Tuesday, February 10, 2015

WELCOME TO RAMEY NUTRITION BY SCARLETT RAMEY, MS, RD, CD

The passion that comes from working with geniuses, which most of my patients are, is immeasurable.
Witnessing the healing process they own is the primary reason I opened this clinic. My patients achieve results due to choices we make together. They are on their own time line for long and short-term goals, and I always go at their pace, not mine. Food issues I am faced with usually have a story behind them, and working through that story leads my patients to eating disorder recovery, weight management goals, diabetes management, and medical nutrition solutions. Trust is the “how” of what I do. Changing food in someone’s life can be highly detrimental, if not traumatic. Building trust is the key to allowing my patients to shift in ways that are dynamic to their goals.

One of my strengths that lead to my patients succeeding on their own is my own realization and belief that we live in the REAL WORLD. This means goals must be set that are not far off from what people normally do. When given medical goals, that seem un-doable, it can feel futile, frustrating and hopeless, but if I can align those goals with their lifestyle, I consider it a success. Often times, just
listening to my patients is the best path to success. They know more than I ever will about what the real issues are and can heal them quickly if I don’t interrupt.
If you and/or someone you love needs assistance with recovery from an eating disorder, diabetes management, weight management, or medical nutrition diagnoses, I would love to talk with you about how we can attain your goals.

‘Why don’t you just eat?’ Eating disorder patients are caught between stigma and government indifference

Jennifer Sygo | February 5, 2015 | Last Updated: Feb 5 11:42 AM ET
More from Jennifer Sygo

While coverage of eating disorders has increasing in mass media, putting the spotlight on unhealthy images of women, especially, getting care for an eating disorder in Canada can still be difficult, and in some provinces, impossible.

Alberto PizzoliAFP/Getty Images filesWhile coverage of eating disorders has increasing in mass media, putting the spotlight on unhealthy images of women, especially, getting care for an eating disorder in Canada can still be difficult, and in some provinces, impossible.

We’ve all talked a lot about mental health in the last week or so, but when it comes down to the hard health risks, which disorder currently has the highest mortality rate?

‘Anorexia is a lifestyle, not a disease': An investigation into harrowing online forums promoting extreme dieting

“I got diagnosed with my eating disorder at the age of nine. I remember playing tag in the schoolyard with my friends and running around because I wanted to lose weight. I remember throwing out food. When celebrating my birthday, I never wanted a cake; I wanted healthy snacks and told everybody I didn’t like sweets.

“The disgust I felt towards my body developed during a period of abuse. I was sexually abused by a family member from the age of five. It lasted until I was 12 and it has made me hate my body. Starving myself is a way to make it disappear, to vanish, to clean, purify and punish myself.”

This is Jade’s story. Jade is 24 and lives in the North East of England. She studied social work at university, but is now unemployed, “because of the obvious.” Instead, Jade runs a website that has thousands of followers around the world. At the top of the home page is a red banner that reads: “Anorexia is a lifestyle, not a disease.”

Friday, February 6, 2015

We're Moving!

Please visit our new blog at http://rameynutrition.com/blog/ for recent posts!

Saturday, November 15, 2014

Myla Dalbesio on Her New Calvin Klein Campaign and the Rise of the 'In-Between' Model

By Leah Chernikoff

Photo: Calvin Klein

Myla Dalbesio explodes with laughter on the other end of the phone. “It’s crazy!” she exclaims. “I can’t even.”

The 27-year-old model is talking about booking her latest gig, modeling Calvin Klein underwear in the brand’s latest "Perfectly Fit" campaign, which was shot by Lachlan Bailey. “It was such a surreal moment. I cried,” she admitted.

Booking an underwear campaign for such an iconic brand would be a coup for any model. But it’s especially notable for Dalbesio, who, at a size 10, is what the fashion industry would—still, surprisingly—call “plus size.” (“In fact, not so long ago plus size models were around size 10-12, but that number has recently shrunk to an 8,” said Cosmopolitan earlier this year, while PLUS Model concurs that models “between size 6 and size 14” are typically considered plus size.)

“It’s kind of confusing because I’m a bigger girl,” Dalbesio says. “I’m not the biggest girl on the market but I’m definitely bigger than all the girls [Calvin Klein] has ever worked with, so that is really intimidating.” (We have reached out to Calvin Klein to confirm.) She wasn’t sure, she said of the shoot, what was expected from her “in terms of her size or shape.” Refreshingly, what was expected of her was the same thing that was expected of the other models featured in the campaign (Lara Stone, Jourdan Dunn, Ji Hye Park): to take a beautiful picture. “No one even batted an eye,” she says. “It was very cool.”

Myla in an editorial shoot (Photo: Courtesy JAG Models)

So what does it mean for a brand like Calvin Klein—known for launching the careers of such svelte models as Brooke Shields and Kate Moss—to cast a model who deviates from the size 0 standard and not make a fuss about it?

To Dalbesio, who spent years abusing Adderall, crash dieting, and flirting with bulimia in an attempt to whittle herself to “straight size,” it represents progress. “It’s not like [Calvin Klein] released this campaign and were like ‘Whoa, look, there’s this plus size girl in our campaign.’ They released me in this campaign with everyone else; there’s no distinction. It’s not a separate section for plus size girls,” she says.

There was a time in the industry, not too long ago, when it seemed that the high fashion world was using plus size models as a headline-grabbing gimmick (see: the groundbreaking Italian Vogue cover featuring Tara Lynn, Candice Huffine, and Robyn Lawley in June 2011; Crystal Renn in a 2010 Chanel campaign.)

“I feel like for a minute, it was starting to feel like this ‘plus size’ thing really was a trend, and that it was over,” Dalbesio says. “There was that beautiful Italian Vogue story, and the girls that were in that ended up doing really well [in their modeling careers]. But when that happened, we felt really excited; we thought it was going to open so many doors for all of us, you know? And it felt like it hadn’t. It was dying out.”

Now, Dalbesio is a bit more hopeful about size in the modeling industry. “I’m in the middle,” she says. “I’m not skinny enough to be with the skinny girls and I’m not large enough to be with the large girls and I haven’t been able to find my place. This [campaign] was such a great feeling.” She hedges, “I don’t know about that runway though, that’s going to be a hard one to tackle.”

***

Most Common Mental Illnesses On College Campuses

By Walbert Castillo

Open up your eyes and ears. Mental illnesses are real and they are prevalent within our society, especially for college students.

On a national level, 42.5 million (18.2 percent) American adults suffer from some form of mental illness each year, according to News Week. Out of the 18.2 percent of American adults suffering, USA Today stated 27 percent of college kids experience some type of mental health problem, which includes Depression, Anxiety, Eating Disorders, Substance Abuse, Insomnia and Attention Deficit Hyperactive Disorder (ADHD).

Many of these mental disorders are an impediment for academic success, which could eventually lead to a lower GPA and/or dropping out of school. One thing students should keep in mind is that their university offers health services, which are geared to lift their ailment.

However, 50 percent of students who have a mental illness do not access these mental health services offered at their university and 45 percent drop out of college in not doing so. Sometimes, these mental illnesses occur because students find difficulty in adjusting to these new environments, are stressed from schoolwork, are homesick and/or lonely.

What can I do if I have a mental illness and I am having a difficult time in school?

Check out your school’s mental health services
Talk to your professors and tell them what you are going through; they can possibly accommodate you by lowering your course load
Join support groups: sometimes talking about your problems with others can relieve you of your pain
Talk to your family and friends who will support you.
According to Everyday Health, there are approximately 1,100 suicides on college campuses nationwide each year. The majority of these deaths are caused by untreated depression. Depression has increased approximately 10 percent over the course of the past 10 years. Depression is an intense feeling of sadness that overtakes a person.
Depression usually lasts for an extended period of time from many days to weeks and may hinder your ability to function normally. Depression is the second leading cause of death for college students across the nation.
The National Alliance on Mental Illness conducted a survey and discovered women are two times more likely than men to experience a form of depression.
Image via: http://www.sparqvault.com
Anxiety
Social anxiety disorder, phobias and panic disorders fall under the category of anxiety disorder. These disorders can highly hinder a person’s habitual routines and make them stressed and/or scared about future events. Stress amps up the anxiety to a level where people will not be able to function properly. Anxiety disorders are common on a college campus.
National Alliance on Mental Illness stated that 50 percent of college students who have felt anxiety said that it was difficult to succeed academically. In addition, 75 percent of people who have anxiety disorder are those 22 and younger.
When you have a friend suffering from anxiety disorder, listen to their thoughts and encourage them to seek professional help. Best Colleges states several symptoms of anxiety disorder: feelings of apprehension, fearfulness, irregular heartbeat and muscle pain.
Eating Disorders
Eating disorders include anorexia, bulimia and binge eating disorders. If you are starting to develop abnormal eating patterns, or any mental illness, seek professional help.
People who have eating disorders will find themselves obsessed with their body weight and the intake of food.
“People with anorexia nervosa and bulimia nervosa tend to be perfectionists who suffer from low-self esteem and are extremely critical of themselves and their body,” American Psychiatric Association stated.
In a study done by Best Colleges, 62 percentof college women have abnormal eating patterns.
Image via: http://img.emedtvdt.com
Substance Abuse Addiction
Partying in college has become the social norm for any type of student. Along with these parties comes alcohol and drug use that may end up being taken in large amounts.
stated that:
- About 80 percent of college students drink
- 1,825 students, ages 18 to 24, die each year from alcohol-related injuries
- About 25 percent of college students report academic consequences of their drinking
- More than 150,000 students develop an alcohol-related health problem.
- Image via: http://cdn.healthworks.m
  If I have a mental illness going into college, how can I prepare myself?
  It’s always best to talk with your parents about your mental illness. This way you can figure out the right approach to take for college. Do you need to seek medical services first before you can go to college? Parents are the best supporters you will have so be open with them. Once you seek help from these medical services, your therapist can assist with your long-term scheduling.
  The best universities to select are the ones that provide students the best types of medicinal programs in response to mental illnesses. Other students might be facing similar struggles when dealing with their mental illness, so find a school that can provide the best treatment for you. These services can easily be found through your school’s website.
  According to US News, “some schools, like Cornell University, reach out to students during the summer to request their medical history and tell them about campus services.”
  After your first year of college, figure out a schedule for your upcoming college years. It’s best to time manage wisely and prepare early for the next transition of your life.

Monday, November 10, 2014

Navigating Weight Loss After an Eating Disorder

When people with histories of disordered eating want to slim down, their approach sometimes needs to be more sensitive.

Stepping on a scale can feel like stepping into dangerous territory for people recovering from an eating disorder.

By Anna Medaris Miller Caroline Adams Miller, 53, hasn’t stepped on a scale in 30 years. Technically, she has – during her visits to the OB-GYN for her three pregnancies – but she never looked at the number.

“I would go in and I would say, ‘You’re not going to weigh me unless I stand on the scale backwards, plug my ears and you do not tell me what my weight is,’” says Miller, a positive psychology coach in Bethesda, Maryland, and author of “My Name is Caroline,” the first major autobiography by a bulimia survivor. Her latest book, “Positively Caroline: How I Beat Bulimia For Good and Found Real Happiness,” describes her long-term recovery.

Weight gain from pregnancy, medications or just life happens to most of us. But when it happens to people who have had eating disorders, weight loss often has to be approached with more care.

“You have to accommodate your vulnerabilities in life and when you have this one, restricting food and so on and so forth poses certain risks,” says Marsha Marcus, a professor of psychiatry and psychology at the University of Pittsburgh School of Medicine. “It doesn’t mean you can’t do it, and certainly for some people, maybe they should, but there’s no one answer.”

Redefining Success

According to the National Eating Disorders Association, eating disorders affect about 20 million women and 10 million men in the United States. Many more have likely experienced disordered eating patterns. That means plenty of people who have struggled with the conditions are among us at the gym, the grocery store – and the doctor’s office, where their histories may go undisclosed.

“They might go to see their primary care physician and [he or she] says, 'Hey, you really need to lose some weight,’ but the physician may not even have a clue that the patient has a history of an eating disorder,” says Cynthia Bulik, director of the University of North Carolina’s Center of Excellence for Eating Disorders.

That’s important because, while people with eating disorders can and do recover, certain things like the number on a scale can remain vulnerabilities, experts say. Cutting calories and amping up exercise – touted as the hallmark of healthy weight loss – in and of themselves can be risky for people who’ve had eating disorders, since being in a state of “negative energy balance,” or expending more energy than you're consuming, might trigger those unhealthy patterns again, Bulik says.

“For most of us, that's a really uncomfortable physical experience: When we’re hungry, we get irritable, we get headaches and it’s not a good feeling,” she says. “For people with anorexia nervosa, it’s probably their favorite physical state – it feels good to them. They feel worse when they’re full.” Bulik says this trait is likely due to a biological mechanism that made them more vulnerable to an eating disorder in the first place.

For Miller, such potential vulnerabilities are part of the reason why she doesn’t step on the scale, doesn’t drink alcohol and swims competitively for the love of the sport, not its body-shaping effects. “I had to go back and redefine what I want my body to do, not what I want it to look like,” she says.

Do Ask, Do Tell

One of the most important ways for people with histories of eating disorders to stay healthy while losing weight is to discuss their backgrounds with their doctors and even their personal trainers or fitness instructors, experts say.

Bulik, for one, would like to see “eating disorders” as a checkable box under medical history at doctor’s appointments, right alongside history of heart disease or glaucoma. That way, clinicians might rethink how they’re prescribing weight loss or choose to focus on aspects of a patient’s health other than weight.

“Whatever approach is taken with these folks has to be an anti-dieting approach,” Bulik says. For example, the goal might be to lower cholesterol or to increase physical activity. Striving to hit a certain number on the scale, on the other hand, is “the danger zone” for people who have or have had eating disorders, Bulik says.

The conversation about eating disorder history should also happen at the gym, says Jodi Rubin, a social worker and eating disorder specialist in New York who founded “Destructively Fit,” a program that trains fitness professionals to recognize eating disorder symptoms in their clients and then address those issues appropriately and sensitively.

“What I’ve found is that nobody talks about eating disorders – they talk about food, they sort of dance around it, so what I encourage people to do is ask, ‘Have you ever had an eating disorder or do you now, and how is exercise connected to that?’” Rubin says.

If a client does reveal a history of disordered eating, his or her personal trainer might consider focusing on measurements such as how much weight the client can lift or how quickly he or she gets winded after climbing the stairs, since stepping on the scale at each session could be “devastating," Rubin says.

People with histories of eating disorders might also benefit from exercising away from the mirror and learning how the proper techniques feel, rather than how they look. Exercises like yoga that open up the body and facilitate connection with it, too, can be good choices for people with histories of eating disorders, Rubin says. Of course, all these approaches can be motivating for people who have never had an eating disorder, too.

At the end of the day, experts say, there is no one-size-fits-all approach to how people who have had eating disorders approach weight loss later in life. In fact, Miller says, if they received appropriate treatment from a mental health professional and recovered by learning to address the condition’s underlying factors, their approach to weight loss later on might not be all that different from the rest of ours.

“How do people not relapse after having a baby? How do people lose weight and not trigger an eating disorder?” Miller asks. “If you’ve gone through recovery in a strong way, those don’t become challenges.”

Saturday, November 8, 2014

Living with binge eating disorder

Living with Binge Eating Disorder If you have binge eating disorder, please know that you’re alone. Binge eating disorder (BED) is actually the most common eating disorder. It affects about 3.5 percent of women and 2 percent of men.

You’re also not weak, wrong or crazy. BED “is not a reflection of who you are as a person,” said Karin Lawson, PsyD, a psychologist and clinical director of Embrace, the binge eating recovery program at Oliver-Pyatt Centers.

Binge eating may serve many functions, according to Amy Pershing, LMSW, ACSW, the executive director of Pershing Turner Centers, an eating disorder recovery outpatient clinic in Ann Arbor, Mich., and Annapolis, Md.

It might soothe stress and help you escape, especially when you’ve experienced trauma or significant shame, she said. “You have survived, perhaps in part because your relationship with food was a powerful coping strategy. There are better strategies now; you can learn them, and you can heal.”

Some people can get better by using self-help strategies, but BED most often requires treatment. People with BED typically suffer for many years, have co-occurring physical and mental health issues and severe body image issues, which perpetuate weight cycling and exacerbate the disorder, said Chevese Turner, founder and president of the Binge Eating Disorder Association and co-founder and managing director of Pershing Turner Centers.

But the good news is that BED is highly treatable, and you can recover, said Judith Matz, LCSW, co-author of Beyond a Shadow of a Diet: The Comprehensive Guide to Treating Binge Eating Disorder, Compulsive Eating and Emotional Overeating.

Below, you’ll learn more about what BED is (and isn’t) along with treatments that work (and don’t work) and helpful coping strategies.

What is Binge Eating Disorder?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines BED in this way:

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
The binge-eating episodes are associated with three (or more) of the following:
eating much more rapidly than normal
eating until feeling uncomfortably full
eating large amounts of food when not feeling physically hungry
eating alone because of feeling embarrassed by how much one is eating
feeling disgusted with oneself, depressed, or very guilty afterwards
Marked distress regarding binge eating is present.
The binge eating occurs, on average, at least once a week for three months.
The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

Pershing stressed the importance of paying attention to the client’s experience with food, not just to the criteria. “[I]t is critical to remember that the most important issues are a lack of control over the eating behavior and distress/shameover the behavior.”

She noted that some clients may “graze” throughout the day, and eat significantly more than needed, but in a longer period of time than the DSM defines.

Lawson also defines BED more broadly. In addition to the lack of control and feelings of shame, she’s seen that most clients have a “preoccupation with food and/or body image [and] eating compulsively while feeling numb or checked-out.”

BED has a complex etiology. Family dysfunction, genetics, attachment ruptures, mood disorders, trauma (“rates are significantly higher with BED, especially complex trauma”) and environment (such as experiences with weight stigma) may all play a role, Pershing said.

It’s also serious. According to Turner, “Within the BED community, it is not unusual to hear of individuals who have experienced serious organ failure, suicidal ideation or completion, disability due to crippling co-morbid psychiatric conditions, and metabolic issues related to weight cycling and nutritional deprivation.”

Myths About BED

There are many myths about BED and its treatment. Here’s a selection:

Myth: If people had more willpower, they’d stop bingeing. BED has nothing to do with willpower. Again, it’s a serious disorder. This egregious myth only “contributes to the eating disorder voice that maintains and exacerbates the condition,” Turner said. “For people with BED, eating feels out of control … is disconnected from physical hunger, and is often connected to other issues such as anxiety or depression,” said Matz, LCSW, who treats BED in Skokie, Ill.
Myth: People with BED are “overweight.” Actually, they “come in all sizes,” Matz said. About 30 percent of people with the disorder are considered “normal” weight and one percent are underweight, according to body mass index, Turner said. (“There are people at higher weights who do not struggle with BED or other overeating problems,” Matz said.)
Myth: “BED is treated by a ‘sensible eating plan’ (i.e., a diet),” Pershing said. Diets are actually contraindicated for BED and may trigger it, she said. “[T]hey can lead to weight cycling (losing and then regaining weight), which is actually hard on the body and can lead to health issues,” Lawson said. Treatment requires that people with BED work through the psychological, physical and situational factors that trigger binge episodes, Pershing said. “Another diet will not change anything; all it will do it lighten your wallet and leave you with a 95 percent likelihood of regaining the weight in 3 years.”
Myth: BED doesn’t require the same level of intervention as anorexia or bulimia. Typically, it requires the same treatment as any other eating disorder, Pershing said. This may include: “individual therapy, nutrition professional, groups, expressive therapies [and] medication management.”

What Doesn’t Work in Treating BED

“People with BED may turn to weight management programs,” Matz said. In fact, about 30 percent of people who seek these interventions have BED. But food restrictions actually promote binge eating, she said.

Unfortunately, many professionals think weight loss is essential for recovery for individuals at higher weights. “This is a dangerous concept because the very behaviors that are prescribed for weight loss in those with BED are ‘diagnosed’ in eating disorders that do not involve higher weights,” Turner said.

“For example, individuals with BED are encouraged to count calories, limit food groups (sugar and fat particularly), and restrict food intake with no regard for hunger or satiety.”

The weight-loss approach only fuels feelings of failure and shame, perpetuating the cycle of “self-loathing, defeat, and further eating disorder behaviors,” said Turner, who described below what this feels like:

Having BED means living in a constant state of anxiety and yearning for something that is seemingly forever elusive. Imagine having a stomachache that never goes away. You get up daily and hope that today will be the day that your stomach feels normal again.
You are determined that you are going to find the cause, but each time you go to the doctor, she tells you that it is your fault you have this pain and that you just need to follow the very specific but easy directions she will provide to you. You go home and are determined to implement the doctor’s recommendations perfectly.
After some time, you realize that you are following the doctor’s orders to a “T,” but nothing has changed. Your stomach continues to hurt and you find you are more distressed than ever because you know that everyone around you is assuming that you are not following the recommendations. You are confident that you are the only one who is suffering like this and there is a major defect in your character that is propelling the stomach problems and your ability to control them.
You decide that you are going to isolate and keep everyone away because you do not deserve friends or love. You and your stomach pain are together forever — it’s all you have.

What Does Work for Treating BED

There are different treatment modalities, including cognitive-behavioral therapy, dialectical behavior therapy, internal family systems and trauma therapy, which have shown benefit for BED, Pershing said. The key is that the “client feels validated, taken seriously and respected.”

It’s important for treatment to target the emotional and behavioral aspects of BED, Matz said.

Clients learn the underlying emotional reasons they turn to food along with coping strategies to use when they’re emotionally distressed. They also learn to relinquish dieting and restrictive behaviors around food, which only perpetuate binge eating, she said.

It’s also important to have a multidisciplinary team, which ideally includes “a therapist, nutritionist, non-shaming physician, and a psychiatrist (particularly if there are co-morbid struggles, such as depression, anxiety, attention deficit hyperactivity disorder, obsessive compulsive disorder or substance abuse),” Lawson said.

She recommended seeing a registered dietitian who is well-versed in intuitive eating, which focuses on reconnecting to your body and your natural sense of hunger and fullness. This is in stark contrast, she said, to society’s belief that people with BED “can’t trust themselves, need to diet and rely on external numbers and messages.”

When you learn to trust your body, this trust spills over into other parts of your life. You become more confident in using your voice with others, setting boundaries and pursuing meaningful goals, Lawson said. “It all takes practice and none of it is easy, but food is the metaphor, not the problem, per se.”

People with BED commonly have physical issues, such as polycystic ovary syndrome (PCOS), hypothyroidism, low vitamin D, sleep apnea and inflammation, Lawson said. This is why having a physician on your team is helpful.

If you or someone you love struggles with binge eating disorder please call Ramey Nutrition at 206-909-8022, or visit us at www.RameyNutrition.com. You're not alone!