Transgender and Eating DisordersChristie Caggiani, RDN, LDN, CEDRD
It has long been said that eating disorders don’t discriminate: we know they affect people of all ages, education levels, ethnic backgrounds, lifestyles and genders.We’ve become clear that it affects middle-age women at an alarming rate, is on the rise in underdeveloped countries and impacts males as well as females. Yet little has been researched on the prevalence of eating disorders among the transgender community.However, the research is slowly emerging, giving us some insight on the impact felt in this community.
One study of 289,024 college students found that transgender students, compared to cisgender students, are almost five times as likely to report an eating disorder and two times as likely to use unhealthy compensatory methods (e.g., vomiting) for weight control.*Another study of almost 2,500 teenagers shows that transgender individuals are almost three times as likely to restrict their eating, almost nine times as likely to take diet pills, and seven times as likely to take laxatives.*
We live in a society filled with mixed messages about body image, health, and what loving ourselves truly means – it can be overwhelming!How do we navigate the confusion and learn how to be experts of our own bodies?What does it take to deconstruct social myths about health, replacing fallacies with a greater understanding that each body is unique and wonderfully different?
Luckily, there is an organization dedicated to teaching others how to have healthy relationships with their bodies.The Body Positive, based in California, empowers individuals through trainings and public awareness.This past month, I was thrilled to participate in The Body Positive’s professional training at Florida Atlantic University.Participants learned about the Core Competencies of Intuitive Health Model, found in the organization’s book, embody: Learning to Love Your Unique Body (and quiet that critical voice!).I am excited to share what I learned and hope you embark on your own journey towards body acceptance.The following competencies can stand alone, but when combined they create an enormous feeling of empowerment and positive change. Here is my take on each competency:
(1) Reclaiming Health
Working at the Oasis has taught me to take an intuitive and mindful approach to life.By developing a mindfulness practice that has helped me identify my body’s needs, I have embraced a health-centered approach to self-care versus society’s weight-centered tactics.
(2) Practice Intuitive Self-Care
Self-care is not a cookie cutter process – it’s about listening to your body’s needs, not what society thinks you need.My intuitive self-care routine varies from movement to creativity.If I am feeling restless at my computer, I will walk.Intuitive self-care helps you cultivate a more authentic version of yourself.
(3) Cultivate Self-Love
Learning to love yourself will help you discover self-compassion.Self-compassion means practicing care and understanding for ourselves, and providing validation when things don’t go our way.The more self-compassion and love we have for ourselves, the more likely we are to take chances and make life-affirming choices.
(4) Declare Authentic Beauty
Once we have cultivated self-love, we open ourselves to authentic beauty.Authentic beauty means that we are able to see others and ourselves from a compassionate perspective rather than society’s perspective of superficial beauty.We are able to appreciate our own beauty for its uniqueness.
(5) Build a Community
This competency espouses finding people who share your vision of self-compassion and health.Individually, we may find it difficult to change the media and society, but together we are able to empower each other by creating a community where principles of self-love and compassion take precedence over harsh judgments.
I look forward to incorporating The Body Positive’s core competenticies into my life, both personally and professionally.For more information,visit thebodypositive.org.
If you’ve ever tried to have a clear and concise conversation with your child after school, you might find it a daunting and nearly impossible task. Typically, you will find their attention, energy and desire to recount the day stretched thin, and much of that is simply because their bodies have run out of fuel. If it’s been at least 3 hours since their last meal or snack, or their previous amount of food was small, rest assured it is time for them to eat. They need a snack.
As Ellyn Satter so beautifully explains in her Division of Responsibility, one of the parental roles in the feeding relationship is to “provide regular meals and snacks”. This provides stability and the reassurance that food will always be available, thereby allowing children to develop a regular rhythm of hunger and fullness signals which will serve them well throughout their life. As they trust that we will provide food in a regular and timely manner, they can best develop a sense of trusting themselves and their internal signals.
Snacks, however, have many stigmas and much confusion abounds as we try to determine the “best way” to provide them to our kids. Here are some suggestions that may answer a few of your questions:
Snacks are typically best thought of as little meals, not a single stand-alone item. Our culture has branded certain categories as “snack foods”, however anything you would serve at a meal could feasibly be a snack and will undoubtedly be more satisfying than a single-serve package of baked crackers! How about a slice of leftover veggie pizza and some grapes?
Include two or three foods from amongst: whole grains, protein, dairy, fruits, vegetables, and fats. Make certain to also offer some ‘fun foods’, and pair them with foods that have a little staying power, such as chocolate chip cookies and a glass of milk. Having foods with a higher fat content will hold them longer, and create greater satisfaction.
Since all foods can be part of a balanced eating relationship, I tend to recommend buying full-sized bags of products (chips, crackers, cookies), rather than 100-calorie individual versions. Not only does this save you some money, it most importantly avoids all of the subtle messages that we give our kids by placing “calories” as part of a food decision. Have you ever had a 100-calorie bag of anything? Were you completely and utterly satisfied after finishing it? If you wanted another one, did you feel like you “shouldn’t”? In my experience, they leave us hanging, wishing we had more. There is nothing magical about that number “100”, except that it’s an effective marketing strategy. By focusing on the number, we have a much harder time listening to our tummies and the signals that tell us if we are still hungry or comfortably satisfied. Instead, present these foods on a plate or in a serving bowl, allowing kids to fill their own plate and gauge the food amounts to their hunger levels. For snacks you need to pack, keep some reusable snack containers on hand and make certain to include enough so that they can eat sufficiently.
A snack is not a treat, not a reward, not withheld in a punishing manner, not conditional. It’s simply a consistent part of a normal day between meals. It is just food.
Have your kids sit at a table for snacks (without TV, Instagram, or homework!), allowing them to better listen to their bodies and know when they’re satisfied, (not to mention the fact that running around the house is dangerous and messy if done while eating!). If your child needs to go straight from school to a practice, event or appointment, make certain to have packed a few snack options, and give him time to fully taste and enjoy before running out of the car.
Sit down and keep your child company, listening to your own body’s signals of hunger or thirst. Snack time is designed to relax and regroup. Take a quick minute to breathe, stretch and transition from the busy day. Don’t create a stressful conversation about the hours of homework they have yet to face! Our children are watching us always, and modeling consistent snack and re-charge time is helpful for their development, as we as for our energy and patience.
Try to give at least two hours and not longer than 3½ -4 hours between a snack and the next meal. For example, if dinner is at 6:00, aim to have snack time completed by 4:00, in time for your child to get hungry again by the meal. In the meantime, make certain your little one has caught up on their water intake, adding in some fresh fruit, ice cubes or cucumbers for a little flavor and fun.
If your child is truly not hungry, they won’t eat. They can then eat at the upcoming meal – no grazing later on as the meal approaches.
When your kids are older, they can begin to make some choices about snacks, within the guidelines that you’ve demonstrated. Remember to keep them planning and eating at a generally consistent time.
If you maintain the reliable consistency of meals and snacks, including a variety of foods, your child will regulate and be able to trust their body’s signals of hunger and fullness. Happy snacking!
Everybody, regardless of color, shape, or size is born with a metabolism. It breaks things down—so we may have the energy to do the things we love—and it also builds things up—so our cuts may heal fast and our hearts may beat strong. Certainly, the unseen reactions that compose our metabolic pathways are fundamental to our very existence. However intricate and complex, this innate system of “breaking down” and “building up” only requires one conscious effort from each of us: to consume the nutrients it requires to keep the system running. All three of the macronutrients play countless essential roles: protein is converted into the enzymes that metabolize carbohydrates into usable energy and fats/lipids into the compounds that create our hormones and strengthen our minds. Our bodies are made of countless interconnected, interdependent systems, each relying on an adequate intake of protein, carbohydrate and fat. Our metabolism knows it needs these things to keep us going. So, in the midst of continuous, devoted effort, it speaks to us. When it needs fuel, it tell us to be hungry—so that we may seek its nutrients—and when it has all it needs, it tells us to feel satiated—so that it can work its scientific magic. Our brilliant metabolism naturally tells us what to do; all we have to do…is listen.
As a South Floridian in the summertime, you know this all too well: whether you’re taking the dog out for a walk, or just trying to get from the front door to the car, it’s nearly impossible to be outside without breaking a sweat! Sweating out water and other nutrients can leave us feeling tired and dehydrated, which can ruin our summer fun. Thankfully, Mother Nature doesn’t want us to melt! To help endure the grueling heat, we’re offered an abundance of the perfect thing to keep us hydrated and full of energy: fruit! Full of water, vitamins and even fiber, fruit can help us beat the heat and enjoy the summery flavors we love. Cherries, nectarines, berries, honeydew, peaches and plums are all in season. You can always enjoy fruit on its own or incorporated into your favorite dishes to give them a summer twist: try topping your oatmeal or cereal with berries or slicing up pears or mangos for a salad. So if you’re feeling the heat this summer, “Don’t sweat it!” Remember that fruit is a nice refresher.
The Institute of Medicine identifies registered dietitians as qualified professionals for nutrition therapy. According to IOM, “the registered dietitian is currently the single identifiable group of health-care professionals with standardized education, clinical training, continuing education and national credentialing requirements necessary to be directly reimbursed as a provider of nutrition therapy.”
A Registered Dietitian Nutritionist (RD or RDN – these credentials can be used interchangeably) is a food and nutrition expert who has at least a Bachelor Degree in Nutrition and has completed a rigorous training with supervised practice in a variety of clinical settings. The majority of Registered Dietitians work in the treatment and prevention of disease (administering medical nutrition therapy, often part of a multi-disciplinary team), in private practice, hospitals, other health-care facilities, as well as research, business and sports nutrition. All Registered Dietitians are nutritionists, however not all nutritionists are Registered Dietitians.
The following criteria have to be met to earn the RD or RDN credential:
Completion of a ACED (American Council for Education in Nutrition and Dietetics)-accredited supervised pre-professional experience program including practicing at a variety of settings such as healthcare facilities, community agencies, and foodservice institutions.
Passing an extensive national Registration Examination for Dietitians administered by the Commission on Dietetic Registration (CDR).
Completion of continuing professional educational requirements to maintain registration.
Additionally, nearly all states have their own licensure requirements which further helps regulate standards within which the dietitians must practice.
How does a Registered Dietitian differ from a Health Coach, Health Counselor, Nutrition Coach or Holistic Wellness Provider?
As people have become more interested in nutrition and overall health, there has been a rise in programs and services disseminating nutrition information. Additionally, online nutrition schools are emerging, many of which have no prerequisite to enter. They usually do not require or produce a Bachelor’s degree and can be finished in less than a year online. There is typically not a licensure governing the practices of Health Coaching or Nutrition Coaching, and they are not reimbursable by insurance plans. Registered Dietitians have a minimum Baccalaureate degree granted by a U.S. regionally accredited college or university, or foreign equivalent. There are a variety of specialty certifications available within the field, including sports nutrition, eating disorders, pediatrics and diabetes to name a few. Many RDs practicing in outpatient or private practice settings employ a therapeutic approach as a Nutrition Therapist, guiding their clients toward balanced and normalized eating patterns.
Christie Caggiani, RD, LDN, CEDRD is Co-Founder of Therapeutic Oasis of the Palm Beaches in Delray Beach, Florida. Christie is a Registered Dietitian within the State of Florida and is certified as an Eating Disorder Registered Dietitian from the International Association of Eating Disorders Professionals (IAEDP).
“We don’t keep bread in the house.” “One serving is enough – kids don’t need seconds.” “We just have protein and veggies at dinner.” “Why is my child sneaking food and snacking all the time?!”
Hmmm – at first glance, these may seem like separate, unrelated statements. There is, however, a common thread and a chain reaction that is in play throughout the scenarios…and it all starts with restriction. Carb restriction, calorie restriction, food restriction. If you consider the unrelenting headlines that tell us obesity is an “epidemic”, that individual foods will either kill or save us, and the sneaking messages that lead us to think we’ll only be happy if we are sexy and skinny, then it makes some sense that people are grabbing at the latest food rule (aka, restriction), to take control of their or their kids’ lives. Yet the more we reach for restriction, the more out of control we become.
Let’s keep it straightforward. There are some basic side effects of over-controlled under-eating:
it confuses body chemistry, triggering it to more readily lose muscle and regain weight as fat
it causes feelings of deprivation and depression that often rebound to overeating
it creates a lowered self-esteem, and disconnects individuals from their emotions and sense of well-being
it creates irritability, decreases concentration and memory, (especially if carbs are limited) and causes tension in relationships
it can disrupt a female’s menstrual cycles
it makes exercise ineffective, because there isn’t enough fuel to run your body’s basic processes
So when you feel the need to snack on cookies and chips after the kids have gone to bed, notice if you’ve eaten enough during the day or pulled carbs out of the meal prior. We can’t function effectively if we are depriving ourselves of enough fuel – and we are destined to swing the pendulum the other direction to try to create balance.
And the next time you feel the emotional tug to try the latest fad diet, label carbs as evil or tell your kids to stop eating, take a deep breath and remember:
Eating is Normal. Restricting is Ridiculous.
Christie Caggiani, RD, LDN, CEDRD is Co-Founder and Registered Dietitian at Therapeutic Oasis of the Palm Beaches in Delray Beach, Florida.
More often than not, when we see someone who we have not seen in a while, it is not uncommon to make a comment about his or her shape or size. This is clearly not shocking when one considers the world we live in. However, even if body-focused comments are intended as compliments, I challenge each and every one of you to be mindful of body talk. For those struggling with an eating disorder or body image issues, even a positive comment can be misconstrued.
As parents, I implore you to be particularly mindful of your language around food, calories and weight, whether speaking directly to your children or conversing with friends. I will never forget the day my Kindergartener at the time came home from school and reported that a 5th grade boy on the bus told her that calories were “bad.” She innocently responded that we need calories to grow. I can only assume the 5th grade boy developed that belief from some adult in his life. Had I not happened upon that conversation, my daughter may have believed that statement to be fact.
So, let’s begin with new traditions. Let’s comment on how “healthy” or “happy” or “relaxed” our peers look. Let’s focus on learning about how friends are doing on the inside and get curious about their summer vacations. Let’s redirect conversations around fat and calories. Some of you may even be bold enough to say, “NO FAT TALK.” It’s up to you to take the power back, and one by one, we can slowly reshape the society we live in.
Dr. Nicole Friedman is a Co-Founder and Clinical Psychologist at Therapeutic Oasis of the Palm Beaches in Delray Beach, Florida.
Emotional Eating. This term has become a bit of a buzz word in recent years, typically having negative connotations and leading to the assumption that we should completely learn to separate emotions from our entire eating process. This couldn’t be further from the truth, however. In fact, our feeding relationship is best healed and balanced when we allow ourselves to (1) feel our emotions without judgment, and (2) eat with joy and awareness.
When food is used to bypass or stuff emotions, then our lives become out of balance. The process of healing and resuming balance begins with acknowledgment of emotions – even if you can’t name them completely. Just as you become willing to see your emotions, you must then be willing to see your eating patterns – again without judgment. Become curious, almost detective-like in your observations.
If you find the following, you may be experiencing unbalanced emotional eating.
Hunger or desire to eat comes on suddenly and urgently
A little food doesn’t make you feel better – you want more
Hunger is often paired with an uncomfortable emotion, sometimes brought on by a situation or event
You don’t recognize that you started eating
You don’t stop eating even when full
Hunger isn’t located in belly
After you satisfy hunger, you feel a sense of guilt and regret
As you become more aware of how emotions and eating meet in your life, you can begin to make steps to handle both in a way that creates peace.
Christie Caggiani, RD, LD/N CEDRD is a co-founder and Nutrition Therapist at Therapeutic Oasis of the Palm Beaches in Delray Beach, Florida.
Congratulations to Christie Caggiani, RD LD/N for obtaining her CEDRD from The International Association of Eating Disorder Professionals (IAEDP) and becoming one of the few registered dietitians certified as an eating disorder specialist in the state of Florida. This certification is awarded to dedicated and experienced professionals who have completed a rigorous training process and demonstrated a commitment to the highest of ethical standards.