What Hinders Eating Disorder Recovery

Following from an earlier post about what helps. There are also things that don't work for recovery.

Having a label pinned to your chest.

Too many therapists label you as anorexic or bulimic, or an addict. Having a diagnosis doesn’t fully describe who you are or how you got the problem. We don’t call depressed people “depressives”. The ED is an illness, but you are not the disorder. Discovering the pathway into your disorder and what is keeping you stuck is better than a label for aiding your recovery.


Trivilialising your symptoms and experience.

Some support systems are not supportive, with family members ignoring the eating disorder altogether or not taking it seriously as a difficult issue that needs attention. Some people call it stupid or vain. They might say “Don’t you know better, you are an intelligent girl.” Or they say you are not fat or thin enough to warrant concern.
Families and friends need to understand what an eating disorder is. They may think that if you just eat more, the problem will be fixed. One girl said that if her parents had come and said lets all talk about this, how you are feeling, what is our role in this, it would have been awesome.


Too much focus on food or on weight.

I’ve heard it said, it’s not about food, it’s about feelings. It is both of course. Your weight might be important, but it is not the only thing we have to attend to. Many people say that the scales are too powerful. So many people don’t feel good enough because they are not thin enough according to their value system. So feedback about their weight can be hurtful.

Focus on health trumps focus on weight for sufferers and no-one must make a big deal of small changes in weight. Emma Woolf, writing in the Times said that focus on weight is crazy. Half the population is given brownie points for losing weight, while people with anorexia are told that to gain is good. How is it helpful to have one rule for some and one rule for others? Therapists must pay attention to overall health and wellbeing. Weight is part of that of course because you cannot be healthy too thin or morbidly obese. Moving focus away from weight and weighing fosters self acceptance. You can learn to stop using the scales as a way to gauge if you are OK, or not.


Being secretive.

Some therapists listen to what you have to say without giving you any feedback. They take notes about your story without helping you to make sense of it. Talking on its own isn’t helpful. Practical skills are helpful, like teaching someone how to eat healthfully and, significantly, how to reconnect to their natural appetite. (how many therapists know how to do Appetite Sensitivity Training?)


Isolation hinders recovery.

But I’m not sure if being in a group with other people with an eating disorder is the best company. There are times to stop thinking and talking about eating disorders and get on with life. Relationships suffer as a result with eating disorders and repairing these relationships is one reason why people decide to try and get better. Helping people to make these repairs and especially helping someone to forgive themselves for all the wasted time and family disruptions must be major part of treatment.

It also helps if we can teach our clients to eat with other people, and socialize without having to put on acts with other people. Learning to be comfortable with other people breaks the wall of isolation that can keep someone trapped in an eating problem.

Being stereotyped and stigmatized.

Feeling ashamed puts up a barrier between the sufferer and other people and we know that poor connection makes the disorder even worse. If someone had cancer, people would have been there for them, but people think that an eating disorder is self inflicted. If other people can’t always be kind, start being compassionate toward yourself.
Make sure that everyone around you learns what an eating disorder is and why some people fall ill, not others. Carers and friends all need to have this information so that they can be a source of help.


The wrong treatment.

While some people get good treatment, others get treatment from judgmental professionals who do not know how to work effectively with eating disorders. Being patronized and criticized destroys your confidence that therapy can work. Providers can inadvertently look down on someone who is struggling with food, and even make threats or hurtful comments rather than trying to understand. Working shoulder to shoulder together rather than face to face is how providers should behave.
Therapists who don’t even talk about food (it’s about feelings, not food) aren’t helpful. Patients express appreciation for learning how to start eating safe foods, and how to listen to their bodies for hunger cues. Getting in touch with hunger and satiety in recovery is important, as well as learning how to eat in front of other people, changing eating rules, and learning how to cook.

It’s really sad that very few people know what good treatment really is, they just have to take what they can get. If a sufferer is difficult, angry and combative, this is the disorder speaking. Good therapists should be able to work around this.

The 5:2 Diet? Good, Bad or Mad?

Laura and Miriam asked me to comment about the Intermittent Fasting or 5:2 diet which has been attracting rave reviews on the “inter-web”.


Scientists have long known about some of the benefits of fasting for longevity. Fasting reduces levels of hormones like IGF1 (insulin growth factor), implicated in accelerated ageing and age-related diseases like cancer and diabetes. It also seems important to reduce your protein intake, so calorie reduction can’t be attained by eating lots of protein – a la Dukan.

Scientists at the University of Illinois have trialled a variant of continual fasting, which they describe as Intermittent Fasting. In an 8 week programme,  people eat fewer than 600 calories on 2 days a week with eating what you like on the other 5 days. They have claimed that it improves IGF and other ageing markers as well as enabling weight loss. Here I insert a warning, this trial was only for 8 weeks and we don’t know what happens in the long term.

There is a Fasting For Longevity movement in the USA. Members have been studied extensively. While they claim to have no issues with weight and eating, most show similar personality characteristics to people with anorexia and they display all the signs of people with classical eating disorders, preoccupation with food, cravings and high levels of emotional distress.

The 5:2 way of eating intended for longevity has been captured by the weight loss movement. Now there's a surprise!   For weight loss, this isn’t new. In the 1980’s it was deemed useful to eat sparingly during the week and eat everything you like at the weekend. Many people lost weight on this regime and then- hey - they put it all back on again. Feasting and fasting isn’t the good idea that it is supposed to be.

Behind the hype, even the BBC admits that current medical opinion is ambivalent about the benefits of fasting. Psychological opinion concurs. Fasting and feasting drives people into polarized thinking, good and bad day mentality and catastrophic reactions when dietary rules are breached. Apart for providing fodder for the pro- anorexia movement or the orthorexic community, this insensitive publicity may lead people to thinking that they are doing something that they should be proud of, when they may be doing something which isn’t really very good for them at all.

Let’s take some of the research which was NOT given head space by Michael Molesey and his team. A number of robust studies show that after one month on intermittent feeding, experimental aniamals show a series of behaviours similar to the effects of drugs of abuse. They begin bingeing, and during fasting periods there are withdrawal signs indicated by signs of anxiety and behavioural depression together with enhanced longing for sugar.

Brain imaging shows gross and complex changes in opioid systems such as decreased enkephalin expression in the appetitive system in the nucleus accumbens, with reduced dopamine levels (reward chemicals) and increased acetylcholine (stimulating appetite). The net effect is the creation of sugar dependency together with cross sensitising to other drugs of abuse.

Feasting and fasting thus risks bringing forth long term problems with control of food together with the emergence of compulsive behaviours and emotional problems too.

So with humans as with rats and other primates, it’s useless to test one set of behaviours in a vacuum for 8 weeks and present it as a panacea for weight and other issues. Mr Mosely may have felt good on this diet, but it's pointless for the millions of people out there who have eating disorders and for who this diet could make things considerably worse. I have given this issue lots of head space and I conclude that programmes like this are unbalanced and risk creating false hope for anxious people who are trapped in a poor relationship with food. As the man said, “fasting, like eating, is best done in moderation”

An Axe To Grind

Today I received this email from a young woman

“I am taking part in a 54 mile cycle ride from London to Brighton on the 16th September!

I have struggled with anorexia since I was 8 years old……. After two lengthy hospital admissions and being pushed to breaking point, I am now fighting back with the help of day care. I am not alone in my struggles, there are an estimated 1.6 million people in the UK suffering from an eating disorder; anorexia has the highest death rate of any psychiatric disorder. However, it doesn't just impact on the sufferer, …………. It isn't only the sufferer who requires help in coping and b-eat acts to provide such support.

I am fundraising to help show that eating disorders can be beaten and give something back to the services to which I owe so much for still being here today! Money will go to Beat the eating disorder charity.”

I struggle to understand how B-Eat can raise money through promoting excessive exercise, being done in particular by people who are struggling to recover from anorexia. Is this how we teach people to B-eat eating disorders and all its symptoms?

B-Eat, are you listening? I will give money to people you encourage to have a rest-in. I don’t think anything else is smart.

Debate?

The Wrong Treatment

Hi to all my bloggees, I've been away for a while just thinking about what I need to be paying attention to and watching the Olympics.
I’ve just had a 65 year old woman on the phone wondering how much we charge for treatment and if we had a helpline for her to pour out her troubles with lifelong binge eating.

I said, yes treatment costs money and a helpline won’t help you, only treatment will help you.

Have you had treatment before?

I hear that she has had some really good treatment. She has had “counselling”. Her counsellor told her to imagine that there was a bowl of sick in the fridge alongside all the other foods. Her counsellor told her that she would lose her toes if she continued overeating and that being fat made her a bad mother. Her counsellor knew bugger-all about nutrition and the brain. Her counsellor told her just to eat cereals whenever she felt cravings. Duuh?

Then she had really good CBT. Among other things this person told her to imagine that hair was all over her favourite foods. Was this CBT person an eating disorder specialist? She didn’t know.

Now she has spent some time at a slimming club. Her leader suggests that she should eat a whole chicken every time she wants to binge and this will cure her.

This poor soul has gone through this counselling travesty believing that she is a hopeless case. I told her that I was sorry for her, having such appalling “professional” help.

People with eating disorders need  Eating Disorder Specialists. They don’t need ex-sufferers or addiction specialists, or generalists, or therapies not grounded in evidence at the very least. Therapists can only play with their toolboxes when they have the right kind of training. This training must be very long and very deep.

I don’t know whether we will hear from this poor soul again. I hope we do. I hope that she can look inside her purse and come to us to change her life.
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Have you had lousy treatment?  Tell me all about your rogues galleries of bad therapists. We can put your stories up on the blog and stick pins in them. Or just stick pins in them.

Eating Disorder Recovery - What Helps

This is how it is from the view of sufferers

Its not just about being a good therapist. Or having the right tools.  We must realise how scary change can be. We must know what isnt helpful - that's the subject of my next blog!

The client is the expert, not us, as Emma Woolf showed us in her memoire of recovery, “An Apple A Day”. But, the client still needs us by their side as what… A therapist? A mentor? A guru? They need our wisdom alongside their own. They need our sense of humour and basic optimism. They dont necessarily need our University Degrees. They certainly dont need "what worked for us".

This is what they tell us aids their recovery; in no order of importance

Reconnection: – but not, I think the pro anorexia, community. People way that doing things like YOGA JOURNALING and SPIRITUALITY helps them to reconnect to themselves. Therapists take note!

Close relationships: Knowing that your family and friends really care about you and you are in reach.

Statements of support: "I know you're trying"  “I’m there for you” – what other statements are useful and what are not.? If someone says “You are looking better these days” it can send your client into a spiral of worry.

Empathetic Friends: Its useful if your friends know what they can and can't do and say.

Compassion: Eating disorders are such hard work.Compassion must flow from us to them and they need to learn to be compassionate for themselves whatever they are doing.

Therapy: it’s good to know that therapy helps as well, but looking forward is more important than looking back. Beware of therapists who don't know anything about nutrition, or the link between food and mood. But beware of therapists who focus on food instead of your general wellbeing.

Learning HOW to eat healthfully: Now there's a big chunk. There are so many food rules inside eating disorders, like being scared of carbs and counting all your calories. Wisdom, education, experimenting and reconnecting to natural cycles of hunger and satiety must be given by an expert not just someone who wants you to start eating more (or less).

This was in The Journal of Treatment And Prevention:  May-June 2012

The NCFED website tries to provide this help to people with eating problems. If there is anything that we can do or write to help people on their recovery journey, let us know. A quick email to admin@ncfed.com will always guarantee a personal reply from the Founder, Deanne

The Men Who Make Us Fat

Last night I walked down Marylebone High Street, London. Every two yards there was another place to eat, a Pain Quotidien, a cafe, an epicerie, a Costa Coffee and a cake shop from heaven. People were eating as they walked along the street.


20 years ago I walked down the same street and every 100 yards there was a place to eat and very few people ate as they walked.

40 years ago I walked down Marylebone High Street. There were no places to eat, lots of other shops and no one ate as they walked.

They assume that people who gain weight are weak willed. On the contrary, people who keep their weight stable have to work really hard 24 hours a day 7 days a week to avoid - like bouncing bagatelles- the food they see around them saying "eat me now, you will feel nice, I will give you a lift, you don't need to be hungry -you just need to be wanting a bit of fun and what's the harm in that".

On top of that are the dangers that we can't see; the men who made us fat have inserted them quietly into the food we eat. Corn syrup, tastes so nice but it is food that our body cannot deal with properly. Relax, have a beer, or a bit of ketchup on your chips. It will make you fat while it makes them rich.

Going shopping? Have a packet of crisps, it will reward you for doing all that hard work. They made it big so you would spend more money and feel virtuous because you hadn't bought 2. They knew that you would eat it all up in one go because thats what people do. And while you were scoffing, it made them rich.

Did you know that the food industry has blackmailed, denigrated, rubbished and possibly even murdered the people who wanted to tell you the truth? They have bought or crushed the politicians who could have done something about this. They wanted to make you fat so that you would need what they had to sell you.

And everyone is frightened of taking them on. See that bag of treat sized chocs? See that double caramel flavoured frappucino? JUST SAY NO.

Bulimia Suicide: Is Fashion To Blame?

A 14 year old doctor’s daughter has hanged herself. She has been suffering from bulimia resulting apparently from fat teasing at school. The coroner blames the fashion industry. He suggests that 30 years ago young women were not exposed to as many thin images as they will find now everywhere they look – not just in magazines. He is right.

The death of a young woman on the threshold of her adult life is horrible. Equally horrible is living with the stress of bulimia. Equally awful is the pain of having so many emotions that are so unbearable and overwhelming that the only way out is to self destruct in this final way.

We don’t know the full story; her parents had taken her laptop away and this is information which we don’t yet understand.

We do live in a different world right now which crept up on us silently like cats paws. So many things - not just fashion magazines - make it hard to float above the waves. 40 years ago I could walk for 5 minutes down the High Street without seeing one fast food joint, not one single restaurant and not even a coffee shop. People only ate at home.

I could go shopping without having to choose between 30 different types of crisps or 40 varieties of yoghurt and we bought our chocolate in bars so small that they were gone in just two bites.

I didn’t have to worry about being left behind in case I missed an episode of East Enders, or stay awake at night in case my friends were talking about me on Facebook. There was very little fat teasing since very few people then were fat.

I didn’t have to worry in case I couldn’t get into skinny jeans and cropped tops because they simply weren’t cool back then. We didn’t have to be exposed or die.

We were able to have fun in our own way without being in the glare of social media for people to comment on and pass judgment on. We were able to have fun without the need for drugs or drink.

Life went by more slowly, so even unhappy people had time to digest their emotions and try to make sense of them without the help of this army of counsellors and psychotherapies and peddlars of happiness that we have today.

So the coroner wasn’t quite right to pour blame on the fashion industry. There have been too many changes making it hard for anyone to survive their teens intact.

But why didn’t this young girl get proper help from an eating disorder specialist? Perhaps I could have saved her life. This haunts me. If you know a 14 year old with bulimia call me NOW! 0845 838 2040.

Anorexia And “Force Feeding”- Self Determination Or Self Annihilation

Today I was listening to LBC radio regarding decision in favour of the so-called force feeding of patient E. On Saturday Norman Lamont suggested that the decision to force feed could be an intrusion on her right to self determination . What complicates this case is that the parents of this young medical student,- anorexic since eleven years of age-wants their daughter to be left to die with dignity.

There is nothing dignified about anorexia or any other mental health condition for that matter. Also, I just wish that people would STOP using the term “force feeding”, which reminds us of the traumas inflicted on hunger striking suffragettes wanting to obtain the vote for British women. I just wish that people would use the proper term, which is ENTERAL FEEDING.

Many clinicians have been writing in favour of the judge’s decision on Linked In. We talk to each other about things we know, which is that low weight impairs the ability to think clearly. That at low weights the anorexic voice drowns out logic, reason and happiness.

But nothing said it better than Kate, who came nervously to the radio to express her point of view. Kate has been anorexic since age 9 and in hospital many times during her young years. She said “I have no idea why I just didn’t want to eat, but I didn’t, and there were times when I would have been very happy to just fade away.


“But they didn’t let me, and there were times when I was on a section and they threatened me with the tube…. No it wasn’t a threat, it was just something they said would happen but it felt like a threat at the time. Having no control over what they put in it was the worst thing imaginable for me.


But I somehow got to the age of 20 and I said to myself, I’m sick and tired of this anorexia. It took 11 years for me to admit I had a problem. So I made myself start to eat. I’m 24 now and life is so much better. Life isn’t a bed of roses but anorexia is very hard work; and I had enough.


I spoke to my father about it and he admitted that he had something like me when he was in his teens, but being a man nothing was said or done about it.”

The interviewer asked, “Everyone is saying that it’s all the pressure on young girls to be slim, in magazines and so on?

“Oh no”, she said, “When I was nine I hadn’t even seen a magazine. It’s nothing to do with magazines and models, it’s just the way the brain is wired”.

So there you have it from the people who really count. Clinicians know very little. Listen to the people who have looked into the pit and been dragged into the light, kicking and screaming. At all costs we have to arbitrate in favour of the wish to live.

Is Undieting A Good Thing?

This week I have done an obesity training. One of the delegates said I should not be teaching therapists to help people lose weight or restrain their eating. I should be helping people to be healthy at any weight, even very large weights.
There is no doubt that dieting has consequences. Many writers say that dieting leads to compulsive eating and disconnects people from their real appetites. They are right. The first research into the effects of dieting was done by Ancel Keys in the 1950’s. He showed that dieting is linked to food cravings and to abnormal hungers for fattening foods.

A few years later, researchers (Herman and Polivy) have linked dieting to "eating dysregulation and disinhibition". These big words mean that dieters start eating in response to cues like food just being there, or any kind of emotion. People call this kind of eating  "comfort eating". Dieters think about food a lot of the time and another researcher called Kelly Vitousek - in her work with anorexics, concentration camp survivors, and people who restrain their eating for longevity - has shown that this kind of preoccupation is common among food restrainers.

We are all familiar with the kind of thinking that accompanies food restraint. One slip or lapse and the dieter can end up on a slippery slope. She says, I've blown it and carries on eating with a plan to re-start her diet tomorrow or next week. So even thoughts about breaking your dieting rules can lead to a heck of a lot of overeating.
By denying themselves food, dieters make it much more important. Dieters are more likely than non-dieters to turn to food when they are emotionally anxious or depressed. At a recent study carried out in London, female volunteers were divided into three groups, the first went on a strict diet, the second a rigorous exercise programme and the third neither dieted nor exercised. After 5 weeks the subjects took part in an experiment which assessed their food intake while watching a stressful film. Bowls of sweets and nuts were left beside them and they were told to eat as they liked. Women in the dieting group ate far more than the others.

Even thinking about dieting can make you overeat. In anticipation of deprivation to come, dieters’ indulgences “the night before” can reach legendary proportions. The seeming inability of dieters to stop once they have started, stem from the Faustian bargain they make with themselves at the start says my colleague, Sara G.
Undisputed as health risks of dieting are the eating disorders, particularly anorexia, bulimia and binge eating disorder, which can at their most extreme, be life-threatening. It is not surprising that when people with eating disorders do binge, they eat foods deemed forbidden in their dietary systems. Although not all dieters develop eating disorders, serious eating disorders are usually preceded by diets. There are many more people who diet than develop eating disorders, but over-restraint of food has a lot to answer for. So is the solution to give up dieting altogether?

Some writers propose that the solution to compulsive eating is to eat whatever you like including  huge amounts of food previously regarded as forbidden. This is supposed to reduce the attractiveness of forbidden foods, and to stop you from feeling guilty about how hard you find it to control your eating.

The implied promise of undieting is that weight gained as a result of compulsive eating will be lost. It promises that you will regain your innate wisdom of what your body really needs. You will get back in control of foods like chocolate and cookies, and eat them in small amounts again. This is a seductive proposal; after all dieting doesn’t solve the problem of compulsive eating. We are all familiar with the mantra of some of our clients, “Every diet, you name it I’ve done it and I’m fatter than ever”. But might this also be a dangerous thing to do?

I don't think that a knee-jerk return to undieting in overweight people is helpful. For some people, being on a diet is the only way they know of being in control of food. Such people could be described as “diet addicts”. Giving up food restraint altogether may result in rapid weight gain unless appropriate advice is given.

An “un-dieter” eating large amounts of “desired foods” will also risk harms to their health. The eat-all-you-like solution is unethical. If you eat large amounts of your favourite food because someone has told you it is a good idea, you will rapidly develop symptoms that will take you down a long road toward diabetes ......if you don't already have it. That won't help you very much at all.
Undieting won't help change ingrained bad habits such as strategies many people use  in an attempt to offset the calories they are eating. These strategies include drinking diet colas, eating sugar reduced products,  drinking large amounts of tea and coffee or using alcohol to dull the appetite or to deal with low mood states. Is this healthy?  These practices increase bad moods like anxiety and depression -hardly the nirvana that the un-dieting movement suggests.


Dieters can and do lose weight and keep it off. Our solution is to find the strategy that works and a therapy that is holistic. This therapy proudly targets weight loss. And that, as they say, is another story told at my recent training.

One Fat Child Inside A Perfect Storm

I write this as a psychologist specialising in obesity, childhood obesity and eating disorders; a member of the National Obesity Forum and an All-Party Parliamentary Obesity Group. I am a spokesperson for the British Psychological Society on all matters relating to eating and obesity, and I am Founder of the National Centre for Eating Disorders.

Every parent dreads getting the dreaded fat letter or a summons from the school. One such parent I know has had such a summons. Healthy schools policies now mean that schools are taking some responsibility for the wellbeing of children, by providing healthy lunches and in some cases banning high fat-sugar snacks. I applaud these policies to some extent. They are also weighing children to alert the parents about potential dangers such as increasing BMI or anorexia in older children. This is controversial and my thoughts about in-school weighing belong elsewhere. However in this case, the child aged 10 looks and is fatter than his classmates. And the parents have been told that Social Services may be invoked.

Even worse, the child himself has been told that his weight is a matter of concern. This the first time that the child has had negative feedback from an adult.

Now where a child’s weight is concerned, some parents are ignorant about what to feed their children and some try hard to feed their child a healthy diet but are thwarted by all that is out there and some parents are too lazy to bother thinking about it all. They say, let children be children and eat what they like.

Some mothers have eating problems and buy food for their children so that they have an excuse to eat it themselves. Some parents have a child who gains weight extremely easily because they were born that way. Most onlookers blame the parents if the child is fat. They think that the parent is over feeding their child.

Or they assume that the children are compulsive overeaters, sneak eaters and so on, that they are unhappy and that their weight gain signifies underlying psychological problems. They might look at the child and discover that the child is eating more than their peers. This would be normal because a fat child needs more calories than a thin child; they have more muscle as well as fat to carry around.

The parent has refused permission for the school to weigh her son. She knew that her child was large, and the diet at home is reasonably sound. I endorse her decision, since the weighing was not routine and the child would have been singled out, a horrible experience for a young person growing his wings. Now she has been told that the school is sending out for counselling for the child. The child will once again be singled out.

First do no harm. Identifying a fat child is one thing, knowing what to do about it is something else, which is why I say the following. By all means weigh children and inspect their size. But be clear that you know what to do about it so that you do not harm the child. Some children will need help and some will not. But in some cases insensitive intervention will create a tragedy. For example, is the next step to put the child on a diet? There is very strong evidence that 99% of children who are put on a diet gain weight excessively afterwards. They develop unreasonable attachments to food which is denied them; they suffer from feeling different from their peers and their self esteem can fall. My eating disorder casebooks are full of people who have been dieted or given pills as children; told that they are unacceptable and thus unlovable.

These are the circumstances for a perfect storm brewing up in which everybody could be hurt. Everyone needs to take a big step back. I would offer the following advice.

1    I would ask the school to wait, do nothing and revisit the situation in a few months time. During that time the professionals involved need to learn more about how to help fat children. They should not just swing into action with panic strategies unless there are other strong reasons for concern. They should liaise with the parents and agree together the best way to proceed.

2     The school must not be led to believe that a fat child is an unhealthy child; this is a myth. While there are health risks associated with being overweight the risks are greater for thin children who do no activity and who eat poorly at home. I would refer to the school to research the HAES research (healthy at any size). The school needs to have a written policy guided by appropriate health professionals for managing children they think have eating or weight problems.

3    The school must immediately remove any pressure on the child that would lead to him feeling different from his peers and must be open to listening to the child if he is being teased.

4   Let the parents, with some help if necessary, take a fearless inventory of the food and eating patterns at home. Even where the parent has expertise and knowledge about healthy nutrition, there are always some small improvements that can be made. This will help the child be more healthy; this will not necessarily result in weight loss. The school must be fully aware of this.

5    Neither the school nor the parents must fall into the trap of insisting that the child do more exercise if he is already doing a reasonable amount. There is no association between insisting on programmed activity that the child does not enjoy and long term weight control. Limiting TV at home is useful but not only for managing weight.

6   At the age of 10, the child is approaching puberty. Children tend to gain weight at this time to provide the energy for a huge amount of pending growth. It is also a time critical for developing self esteem. The parent and the school must do everything possible to support the self esteem of the child and to give them well paced information about nutrition in a sensitive way. This will put the child in a good position to make their own decisions about weight control when they are old enough to be autonomous.

7   Counselling should only be given if the child really wants it and if there are really good reasons for concern - which should be made clear in writing by the school. The parents should be open to giving assistance for weight loss only when the child asks for it. There are good and bad ways to help children lose weight and this needs to be discussed with an expert in the field. Not a doctor and definitely not a school nurse.

If anyone has a problem with a child who is fat, I am willing to act as an advocate for them. It is hard, not a crime, to be the parent of a child who is fat.

Food Addiction Vs. Compulsive Eating: The Meaning Of Overeating:

The statement I often hear that overweight people surely must be “addicted to food” is contentious and offensive.

In 2004 and subsequently in 2006, two separate NICE guidance processes, one on eating disorders and one on obesity attempted to make sense of what psychologists describe as dysregulated and disinhibited eating. Whether this eating results in weight gain depends on the restraint that a person exerts in between episodes of overeating, or the use of compensatory behaviours such as purging which accompany overeating.

Sufferers speak about irresistible drives to eat any food or certain food types such as chocolate - in the context of cravings, low mood states, excitement and a sense that their behaviour is somehow wrong / abnormal. It seems apt to apply the label “addiction” to the behaviour and its motivations because there are many shared features between substance abuse and overeating. These shared features include ways in which “using food or drugs” brings about mood relief, tolerance, withdrawal symptoms, and the activation of similar neural networks, particularly in reward centres in the brain.

Sufferers also describe their experience in the language of addiction such as “I can’t get on with things unless I have my fix”. Or, “It’s like I’m addicted to food, I wish I could just take it or leave it, but it’s never enough.”

The reason why terms such as food addiction, chocolate addiction, binge eating disorder, comfort eating and compulsive eating are used inconsistently in scientific literature are because they are not diagnostic categories. They are simply our attempts to put labels on a rich diversity in human experience and behaviour, which have different meanings to different people (1). They are useful labels because they legitimize the individual’s search for treatment for eating behaviour which they consider at least, uncomfortable and at worse, insane.

For this reason, it is dangerous and incorrect to label the uninhibited eater simply as an “addict”. There is evidence for example, (based on pre load studies with ice cream), that the eating patterns of so-called addicts is motivated more by beliefs about what they have eaten rather than the foods themselves (2). Moreover, the label “addict” is often disempowering, suggesting that you are emotionally sick, with the ever-present danger of relapse. While it is true that there is a poor record of weight loss maintenance in anyone irrespective of where they start from, there are evidence based psychological treatments of “compulsive eating” which have a good and enduring outcome (3). These treatments don’t necessarily lead to losing weight.

Ignoring for the moment the question “what is a binge?”, evidence supports the view that among obese binge eaters there is a greater than average risk of the following; history of trauma, psychiatric illness, mood disorders, history of alcohol abuse, avoidant, dependent and borderline personality disorder (4). But don’t assume that this is true for all obese binge eaters, many of who just got into bad habits, enabled in part by the people who live with them. Or alternatively there are sufferers who have not learned how to manage stress.

So this is why labelling overeaters or even compulsive eaters as “addicts” is nonsense. Careful assessment will pick out factors that may interfere with treatment for weight control. Then, using techniques such as cognitive therapy to deal with the obesity mindset, emotional resilience training, mindfulness work, trauma counselling for some people and nutritional rehabilitation, we can package together a treatment which will help even the most disinhibited of overeaters – often quickly. They will stop bingeing and they will be able to eat their forbidden foods without danger of relapse.

Personally speaking, I have found it helpful to say to my clients “I refuse to call you an addict – you simply have some things to learn which will help you to manage your life differently.”


I would only start thinking about addiction if my overeater also has existing substance abuse problems or a history of them. For sure, there are aspects of 12 step programmes which are useful for anyone with a mental health problem to help with things like self worth and forgiveness, getting help from others and taking an inventory of all ones difficulties. But first and foremost I would turn to cognitive –emotional behaviour therapy for my overeaters(5).

Do we not owe it to our clients to “label” them as potentially normal as the rest of us?


HERE ARE SOME REFERENCES FOR STUDENTS

1 Fitzgibbon and Kirschenbaum (1999). Heterogeneity of clinical presentation among obese individuals seeking treatment. Addictive Behaviours 15, 291-295


2 Wilson T. (1993). Binge Eating And Addictive Disorders, in Binge Eating, Nature Assessment and Treatment. Eds Fairburn, C. and Wilson, T. Guildford Press.

3 Gladis, Wadden et al. (1998). Behavioural treatment of obese binge eaters, do they need different care? Journal of Psychosomatic Research 44 375-384.


4 Yanovski, Nelson, Dubbert & Spitzer (1993). Association of Binge Eating Disorder and psychiatric comorbidity in obese subjects. Am J Psychiatry December (12):1910


5 Smith, Marcus & Kaye (1992). Cognitive behavioural treatment of obese binge eaters. International Journal of Eating Disorders 12, 257-262

Vogue Bans Under Age Catwalk Models - Is The Tide Turning?

Alexandra Schulman is banning models who are under 16 years of age or "who are showing obvious signs of an eating disorder" from her pages. She castigates designers who only provide sample sizes in size 2 which means that she has to seek the very thinnest models from the agencies who sell their girls to the media.

This follows on from a gentle but increasing wave of editorial changes taking place in Israel, in France and Italy. They are finally cottoning on to the notion that they have some resonsibility for the epidemic of poor body image and weight anxiety that is afflicting their readers.

Two anorexic women writing in the Daily Mail, May 5th 2012 described how their anorexia was induced by their obsession at looking the skinny models in fashion magazines. Is this true?  This is not a good argument for banning skinny models. As I have written in an earlier post, skinny models don't cause anorexia; if they did millions of women would have anorexia. Thinspiration and obsessional looking at fashion pics simply reinforce an illness which is already there. Women who are obsessed by looking at fashion magazines need to have an hour with an expert to show how these images are digitally altered. The pictures by and large aren't real.

The big challenge is, how we can teach our girls and our boys how to look at these fabulous icons, these long legs, skinny thighs, plasticated boobs and chiselled stomachs without automatically coming to the conclusion that "I am ugly". Just try this, step out into the street and count how many perfect bodies you will see. Not all that many.

There will always be someone you can find who is thinner than you, or stronger with bigger muscles or nicer hair. Even though I'm an eating disorder therapist who should fully understand, I am sometimes at a loss about addiction to fashion magazines,  images of perfection and people who covet boobs made of industrial plastic.

We have an internal mirror that only needs to be taken out from time to time. If we keep on looking into it and sighing, like Narcissus, we will fade away and die.

Compassion Versus Coldness in Eating Disorder Treatment:

On Linked-In a therapist asked should an eating disorder therapist be compassionate or “cold and rigid”?

This is a huge question; boundaries are important because they foster trust and engagement; many of our patients lack boundaries and we need to model good boundaries for them. Treatment requires compassion, speaking the language of the eating disorder using "hip pocket patient thinking" to show people we "get them”. But too much compassion may mean that we collude with eating disorder thinking and behaviour so it is not sufficient for recovery to take place, we also need to do some hard work shoulder to shoulder with our people, insist on home assignments and even use "blackmail strategies" such as a 10 minute interview instead of an hour of therapy if a client engages in treatment resistant behaviour. So, sometimes being provocative and challenging too. I once did a 2 hour presentation for an NHS service in the UK on therapist qualities for eating disorder treatment and (only) one of the conclusions is that a sense of humour helps too.

Compassion is important, yet bear in mind that often a client becomes more interested in their relationship with the therapist rather than doing the work because of early attachment problems with their parents or a history of neglect and abuse. This is a vulnerable client group. I don’t think that we can do much unless we have a good relationship which becomes a template for other relationships in a sufferer’s life, which involves learning skills for managing conflict and a good balance between avoidance and dependency.

Psychotherapists have to be on guard against NEEDING to be liked by our patients, and always having to be too kind, which can interfere with their treatment and which puts us at risk of colluding with the eating disorder. This is, I guess, why I am not scared of being controversial and at times making people angry with me.

Poorly Pics And B-Eat: The Truth Might Set You Free.

There is a movement to persuade the TV and the poular press to stop using "poorly pictures" of people with anorexia. Even I was gently chided by my colleague Susan Ringwood at B-Eat for appearing on a TV programme with an anorexic male alongside some photos of him when he was at his lowest weight. The pictures are usually quite shocking and show people in a very ill and skeletal state. If they didn't catch the eye, why then print them? Clearly there are some very thin people around who dont have anorexia and no-one says much about them. So what is this fuss all about?

Perhaps such pictures are deemed to add to the stigma of the illness. The public often regards people with eating disorders as vain, self obsessed and attention seeking.  If only they would just get a life and eat something. But, would it be more helpful to regard a person with anorexia as mentally ill or temporarily insane; that is hardly better either.

Then, might such pictures do harm by encouraging some vulnerable people to start losing weight too? I don't think so, nooooo. Perhaps you disagree?

Does this paint the wrong picture (to use a pun) of the typical anorexic?  Many are not very thin but the ones we worry about are very thin indeed. Anorexia is a starving, restricting illness whether we couch the restriction as a quest for health, control or purity or whatever justification comes to mind.

Some severely ill people are so thin that they scare the life out of us, drive parents insane with worry and hide their emaciation as best they can from others. And some are so fiercely proud of their emaciation that no one dares to talk about it. Carers and loved ones stand mute and silent for fear of bringing forth anorexic aggression. This IS what anorexia does to perfect souls.

So why not show it as it is? In all its skinny, wasted and emaciated glory. The truth may set you free.

On Orthorexia

From someone’s diary before treatment.

“Everyone around me from the employees or the customers who spent hundreds of dollars on nutritional supplements and organic goods believed that eating in this way represented a healthy lifestyle which then would ensure a healthy outlook on life, There was a sense in that environment that the outside world was toxic and contaminated and that by controlling what we put in our mouths and on our bodies we could cleanse ourselves internally and spiritually".

Result: bizarre special diets, food allergies, food sensitivities, raw diets, low fat diets, low carb. diets, weight loss diets, intestinal cleaning and detoxing, vegetarian and vegan diets, food phobias and compulsive food rituals.

Will you really live longer, be healthier, be happier, be an inspiration to others, love, go to heaven? Is this really being in control?

Some Thoughts About Counselling

Writing as a psychologist who reads the BACP Journal to keep in touch with the world of counselling, I was left perturbed by an article named Who Is This Man? March 2012.

The client C.W. in this article ruminates about the wish to know more about her therapist and thinks that after 3 years of therapy it is “not fair” for disclosures to go only from her to her therapist. She manages to extract from him a confession that he has once lost his temper with a mobile phone as did she. Thereafter the client begins to quest for other ways of getting information from him (along the lines of you show me yours and I’ll show you mine) so that she can feel that her therapist is “real”.

Perhaps it is normal for a client to start wondering about the personality/life of a counsellor. It is more sinister to think it isn’t fair for disclosures to go one way (why not?) and to use the counselling space to manipulate information from the therapist – instead of attending to the process of growth and change. Where does it stop? The client seems to be showing all of the signs of narcissism, the effects of which presumably have got her into therapy in the first place. Why is the counsellor not bringing this into the room? And when a therapy extends 3 years, what on earth is going on?

In an earlier version of the BACP Journal, a similar process was taking place where the client wittered on to the point of indigestion (mine) about whether her therapist would think about her while he was on his holiday. I hope that he did not, but why is this stuff published without comment?

Congruence is important, and I may use some of my own emotional reactions judiciously to help the client validate and develop their emotional vocabulary, to build resilience. But the narcissism/dependency of client submissions in the BACP Journal read distastefully. Does anyone else feel this?

If I want my health addressed, I would choose an expert who knows their job; There is no concern to know the details of their private life. Nor do I mind whether the physician thinks about me once I have left the room. Perhaps counsellors should give their clients an introductory booklet in which conditions of the counselling relationship are laid bare. Disclosures DO go one way; the counsellor does not and maybe should not give the client mental space once the session is finished, the notes are written and the supervision is under wraps. Would that be too difficult to bear?

Ghrelin Or Gremlin - To Coin A Phrase

Title with acknowledgement to Richard Robinson
Did anyone see last nights Horizon Programme about Obesity .... the ultimate facts?

The programme pointed to some distinct differences between people in terms of their suceptibility to overweight, with focus on two hunger and satiety hormones, ghrelin and Pyy3-36. The programme suggested that bariatric surgery would correct the appetitive brain and make fatty sugary foods unattractive.

Having watched the programme, I feel that it was unduly reductionist. For example the distinct differences between the hunger and satiety hormones ghrelin and Pyy may have been caused by overeating and may not be endogenous. There are many other less well understood appetitive hormones which play a role in eating.behaviour.


The brain changes in bariatric patients affecting reward systems and the drive to eat high fat/sugar foods might well be influenced by gut function. Bariatric patients do tell me that they feel transformed by their operations. However the programme did not inform us about the cons of surgery.

I have sought the opinion of someone who is overweight and not an obesity professional, who didn't find this programme very useful. He said, I don't want surgery, is this the only thing that I can do?

It might be useful to have people believe that obesity is "not their fault". There are differences between individuals in terms of genes, life experiences, cognitive function, maternal eating habits in pregnancy, emotional resilience, environment and physiologcal makeup. So obesity treatment will remain complex and personal. One day there may well be a brave new world where each child showing risks for obesity can be fitted with a gut implant to control their appetitive brain. Until then, the battle against our fat cells continues.

Anger

Reproduced with permission by Sally Brampton; Expanded slightly by Deanne

Have you been really hurt by someone who should have known better? Do you have a client who has been emotionally abused and cannot move on? Do you know someone who wants revenge and retribution, and it is justified? Is there a person who is going to make you angry for the rest of your life and you are sick and tired of it?

Here are some thoughts.

“Holding on to anger is like grasping a hot coal with the intention of throwing it at someone else; you are the one who gets bunt”

“Resentment is like swallowing poison and waiting for the other person to die.”

We know all that, which is why so many of us want to be rid of our anger but it keeps coming back and talking about it makes it even worse not better. It brings back all those old memories.

If we have bad feelings, we are often also guilty about our rage, and guilt leads to shame which in turn feed the anger and resentment. It is a never ending cycle. Grief sets in and becomes well rehearsed when we realize what we have lost. At one time or another we are all familiar with it.

Let’s begin with the guilt, which is often misplaced. You do not have to like the person who violated your values. You can even dislike them very much whoever they are, a parent even or someone who used to be your friend. What we do have to do is learn how to tolerate them in our head and be at peace with our own feelings. We cannot change people, all we can do is to learn how to change our response to them. It can be very hard.

Some people are emotionally flawed when we are engaged with them either through our choice or an accident of birth. Perhaps we have moved on while they have not. We might accept an apology but we will never get it and that hurts more than the behaviour we were subjected to which may have broken our heart at the time. Some people never grow up and accept what they have done. Perhaps this person has hurt someone close to you like your parent or your children and the person who feels the pain most of all is you.

The bottom line about such people is: they are what they are. We can call them names, they are cruel, mad, psychopathic or ill, the damage they can do is much the same whatever the explanation you foist on them to try and make yourself feel better, to reduce the confusion you face. It is normal to try and explain the confusion you feel about what you have suffered.

They are what they are, and repeatedly asking them for help or trying to remake a relationship with them on better terms is like banging you r head on a brick wall and all that will do is give you brain damage. You might as well shout at a tree and expect it to respond; it is not going to happen. If you can rid yourself of expectations, you rid yourself of disappointment and its bedfellow, resentment., one baby step at a time.

As for the rest of the time, if you have to continue with some sort of relationship with someone who gives you pain, you run the risk of experiencing continuous corrosive anger. How can you deal with this? No easy answer, try letting it go, dropping the hot coal and not swallowing its poison. Each time you clutch at the hot coal or ingest the poison you taint the relationships you have right now as well as the one you wish you didn’t have. Oh, this is easier said than done. It doesn’t mean that you accept the person and do not judge their actions. It might take all kinds of practice, such as taking a deep breath when the heat comes up and saying to yourself “I am really truly OK, I let the anger go for now.” It might be as simple as going to put on your favourite perfume or listening to music which makes you smile.

If we can let it be, rather than roll snowballs of anger and grief around in our memory stores, we can feel stronger and move toward a sense of peace.

There is a method of acceptance practiced by Buddhists that you might find helpful. It is called the art of loving kindness. This HAS to start with yourself; too many angry, grieving people take our their rage upon themselves, with drink, drugs, overeating, purging or self starvation. It is only when we find compassion for ourselves that we can extend it to others. We can forgive people one per cent at a time. Here is one of the many Buddhist sayings- repeat it daily or whenever anger raises its ugly head.

“May I be held in compassion. May my pain and sorrow be ceased. May I be at peace.”

It may feel awkward and foolish at first but after a while it becomes familiar. Once it feels natural, extend it to those you love. The final step is to extend it to the one you find difficult. It helps.

Read: The Art of Forgiveness, Loving Kindness and Peace. Jack Kornfield, Bantam Press.
Visit http://www.eating-disorders.org.uk/

Eating Disorder Awareness Week. Time To Go.

It is about to hit us. Or did it come and go? Whatever, I think it is time to be banned.

Years ago, no one knew anything about eating disorders.  No one understood and knew how to recognise the signs and symptoms in either themselves or other people. This is no longer true.

The net result is that people with eating disorders are stigmatized. That hasn't changed. Even doctors regard people with bulimia as at least unfortunate and possibly weak willed. They regard anorexia as a vanity illness suffered by willful and irrational people. Even some experts regard compulsive eaters as weak. The new rash of articles about men with eating disorders is helping perhaps but not changing the general image of people with eating disorders as being somehow lesser, sicker beings than other people. You wouldn't want to ask them home for tea.

Well meaning people in their hundreds, go into schools to teach Health and Education studies about eating disorders. This does little to change the incidence of problems and in some cases made the situation worse by sensitizing vulnerable girls and boys about issues of food and weight. These do-gooders don't like to hear this. I once had to argue against a former anorexia sufferer going into schools to warn pupils about the dangers of self-starvation. If you tell someone not to do something, chances are they will.

When people with eating disorders pass through the sieve of investigative journalism they are portrayed in sensationalist ways, which often only enhance a sense of disgust and revulsion among onlookers.  You even get a chance to see vomit in 3D.  Lets face it, the symptoms of an eating disorder are unpleasant and people do terrible, unbelievable things to themselves because of their apparent fears of fatness.

It’s time to stop doing the very thing central to eating disorders, the sense that somehow this condition is special. Even putting eating disordered people on Supersize/Superskinny is unethical.  Why not have Depression Awareness Week or Borderline Personality Disorder Awareness week? Why not have a different Awareness Week every year; surely all the walking wounded deserve their mention.

Lets have an informed debate about what it is helpful to communicate – such as which kind of therapists are to be avoided because their training is partial, or inadequate; or, how to help schools develop an eating disorder policy to protect the healthy as well as the ill.  The rest, I believe is a disservice to the sufferers.

If you like or don't like what I have written contact me on Deanne@ncfed,com  and at least THINK before you leap!

Get A Grip: Love, Cherish And Protect Fat Children

Two articles in The Times Saturday 11 February 2012; the first worrying about children who consider themselves fat when they aren’t. The second, a cry for help from Lucy Cavendish, mother of a fat child who doesn't understand her son’s fatness and doesn't know what to do about it.

Lets take the former first which deserves a blog to itself. God (or whatever) save our children from parents who make comments about weight, their own willpower or lack of it and who flaunt their own obsessive attachment to the gym, pilates or running marathons.

The second article resonated with me more, having it on good authority that being the Parent Of A Child Fatter Than Other Children (PFOC) has its challenges.

I understand that Lucy, like many other PFOCS, will first try to figure out why her child is fat. Is it the genes, is it something she has done, or something about the character of the child. She seems to be blaming all of the above. She once cooked like Nigella and now one of her children is paying the price. Or perhaps he just is lazy or is having a love affair with food. There was a fat ancestor somewhere in the past.

Even if it isn’t her fault, it is her responsibility to do something about it. Everyone tells her so. Some people are telling her to put her son on a diet. HORRORS! Please find her and warn her that dieted children are more likely to gain weight even faster than before the diet. It doesn't work to put children on diets.

When you have a fat child, people think you are a bad mother or at least an irresponsible mother. People will say how can you let your child get like that. Lucy feels guilty when she buys fattening foods and is bending over backwards to put everyone at home on a healthy eating programme. That sounds fine and will convince her that she is being a good mum.  But, Lucy, if you are reading this, that doesn't work either.  For every PCFOC buying normal foods in a supermarket there are a dozen parents buying ordinary food with normal skinny children. Many children just don't gain weight.

The Government has decided to wage war on the fat child with warnings about health risks and risks to emotional well-being. In some ways they are right and Lisa is correctly afraid that a fat child is probably going to be a fat adult. But many adults are fat who were never fat as children.  I think it is these adults who find it hardest to manage their eating habits, since they were never called into question when they were young.

The days of bad interventions are gone. Doctors no longer give slimming pills to children as they did but rest assured, they don't know what else to do. Obesity is the physician’s Achilles heel.  Instead we have do-gooding, Jamie Oliver, bless him, and earnest strategies trying to foster healthy eating for our kids. We have the dreaded “fat letter” and a fat lot of good that is going to do. We even have a MEND child obesity programme which appears to have failed Lisa and her son. Although MEND received a gazillion pound grant, I would love to meet just one cured-fat success story, a fat child made thin. I haven’t yet.

There is no doubt that there are some lazy, irresponsible and unknowledgeable parents who stuff their children full of junk. There are parents who simply do not know that their child is fat, because they do not know how to interpret what they see. Despite what we are led to think, I believe that these are in the minority.

The rest of us have to do daily battle, with our need to defend ourselves from criticism, and with the unending responsibility to conduct a battle, which we cannot win. There is a limit to the control we can exert and limit to the miles we can force these little ones to run. We risk doing damage in the process; a child deprived of treats will only want them more. We stop just appreciating our fat children and envelop them in the pall of our own anxiety, always wondering what to do that will work this time.

To the mother of a fat child I would say this.  Really there is nothing you can do. This is a child who above all needs to be loved and celebrated, learn to view their difference as a gift to help you to rise above yourself. Let them eat all they want; do not try to convince them that they cannot be hungry; do not scrutinize their portion sizes; they really do need more than thin children.

Above all, deprive the child of nothing that you would not let them eat if they were thin. By all means take them out for a walk for fun, but do not heed the advice to deprive them of their TV and to force them onto the football pitch.

The child who is fully accepted and loved at home will be better able to overcome the difficulties they will face outside. To any young and vulnerable person, teasing and bullying is the worst thing that can happen. Above all it mustn’t happen at home with guarded comments such as “You would look better in that if you were a bit thinner.”  A zero tolerance policy of teasing among siblings should also be in place.

Instead of trying to fix the child’s weight, fix their ability to manage these torments and to overcome them. You may need to call on professional help to keep their self esteem intact.  Above all, you must find a way to let them know that it is not their fault. Nor, when they are children is it their responsibility to do something about it. Nor, strangely enough is it yours for now.

Having worked unceasingly with fat people for decades, I am now convinced that fatness is a disease that can only be managed, never cured. The best chance a fat child has of losing weight is to do it for themselves, when they are older, in time and in the best way for them.  They have a far better chance of managing their weight in the future if you are able to give them a solid sense of self worth and self respect in early life.

So, if you are going to stop trying to manage their weight, what can you do? If I did have a checklist, it would contain some of the following;

Adore and be proud of your fat child, give them loads of hugs and listen to their problems.

Engage the school, make sure you let them know that your strategy for your child is long term and alert them to let you know if there are problems.

Make sure he knows that weight is not his fault. You might need help to put this in the right words. If he thinks it isn’t fair, he is right.

 Ignore comments or assumed comments from others. Make sure that everyone in the family reads this blog.

Tell well-meaning others that diets make fat children fatter. Tell the child that missing meals is fattening.

 Do not diet yourself, or make weight comments about yourself or others, do not praise beautiful children, do not use the child to compete with you in a weight loss programme.

 Help your child to love a large range of foods.

Teach your fat child how to cook (all foods including treats).

Do not ban any food, under any circumstances including visits to Macdonalds, do not make comments, but use substitutions, like sorbet rather than ice cream for the family.

 Get help if necessary to teach her how to combat teasing including Facebook bullying.

 Make sure she is doing things she enjoys, from ice skating to dancing or tweeting.

 If your child wants to diet, do NOT quickly agree and I advise some expert help, such as from me!

If she is bingeing or secretly eating, she is deeply alone and unhappy. Spend time with her and find out what she is feeling.

If you have any questions or concerns, email me at admin@ncfed.com and meanwhile, celebrate your fat and hungry child.