Dear Doctor, commenting on my weight is damaging…

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…please don’t make comments about my weight without me expressing concern about it or not knowing anything about my lifestyle or behaviour. It is not helpful and in fact is damaging.

This is meant to be more of a plea on behalf of my clients rather than a critique as I know many great doctors. I know most doctors also have great intentions. However, I have clients and people I know continually telling me stories of negative experiences in the doctor’s office (and with other health professionals) that have affected them deeply. Most of them caused by a few words: you need to lose weight, you should try this diet, etc. without any other conversation on what is going on in the patient’s life.

Let me give you a few examples directly from my clients on how this is damaging:

  1. “I have had doctors congratulate me on weight loss (in a way reinforcing my eating disorder, because often my weight loss is a result of unhealthy behaviours)”
  2. “I went in for a full physical exam and without any conversation on what I was doing for exercise or any other lifestyle behaviours, the doctor weighed me and said “ooh you used to be ___Kg…we need to keep an eye on your weight”. Little did the doctor know that I was feeling really good about my health because for the first time in a while I was in a regular exercise routine and had gained muscle mass and strength with guidance of a trainer.  (To make matters worse ~10 years ago, the same situation had occurred where I gained weight with building muscle and I ended up quitting solely because of the weight gain despite the health benefits)”
  3. “I’ve had doctors make diet suggestions (i.e. keto) for weight loss when in reality I was suffering from anorexia and was already severely restricting my intake. This was obviously triggering.”
  4. “I had a doctor directly tell me that I was overweight with recommendations to “eat less, exercise more” without first asking me what I was doing.”
  5. “When I’ve shared that I have an eating disorder, I’ve had several doctors assume that I binge eat or overeat based on my weight and they’ve provided weight loss suggestions without first assessing what my eating disorder behaviours are.”
  6. “I went to see my doctor for cold/flu symptoms and she started lecturing me about how I should work on losing weight. I felt embarrassed and it has made me reluctant to see any doctor for any issue in the future.”
  7. “I’ve had doctors minimize my eating disorder because I am not underweight.”
  8. “I have had comments about my BMI (body mass index), like “are you aware that you’re in the overweight range?” Thanks for pointing that out when I already hate my body. Not helpful.”

What to do?

Ideally ending weight bias/stigma and a shift in focus to promoting health behaviours vs the number on the scale are important for doctors and any health professional. However, just as essential is the need for a patient-centered approach in terms of really listening and understanding what is going on in the patient’s life (and yes that includes addressing weight concerns if that is the patient’s concern) and then individualizing care plans.

No matter what our job title, area we specialize in or our personal beliefs (General Practitioner, Dietitian, eating disorder expert, weight-inclusive, weight neutral, Health at Every Size® practitioner, obesity specialist, certified bariatric educator, weight management practitioner, etc.), we need to address and listen to our patient or client’s experiences and concerns, not our own agenda. Otherwise we are missing the point of patient-centered care. Also, in order for patient-centered care to be evidence-based practice we must integrate the best available research evidence, clinical judgement and expertise, and client preferences and values.  We cannot let our pronounced views, title, network, paradigm or guidelines prevent us from openly listening to the people we are supposed to be supporting.

In the end, imposing conversations on weight can be just as damaging as avoiding conversations on weight. Both can make people feel unheard and unsupported. Lets do a better job at listening to the concerns of our patients.

If you or someone you know has been impacted by a health professional commenting on your weight please comment below. 

Baba’s Borscht

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Baba’s Borscht

  • Servings: “~10-12”
  • Difficulty: easy
  • Print

I grew up in a Ukrainian family so eating borscht was a common dish especially with Christmas Eve dinner. Now I enjoy making borscht for my own family and love that it freezes well for an easy vegetable addition to meals!

Ingredients

  • 6 unpeeled beets (with tops/greens removed)
  • 1 Tbsp olive or avocado oil
  • 2 cups onions, diced
  • 1 cup carrots, diced
  • 1 cup celery, diced
  • 4 cloves garlic, minced
  • 1 cup green beans, cut into bite size pieces
  • 1 can 28oz/796ml diced tomatoes
  • 2 cups peeled potatoes, cubed
  • ½ tsp ground black pepper
  • 2 Tbsp Worcestershire sauce
  • 1 Tbsp white vinegar
  • Optional: 2 tsp fresh dill, chopped
  • Possible Toppings: hot sauce and/or sour cream

Directions

  1. Place beets in a large covered soup pot of boiling water for ~30min or until you can pierce them with a fork. Run cold water over the beets to easily rub off the skins. Then cut into small bite size cubes. Set aside.
  2. Heat oil in soup pot and sauté the onions, carrots, celery until softened ~5min. Add the minced garlic for the last minute.
  3. Add the beat cubes back to the pot along with all the rest of the ingredients. Stir and cover.
  4. Cook over medium heat for about 1 hour until vegetables are tender. Enjoy!

 

Chili Garlic Pineapple Chicken Skewers

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Chili Garlic Pineapple Chicken Skewers

Ingredients

  • 5-6 chicken breasts cut into 1” cubes
  • ¾ cup pineapple juice
  • 3 Tbsp soya sauce
  • 2 Tbsp honey
  • 2 tsp chili garlic sauce (I use Lee Kum Kee brand found in the Asian food aisle)
  • 1 clove garlic minced (optional)
  • 1 tsp sesame oil
  • 1 Fresh pineapple cut into 1” chunks
  • Green onion (optional) as garnish

Directions

  1. Make marinade by combining pineapple juice, soya sauce, honey, chili garlic sauce, garlic, and sesame oil. Pour over chicken in a small dish or Ziploc bag, Stir until chicken is submerged. Leave in fridge for a minimum 1 hour but can be left overnight.
  2. Alternate threading chicken and pineapple onto skewers. (I find metal skewers work great but if using wooden skewers make sure you have soaked them in water first)
  3. BBQ skewers on tinfoil for ~10min or until chicken is no longer pink. Turn them as grilling (the pineapple will create a nice brown glaze). Enjoy!

 

Homemade Taco Seasoning

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Homemade Taco Seasoning

  • Servings: single meal or batch
  • Difficulty: easy
  • Print

Great flavor without all the salt!

Ingredients

Single Batch:
(makes approximately 2 tbsp spice mix for 1 pound ground meat)

1 Tbsp chili powder
1/4 tsp garlic powder
1/4 tsp onion powder
1/4 tsp dried oregano
1/2 tsp paprika
1 tsp ground cumin
1/2 tsp salt
1 tsp black pepper
1/2 tsp cornstarch
1/8 tsp or more cayenne pepper (optional if you like it spicy!)

Make Ahead Big Batch:
(makes 8 batches of spice mix; use 2 tbsp spice mix per 1 pound ground meat or poultry)

8 Tbsp chili powder
2 tsp garlic powder
2 tsp onion powder
2 tsp dried oregano
4 tsp paprika
8 tsp ground cumin
4 tsp salt
8 tsp black pepper
4 tsp cornstarch
1 tsp or more cayenne pepper (optional if you like it spicy!)

Directions

  1. Combine all the spices in a bowl (store extra in an air-tight container or jar).
  2. Brown ground meat in a saucepan. Add 2 tbsp taco seasoning per 1 pound of ground meat or poultry along with 1 cup water and simmer until most of the water has evaporated.
  3. Serve ground seasoned meat in soft corn tortillas, hard shell corn tortillas or in flour tortillas along with your favorite toppings such as shredded lettuce, diced tomatoes, diced onions, diced peppers, cubed avocado, beans, salsa, grated cheese, sour cream and/or cilantro. Alternatively you can use the leftovers make a taco salad out of the same ingredients.

Avoidant/Restrictive Food Intake Disorder (ARFID): How does it differ from other eating disorders?  

As a Registered Dietitian that specializes in disordered eating, I see a wide variety of clients (both male and female and of varying ages) that struggle with food. While you have likely heard of anorexia, bulimia and binge eating disorder, how much do you know about ARFID?

What is ARFID?

ARFID stands for Avoidant/Restrictive Food Intake Disorder (See DSM-5 for diagnostic criteria).  Individuals diagnosed with ARFID have developed a problem with eating or feeding which affects their ability to eat enough to meet their nutritional needs.  Food intake may be restricted based on the food’s taste, texture, smell, colour or past negative experience with the food.

As a result, children or teens may lose weight or not gain weight during growth or may not grow in height as expected. Adults may lose weight and/or not eat enough to maintain basic body functions. ARFID can cause social issues because individuals may have extreme anxiety with eating around other people and/or isolate themselves to avoid social situations that involve food.  Ie. At school or work lunches, holidays with family or gatherings with friends.

Examples of possible ways ARFID may present itself (with no other medical explanation):

  • A child/teen is an extremely picky eater since childhood + not gaining weight or growing.
  • Child/teen/adult had a negative past experience with choking or vomiting followed by a fear of eating solid foods.
  • Child/teen has abdominal pain that prevents them from eating enough + height has dropped or stopped on their growth curve.
  • Client is unnecessarily avoiding a long list of foods that they claim to be triggers for digestive symptoms, are very rigid and fearful of the restricted food/symptoms + losing weight.

What is not ARFID?

People with ARFID don’t typically fear weight gain and don’t have a distorted body image which are characteristics of other eating disorders.  (However, if left untreated ARFID can develop into anorexia or bulimia nervosa.)  Also, if inadequate food intake is better explained by a medical condition or limited access to food then this is not an ARFID diagnosis.

Don’t confuse ARFID with Obsessive Compulsive Disorder (OCD).  For example, an individual with OCD may not eat any raw food for fear of contamination. However, OCD and ARFID can co-occur together.

Remember ARFID is not the same as picky eating.  ARFID and eating disorders are a mental illness.  Ellyn Satter, Family therapist and Registered Dietitian says “Most problems with eating and feeding are not psychiatric disorders. They are problems, and, as such, they can be addressed by education or brief intervention conducted knowledgeably.” Therefore if you are unsure it is important to seek the advice of a health professional with good experience in the area of family feeding (for children), disordered eating and eating disorders.

Is a diagnosis needed before seeking support?

Knowing a diagnosis can be very helpful but it is not necessary nor the solution to recovery.  For example, a diagnosis can help guide which type of psychotherapy to use (ie. Cognitive behavioral therapy, dialectical behavior therapy, etc.) using evidence based guidelines for effectiveness.  However, often behaviors and symptoms are “grey” in terms of whether it is an eating disorder, type of eating disorder and/or whether other mental illness is a factor (ie. OCD, depression, ADHD, etc.).  This is why collaborating and referring to other experienced health professionals is crucial.  However, you can still successfully support someone with healthy change with or without an official diagnosis or while they are seeking out other supports and assessments.  Most important is supporting the individual and creating a plan specific to their needs and situation because even two people with the same diagnosis can have very different struggles, fears, behaviors, etc.

Treatment for ARFID:

Because ARFID is a relatively new diagnosis, the most effective treatment is still being studied.  Treatment must address any nutritional deficiencies, inadequate growth, weight loss and psychological concerns.  Some programs use nutrition counseling, cognitive behavioral therapy, exposure therapy and/or family counseling for children/teens (and many other therapies are being explored).  Also treatment of other underlying conditions is important. Ie. anxiety disorder, OCD, ADHD, and autism are common.  This is why having a medical doctor, Eating Disorder Dietitian, and Psychotherapist (experienced in eating disorders) are all important professionals on a  support team.

Specifically when it comes to nutrition support, here are a few things I have found helpful for my clients with any eating issue including ARFID:

  1. Meet the client where they’re at. Every client is different even if they have the same diagnosis so you need to ask questions, be a good listener and individualize treatment plans with every client.
  2. Explore the home food environment and feeding relationship between the parent/caregiver and child. (Even if the client is an adult it is important to get their childhood food and feeding history.)
  3. Involve and educate the client’s supports (ie. parents, caregivers, spouses or other loved ones) in terms of eating and feeding no matter what age the client is.

When is Mindful Eating an effective strategy for Eating Disorders?

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Mindful Eating is often promoted and supported in the treatment of eating disorders.  It is important to point out though that the majority of research and evidence for mindful eating has been focused on overeating, bulimia and binge eating disorder (BED).  Very few studies have looked at mindful eating and anorexia or other restrictive types of eating disorders.  (Please note: this article discusses “mindful eating” not to be confused with the broader practice of “mindfulness“.  Mindfulness may be taught by experienced eating disorder professionals and used for all types and stages of treatment.)

What is Mindful Eating?

Mindful Eating involves an intentional awareness of our food choices and paying attention to how we eat (focusing, limiting distractions, listening and trusting our body’s hunger/fullness cues).  Professionally I have seen the benefit of clients using mindful eating because it fosters a healthy non-judgmental relationship with food that supports flexibility and variety.

When is Mindful Eating not effective?

Many experienced eating disorder health professionals would agree that mindful eating is not appropriate or effective for people with anorexia in the early stages of treatment.  This may also be the case for other restrictive or extreme eating disorder cases.  Health professionals need to assess client appropriateness before utilizing a mindful eating plan.

6S’s to Assess:

  1. Safety: Have physical health indicators been checked? (ie. blood pressure, heart rate, blood work, electrolytes, etc.)  Is there a risk for refeeding syndrome?  Does the person need to be medically monitored in an inpatient program or hospital setting?  Is the individual self-harming in other ways?
  2. Supports:  Is a full support team in place including a therapist (and/or psychiatrist), medical doctor, and registered dietitian.  Is there family or other supports?
  3. Stability: Are mental and emotional health stable?   Is medication needed?  Is weight restoration needed?  Are basic nutritional needs being met?  A meal plan from a Registered Dietitian is often utilized to ensure adequate intake.
  4. Slowed Digestion: Has food been restricted for a prolonged period of time?  If so, digestion can be slowed and fullness reached really quickly with a very small amount of food.  In this situation, feeling “uncomfortably full” may be necessary in the refeeding or weight restoration process.  Hunger and fullness cues are often not relied on or trusted until nutritional needs are being met and sustained.
  5. Stress: Can the person tolerate stress? (and to what degree?) Stress and anxiety surrounding food and mealtimes can often create stomach discomfort which can be confused with physical fullness.  Initially distraction strategies are often used as a part of meal support because the goal of treatment is to just complete meals.  A trained therapist can help clients build resiliency, develop stress tolerance and differentiate between emotional and physical discomfort.
  6. Stage of Change: Does the person even think their eating disorder is a problem? Are they even contemplating change?  If not, mindful eating will not be effective.  Remember many people suffering with eating disorders will initially be forced into treatment or forced to seek support but are still in the precontemplation stage of change.

Most importantly when supporting someone with eating disorder recovery remember that there is never one best approach for everyone.  Eating disorders are very complicated and individualized treatment is absolutely necessary.

If you’re in the Calgary area and you’d like to learn more about nutrition counselling for eating disorder recovery you can book a free consultation here:  https://www.healthstandnutrition.com/request-a-consultation/

Or if you are looking for an eating disorder specialist in your area (in Canada), check out the National Eating Disorder Information Centre’s (NEDIC’s) Service Provider Directory:  http://nedic.ca/providers/search

*Photo credit: Brooke Lark

Easter Blessings – Food for the Soul

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This Easter weekend I returned to my Ukrainian roots and took part in the Blessing of Easter baskets.  Easter and the Holy Week leading up to it, has always been a very special time of year for me.  Growing up in the Ukrainian Catholic faith, we had so many faith-filled traditions with deep-rooted meaning and many involving food.   I still have fond memories of all of our extended family celebrating at the table with the basket of blessed food.

As a dietitian, Easter is a good reminder to me that food is so much more than nourishment.  Sharing food is also about human connection.  It is a way that people connect on a social and cultural level.  Sharing meals establishes a sense of stability, security, togetherness and belonging that not only benefits children but adults as well.

The day before Easter on Holy Saturday, Ukrainians prepare a basket of food for their families and then have it blessed by the priest at their church. The Easter basket symbolizes the joy and gratitude marking the end of Lent.  After the Easter Sunday Divine Liturgy the food is eaten in celebration of the Resurrection of Christ.  Not a morsel of food is thrown away because everything is blessed.  (Even the egg shells are ground up and often put in the dirt outside with the plants.)  The basket contains specific foods and items that symbolize different aspects of our Christian faith:

Pascha: 

  • symbolizes Jesus Christ and the joy of the new life He has given to us
  • a sweet white bread rich in eggs decorated with braids, crosses, etc.

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Candle: 

  • symbolizes Christ as “the light of the world”
  • made of beeswax and lit during the blessing

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Eggs:

  • symbolizes Christ’s death and resurrection
  • Pysanky are intricately decorated eggs

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  • Krashanky are hard-boiled eggs often dyed and meant to be eaten

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Butter: 

  • symbolizes the goodness of Christ which we need to reflect to others

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Ham: 

  • symbolizes the great joy and abundance of Easter

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Kobasa:

  • symbolizes God’s favour and generousity

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Cottage Cheese:

  • the blandness symbolizes the moderation that we should cultivate in our daily lives

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Salt:

  • symbolizes that we are followers of Christ and the meaning of life is to live according to the Gospel
  • a reminder of Christ’s words: “You are the salt of the earth.”

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Horseradish:

  • symbolizes the passion and death of Christ and the bitterness of sin

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Embroidered Cloth Cover: 

  • symbolizes Christ’s shroud (white linen)
  • (this cloth is usually embroidered with an image of the risen Christ, a cross or other appropriate symbol or words)

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I feel blessed to have a heritage so rich in customs and traditions that has brought me so many fond childhood memories.  Whatever your culture or customs may be, I encourage you to keep them alive with your family and pass on these beautiful and meaningful traditions to your children!

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Every BODY needs Boundaries

canstockphotogirlAs a Registered Dietitian, I have been seeing people struggling with weight and eating disorders for over 14 years. I have seen first-hand how one comment about a person’s body or weight can have such a negative impact (sometimes for the rest of their life). I’ve seen single comments reinforce damaging dieting cycles, disordered eating, eating disorders, feelings of worthlessness and poor self-esteem.

More recently in the media, we have seen terms such as “fat-shaming”, “thin-shaming”, and even women being mocked for their post-pregnancy bodies. I remember being teased in elementary school, called “flat as a board” for having no breasts. No one seems immune. I’m always left wondering, why do we feel the need to comment on a person’s body?

Most people are so unaware how their comments affect others. Sometimes the comment is innocent or even intended to be a compliment. Other times people think they are being helpful or some intend to be hurtful. Some people just don’t think before they speak. But because I work with people on the aftermath of repairing their relationship with food and body image, I see a great need to work on awareness and prevention.

Reasons not to comment on a person’s body:

1. We don’t know their situation.  A friend of mine went through a difficult time with her Dad slowly dying of cancer in the hospital. He couldn’t eat and was basically wasting away. As she was grieving, she had a hard time eating, ended up unintentionally losing a significant amount of weight and was not healthy. A few years later she ran into someone she did a yoga class with during that difficult time. The woman said to her “Are you not doing yoga anymore? Because you looked so good when we were doing that class.”

My friend’s first reaction was a mix of emotions from anger to hurt to grief. She herself knew she was much healthier now but the comments left a sting. Then it was like a flood of old disordered eating, body image, and dieting thoughts came over her.

We need to think about how our comments can really affect people’s well-being.

2. You can’t judge a person’s health by their size.  Our world needs to prioritize and value health over weight. People come in all shapes and sizes. Thinness does not equal health. Overweight and obese people can be healthier than thin people. Also, just because someone is skinny doesn’t mean they have an eating disorder and not all people with eating disorders look extremely thin.

For people with eating disorders, negative behaviors (ie. Restricting, binging and purging, etc.) can be reinforced by random people that tell them they are “looking good” when in reality they are extremely ill mentally and physically.

An eating disorder client that I was seeing who was severely malnourished, finally had reached a turning point and seemed motivated for recovery. A few days later, they bumped into an old friend they had not seen in a while, who to my horror said “Wow! You look amazing!” This client was left feeling so confused and frustrated – it took a long time before they could get back on track with recovery.

3. Respect others: Be a good example.  Commenting on a stranger’s body can affect others as well. Whether it’s discretely talking about a passerby or making comments while watching TV.

I had a client share with me how affected she is personally when her husband comments on other women’s bodies. “Look how big her butt is!” It makes her feel really self-conscious about her own body and feeds her body-dissatisfaction.

This is important for children as well. I was shocked to hear a 7 year old girl calling herself “fat”! Where is this learned at such a young age? Listening to a parent’s conversation is a common way children are misinformed and learn that weight and body image equal self-worth. Parents are the biggest role models and have to be aware of what they are saying about others and themselves.

4. It’s none of our business.  On a personal note, I have had some struggles with body image post-pregnancy. My stomach muscles never fused back together after gaining a fair amount of pregnancy weight and having 3 C-sections. So although I am a healthy weight, my flat stomach never returned and still bulges out 7 years later. I try to find flattering clothes to hide it but every once in a while I have an unpleasant reminder that it still exists…

In the middle of an exercise class our fitness instructor started showing the alternative way of doing exercises if you were pregnant- I didn’t think too much of it but after class to my horror she asked me outright in front of others “are you expecting?”. I muttered a polite “no” trying to pretend I wasn’t offended. But I was devastated and humiliated- just when I thought I was starting to accept my body!

Another time, I had a colleague ask me “Did you lose weight? You look great!”   I told her no- I was actually trying to work on my strength and build muscle. It was an awkward conversation. I felt good about being a little more assertive but wouldn’t most people be left wondering, “did she think I needed to lose weight?”

5. Long-term Damage.  Sometimes all it takes is one person or one comment that is never forgotten.

I met a woman who has been struggling with anorexia for 20 years because of a family member teasing her as a child about being chubby. For one lady it only took a single comment from a parent that she would look prettier if she lost a little weight…she has never forgotten. She has battled with poor self-esteem and self-worth, yo-yoing in weight with endless cycles of dieting. Another young man is now suffering from bulimia. He told me it all started as a teenager when his competitive sport’s coach said he would perform better if he lost 10lbs (even though he was already at a healthy weight).

On occasion, I also hear about health professionals that comment on people’s size or weight in an insensitive manner. Sometimes talking to parents about their children’s weight concerns in front of the child (children are listening). Or one lady tells me of a Dr.’s appointment where she was labelled as “obese” according to the BMI scale. She has been struggling with weight for several years and the classification did not help her. Instead of getting help and support, she went home and cried.

 What should we say?

Here are a few tips to making positive comments:

1. Anyone: Even if you think someone has lost weight, don’t comment on it. You don’t know their circumstances. There’s other more meaningful ways to compliment someone (and build self-worth):

Friend: Thank them for always cheering you up or making you laugh.

Old acquaintance: Tell them you miss hanging out or just a simple- “it’s great to see you!”

Colleague: Tell them how much you enjoy working with them.

2. Parents: Focus on your children’s internal qualities. For example, compliment them on their kindness, generosity, etc. Help build their sense of self-worth outside of their external appearance.  Even if your child is overweight, focus on being a good role model and celebrating your child’s healthy behaviours. Never single out one child or make comments on your child’s body or weight. Also, do not encourage dieting of any sort.

3.Coaches: Have a health professional provide education for your entire group of athletes (ie. Registered Dietitian who specializes in sports). Focus on healthy eating for performance and recovery but also positive body image. Do not comment on an individual athlete’s body or need to lose weight.

4.Medical/health professionals: Be sensitive to the fact that weight does not equal calories in vs. calories out. Weight is multifactorial. Also, eating disorders affect people of every body size and shape. Have information and supports available if your patient needs help. Seek out continuing education on eating disorders, healthy weight management and sensitivity training. (NEDIC and The Canadian Obesity Network are great resources).

5.Personally: Be aware of your own boundaries and be assertive if someone comments on your size/body or someone else’s. Tell them it’s inappropriate!