Arkansas Tackles Eating Disorders

Last week, I was honored to participate in a number of creative events in Conway, Arkansas to celebrate National Eating Disorders Awareness Week.  A dedicated and diverse group of faculty, health professionals and students from the University of Central Arkansas and Hendrix College along with dancers and choreographers from Atlanta all came together to raise awareness of eating disorders in the community.  The effort was the brainchild of UCA's Art History Professor Gayle Seymour and Sue Schroeder, artistic director for CORE Performance dance troupe.  

Here’s the Backstory:  

As you know if you read my blog, I wrote a children’s book called Full Mouse, Empty Mouse about two stressed out mice. The boy mouse uses food to comfort his feelings, while the girl mouse stops eating as a way to make herself small and safe from danger. Other mice bully the boy mouse for being Fat, while the girl mouse is told she looks great! Thankfully, their wise aunt mouse helps them learn to listen to their bodies and find healthier ways to deal with their feelings. 

Several months ago I learned that Atlanta's CORE Performance Company had created a dance program for children based on the story, and they’d be presenting it to thousands of grade school kids in Conway, Arkansas.  Last week I had the honor of watching these talented dancers take key concepts from the story and convey them through movement, colorful costumes and an interactive story. 

Three dancers played the roles of the Heart, the Tummy and the Head of a little girl who was being bullied at school.  The girl feels sad and hurt, and her Heart forces her Tummy to eat and eat in order to make the bad feelings go away. 

Throughout the show, the characters stop and speak with the audience, asking them for advice about how the girl should deal with her feelings and with the bully. 

What was most gratifying to see was that the kids GOT IT!  Even young children can understand Emotional Eating, a concept which is absent from programs for childhood obesity.  Since obesity prevention programs are typically developed by dieticians and physicians, the social-psychological piece is often missing. But these gifted dancers were able to convey important information about the importance of “Listening to your Body” (e.g. don’t stuff your belly when you feel sad!) and “Talking about your feelings” (e.g. there are healthy ways to cope with painful emotions).

Over the course of the week, these dancers reached almost two thousands 3^rd and 4^th graders at seven schools.  The children were energized and delighted by the program!  And I believe that because the messages were conveyed through a creative medium that tapped into universal emotions, the messages will not soon be forgotten.  I have no doubt that this program planted some life-changing seeds in these kids, and perhaps in their teachers as well.

Dr. Seymour and other devoted professors, students and artists created a number of other activities devoted to eating disorder awareness over the course of the week: more public dance performances and a photography exhibit of teen portraits.  Theater students from Hendrix staged short surprise skits on the UCA campus about eating disorders.  I spoke with grade school teachers about how they can help their students and themselves have a balanced approach to food.  I also spoke with students at UCA about how to have a healthy relationship with food amongst the food, body image and diet pressures of college life. 

All in all, the week of activities reached and impacted thousands of people.  I am heartened to think how many children, college students and adults were exposed to some vital and potentially life-saving information. I look forward to seeing what amazing things grow from the seeds that were planted this week!  Thank you to Gayle and Sue and countless others for being the heart, soul, brains (and tummy) behind this exciting project!      

  

Mothers, Daughters and Food: Handing Over the Reigns

Karen, an attractive, fit and fashionable 48-year-old mother, has come to get help for her 17-year-old daughter Ashley’s weight problem.  “I’m really worried about her health. She’s put on 30 pounds since middle school.  She’s a bright and beautiful girl, but her weight is making her miserable,” she told me.  “She’s never had a boyfriend and she’s avoiding her friends.  Every time she gets in the car, she’s buying junk food. I’ve tried dieting with her, signing her up for gym memberships and personal trainers. I’ve offered to buy her a new wardrobe if she lost weight.  Nothing motivates her! I’m afraid whatever I do is only making things worse.”

The next week, I hear Ashley’s story. She’s overcome with tears as she describes her struggles with food and her mom.  Perceptive, sensitive and academically accomplished, she’s very hard on herself. “I can’t understand why I can’t get my act together in this one area!”  She feels hurt by her mother’s pressure to lose weight. To Ashley, whether it’s shopping together, having a meal, or going for a walk, it feels like every encounter is an opportunity for her to feel judged by her mom.  

Ashley’s mother’s concern about her weight is an octopus whose tentacles wind through every interaction, choking the fun out of their relationship. Her mother’s unspoken message is: “I’m disappointed and embarrassed by you. Something’s wrong with you, but I’m at a loss.”

This painful pattern between Karen and Ashley is the age-old dance of millions of mothers and daughters. 

To the Moms: Let Go.

Your daughter’s problem is not that she isn’t motivated enough. She doesn’t need to be “incentivized” with clothes, trips or cash if she drops weight. Believe me, she wants it as much as you do.

What’s happened is that your daughter’s struggle with food  -- an area that should be a negotiation among her head, her belly and her heart -- has become a relationship issue between the two of you. Over the years, your concern and disappointment in her weight has taken up residency in your daughter’s psyche. Your feelings are so salient that she can’t discern the subtle signals in her own body. 

You may be a successful, take-charge woman, used to influencing outcomes. But as difficult as it may be to accept, this one’s out of your hands.  Perhaps you’ve struggled with your own weight issues. Your fear for your daughter has intensified your involvement in her problem. You’d do anything to prevent her from suffering the way you have.  Or perhaps you’ve never had food issues and your daughter’s drama is a mystery to you.  Maybe you can eat and exercise without all the fuss, and you view her struggle as a character flaw. 

Whatever your story about food, you can’t solve her problem.  It’s time for you to let go. 

When I say “let go,” I mean not offering to diet with her, not cutting out weight loss articles for her, not asking after her walk how many miles she went. It means not sighing when she reaches for seconds or stiffening when she orders fries. It means not showing off your skinny jeans or bragging about how great you feel after your workout. It means never uttering, “Are you sure you really need that?”

Letting go means trusting that she’ll figure out her weight issues on her own time table.  It means accepting that this might take years, not weeks or even months. 

At the same time, it doesn’t mean denying support if she ASKS for it. If she can’t afford a dietician, therapist or personal trainer and you can, this could be a meaningful gift, if it’s freely given.  No checking in about “how it’s going,” with the implication “I better see results on the scale.” If that’s your mind-set, don’t bother. It will only become another place for her rebellious instincts to sabotage the process.

Here’s the New Paradigm: your role is to develop a more loving and connected relationship with her, whatever her size. This means consciously, deliberately never implying that her value goes up as the number on the scale goes down. She gets that message every day in the culture. Your role is to be a buffer –to detach her worth from her weight.    

To the Daughters: Grab the Reigns and Take Five Steps

Step 1: Get your Mom out of your food. Your relationship with your body is yours and yours alone. That means doing the right thing for your body, not rebelling against your “controlling mom” by eating junk and lying around. Grab the reigns. Instead of rebelling against her, rebel against the diet mentality...which leads to Step 2.

Step 2: No more counting points, fat grams, pants sizes, calories and pounds. Letting go of the numbers might seem scary, but be honest: all that counting only raises your anxiety, which makes you want to eat! Steps 1 and 2 should lower your anxiety. Good.  Breathe. 

Step 3: Become a Belly Whisperer by learning to discern the signals in your gut. It’s recognizing when you’re eating past the point of satiety, and when you’re eating because you’re procrastinating, rebelling, rewarding yourself, or taking a break. At this Step you’ll still do all these things, but you’ll watch yourself do it and imagine better alternatives.  Even if you still choose to eat, the key is that you’re turning your compulsion into a choice.  Even if nothing changes behaviorally, you’re making progress. These deeper changes must take place in order for lasting behavioral (and weight) changes to occur. 

Step 4: Make a different choice.  Instead of eating when you feel like procrastinating, try painting your toenails or reading a magazine instead.  You’ll notice you feel better.  The new choice will reinforce itself, making it easier to do it again.      

 Step 5:  Choose healthier foods because you feel better when you eat better. This feels very different from eating healthy because you’re “on a diet” or because your mom is watching. By the time you get to this step, the change in your eating is organic and based on self-love rather than a capitulation to your mom’s wishes.  Organic changes stick.  But getting to Step 5 takes time, so be patient!    

A final word to you both:

Getting the Food Fights out of your relationship is an important developmental milestone in the lifecycle of the mother-daughter relationship.  From the day a little girl is born, the mother-child bond is embodied through food and feeding. The path to a healthy separation around food issues can be bumpy and painful, but the rewards to you as individuals and for your relationship are well worth the struggle!

 

Speech at EDIN's Celebrity Dance Challenge, December 3, 2011

Fifteen  years ago when we started EDIN, eating disorders were a taboo topic in schools.  People avoided talking to kids about these issues out of their fear of creating problems. But we started planting seeds.  We started openly addressing the issues surrounding eating disorders for the first time.   Now high schools, middle schools and elementary schools all over this state are using our model and our materials, creating student-run EDIN Clubs and hosting creative, educational and fun events throughout the year focused on media literacy, the dangers of dieting and the importance of Loving Your Body. 

Fifteen years ago, the Obesity epidemic was a blip on the screen. But with the increased attention on this issue, EDIN has been at the forefront of efforts to make the connection between obesity and eating disorders, advocating for a non-diet approach to weight issues, shifting the focus from being skinny to being healthy.  

We were thrilled this year when The Georgia Department of Education decided to feature our children’s book “Full Mouse, Empty Mouse” in its Georgia Eat Smart Initiative to combat obesity, sending the book to every elementary school in Georgia.  Now instead of kids starting on diets, they’ll be hearing about respecting the signals in their bodies and healthy ways to cope with feelings. Without EDIN to balance out the cultural pressures to diet, we’d be ushering in a new generation of anorexia, bulimia and binge eating.    

But what’s truly gratifying is to hear about EDIN’s impact on an individual scale.  I was recently approached by a teacher who thanked us for bringing EDIN’s programming to the school.  She admitted that she’d been suffering from binge eating disorder for years, and through EDIN’s website she’d found a dietician and a therapist who were helping her recover.  Or the mom who attended an EDIN talk at her kids’ school focused on preventing eating disorders, who reached out to us saying, “I’ve had bulimia for 30 years.  I realize now that, for my kids, I need to get help.”

THIS is true prevention, because that mom and that teacher will now be passing down the right messages through their words AND their actions, to their students and their children.

Prevention is about changing a belief system. It’s about changing the way we talk to each other and the way we talk to ourselves so that we can provide a buffer  from the cultural trends that vilify fat and glamorize anorexia. We have our work cut out for us. 

This past Tuesday 9 million people watched the Victoria’s Secret Fashion Show, and Model Adriana Lima walk down the runway with a LOWER body mass index than is required to receive a diagnosis of Anorexia.  Asked how she achieved this body, she shared that she worked out twice a day for months, then drank only liquids for the nine days leading up to the show then didn’t eat or drink anything for 12 hours before the show, forcing her body to devour any ounce of fat that was left.  Not only were people unconcerned about this potentially life-threatening behavior, but the Twitter-verse lit up after that show with people inspired to start starving themselves to look like her.  

No other potentially deadly mental illness is so highly promoted and glamorized in our culture.  I just hope it doesn’t take an angel collapsing on the runway from cardiac failure for America to wake up. 

Thankfully you, here, tonight, are awake!  Thank you for coming tonight and for helping change things.  For ourselves and for our kids, keep fighting the fight.  THANK YOU!

Eating Disorders: Stigma & The Social Cure

Two decades ago, people would only whisper the words “breast cancer.”  Susan G. Komen, as she lay dying from the disease, asked her sister, Nancy Brinker to try to raise awareness. http://www.npr.org/2011/09/14/140477589/susan-g-komen-founder-discusses-her-book.  Because of Nancy’s tireless outreach, people now discuss breast cancer openly.   Along with this new openness, Susan G. Komen for the Cure has raised millions of dollars for research that has helped save lives.

Today the topic of eating disorders is where breast cancer was twenty years ago.  There is still tremendous shame and stigma surrounding these problems, which only increases the suffering of victims and their families.  Anorexia, binge eating and bulimia are still viewed as shameful, disgusting, embarrassing and a sign of mental weakness. 

There is a community of eating disorder survivors, family members and treatment providers working hard to remove this stigma.  I decided to use theater to break through defenses and touch folks at an emotional level.   Back in 1996, I wrote the play “What’s Eating Katie?” about a 13-year-old girl who struggles with an eating disorder.  In the show, the Eating Disorder (ED) is played by an actor representing a separate character (based in the Narrative Therapy approach which “externalizes” problems).  This technique allows the audience to hear what it sounds like inside of Katie’s head. Katie, like most eating disorder sufferers, is a high achiever, one of “the best and brightest.”  She is a perfectionist who want to make everyone happy. Like the canary in the toxic coalmine of our culture, she’s the one who succumbs to the stress and pressure.  Audience members relate to Katie since we all have an internal negative voice; the only difference may be that Katie’s internal negative voice is meaner, more controlling and highly destructive. 

   My goal in creating the show was to rip the lid off this topic, even though many adults are afraid to address eating disorders out of their fear of glamorizing them or giving kids ideas. In fact, the ideas that teens take from this show are: dieting is ridiculous; starving leads to moodiness, spaciness and weakness; binge eating is an out-of-control nightmare; and throwing up is both addictive and dangerous. The only rational conclusion is to respect, feed and take care of your body!

I’m happy to report that over the past 15 years, high schools and colleges around the country (as well as Scotland and Australia!) have performed this show.  Act I takes place over the course of one day, when ED recruits Katie into engaging in an extreme diet that takes a frightening turn.  Act II takes place three months later when we can see the toll that ED has taken on Katie, her family and her friends.  It ends with an uplifting scene in a therapist’s office where Katie begins her journey towards recovery.

Between scenes are hilarious “ads,” spoofing the diet, fashion, fast food and fitness industries.  The idea is not to “blame” these forces for Katie’s eating disorder but to place her struggle within a wider cultural context.  By seeing plainly the manipulations of the  corporations that profit from making us fat, insecure and then thin again, the audience will be better at critiquing the core messages that can lead to unhealthy behaviors (“You will be popular, loved and happy if you are THIN, so get there no matter what the price!”)  By making the messages explicit, they have less power to influence attitudes and behaviors.   

One of my favorite things about this project is that the purveyors of the new messages are the teens themselves. An audience of middle school kids is going to be much more open to messages in a show performed by high school students than to adults lecturing them about taking care of their bodies.  We know that peers are a potent influence regarding attitudes and behaviors; unfortunately we typically hear about how this influence leads kids to dangerous places (sex, drugs, rock 'n' roll!).  The idea of this show is to use "peer influence" for Good rather than Evil.  This process has been dubbed "The Social Cure." 

I recently updated the script to including cell phones and texting, Google and Facebook (none of which were around in 1996!). But I wanted to bring the show to the next level by turning it into a musical.  I stumbled upon a gifted actor-composer-music director named Bryan Mercer. He knows how to make a show fresh and engaging, hip and meaningful.  We feel that the combination of my 20 years as a psychologist combined with his 30 years in musical theater will allow us to create a show that will both educate and entertain today’s sophisticated youth audience.

In order to help fund this stage of the project, I decided to work through the Kickstarter.com website.   If you care about this issue, we want you to be part of this project!   Your donation (large or small) will allow us to fund the composing of nine songs and the recording of the tracks.  We’ll reach out nationwide to promote this as a fresh, bold way to address dieting, weight stigma, body image and eating disorders.  We’ll also approach local schools and community groups about performing the show in Atlanta in 2012.

This is a life-changing and potentially life-saving project. The show will engage and enlighten cast and audience members and provide hope for sufferers and loved ones. Ultimately, it encourages people to seek help because recovery is possible.  We hope that you want to be part of it!  Click here to find out the how we will be thanking you for your gift (including writing your name into the show!) http://www.kickstarter.com/projects/1746338650/whats-eating-katie-the-musical?ref=live

Thank you~

Read Dina's blogs on www.mindfullivingnetwork.com and www.sharewik.com.  Learn more about her at www.dinazeckhausen.com or www.powersferrypsychology.com.

Surgery on Your Stomach Won't Fix a Problem in Your Head

Bariatric surgery has catapulted us into a Brave New World. These days many eating disorder therapists are seeing a new type of client: the pre- or post-bariatric surgery patient. While we may not be schooled in the gastrointestinal and hormonal intricacies of obesity surgery, we are knowledgeable about the complex interplay of emotions, relationships, trauma and food. Unfortunately, bariatric surgeons may have only had one class (that’s class, not course) on eating disorders in medical school.

Many in the eating disorder community are adamantly opposed to this surgery. They view with suspicion physicians who are quick to promote the procedure as the Holy Grail of weight loss rather than viewing it as a last resort. And while insurance companies may insist on six months of pre-operative nutritional counseling, they do not insist on (and often balk at paying for) pre-operative psychotherapy.
It’s hard for me to take a hard-line stand on the surgery itself. I know people who’ve destroyed their health, developed eating disorders and alcoholism, gained back all the lost weight and even died following gastric bypass surgery. I also know people who’ve lost weight and kept it off, and whose quality of life has improved 1000 percent following surgery. They have no regrets and tout it as a life-saving operation.
Get Thee to a Therapist!
I met a bariatric surgeon who’d conducted his own extensive pre-surgery assessments of his patients. He was shocked to find that 80 percent of his patients who were about to undergo surgery reported being sexually abused as children.
I wasn’t shocked at all. It’s widely accepted in the psychology community that sexual abuse survivors often develop problems with overeating. An abuse survivor may use food to numb her feelings or punish herself. She may try to make herself less attractive by gaining weight. Over the years, eating can become a default way of coping with negative emotions, while being overweight becomes self-defining.
Now imagine this woman gets gastric bypass surgery to “fix” her weight problem, without stepping a foot in a therapist’s office. Post-surgery she may be ill-equipped to cope with negative feelings since her default mechanism has been taken away. As her body changes and men start noticing, she may be unprepared for the sense of anxiety that she cannot identify or manage.
This is the patient who may turn to alcohol, cigarettes or shopping for emotional anesthesia. Or she may just eat her way around that tiny stomach pouch. Once I met a woman who lost and then gained back 250 pounds post-surgery.
More tragically, ERs have a short-hand for the post-surgery patient who’s binged and burst through the tiny stomach-pouch. “GBGB.” Gastric Bypass Gone Bad. GBGB can be deadly.
“Those who do not learn from history are bound to repeat it.”
Doesn’t it make sense that a person who is 100 pounds overweight should address his or her “food issues” before getting gastric bypass? Here’s a story to illustrate the work that needs to happen between your ears before someone opens your gut.
Brad is a bright, vivacious and extremely likable guy. A successful man in a long-term relationship, when he arrived for pre-surgery psychotherapy he weighed 386 pounds. Here are just a few of the themes that we addressed during our year together.
Early family messages
When we explored why Brad had ignored his health, he stated that he believed he was not worth the effort. So we dug deeper.
Brad was adopted. He never felt like he “belonged” to his parents. His mother was obsessed with her own fitness but rarely cooked or cared for her son. Brad always sensed that his mother felt burdened by his needs. Brad’s father was a harsh disciplinarian. A controlling military man, he’d measure the hangers in Brad’s closet to be sure they were one-inch apart. Sharing these stories helped Brad realize that his parents did not love him in the way that he needed to be loved. This insight was accompanied by deep sadness. This “grief work” helped him let go of his old self-perception. Acknowledging that their treatment of him was more about their short-comings than his value as a son, he recognized that he was worthy of the effort it took to take care of himself.
Self-talk
Brad had internalized his father’s perfectionism along with an equally powerful rebelliousness. If you’re surprised to think of someone weighing over 380 pounds as a perfectionist, here’s how it works: If I can’t be Perfect, why bother?
Perfectionism and Complacency are flip sides of the same coin.
In therapy Brad recognized that his harsh self-talk not only didn’t make him a better person, it actually contributed to his weight gain. Brad recalled a high school gym teacher who had believed in him and pushed him to get fit. With her encouragement, he started to feel good about his body. Realizing that her positive approach had helped him get in shape years ago, he started speaking to himself in kinder tones, rather than listening to – and rebelling against – his internalized father.

Current Relationship Issues
Brad’s partner was a caretaker. He loved to feed Brad, but a bit too well! Brad suspected his partner might be sabotaging him since he’d gained 100 pounds in the time they’d been together. We anticipated ways that Brad’s weight loss might alter the dynamics of the relationship. Brad’s new confidence would likely make him more assertive, which would add stress and conflict.
Brad’s partner decided to get in therapy to work through some of his own issues. This helped prepare them both for a new post-surgery relationship, especially with regards to food, love, power and control.
The Update
Following his surgery, Brad accepted a job in a new city. It’s been a year. Here are his words:
“As far as the surgery itself, it was actually better than expected. The doctors…made sure I understood any potential complications, discomforts, recovery times...The side effects were exactly as expected…The positive effects far FAR outweighed any of the negatives…It’s been 12 months and I’ve lost 170 pounds…Within 2 weeks…my blood pressure was completely normal…
Within 7 months, my sleep apnea had improved... My energy levels soared and are consistent throughout the day. Food went from being something I was completely obsessed with to almost an afterthought – who knew I had to remind myself to eat...I had not realized how limited I had made my life, avoiding all the anxieties like air travel, small chairs, parties, social activities…I am more social, throwing parties, going to clubs, going dancing, hiking…I started at 386 pounds. Today I weigh 216 lbs. If I didn’t lose another pound, I would be content…
And the take-away:
“I feel like (our) therapy was extremely beneficial in dealing with the issues of satiety (emotional versus physical), the feeding of the emotional stuff, acknowledging what my triggers were, and more. I really attribute my success to the therapy I had before surgery, and the lessons I learned from it that I have brought forward post-surgery. I know other bariatric patients that had little to no therapy, and their success has been very limited. My recommendation would be get some serious therapy before you embark on a surgical solution.”
Amen Brother.
Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for ShareWiK.com and mindfullivingnetwork.com. You can visit her on the web at dinazeckhausen.com and MyEdin.org

Depression: It Gets Better

A core belief of depression is not only that “Life sucks,” but “It Will Always Be This Way.” This hopelessness can lead to suicide.

That’s why I’m so grateful to the folks who are reaching out to gay youth with the “It Gets Better” message. Started by Fort Worth City Councilman Joel Burns, who spoke openly about his struggles growing up gay, the message to “hang in there” past the pain is simple but profound. The “It Gets Better” message is at the core of psychological resilience.

I recall my mom giving me that message when I was a kid by repeatedly counseling me, “Tomorrow this will be behind you and you will be looking back on it!” I have used this belief to calm myself through anxieties throughout my lifetime.

Many of my therapy clients were not so lucky.

Their parents did not give them life survival skills because they were too caught up in their own pain. My clients-as-kids dared not imagine a brighter future; life was about minute-to-minute survival. Fantasizing about a happier time was a luxury they could not afford. Keeping expectations low protected them from being blind-sided by more disappointment. Why set yourself up, when the other shoe always drops?

This adaptive survival strategy becomes a problem when they’ve grown up, escaped their dysfunctional families and built loving homes. They cannot allow themselves to see and appreciate how far they’ve come, to experience joy in the present, nor to dream. Expecting to suffer, they make sure that they do, even if it is of their own making. Plagued by chronic anxiety, they still anticipate the worst. They may call themselves “cautious”or “realistic,” but this life-stance can morph into chronic negativity and even paranoia.

I use a powerful imagery exercise with these clients. Here’s how it goes:

Close your eyes and connect to a recent moment when you actually DID feel good, even if it was fleeting. Now turn up the volume on that moment and really EXPERIENCE it. Then, while holding onto that feeling, imagine yourself walking back into the past, down a long hallway with many doors. Pick a door and walk through. You’ll see a vision of a child in the distance, sitting in front of your childhood home. As you get closer, you notice that the child is a younger version of you. Sit down beside that child and let them know, “I’m from your future, and It Gets Better.” This child has been waiting for your arrival, waiting to hear from you. The child has been wanting to share the pain they’ve been experiencing, so you just listen as the child shares their pain and sadness and anger. After a while, pick her up and carry her with you away from the house, through the door and back into the Here and Now.

Often a person who has experienced a painful childhood is reluctant to go back and greet this child-part of herself. She may say, “That’s ancient history. It doesn’t affect me now. Why go back and feel all that pain again?”

Far from “not being affected” by our histories, in fact, that CHILD may be running the show (like the little man behind the curtain in The Wizard of Oz). The kid-part can lead us into poor relationships and bad career choices. She may push love away, or fuel deep sadness, uncontrolled rages, gripping addictions or paralyzing anxieties.

Sometimes the reluctance to travel back in time is really because deep down she believes she was essentially a bad kid and deserved the poor treatment she received. Or she fears that if she connects to that kid, she’ll feel burdened and drained by her incessant needs and demands.

In fact, by re-connecting to and embracing your child-part, and letting yourself know that this time you will be heard and cared for properly, you may start to feel more whole… and more hopeful. When the kid-you hears “It Gets Better,” the adult-you may be able to actually relax and experience some childlike joy again.

Re-connection and hope will get you through…

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for ShareWiK.com and mindfullivingnetwork.com. You can visit her on the web at dinazeckhausen.com and MyEdin.org.

Carrying a Family's Weight

Cara has been seeing me in therapy for several years for help with her food and weight issues. A bright, attractive woman married to a great guy, she has a significant amount of weight to lose. Over the years, she has lost weight through dieting only to gain back more than she originally lost. The extra weight holds her back sexually with her husband, decreases her physical activity and has contributed to arthritic pain. She fears that cancer, heart problems or diabetes could be in her future.

Through the course of our work, she has made tremendous progress in multiple areas. She’s set up her life to pursue her many creative gifts, including building a career that combines her business savvy with her passions. She and her husband have improved their communication. She has widened her network of support and developed deeper and more authentic friendships.

However, her weight has barely budged. Frustrated with herself and this therapy process, she wonders if the change will ever take place. She has trouble trusting that, in fact, she has been putting the pieces in place for her to finally succeed.

There is a term in Science called “homeostasis,” defined as: the property of a system that regulates its internal environment and tends to maintain a stable, constant condition. Family therapists use this term to describe the family system. Members of a family often feel pressure to remain the same so as not to throw the system off balance. Rigid families discourage change, while flexible families are more likely to evolve in positive directions together.

In a healthy family, the dramatic weight loss of one member may cause everyone to get healthier; the system is flexible enough to “bend” and it can re-organize itself at a higher (healthier) level. But in a rigid family system, one member losing weight may put too much pressure on the family. Sometimes the family cannot bend that far, and it breaks.

For Cara, the fear of this break is at the root of her weight problem. Losing the weight for good will take a profound and deep mental shift. In order to consistently make the daily changes, she will have to re-write her family story--a story which was composed generations ago. Then she will need courage to hold onto her new story while remaining engaged with her closest family members.

Cara grew up in a working class family in a small town. Her parents divorced when she was a kid and it was her job to care for her younger sister, do well in school and be the emotional caretaker for her parents. As a child she comforted herself with food (like everyone in her family). No one spoke of, nor thought about, the concept of emotional needs. Life was about daily survival.

Cara grew up fast. Bright, exceedingly capable and responsible, she pretended that she was fine so as not to trouble her family. Over the years, her weight climbed as she buried her feelings in food. She went to college, got a job and left her small town for the big city.

Cara was saddled with two conflicting family messages: while it was her role to bring esteem to her family (they loved to “brag on” her successes) it was also conveyed that she should never act “too good” for her family. The no-win message was:“Succeed!... but don’t make us feel bad about ourselves. Make us proud, but don’t get too big for your britches.”

As an adult, Cara can now see from the outside how her family has made and continues to make poor life decisions, how they are often the cause of their own misery. There is a sense of fatalism and passivity in her family. In all the things they say and do, this message is conveyed: We are unlucky. Bad things happen to us. Let’s pray things get better some day, but we might as well EAT since our fate is out of our control.

As a successful, married woman hundreds of miles away, Cara has proven to herself that she is the writer of her own script. But when it comes to her weight, Cara has bought the family myth: There is nothing I can do about it. We’ll just see what happens. Maybe someday it will change.

But the core fear is that eating healthy, exercising and feeling good in her body will mean that she has out-grown her last connection to that which is familiar. When she goes home, their idea of fun is eating lots of fattening and delicious food. They bond through Food and the misery of being overweight. If Cara makes a healthy food-choice in their presence, they chide her for being a “party-pooper.” In her family the unhappy, over-weight women view women in healthy bodies as alien, superior creatures: it is an “Us vs. Them” mentality.

While being an “Us” may kill Cara, being a “Them” feels like abandoning (and being abandoned by) the family she loves.

Cara will need to accept that it is possible to BOTH take care of her body AND love and connect to her family members. She will have to develop stronger psychological boundaries, so that their suffering does not become her burden to fix. When they tease her for being healthy, she can learn to not take it personally. Cara can find a new way be part of her family, with physical energy and healthy self-worth.

There may be more tears shed in my office as she grieves the loss of the old, familiar way of being close to her family, but she can learn how to forge new healthier bonds without sacrificing her own well-being.

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for ShareWiK.com and mindfullivingnetwork.com. You can visit her on the web at dinazeckhausen.com and MyEdin.org.