You state your message in NO WEIGH! A Teen’s Guide to Positive Body Image, Food, and Emotional Wisdom is for readers “to have a friendship with food.” What is your best guess as to the percentage of American teens who do have a friendship with food?
The concept of friendship is abstract in some ways and concrete in others. A healthy friendship is generally defined by mutual respect, trust, and good listening skills. Our best friendships are often filled with true enjoyment of each other’s company. If we extract these qualities, respect, engagement, trust, listening, joy and apply them to interactions with food, it is not too far-fetched to conclude that most people do not have the best relationship with food. When we continue to treat ourselves and our friends with respect even in conflict we are more likely to have healthy resolutions. Many people have limited skills when it comes to reconciling their conflicted feelings about food and body image. It is hard to estimate how many teens truly have a friendship with food. “No Weigh” takes aim at these unfriendly relationships in the hope that with support teens can create great, long lasting friendships with food and themselves.
Can you please tell us a bit about the teen-age brain and its connection to teen-age emotions?
Adolescence is a dynamic process and the adolescent brain is evolving as teens grow into their adult bodies. Teens are experiencing numerous changes during puberty, including physical changes as well as social and emotional change. Often teens are labeled “emotional,” and maybe even “irrational,” and this is a disservice to them. The reality is that the adolescent brain matures in such a way that the more “emotional” centers of the brain, like the amygdala, mature prior to the “executive” centers such as the prefrontal cortex. This process suggests that functions such as emotional regulation maybe more difficult for teens. Also, research studying teen brain images as well as neurotransmitters also indicates that the “pleasure centers” or the reward systems in the adolescent brain can be more responsive to rewards compared to adults. Adolescence as a time of exploration and seeking stimulating experiences may be tied into basic biology and reward seeking. That being said, it is important to keep in mind that adolescence is also the time when people are experiencing some things for the first time; the first party, the first date, the first time driving, the first “C” in a class, etc. This mix of variables, a drive for stimulating experiences, the realities of development (a maturing prefrontal cortex), compounded with “newness” and less practice with managing complex feelings can make teen emotions seem more intense. This may lead to situations seeming more significant and more challenging to overcome. However, intense emotions and struggling to reconcile them does not mean that all teens are destined to or expected to make impulsive decisions. In fact, many scientific studies have also demonstrated that teens have risk assessment similar to adults. Ultimately, adolescence is a complex time of biological as well as social and emotional change. Understanding adolescent brain development can help us better support teens through this time. All of this being true, the other truth is that living life and experiencing distress, using healthy coping skills, and knowing you are going to be okay is fundamental for development.
How did you develop the exercises you include in your chapters?
The tools and skills in the workbook have been pulled from a comprehensive review of a variety of theoretical orientations, as well as our own work treating adolescents over the past couple of decades. They have been extracted from principles of Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Acceptance Commitment Therapy, as well as the mindfulness and meditation literature. The Cope Ahead technique is pulled from exposure therapy and the Body Image work is pulled from social science research related to happiness. Teens are offered an easily accessible toolkit. The goal is to have the skills and tools be transformative, supporting the principle that they work a little bit better than not doing them. Of course, the more you practice, the better you get with the skill set.
Please translate “The Hunger Meter.”
The Hunger Meter is probably one of our most useful tools for understanding the varying stages of appetite from hunger through satiety. Our clients will often struggle with knowing when they are hungry or full. The hunger meter helps the client tap into their body’s own innate wisdom, to look inward, and find answers that only their own body can provide. Learning the gradations of the Hunger Meter is simple, but it’s not easy, and can take some practice (and patience!) to master.
Levels 1, 2, and 3 are the levels of hunger from starved (1) to the first “hit” of appetite which we define as a “3.” Levels 8-10 reflect satiety and fullness, with gradations in between. A “6” on the hunger meter would be a comfortable stopping place but you might have room for more food. An 8 would be the “beginning of full.” A 10+ might be “Thanksgiving stuffed.”
We encourage the reader to think about where they are on the hunger meter before they eat. Through thoughtful reflection and some curiosity, the reader is asked to connect to their innate hunger cues and act accordingly. For example, if you observe that you are ravenous, at a “1,” you might realize it would be helpful to pack extra snacks or a heartier lunch for tomorrow to reduce the intensity of the hunger. If you find you are a “4” on the hunger meter (not that hungry) you might decide to fuel up regardless because you’re headed into an intense sports practice and know you will need the extra fuel to carry you through the long practice. Over time, you may recognize that you are not hungry but still craving the cupcakes at the picnic, ultimately deciding to have one or none at all. The entire goal of the hunger meter is to be connected and tuned into yourself.
What are some of the skills of a connected eater?
As we progress from infancy to childhood, most kids have an innate wisdom and knowingness of their own appetite. However, our culture can negatively shape food beliefs and impact this inherent wisdom of appetite and satiety. Connected eating is about strengthening that inherent wisdom and allowing teens (and adults) to maintain their connection to what their body already knows – how to eat in response to hunger and fullness. Fad diets and weight cycling lead to physical, emotional, and social disruption in so many ways. By tuning into the primary need, identifying the emotional triggers and making mindful decisions that are informed with a true understanding of one’s needs, we can make better decisions about how best to nourish ourselves. The skill set of a connected eater is all of the above, and being connected is possible when approached with curiosity and commitment.
Emotion—>Habit—>Reprogram. Can you please provide a summary of this skill?
When an emotion gets triggered (a trigger is an emotion bigger than the here and now) we typically revert to a familiar bad story or feeling. By revisiting maladaptive patterns of coping, we strengthen the habits and even the neural pathways of certain thoughts, behaviors, and feelings. However, through “cognitive reframing in an emotional state,” the work by Brenda Schaeffer, we can reform familiar patterns by responding to the emotional trigger in a way that matches the present moment. We can use our brain to heal this emotion by being diligent about the way we respond (Dr. Rick Hanson’s example, “I am all right right now, the thing I’m worried about is not happening right now”). Often our responses are our brains’ attempt to avoid harm so that we do not suffer or repeat history. However, maladaptive habits such as avoidance rarely lead to true soothing. By recognizing familiar patterns and using emotions wisely we can respond to our own needs in a more productive way and reshape our reactions and support our own healing. Hence the equation: Emotion—>Habit—>Reprogram.
The second school of thought comes from the literature using the habit-based model with food. Similar to reprogramming emotion, we can reprogram behaviors. If you are in the “habit” of regulating emotions with food, a particular emotion will create an urge for food given the brain has associated food with relief. According to Dr. B. Timothy Walsh’s team at Columbia Center for Eating Disorders, the key is to replace the old habit with a new habit that is somewhat rewarding. In other words, don’t just grit your teeth when feeling a pull toward the ice cream without hunger. When you have the first inkling, let’s say you are taking your first step toward the refrigerator, that is when you engage in a new habit (ultimately it would be the same new behavior every single time so that it can become the new automatic behavior), like squeezing a stress ball, taking a walk around the block, or art-making. And, of course, the highest goal is to have no habit at all, but to have food freedom, where sometimes you have ice-cream just ‘cause, and other times you head toward a type of foodless fulfillment.
A part of this skill is also an ability to create space between you and the non-hunger eating so you can hang out in the emotion long enough to identify if there might be a better tool to pull from the tool box. Using food for comfort can be a part of connected eating as long as you have other ways to cope as well.
What do you suggest to teens and their use of the scale?
Don’t do it! Weighing yourself on a scale is problematic in many ways. For starters, if you’re are practicing Connected Eating (relying on hunger and satiety cues to regulate your eating) the number you see on the scale will likely take you “away” from being attuned to your body and prompt you to make food choices based on the number on a scale and not what you actually need.
When we weigh more on a given day, even if it is a little, we are inclined to cut down what, and how much, we are eating. When we “diet,” our body doesn’t know if this is a choice or if there just isn’t enough food available. Being “up” a bit on the scale tends to cause us to panic and restrict our food, which lends itself to a deprive/devour cycle.
Scales also create mood dependency. Weighing yourself regularly promotes scrutiny, and scrutiny breeds dissatisfaction. They are also incredibly inaccurate. For one, you can check your weight on four different scales and get four different results. Or, you can go to bed and weigh a few pounds lighter than when you wake up the next morning. How is that possible? It’s not! Scales often reflect fluid status in the body (are you hydrated or dehydrated?), and can shift depending on whether you have eaten, how much fluid you have consumed, whether you are premenstrual, or whether you have used the bathroom or not.
Bottom line, the kind of reactivity that occurs by closely monitoring our weight on a scale overrules our ability to eat in response to our body’s wisdom.
About the authors:
Signe Darpinian is a Licensed Marriage and Family Therapist (LMFT), Certified Eating Disorders Specialist and iaedp™-Approved Supervisor (CEDS-S). She is also a public speaker and a co-author of No Weigh! A Teen’s Guide to Positive Body Image, Food, and Emotional Wisdom with Jessica Kingsley Publishers in London. With private practice offices in two California locations, she is able to service both the Central Valley Region as well as the San Francisco Bay Area.
Signe holds an M.A. in Counseling Psychology from San Francisco’s John F. Kennedy University and a B.A. in Psychology from University of the Pacific. She is the President of the International Association of Eating Disorders Professionals (iaedp™) SF Bay Area Chapter and she serves on The Body PositivePartnership Council. Over the past several years, she’s been recognized by various organizations for her accomplishments in women’s health and business while also being requested for speaking engagements at renowned institutions like top-rated Rancho La Puerta Spa in Mexico, Stanford University, and Pinterest Headquarters.
Wendy Sterling, MS, RD, CSSD is a Registered Dietitian and a Board-Certified Specialist in Sports Dietetics in the Bay Area in California. She specializes in sports nutrition, eating disorders, and weight concerns. Wendy maintains a private practice in Menlo Park and Los Altos, California.
Wendy was a nutritionist for The Healthy Teen Project, where she worked as part of a multidisciplinary team to provide treatment for teenagers struggling with eating disorders from 2015-2017. Wendy provided nutrition counseling to children and adolescents in the Eating Disorders Center at Cohen Children’s Medical Center of New York, which is part of the NS-LIJ Health System, from 2001 to 2011. Wendy has been on the Clinical Advisory Board of Project HEAL, a nonprofit organization created to aid in funding for the treatment of eating disorders, since it was created in 2008. Wendy is a co-author of No Weigh! A Teen’s Guide to Positive Body Image, Food, and Emotional Wisdom, which is forthcoming from Jessica Kingsley Publishers as well as a co-author of How to Nourish Your Child Through an Eating Disorder with The Experiment Publishing in New York.
Wendy is currently the Team Nutritionist of the Oakland Athletics. She has consulted for the Golden State Warriors, Menlo School, New York Jets (2006-2013), NY Islanders, and Hofstra University’s women’s lacrosse and volleyball teams. Wendy is part of the United States Olympic Committee Sports Dietitian Registry. Wendy received her B.S. in dietetics/nutritional sciences from Cornell University. She earned her Master’s Degree in Nutrition Education at Teacher’s College at Columbia University, where she also completed her dietetic internship.
Shelley Aggarwal, MD, MS is a board certified Pediatrician and Adolescent
Medicine Specialist. She worked with the Stanford Division of Adolescent Medicine for several years and is an expert in eating disorders and adolescent health. She is currently the Medical Director of the Santa Clara County Juvenile Hall Medical Clinic. Dr. Aggarwal is a co-author of No Weigh! A Teen’s Guide to Positive Body Image, Food, and Emotional Wisdom with Jessica Kingsley Publishers in London.
As an adolescent medicine physician, she has provided care for teens and young adults, ranging in age from 12 to 25 years-old. She treats medically complex individuals and has consulted on a variety of issues including adolescent development, the management of eating disorders, reproductive health, the needs of the chronically ill child, weight concerns, and medical complications related to mental health conditions, to name a few. Working effectively in a multidisciplinary model is key in adolescent health and Dr. Aggarwal works in close collaboration with a variety of specialists and mental health providers to align goals and provide holistic care.
She has worked within premiere academic institutions such as UCSF, Children’s Hospital Los Angeles, and Stanford University and is currently the Medical Director of the Juvenile Hall Medical Clinic in Santa Clara. As an adolescent health expert, she has spoken to small groups of parents and teens about youth well being and also presented at regional and national meetings on scholarly topics. She has provided on-the-ground care with local and international non-profits, volunteering her time in places such as Mongolia, Cambodia and Mexico to name a few, and she has also worked with agencies such as the WHO. She continues to be teaching faculty with Stanford Children’s Health at Stanford University, and has been recognized multiple times for teaching excellence.
Dr. Aggarwal is faculty for the Stanford Pediatric Integrative Medicine Program for Pediatric Residents. She incorporates integrative medicine principles such as mindfulness and meditation into her daily practice and teaches IM principles to colleagues, training doctors and patients on a regular basis. She has also co-authored a chapter on Developmental Factors in Driving Risk, highlighting how development can influence adolescent decision making.