N., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders, 44(5), 412-420.
 
Mumford, D.B., Whitehouse, A.M., & Platts, M. (1991), Sociocultural correlates of eating disorders among Asian schoolgirls in Bradford. The British Journal of Psychiatry, 158(2), 222-228.
 
Soh, N.L. & Walter, G. (2013), Publications on cross-cultural aspects of eating disorders. Journal of Eating Disorders, 1(1), 1-4.
 
Solmi, F., Hatch, S.L., Hotopf, M., Treasure, J. and Micali, N. (2014), Prevalence and correlates of disordered eating in a general population sample: the South East London community (SELCoH) study. Social Psychiatry and Psychiatric Epidemiology, 49(8), 1335-1346.
 
Wales, J., Brewin, N., Raghavan, R., & Arcelus, J. (2017). Exploring barriers to South Asian help-seeking for eating disorders. Mental Health Review Journal, 22(1), 40-50. doi:10.1108/MHRJ-09-2016-001

Everyone experiences shame and guilt at times. While these emotions can be helpful in guiding our social behavior, they can also bring a lot of discomfort and even trigger depression and other psychological disorders, such as eating disorders. Let’s differentiate between shame and guilt, describe in which situations they can be useful or harmful, and discuss how to cope with them.

Guilt is an unpleasant emotion about something we have done. It is often used synonymously to remorse, meaning that we regret the action, and guilt may involve sadness and empathy towards the person harmed. Guilt is generally seen as a useful emotion that encourages us to follow moral and societal norms. For example, we may feel guilty about lying to a friend or skipping a volunteering shift at the local shelter. Guilt may also occur if we act inconsistently with our personal values. For example, someone who values family above all else may feel particularly guilty about skipping a family holiday dinner.

In contrast to guilt that involves feelings about an act one has done, shame involves negative feelings about oneself. Shame encompasses a feeling of inferiority and perceiving oneself as a small, lesser person, worthless, and a failure. Another way to differentiate guilt and shame is by what the emotion urges us to do: guilt usually triggers a desire to apologize and redeem oneself, while shame may lead to a desire to hide or escape. Although shame can be helpful in some situations (i.e. serious wrongdoing) and is used in programs redeeming violent offenders (Loeffler, 2009), it generally is associated with increased distress and may lead to depression, self-harm, and disordered eating (Muris, 2015).

Feelings of guilt can also be harmful if it is based on an irrational belief, such as feeling guilty for something that was not our fault. For example, if we witness an injustice, we may feel guilty because we think we could have done something to prevent it. Guilt can also transform into shame if a “bad” action is interpreted as having occurred because one is a “bad” person. Example: “I feel guilty that I didn’t visit my family this month” can lead to two different outcomes: 1) Call or visit the family to release the guilt or 2) Feelings of shame because “I am a bad son.” The problem with feeling shame in the second scenario is that it may lead the individual to further avoid visiting family and feeling even more shame.

How then can we cope with guilt and shame? First, check your guilt or shame statement for accuracy. Was it really your fault? Can you think of anyone or anything else that may have contributed to the situation? Make a list of any other possible causes and state how much you think each cause contributed in percentage. Then add up all the percentages and subtract from 100%: How much is left? You may want to do this exercise with someone else who can help you see all the perspectives.

To cope with shame, it can be very helpful to examine the evidence and rewrite shame statements into statements of guilt. For example, if you got frustrated and yelled at your child, does it really mean that you are a bad parent? Generally, we want to change the statement from “There is something wrong with me” to “I have done something wrong.” Most of the time, a guilt reaction is more accurate than shame.

Statement of shame: I yelled at my child again! I am a terrible parent.
Statement of guilt: I feel guilty about yelling at my child.

What if you truly have done something bad and can’t shake the regret or shame? Think back to the situation and answer these questions: What purpose did this action serve to you at the time? What did it help you accomplish? What would have happened if you didn’t make that choice in the moment? It’s easy to see what we did wrong looking back and knowing what we know now; it’s called hindsight bias. Most often, we make the best decision based on what we knew at the time.
​
Finally, if logic and reason are not helpful in dealing with guilt and shame, practice self-compassion. Most of us are very good at being compassionate towards others, but find it hard to be compassionate to ourselves. Self-compassion entails being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or beating ourselves up with self-criticism. Imagine that your close friend or a loved one tells you about their guilt or shame, what would you say to them? Say those words to yourself. You can also find many useful self-compassion exercises on Cristin Neff’s website http://self-compassion.org. 

By Shruti Shankar Ram

Consider this: a friend or peer of yours has developed a particular obsession with food – to the point where they count the number of bites they take from their meal, or arrange their food in a specific way every time they eat. They might also have to eat their food in a methodical way and refuse to eat certain foods.
 
This information alone might make you suspect that they have an eating disorder, but these symptoms could also be seen in another mental illness – obsessive compulsive disorder (OCD).
 
Obsessive-compulsive disorder is characterized by repetitive, intrusive thoughts, feelings or sensations that cause anxiety, often accompanied by the need to engage in a repeated habit or ritual that serves to reduce this anxiety in the short-term. Similar to eating disorders, there are also various types of OCD, and the obsessions and compulsions can range from a variety of different things – from health to religion and sexual orientation.
 
Eating disorders and OCD are often heavily stereotyped in the media. While you may immediately think of a teenage girl with anorexia nervosa when thinking of an eating disorder, or a person excessively washing their hands when thinking of OCD, the reality is that both these disorders affect individuals from both genders from a wide variety of different backgrounds and across all ages. Unfortunately, these stereotypes could keep individuals with both these disorders from realizing that they even have the disorder or recognizing the signs in their peers, and this keeps people from getting the treatment that they need.
 
Stereotyping aside, OCD and eating disorders actually share a lot of commonalities. There are several parallels that can be drawn between these two mental illnesses. An example of an obsessive behavior that is seen across both these illnesses is checking. While someone with OCD may constantly check their stove or locks in their house, a person with an eating disorder may constantly check themselves in the mirror or weigh themselves frequently.  
 
This is no coincidence, eating disorders and OCD actually co-occur quite frequently (Rubenstein et. al., 1993; Halmi et. al., 2005; Swinbourne and Touyz, 2007) and eating disorder pathology has been shown to be positively associated with obsessive-compulsive symptoms (Davies et. al., 2009; Naylor et. al., 2011). In fact, obsessive-compulsive symptoms have also been associated with higher relapse rates in eating disorders (Carter, et. al., 2012).
 
Individuals with OCD and eating disorders typically also share two traits in common – high levels of anxiety and perfectionism. In fact, it is quite common for individuals with these disorders to excel in various other areas of their life while silently suffering from the illness. Perfectionism may be seen as a positive trait by some, but it has been shown to mediate the relationship between OCD and eating disorders, and individuals with either or both of these illnesses typically have high levels of trait perfectionism (Bernert et. al., 2013).
 
Additionally, obsessional anxiety could help maintain both OCD and eating disorder symptoms.  This anxiety surrounds possible catastrophic outcomes that may occur if the ritualistic behaviors is not completed – in the case of an eating disorder, this could mean that an individual believes that, unless they heavily restrict, they will gain large amounts of weight and become overweight. In the case of obsessive-compulsive disorder, this could mean that an individual believes that they will die unless they are constantly avoiding germs and washing their hands. This anxiety leads to drawing associations between certain rituals and outcomes – even if they appear irrational to others.
 
Not only are there common symptoms between eating disorders and OCD, but the treatment can also look similar. Specifically, exposure and response prevention therapy (ERP) is an evidence-based treatment that has been well established as the most effective treatment for OCD (Koskina et. al., 1996), and research is beginning to show that ERP may be effective in treating eating disorders as well (Ambramowtz et. al., 2013). Combining exposure therapy with cognitive-behavioral therapy (CBT) is effective in breaking up these irrational associations between ritualistic behaviors and the reduction of anxiety.
 
It is important to note that, of course, eating disorders and OCD, are two very different illnesses. The obsessions and compulsions of an individual with OCD can extend far beyond food, and individuals with eating disorders often experience symptoms that are not typically present in OCD, such as body dysmorphia and drive for thinness. However, it is important to understand the relationship between these disorders, particularly as the comorbidity rate is so high. So, if you do question whether a friend or peer has an eating disorder or OCD – consider the possibility that it could be both!
 
  References
 
Abramowitz, J. S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy, 27(4), 583-600. doi:10.1016/S0005-7894(96)80045-1
 
Bernert, R. A., Timpano, K. R., Peterson, C. B., Crow, S. J., Bardone-Cone, A. M., le Grange, D., & ... Joiner, T. E. (2013). Eating disorder and obsessive–compulsive symptoms in a sample of bulimic women: Perfectionism as a mediating factor. Personality And Individual Differences, 54(2), 231-235. doi:10.1016/j.paid.2012.08.042
 
Davies, H., Liao, P., Campbell, I. C., & Tchanturia, K. (2009). Multidimensional self reports as a measure of characteristics in people with eating disorders.Eating And Weight
Disorders,14(2-3), e84-e91. doi:10.1007/BF03327804
 
Halmi, K. A., Tozzi, F., Thornton, L. M., Crow, S., Fichter, M. M., Kaplan, A. S., et al. (2005). The relation among perfectionism, obsessive–compulsive personality disorder and obsessive–compulsive disorder in individuals with eating disorders. International Journal of Eating Disorders, 38, 371–374.
 
Koskina, A., Campbell, I. C., & Schmidt, U. (2013). Exposure therapy in eating disorders revisited. Neuroscience And Biobehavioral Reviews, 37(2), 193-208. doi:10.1016/j.neubiorev.2012.11.010
  
Naylor, H. et. al. (2011) Beliefs about excessive exercise in eating disorders: the role of
obsessions and compulsions. European Eating Disorders Review, 19, 226–236, DOI:
10.1002/erv.1110
 
Rubenstein, C. S., Pigott, T. A., Altemus, M., L'Heureux, F., Gray, J. J., & Murphy, D. L. (1993). High rates of comorbid OCD in patients with bulimia nervosa. Eating Disorders: The Journal Of Treatment & Prevention, 1(2), 147-155. doi:10.1080/10640269308248282
 
Swinbourne, J., & Touyz, S. (2007) The co‐morbidity of eating disorders and anxiety disorders: a review. European Eating Disorder Review, 15, 253–274. https://doi.org/10.1002/erv.784

Does this dress make me look fat? - The Importance of Rejecting Fat Talk
 
By Caroline Christian
 
 “Does this dress make me look fat?” “Oh my, you look so good! Have you lost weight?” “I need to lose a few pounds before spring break if I am going to wear a bikini on the beach.” These are all statements I have heard just within this past week. With the extreme pressure and focus around body shape and weight in our society, conversations like these are extremely common. Most women will hear at least one statement like these every single day. These statements are called fat talk. Below is a short list of fat talk statements that we may hear, or even say, on a daily basis.
 
Fat talk statements:
“Your arms look so skinny today!”
 “If I were her size, I would not want to leave my house.”
“I need to go to the gym so my boyfriend won’t feel my love handles.”
“I could never pull off jeans that tight with my thunder thighs.”
 “Why is he with her? She is a whale!”
“If I was that fat, I just wouldn’t eat.”
“I wish I could be as thin as you.”
“If you think you are fat, I must be a cow!”
“I wish I had a bikini body.”
“That dress is cute, but it isn’t very flattering on you.”
“I need to lose weight before we vacation.”
“Oh my gosh, you look amazing! Have you lost weight?”
“Be honest, do I look fat in this?”
“She probably shouldn’t have been wearing that dress, it was way too revealing.”
 
            The important thing to recognize about fat talk is that it isn’t necessarily malicious. In fact, looking at this list of fat talk statements, you can see that many of the more common examples are actually meant to be complimentary. However, regardless of intention, fat talk statements that equate weight and shape with value or beauty, can be very harmful to you and to the people around you.
 
            Fat talk is extremely prevalent in young women, especially around high school and college years, with around 93% of college-aged women admitting to engaging in fat talk (Salk & Engeln-Maddox, 2012). Other studies have shown the impact negative body talk can have on the people around you. In one study by Gapinski, Brownell, and LaFrance (2003), women who listened to another woman saying negative things about her own body reported higher body dissatisfaction than women who listened to the woman speak about a neutral topic. In addition to increases in body dissatisfaction, exposure to fat talk also increases the likelihood of listeners engaging in fat talk (Tucker et al., 2007). Because of this, fat talk tends to have a cascading effect (i.e., if one friend engages in fat talk around 2 friends, those friends may engage in fat talk around 2 more friends, those 4 friends may engage in fat talk around 2 more friends, and so on.)  
 
            Given the huge prevalence and negative mental health impacts of fat talk, there is a clear need for change. But because fat talk is so inundating, change can be really difficult. Some universities and organizations around the country have started challenging this societal norm by hosting a Fat Talk-Free Week. This movement was started at Trinity University in 2008, as a part of the Reflections Body Image Program, which was started by Dr. Carolyn Becker and the national sorority Delta Delta Delta. Now Fat Talk-Free Weeks are hosted at universities all across the country. In addition to challenging students not to engage in fat talk and to shut down fat talk when they hear it, many other events happen during this week that promote healthy body image, like smashing a scale or writing a letter to a younger girl about body image. Another common exercise promoted at these events is challenging women to look in a mirror and write down only positive things they like about themself, both internally and externally. Dr. Becker said in reference to this activity, “It's really hard for women to do. Women are used to standing in front of the mirror and trashing themselves.”
 
            Additionally, beyond participating in these big events, there are lots of small ways you can challenge fat talk in your everyday life. One way I commonly like to challenge fat talk is when I hear a friend say something negative about her own body, (instead of joining in with another fat talk comment about myself) I tell her to say three things she likes about her body. At first this may be brushed off with a snide laugh, but actually make them say those three things. Saying things out loud has been shown to have a reinforcing effect on ideas and beliefs. So verbalizing positive self-affirmations may help reinforce a body positive attitude. Another great way to challenge fat talk is to just speak kindly about your own body and others. The same way fat talk can have a cascading effect, positive body talk can also spread like wild fire among young women. Instead of saying things like, “Oh my gosh you look so skinny, I would kill to look like that!” practice saying compliments that are not dependent on weight or shape. Try some on this list for example:
 
Positive Compliments:
 “The color of your shirt matches your bright personality.”
“You have a great sense of style.”
“Your laugh is so contagious!”
“I love how down-to-earth you are.”
“You are so warm and fun to be around.”
“Your positive attitude brings out the best in me.”
“I love that dress! You look so confident in it!”
“That thing you don't like about yourself is what makes you so interesting.”
“I am proud to be your friend.”
“Your confidence is contagious!”
 
            At first these changes can be uncomfortable and difficult. But after implementing them in my own life, I have seen a huge boost in confidence and self-love among my close friends and family members. Thinking consciously about the way we talk about others and ourselves in front of our sisters, daughters, mothers, and friends makes a huge difference in the way they see themselves and other women. So next time you face fat talk try to be more conscious about the way you respond, and don’t be afraid to fight back with positive compliments!
 
Gapinski, K. D., Brownell, K. D., & LaFrance, M. (2003). Body objectification and “fat talk”: Effects on emotion, motivation, and cognitive performance. Sex Roles, 48(9-10), 377-388.
Rochman, B. (2010, October 13). Do I Look Fat? Don't Ask. A Campaign to Ban 'Fat Talk'. Retrieved from http://content.time.com/time/nation/article/0,8599,2025345,00.html
Salk, R. H., & Engeln-Maddox, R. (2011). “If you’re fat, then I’m humongous!” Frequency, content, and impact of fat talk among college women. Psychology of Women Quarterly, 35(1), 18-28.
Tucker, K. L., Martz, D. M., Curtin, L. A., & Bazzini, D. G. (2007). Examining “fat talk” experimentally in a female dyad: How are women influenced by another woman's body presentation style?. Body Image, 4(2), 157-164.

Virtual Reality and Eating Disorders: Why Should We Bring VR Therapy to Kentucky?
By: Lisa Michelson
 
Within recent years, virtual reality has gained popularity in the entertainment industry. This new domain, where entertainment and technology intersect, has transformed games and television, making a whole new experience for the user. Healthcare providers have also noticed, and have begun to take advantage of this whole new world of possibilities for treating their patients.
 
Here are a few examples of how health professionals, specifically mental health professionals have begun using virtual reality (VR). VR has been used to treat phobias, anxieties, and fears (Garcia-Palacios et al., 2002). In the United States, Duke University has used VR as a form of cognitive behavioral therapy (CBT) for individuals with anxiety disorders (Zielinski et al., 2006). At the University of Southern California, a VR exposure therapy has been developed in order to address PTSD symptoms for individuals returning from military service in Iraq and Afghanistan (Rizzo & Hartholt, 2005). There are VR medical centers, VR clinical trials, and therapies that continue to be developed. In the eating disorder field, virtual reality is being used to implement CBT for individuals who suffer from eating disorder (ED) behaviors and symptoms. The kinds of VR experiences can range from a full body emersion (wearing sensors all over one’s body) to wearing goggles (for the user to see the VR world they have been placed in). Below is a list of some VR scenarios that participants have been placed in for treatment in Bulimia Nervosa (BN) and Binge Eating Disorder (BED) (Regine de Carvalho et al., 2017):
 

• Kitchen with high calorie foods
• Restaurant with low-calorie foods
• Swimming pool
• Small restaurant with a buffet table
• Bedroom
• Bakery/Cafe

 
Furthermore, below is a list of some outcomes that have been observed in utilizing VR in ED treatment (Regine de Carvalho et al., 2017):
 

• Virtual food was as effective as real food in producing physiological responses in ED patients (Gorini et al., 2010)
• ED patients showed body distortion and body dissatisfaction in high-calorie food VR environments than in low calorie food VR environments (Gutierrez-Maldonado, et al., 2010)
• VR was clinically meaningful to patients (Perpina et al., 2013)

 
Although Regine de Carvalho et al. (2017) did a systematic review of VR in the assessment and treatment of BN and BED, the number of studies that utilized VR in the treatment of BN and BED is few. In researching the use of VR in treating Anorexia Nervosa (AN), the number of studies that used VR within the United States was practically non-existent; most of AN and VR research being conducted in Europe, specifically Spain and Italy (Riva et al., 1999; Perpina et al., 1999).
 
In the previously mentioned studies, utilizing VR in ED treatment has been shown to improve behaviors and symptoms in participants. In other words, what is being done in these treatments IS working. However, the use of VR as exposure therapy for eating disorder treatment is still not only infrequently used, but underutilized and underdeveloped in the United States.
 
Here, at the EAT Lab, one of my jobs has been to find collaborators and programmers to develop such technology. While it has been a steep learning curve in understanding what technology would be most user-friendly, financially reasonable, and the best for therapy, we continue to learn more about this technology every week. In our own research into VR software development, it has become apparent why this form of therapy rarely exists in the United States; the combination of technology/entertainment and mental health therapy is still an unchartered (yet exciting!) territory. Communicating the wants/needs of what we, the therapists, want in the VR technology to the software development is like talking between two languages. However, through talking with multiple resources, we have hope that we are closer to brining this technology to Louisville and being amongst the first ED research facilities here to provide this cutting edge therapy to our clients.
 
To address the question that was posed in the title of this article (Why Should We Bring VR Therapy to Kentucky?), we know it can work to improve health outcomes for our clients and we hope that future advancements will provide more insight to our exposure therapy research. 

Fighting the stigma, increasing awareness and education: Advocating for eating disorders in Kentucky
 
By Leigh C. Brosof
 
Fighting stigma, increasing awareness, and educating our communities about eating disorders are essential for early detection and treatment of these disorders; and we know that the earlier we catch an eating disorder, the more likely an individual is likely to recover. In the state of Kentucky, there is no officially recognized awareness efforts or state-sponsored educational programs about eating disorders. That is why today (February 5, 2018), myself, Dr. Levinson, and Melissa Cahill, an eating disorder advocate in Louisville, traveled to Frankfort, KY to meet with our legislators to discuss how we can get the state involved in the fight against eating disorders.
 
We had meetings with Representative Ken Fleming, who is also the executive director of the Kilgore Counseling Center, and Senator Ernie Harris about sponsoring a resolution in the Kentucky House of Representatives and Senate, respectively, to officially recognize February 26-March 4th as Eating Disorder Awareness Week in the state of Kentucky.
 
We also spoke with them about what other states have done to further the cause of supporting eating disorder awareness. In Missouri, the local government created an eating disorder coalition dedicated to awareness and providing education to health providers about treatment standards. In Pennsylvania, the legislature passed a bill requiring all middle and high schools to provide a fact sheet on eating disorder detection and what to do if you think someone has an eating disorder. These efforts show that state support really can make a difference in the fight against eating disorders, and we hope that Kentucky will follow these examples.
 
Indeed, in addition to meeting with Representative Fleming and Senator Harris about the resolution, we also asked about longer-term plans to get legislation passed in order to increase awareness and education about eating disorders in Kentucky. Both were immensely supportive in helping us understand the steps in order to get such a bill developed. We were briefly introduced to Representative Kimberly Moser and Senator Julie Raque Adams, who both serve on the Health and Welfare Committee, through which the legislation would be drafted.
 
Our ultimate goal is to see a coalition created similar to the one in Missouri: one that spreads awareness and education, provides training to health care providers in eating disorder care, and establishes treatment recommendation guidelines for best care. In the meantime, we are thrilled to see that our legislators are listening to the need for state support of eating disorders in Kentucky and to recognize Eating Disorder Awareness Week, which will be the first piece of legislation including eating disorders ever passed (hopefully) in the state. We are also excited to continue to advocate for eating disorder awareness in Kentucky.
 
Overall, it was a fun and encouraging day, and we are grateful to our legislators for taking the time out of their day to meet with us. This was my first experience with formal advocacy work with legislators, and I look forward to continuing to work toward our goals. But it’s also important to remember that advocacy takes many forms, and it doesn’t always take a trip to Frankfort to make a real difference.
 
Post on social media. Attend a walk. Put posters up around a school or work building. Bring in a speaker or attend a lecture. That’s all it takes to start advocating for eating disorder awareness in our community. Louisville has come such a long way in the short time I’ve been here, and I’m excited to see how we can advocate for a better future for every individual with a diagnosis of an eating disorder.

Read the full article here:

​http://loumag.epubxp.com/i/932456-feb-2018/46?m4=

Avoidance versus Exposure: The Importance of Facing Your Fears
 
By Caroline Christian
 
            What are you afraid of? We are all afraid of something. Fear is not only normal, it is healthy! The tinge of fear you get when a large blur crosses your periphery when you are walking in the woods is the same fear that has kept humans alive for hundreds of thousands of years. Fear helps us to recognize and escape when we are in dangerous situations. The problem with fear is that we can become afraid of things that can’t really hurt us, such as taking a test, giving a presentation, or eating certain foods. These fears may stop us from doing things we like to do or from having meaningful relationships, potentially spiraling into more stress, anxiety, and even isolation.

            The good news is that there are things we can do to reduce these fears. There are basically two options: you can avoid the thing you fear or you can face the fear head on. To see these two strategies in action, let’s look at an example. Say you are afraid of talking to new people:
            1) You can avoid putting yourself in a situation where you may have to talk to new people. This would likely mean avoiding grocery stores, job interviews, dating, holiday parties, traveling, doctors’ appointments, etc. The benefit of this is that never facing your fear can provide a brief sense of relief, and may lessen your anxiety in the short term because the fear is not imminent. However, the problem with this method is that avoidance can intensify the fear in the long term, because by never experiencing this irrational fear, you never see that it isn’t as bad as you thought it would be.
            2) Or you can actively put yourself in situations where you will have to talk to new people. This could be something like: initiating small talk with a new coworker, asking someone on a date, complimenting a stranger at the store, hosting a party, etc. The downside of exposing yourself to your fear is that it can be difficult at first and may cause some (or a lot of!) anxiety. However, the benefit is that by facing the thing you are afraid of, you get to see that you are strong enough to handle it. Over time if you continue to expose yourself to that fear, the anxiety will lessen and the fear will have less control over your life.

            Thus, when it comes to handling fear it may be easier initially just to avoid it, but avoidance in the long-term only serves to worsen the fear. Exposure has the opposite effect: while it may be difficult initially, repeated exposures can lessen the anxiety and make it more bearable. This idea is the basis of exposure therapy, which is a cognitive-behavioral approach that has been shown to be effective in treating anxiety disorders, including specific phobias, PTSD, and OCD. Exposure allows people to confront their fears in a safe and controlled environment, so that when the fears come up in the real world, they have less anxiety and are equipped with the tools to handle it.

            In contrast to the many clinicians that utilize exposure to treat anxiety and eating disorders, there are a small number of psychologists that advocate for avoidance methods in therapy. This approach has been spurred by the increased awareness of using politically correct language and avoiding triggering words in our society. Topics that are controversial, or that could be potentially painful for individuals based on their past experiences, typically are avoided in academic or professional settings. Although it may be helpful in some places in our society, this type of avoidance does not have a place in therapy or rehabilitation programs. The problem with avoidance in therapy is the same as avoidance in the real world. By never experiencing the fear, you never see that it isn’t as scary as you imagined. This will cause the anxiety to build up, and then if something happens to trigger these emotions outside of therapy, the anxiety will be even worse. That is why exposure is so important in therapy- talking about things that are scary and anxiety provoking in a safe environment allows for less anxiety when faced in the real world.

            Additionally, there are things you can do outside of therapy to implement these strategies to better your own life. Beyond therapy, exposure also can be used to tackle everyday anxieties, like testing anxiety or public speaking. Taking sample tests, practicing with friends and coworkers, and visualization exercises are all exposure-based techniques that can help reduce tension and anxiety, so it doesn’t build up on the big day.  
​
            So in conclusion, when it comes to battling your fears (whether they are big or small) choose exposure! Although it is difficult at first, in the long term it will give you more control over your fears. In the EAT lab, we are exploring the use of exposure therapy for eating disorders by exposing people to fears such as gaining weight, losing control, making mistakes, or eating certain foods. If you struggle with an eating disorder and you are interested in participating in these studies, click here!
 
Additional reading:
 
This article discusses ways in which we use avoidance in every day life, and may not even realize it!
 
Check out this article on how to implement exposure strategies into your everyday routine.