It is important to recognize that overcoming any eating disorder is extremely difficult and can take months or years of treatment, depending on the disorder’s severity. Knowing about nutrition and health is not enough. One has to learn to respond to life differently. The following tips can help you be supportive.

1. Reinforce your love by being willing to listen to your loved one’s struggle and give hugs when needed.

2. Do not assume weight loss will solve the problem, even if the person says it will.

3. Do not try to control the person’s eating, even if you are asked to do so.

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4. Ask your loved one what you can do to be most supportive, but do not accept the role of policeman over his/her food intake.

5. Let the person know you love him/her for reasons other than body size or looks.

6. Do not try to “fix” the problem by offering to go on a diet with your loved one.

7. Accept the struggle, even if you do not understand it.

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8. Educate yourself about the disorder. There are many books available in bookstores or the library (see Suggested Reading List below).

9. Attend support group meetings or therapy sessions if asked to do so.

10. Model healthy eating and exercise habits. Do this as a genuine concern for your own well-being, not as a way to try and get your loved one to change.

11. Practice size acceptance of yourself, your loved one, and others. Focus on characteristics other than size or looks that you admire in yourself and others.

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12. Be willing to support the recovery process. This requires allocating family funds to treatment and helping out with child rearing and other household activities when needed.

13. Recognize that it is not your job to fix your loved one. It is your job to be supportive. Tell the person about your concerns in a loving way, and offer information on resources available in the community. Then leave the rest up to her/him.

Seasonal Affective Disorder (SAD) or Winter Depression is a condition caused by a deficiency of light during winter months. SAD was identified in 1979 by A1 Lewy, M.D. at OHSU who pioneered the research that is the basis of treatment protocols today. Dietitians may see clients who experience SAD, but do not know it, nor that their bingeing or weight gain is a result. SAD starts at an early age and is sometimes confused with school phobia. It affects females more than males with approximately 5% of the population having severe symptoms, and another 15% a subsyndromal version.

Some possible symptoms of SAD are:

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1. Increased appetite

2. Binge eating of high carbohydrate foods

3. Weight gain

4. Increased sleep or need for sleep and difficulty waking

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5. Immobilized and/or suicidal ideation

6. Decreased energy

7. Decreased creativity

People with SAD in the Pacific Northwest begin to have difficulty in late October/early November. It is at its worst in January, and is completely improved by May or June. We can determine if a client has SAD by asking if they have noticed that their eating is increased during those months. If they have not, you can ask if they have noticed that if only during the winter months they have difficulty waking up at their usual time, or if they feel depressed or blue. If the answer is yes, and they don’t experience depression at any other time of the year, suspect SAD.

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SAD occurs when days are shorter because longer periods of outdoor light are not available to decrease melatonin, a hormone that causes sleepiness. Daylight (even on cloudy days) passes through the retina and signals the pineal gland to stop producing melatonin. When dawn is later, melatonin levels remain too high for wakefulness and a mood disorder resembling ordinary depression results.

SAD can be treated successfully by using special cool, bright lights of no less than 10,000 lux or light units. Avoid full spectrum as it contains ultra-violet. Most people with SAD have difficulty walking, and respond to light therapy as soon as they get up, ideally between 6 a.m.-8 a.m. They should spend 30 minutes in front of the light machine, perhaps as they eat breakfast or read the paper. They should avoid staring into the light, but rather scan across it a few times a minute for a few seconds. The closer one is to the light, the brighter, so that clients should follow the manufacturer’s directions.

What is disordered eating, and how can it be prevented? Normal, healthy eating behavior may be defined as when a person eats when she or he is hungry, and stops eating when full. That is, the person is aware of and responds appropriately to hunger and satiety cues. Of course, all of us can recall a time when we have eaten past our natural fullness point, or have skipped a meal even when hungry. This does not mean everyone has disordered eating, although variations of this problem are extremely common. It is only when an individual consistently ignores feelings of hunger or fullness and this pattern of behavior becomes usual for them that the person may be said to have disordered eating. “Disordered eating” covers a broad spectrum of eating behavior including eating disorders, while the term “eating disorder” is defined quite specifically by diagnostic criteria.

Some possible causes of disordered eating include negative body image, low self-esteem, peer pressure, and lack of information about how eating and dieting can affect health. In order to prevent these problems, we must look at what is believed to cause them. Both of the topics mentioned above note that eating disorders fill a need for the individual. For example, eating is a self-soothing activity. It is quite possible that a “cause” of overeating might be that the child has not learned any other way to soothe himself or calm down when he is upset. Similarly, a teen girl might find her need for attention met when she loses weight after being on a diet. Like all dysfunctions, the principle of “over determination” applies. There are many causes and predisposing factors, which in combination can influence a person to adopt a disordered eating pattern. Some would say that just being a member (especially female) of western society, is a predisposing factor. Foreyt and Goodrick in their book “Living without Dieting” point out that western culture is a “lookist” culture, overemphasizing appearance and underemphasizing human qualities. Lookism, like racism or sexism, defines people by external characteristics that have nothing to do with a person’s real abilities. Most young people are strongly influenced by media images which associate unrealistic thinness with beauty, sexiness, money, power and happiness. Lookism is not talked about, but is a very real social force.

Recent research shows that body dissatisfaction is the single strongest predictor of eating disorder symptcmolgy (Phelps, Johnston and Augustyniak, 1999)*. Helping teen girls (and boys) recognize the positive attributes of their physical appearance may be the most effective prevention strategy we have. This approach increases feelings of self- efficacy, helping them feel “OK”. It also helps reduce the internalization of the unnatural “ideal” body standard, and lets them realize that each person expresses their own inner beauty differently. It is important to understand that young people are bombarded with hundreds of messages about attractiveness every day. All influential adults play a role in letting kids know what is “right” with their looks. Adults who are not comfortable with their own appearance may be most hard pressed to send positive messages to teens.

Girls and women are more at risk than boys and men, probably due to unreasonable expectations for female body shape and distorted expressions of female beauty portrayed in the media. Debra Waterhouse’s excellent book “Like Mother like Daughter” traces the legacy of dieting and disordered eating through the generations, while offering strategies to break this destructive cycle.

Boys and men are not exempt from the pressures to modify their bodies. Unfortunately, exploitation of men based on appearance is on the increase, and this is likely to result in greater numbers of males with disordered eating. Magazines covers of men with abdominal muscle definition few can ever achieve are found in every checkout stand, next to the women’s magazines featuring impossibly thin but full busted female models. Young people view these pictures as the standard of attractiveness and tiy hard to measure up.

Sports can have a mixed effect on body image as well. Studies show that girls who participate in sports have higher scores for self esteem and are less likely to be victimized by others. However, it is well known that certain sports which emphasize thinness, like gymnastics, dance and figure skating, put girls at higher risk. For boys, wrestling can contribute to dysfunctional eating behaviors and purging in order to attain/maintain an unnatural weight. Parents and coaches need to give healthy, non-diet messages to teen athletes. Coaches especially have a strong influence on whether an athlete learns to be their best with the body shape and size they have, or ends up wasting precious mental and physical energy on artificial weight goals. Dieting has a negative impact on sports performance. Good sports nutrition, on the other hand, can enhance performance on and off the playing field.