Your Interview

Hi! I'm 27 years old and I've 47Kg....I think I'm under normal weight to my age,so, I would like to ask you how to get more pounds? Thanks

Brian Chittock: Hi Charlotte, we are all of different sizes and shapes and it is hard to really determine what is actually “normal.” I think it is more important for you to focus on eating well and eating when you are hungry rather than worry how much you should weigh. I suggest you eat a variety of foods that you enjoy eating and be sure to eat when you are hungry. Our bodies are wonderful machines and have built-in signals to let us know when we are hungry or tired. It is important that we listen to those cues. It is also better to eat more meals but in small amounts more frequently. So instead of just three main meals a day, it is often better to have 5 or 6 smaller meals a day.

As a nutritionist, do you work in conjunction with psychiatrists/psychologists to treat eating disorders? What do you see as the current trend, eating disorder-wise?

Jacqui Gingras: Working collaboratively with other members of the health care team is ideal. Since eating disorders and disordered eating arise from varied issues, recovery requires engaging the physical, mental, emotional, relational, and spiritual aspects of a person’s life.

I believe current trends in recovery are body-centred approaches that provide support for people to expand their personal resources in the areas of creativity and mindfulness. Additional focus is being given to an ecological/relational approach, which entails providing a context for the eating disorder. In other words, an eating disorder is not simply a manifestation in an individual. At the heart of eating disorders is a social issue of how relationships and people are valued.

How is it possible for girls and women to have a positive body image, while emaciated, yet successful role models in the fashion and film industry prove otherwise?

Brian Chittock: First of all, who ever said the fashion and film industry provides us with role models? I was never brought up believing this. We need to provide our children, boys just as much as girls, positive role models in our every day life and not let the fashion, film, diet, pharmaceutical, and magazine industries try to make us believe that what they promote is “normal” and what we should all strive for. They are selling products. They are not providing society with role models. When we realize this, more girls and boys and women and men will have healthy and positive body image and self esteem.

1.In your opinion how strong is the media's effect on girls and their self perception?

Jacqui Gingras: Laura, you have touched on an important issue. I believe media’s effect is part of a larger systemic pressure that suggests people (men, women, girls, and boys) don’t measure up to an impossible standard. Simply put, that impossible standard is created by advertisers to create a demand for different products (diet pills, shakes, bars, make-up, spanx, etc). It is important for young people to hone their media literacy and be able to critically evaluate the messages in the media.

We all need to be able to “talk back” to the messages that say we aren’t good enough as we are.

2.Which medium do you find the most problematic for sending messages of unrealistic body image and success goals to young girls?

Jacqui Gingras: There are a multitude of mediums/media, so I don’t know if one is more problematic. I think the amount of “face time” has decreased overall. That is, the amount of time we spend in contact with people who care about us, who care about each other FACE-2-FACE! Any media that manufactures an unrealistic image of people and promotes that as the norm is dangerous to our social esteem, how comfortable we feel in social situations.

How does one acuratley quantify the recommended caloric intake based on height, weight, age and activity level ?

In my younger years I dilligently followed the Canada food guide while living an active lifestyle, only to succumb to pretty drastic weight loss...whom should I consult to make sure I'm getting what I need from the proper food sources to maintain a healthy active lifstyle ? (ie , carbs protein et. )

Jacqui Gingras: Dustin, this is a great question! It can be difficult to figure all this out. What I try to encourage among people that I work with is to do two things: 1) eat a variety of foods that you enjoy and 2) eat when you are hungry and stop when you are satisfied.

Being satisfied is very different that being full. I will introduce you to a hunger meter — a very simple tool to help you determine how much you need to eat. The scale is from 0 to 10: 0 is hungry, very hungry and 10 is full, very full! Imagine the midpoint between 0 and 10 is satisfied; not hungry and not full. Try to start eating at the early stages of hunger (3-4) and try to stop eating around 5-6. This means we need to eat small amounts, frequently. That is basically how our physiology works — we are always using energy and getting lower on the hunger meter and then we eat something and shift upwards on the hunger meter.

This is all very normal and natural — getting hungry and eating. This works for most people, although if someone has ignored their hunger/satisfied signals for awhile, it can take time to reconnect to those signals. It is worth considering since it simplifies the whole issue immensely.

Do you think full recovery from an eating disorder is possible? How long does it take for the body to re-establish normal hunger and fullness cues once on a normal meal plan and abstinent of all behaviours?

Jacqui Gingras: Maureen, I do think recovery is possible. It can be very difficult and take a long time, but it is possible. It can take several weeks of patient listening to hunger cues to reestablish that trust. I believe it is worth the effort! I would highly recommend “Eating in the Light of the Moon” by Anita Johnston. It is a very good book that explores the purpose of an eating disorder in someone’s life and sheds light on recovery as connected to other issues in a person’s life i.e. relationships, media literacy, resiliency.

What are some of the warning signs that disordered eating probably needs professional intervention (speaking specifically of a teenage girl)?

Jacqui Gingras: This is something to speak with your doctor about in the specific context of that teen’s overall health. Early intervention is always a good idea. I recommend connecting with Jessie’s Hope for ideas (www.jessieshope.org) and Sheena’s Place for an excellent slate of workshops and supports for everyone (www.sheenasplace.org).

Consider the health of your relationships and ways in which to help enhance relational resilience. Relational resilience is the newest focus in prevention of eating disorders. Additionally, Jessie’s Hope has a video contest to promote positive body image, which is a great idea for youth to enhance media literacy and focus on positive messages in the media.

A friend of mine told me that she will be moving from her parents house because her mother constantly makes remarks about her body which makes her uncomfortable. Can you tell me how she should discuss with her mother this topic and make things better rather than move out?

Brian Chittock: Well no one likes to feel uncomfortable and your friend really needs to try to understand why she is feeling so uncomfortable about this. She should really deal directly with her mother and tell her when she says something, that she feels uncomfortable by her remarks. Perhaps it would help if you could be there during one of these times and be supportive of your friend. It really sounds like your friend and her mother just need to sit down and communicate.

What is the optimal weight for a girl/boy at a certain ages? Please provide a range so that girls/boys of varying frames can see that they may fit in a normal healthy range.

Jacqui Gingras: Ah, this is such a tricky question! Every body is different and girls and boys can be healthy at a variety of shapes and sizes. If we continue to focus on weight ranges, we narrow our definition of health to a certain weight. It actually makes the problems worse. We are too preoccupied with weight! Can we look more holistically at this issue?

Is the child/youth eating when s/he is hungry and stopping when satisfied? Is the child/youth physically active and enjoys a variety of activities as part of living well and having fun with others? Is the child/youth enjoying positive relationships with others? Is the child/youth valued for being human and for having an important place in the world simply because s/he is human? I know I didn’t answer your question directly, but I have found through experience that we need to broaden our idea of health beyond weight.

Is it possible to have a healthy body image and yet still want to lose weight? I have a friend who is overweight and needs to lose weight for health reasons. She also hates her body but doesn't believe it's a problem because she actually is overweight.

It doesn't seem right to me that she should hate herself until she is at a healthy weight. It seems to me that it should be possible to love and accept your body; yet still want to change it so that you are healthier. But I don't know how to explain this or even recouncil the somewhat opposing ideas to myself. Please help.

Thanks.

Brian Chittock: Having a healthy body image has nothing to do with how much one weighs. It is simply an inner acceptance of who you are physically, no matter what your size. I think it might be easier for you to help yourself first by learning how this inner acceptance works. Jessie’s Hope Society offers free introductory workshops on our approach to innate health and resiliency. You can contact our office for upcoming workshops at info@jessieshope.org.

Are there signs in children that may be seen as warnings for eating disorders in later life?

Brian Chittock: Yes there are many warning signals. But they vary greatly. Children may develop unhealthy eating behaviours as early as 5-6 years of age. Even earlier in some cases. While they do not necessarily have an eating disorder at that point, it may be the beginning of one which will usually manifest itself when the child reaches age 15-22. Increasingly, we are seeing more boys developing unhealthy eating behaviours, but it continues to be a major issue in girls.

For more information on warning signs, please visit: http://www.nedic.ca/ or http://www.nationaleatingdisorders.org/

With warning signals, it is important to ensure intervention for the child however, it is also important that we encourage children at an early age to be in touch with their innate health and wellness to help them through difficult times and to be able to use their skills, understanding and resiliency against what life throws at them.

As an immediate family member, what can I do to aid in the recovery of a loved one suffering from bulemia?

What, if any, support exists for families of loved ones suffering from eating disorders?

Jacqui Gingras: Again, there are lots of great resources online. Look at Jessie’s Hope under Resources for some innovative stories and ideas (www.jessieshope.org).

It is very important to be informed and to have a solid support system for yourself. Try doing things together such as meditation or pottery. Visit Sheena’s Place if you are in Toronto or check out your community centre for fun activities that break the focus on the more medical aspects of recovery. If your family member has a good health care team, they will need support in the other areas such as the spiritual and relational aspects of recovery.

Is family therapy an option? Talk to your family member’s care team for suggestions that are appropriate in the context of your family member’s situation.

I've lived with an eating disorder for more that half of my life. Now as an adult, 30, avenues towards recovery are generally directed towards younger people. Is there a place, a program, an anything...for adults (with children) to make their steps towards a healthier life with a healthy outlook on food and body image?

Jacqui Gingras: Good point. I do appreciate the perspectives in “Eating in the Light of the Moon” by Anita Johnston. Her work is unlike any other on the subject of eating and body image concerns. You may already have a great therapist, but if not, try to find someone that you can really connect with, perhaps one with a relational perspective. The issues for girls and women originate in similar places, but the way they manifest are different depending on where the person is in their life course.

You may have to re-invent some resources that work best for you or even create some of your own. You could consider authoring a book to explore this under-explored area further! In Edmonton, there is the Eating Disorder Education Organization, which you may have heard about (http://www.edeo.org/). They will likely have some excellent resources to consider or even be open to facilitating a support group for women seeking something similar.

Why is it that when people speak of eating disorders, they tend to be speaking of anorexia/bulemia? Over-eating is also a very serious, sometimes more serious, eating disorder.

Jacqui Gingras: Marie, you bring to light the fact that eating practices and weight concerns are but symptoms of underlying issues such as low social esteem and relational disconnections. Regardless of the way a person looks or how much s/he weighs or the manner in which s/he eats, the possibility for enhancing relational resiliency is a means for reducing the prevalence and incidence of eating disorders. Sheena’s Place provides workshops and groups for people of all shapes and sizes, which I find refreshing since it breaks down the walls that separate and divide people. Let’s talk about what works, what we can do differently, and how we can support each other regardless of what category we find ourselves in.