Q & A with Eating Disorder Specialist Sari Fine Shepphird: Part 1
Sari Fine Shepphird, Ph.D, a Los Angeles clinical psychologist and eating disorder specialist, is the author of 100 Questions & Answers about Anorexia Nervosa. Psych Central contributor Margarita Tartakovsky, M.S., spoke with her about common myths surrounding anorexia, the media’s impact and healthy body image in kids. Be sure to check out Part 2 of the interview next week. For more information about Shepphird and her book, please visit her website.
Q: In your book, you discuss several prevailing myths, including: people choose to have anorexia; they’re just trying to get attention; anorexia is about vanity; a person can’t have anorexia if they eat three meals a day; and anorexia is just a phase. What kinds of myths do the media circulate?
A: One of the things, unfortunately, we see is that tabloid magazines or TV shows talk about anorexia as a tween or young celebrity’s way of getting attention. We see it portrayed as a lifestyle choice. However, anorexia is an illness, and no one would choose to have such a serious, debilitating mental disorder. We also see it portrayed as an extreme diet. However, anorexia isn’t just about food. It does involve disordered eating patterns, but there are other underlying issues. Anorexia has medical, psychological and social consequences — and most are devastating.
Corollary to that, if a celebrity has been underweight and then gains some weight, the media starts speculating about their massive weight gain or pregnancy. For example, the media will include a photo of a celebrity whose stomach is barely protruding and put her on “pregnancy watch.” This encourages the mindset that women are supposed to be too thin.
One of the worst myths about eating disorders is that you can tell if someone has an eating disorder just by looking at that person. If someone has anorexia, they often try to hide it through the clothes they wear. Or, they might drink a lot of water so their stomach looks bloated. Also, if a woman is tall or big-boned, you might not recognize that she has anorexia and individuals with bulimia might appear to be at a healthy weight. An individual might be underweight, but this doesn’t mean they have anorexia. If a person gains the weight back, it doesn’t mean they’re no longer in recovery, because weight restoration is one aspect of recovery from the illness.
Q: You list tips for distinguishing unhealthy exercise from healthy exercise and suggest people ask themselves: Am I exercising more than 5 days a week for more than one hour? Do I exercise in order to lose weight because I feel obligated to, or because I enjoy the activity? Do I try to squeeze in “hidden” exercise in order to compensate for calories consumed?
Interestingly, I’ve read these tips in various magazines, such as “walk an extra flight of stairs after eating a cookie.” What kind of potentially harmful advice have you observed?
A: There has been this new trend based on the book, Eat This, Not That: Dieticians are using the mass media as a tool to talk about which foods have less or more calories. Sometimes a dietician might say you should skip the thick crust pizza and have the thin crust instead, because you’ll have to run for two hours in order to burn it off. This isn’t true; it is a fallacy to say that one has to exercise for every calorie one consumes. Our bodies are naturally burning calories to take a breath, to wake up, to heal from a cold, to do regular activities in daily life that sustain us.
It is a myth to think that we need to burn off every calorie that we consume through exercise. If we want to maintain our weight, we actually only need to burn off whatever calories are in excess of our metabolic rate. A person can do an equation to calculate how many calories they should be eating per day in order to maintain a normal weight. To calculate one’s basal metabolic rate (BMR), one can use the following formula, but keep in mind that the formula is not exact as BMR can vary based on bone structure and amount of physical activity that one engages in. Or, visit the website links here or here.
Women: BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x height in inches ) – ( 4.7 x age in years )
Men: BMR = 66 + ( 6.23 x weight in pounds ) + ( 12.7 x height in inches ) – ( 6.8 x age in year )
Because of the way food is talked about, it is presented as something to fear, as though food is going to automatically cause weight gain. This is a dominant message in the media. The truth is that food sustains your life and lets you enjoy it.
People will avoid eating foods they like because those foods will make them fat. “If I eat that, I’ll have to exercise, so I’d rather just not eat it.” Exercise and food are presented as though both are equal and opposite enemies, when the truth is they’re both very valuable for our heart, brain, digestive system and our mental health to reduce feelings of depression and anxiety. Exercise is a positive thing that shouldn’t be feared or loathed. What we’re told in the media is that we should have a thin body above all. In order to get that thin body, we should be starving ourselves, through torturous exercise.
I have a lot of clients (and I think this is true for the general population), who will say, “I exercised for half an hour. It was kind of easy, and it didn’t hurt, so I don’t think it was enough.” Unless exercise hurts them and is so rigorous and vigorous that it feels like a punishment, they don’t feel like they’ve exercised enough. Exercise should be enjoyed. It is movement that we can appreciate. I would not recommend people choose forms of exercise that they hate. They’re less likely to do it and it ends up being something that brings discomfort and dread, not fulfillment.
The tabloid media ends up seeming like more of a source of authority than science! Celebrities often sell stories and ideas, so we hear about their weight-loss methods rather than what science says. Moderate exercise is the most beneficial. It has just as many benefits as rigorous exercise. Even 10 minutes, two times a day benefits the body. But instead we hear about celebrities who exercise in extreme heat, exercise until they feel like they’re going to drop, and we think that is what we should be striving for. But it contradicts what science says. The same is true for books, where the author tantalizes readers into learning about celebrity weight loss, when some of the tips aren’t a secret at all; they’re just common sense. Or, some aren’t proven by science and some are dangerous.
Q: With so much bad information out there, how can people distinguish between accurate and inaccurate advice?
A: The old adage applies: “If it sounds too good to be true, then it probably is.” When you hear about new fad diets, it’s something that should be considered suspect, because what we know about nutrition and healthy eating isn’t new; it’s long-standing. It’s important to eat certain servings of fruit, vegetables, grains, protein and carbohydrates, but watch the saturated fats and avoid hydrogenated oils. It’s best to stick to the basics that we know about healthy eating and exercise. When you go beyond those simple rules about eating, then you’re probably getting into some sort of a fad, or new training method someone is trying to sell.
Trainers make money when coming up with a new approach. New or different sells, because so many people are looking for that quick fix, for that shortcut to a healthy lifestyle. The straight path, the one where you don’t need a shortcut, is actually the simplest. I teach others about the concept of intuitive eating, which has these basic principles: to eat what satisfies you, to eat when you’re hungry, stop when you are full; to enjoy movement and to find pleasure in it; to eliminate the diet police, the diet way of thinking. To do these kinds of things and to approach food in an intuitive way is the most natural way. Yet many people are skeptical of this because there isn’t some sort of a gimmick. It’s almost as though we are confounded by the simplicity. Also, if people aren’t being deprived, they may believe they aren’t doing enough for weight loss. A healthy diet should be satisfying.
Advertising has such powerful messages. We swallow slogans as though they’re based on science, as though they’re a prescription for a lean body. One helpful thing is to become savvier with media literacy, to understand what an ad is selling. Food and diet ads are selling an image. Studies show that the images really work, and bring in consumers. Unfortunately, these advertising agencies sell an image of deprivation, starvation or guilt for eating something that’s tasty and pleasurable. They’re selling an unhealthy relationship with food.
If people were able to eat more intuitively and to move because they enjoyed it and saw this as part of what they could do for a healthy, pleasurable life, perhaps there wouldn’t be some of the struggles that we see with maintaining a healthy weight. For example, we know that oftentimes binge eating comes after a period of deprivation. A person with an eating disorder may end up binge eating and eating far more calories than if they would have just allowed themselves to eat what they wanted. We tend to associate eating with decadence, being bad and feeling ashamed. We’re told to hide the food we eat (e.g., “don’t tell your husband”). We buy into this and then feel guilty.
Unfortunately, our media doesn’t necessarily support healthy practices, whether it’s the thin ideal, a negative relationship with food or equating exercise with discomfort. A lot of what we learn about our bodies from the media is inaccurate.
Q: When discussing unhealthy practices among kids, you include some startling statistics: In 1990, girls as young as 8 were dieting; 51 percent of 9- and 10-year-old girls reported feeling better about themselves when on a diet; one-third of boys used unhealthy weight control methods (e.g., fasting, vomiting or taking laxatives). How can parents help their kids develop a healthy body image?
A: Studies show that some of the ways in which boys and girls learn how to relate to their bodies are based on how their parents relate to their own bodies. The best thing a mom and dad can do is to have a healthy body image themselves. Refrain from making negative comments about yourself, such as comments about getting “older and fatter.” A child who repeatedly hears such comments may develop fear about gaining weight or may equate getting older with getting “fatter.” These days we see kids who say that they want to delay their own physical maturity. This is part of what we are witnessing as the dieting age is getting younger and younger. Kids may believe that if they delay their physical maturity, somehow they can stave off weight gain. They try to interfere with the normal process of development.
Also, model healthy eating by eating a variety of foods. Allow for a range of foods in moderation, including snacks and sweets. Avoid making comments that would induce shame, embarrassment or guilt. Don’t label foods as being good or bad. Encourage movement as something that is pleasurable. Again, the way parents relate to food, exercise and their own bodies is paramount.
Through both words and actions, parents should embrace a wide variety of body types and not idealize thinner people. Avoid teasing your own kids and others about weight-related issues. Certainly be sure to avoid making disparaging comments about overweight people and generally negative comments about weight gain. A positive role model for a balanced approach to diet and health in families can go a long way and is usually best.
Tartakovsky, M. (2016). Q & A with Eating Disorder Specialist Sari Fine Shepphird: Part 1. Psych Central. Retrieved on September 23, 2017, from https://psychcentral.com/lib/q-a-with-eating-disorder-specialist-sari-fine-shepphird-part-1/