The prevalence of Eating Disorders has increased 300% since Covid began two years ago. Social media and diet culture had already made eating disorders more common. With the pandemic came increased anxiety, isolation and fear of the unknown, three common traits that contribute to disordered eating patterns of behavior.
Some of the most common struggles we see in our Eating Disorder patients are:
Perfectionism
Anxiety
Low-Self Esteem
Isolation
Depression
The treatment models at many residential centers are outdated and while they are a necessary medical step in the treatment process we believe that more needs to be done to see the treatment through.
Many of our girls note feeling dehumanized and confused by the current residential treatment models. The Eating Disorder wreaks havoc on one's cognitive abilities and critical reasoning, so often the girls sentiments are dismissed as just being Eating Disorder Thoughts.
While this may be true to a certain degree, Empowered RX believes that this is simply unacceptable. As the pre-pandemic world fades away we are seeing changes in the workplace, the nuclear family and in social ways of being. Mental health is starting to be more of a consideration in many facets of life. This holistic shift occurring post-pandemic is missing in the traditional ways of treatment and it's no wonder relapse rates within the first year are 72%.
The sad reality is that much of the traditional treatment model hasn't changed since the 1970's, is highly "abstinence" based in nature and fails to take the whole person into consideration.
Everything in the world has shifted post-pandemic and we should be seeing the same with the treatment of Eating Disorders. Empowered RX is changing the status quo. We demand change. As someone who has experienced trauma and disordered eating, let me shed some light into the why.
When I started on my healing journey yoga and meditation were becoming big parts of many health care centers. I was excited, and had a dream of opening a Holistic Health Center that helped women heal through exercise. Yoga finally being recognized as a therapeutic modality was a start.
BUT, I soon learned that in the world of Eating Disorder Recovery movement was frowned upon. We know many struggling with an ED have used movement and exercise as a way to control or compensate for calories. The all or nothing approach that residential treatment centers take though, is prison-like.
Yes- we said it. Many aspects of these old treatment models are prison like and perpetuate problems once back in the real world.
To be clear, we recognize that until medical stability is achieved certain protocols need to be in place for those in critical and life threatening stages of recovery. The part we disagree with is at what point in recovery movement is integrated and HOW.
The "Abstinence" Method
D.A.R.E education, abstinence sexual health classes... ugh, it brings me back to my middle-school days. D.A.R.E would teach us that having just one beer or one hit of weed could kill us. They taught us that we should be afraid and abstain completely. They also sent the messaging that sex was evil and could get you pregnant on the first time. While there is a shade of truth to these messages, they are fear producing and extreme.
The same kind of messaging is made about exercise in recovery. It's traditionally a hard NO until one returns to their regular life.
Weightlifting is proven to be an effective adjunct intervention to recovery.
It helps:
stabilize moods
establishes healthy relationships with movement and exercise
helps to stop or reverse the loss of bone mineral density
helps regulate our nervous system
makes us strong AF 💪
allows us to focus more on the weight loaded on the bar than the scale
gives us community
teaches us how to have balance, health and structure without going to extremes
Where is the balance? Where are the decision making skills? Where is the social responsibility piece and the recognition that we simply can't pretend these things don't exist?
Sex is fun! Weed is now legal in the state of Massachusetts and and quite frankly, has many medical qualities that make it a safe drug of choice for many suffering from chronic anxiety and pain. This old messaging left my generation with a black and white mindset, so it's no wonder our generation took this mental model and applied it to everything else... Food, dieting, dating, money, social media... you name it. I wonder where some of our perfectionism came from?
Diet culture tells us to abstain from certain foods if we want to achieve the unrealistic standards set by media messaging. "Avoid carbs, avoid fat! Eat enough protein but don't eat too much or you'll get bulky." ... well then, what the heck do we do?
We are bombarded by thousands of messages a day telling us we need to change the way we are, that we will make it further in life if we look "good".
The current American Dream: (in our opinion)
Make Money
Be skinny and attractive <----- 💩
Be popular (social media will dictate this, better get your likes...)<----- 🖕that's what we think about that.
Oh and, all of the societal constructs are not the issue... JUST YOU ARE! The onus is placed on the individual. Have an eating disorder? Fix it, just eat. Have depression? Stop being sad and snap out of it. Pull yourself up by your bootstraps and fix yourself. If you're not ahead then you're behind.
Oh HELLLLLL NO!
Empowered RX will not stand for this old way of thinking anymore. We know that when someone is critically ill they must be medically stabilized in a hospital setting. Once their vitals have stabilized and they begin the next leg of recovery we believe treatment can be done and will be more effective outside of hospitalization.
....So check this out...
Anxiety, isolation, rigid eating plans, rules, a voice telling you when and when not to eat, black and white labels (failure Vs. success) ...
Hold on, are we talking about the nature of Eating Disorders or are we talking about many Residential Treatment centers?
Sadly, this could describe both.
I'll never forget when my 13 year old client looked at me and said,
"It was always so confusing. I was in trouble for using myfitnesspal and then they would tell me the calories in the foods I was getting."
or
When an 11 year old told me,
"They made me eat plain pads of butter. They served me a roll and I didn't realize butter was mandatory. Once I finished the woman on duty told me to unwrap and eat the butter by itself. No cheating, she said."
When a 16 year old in our program said,
"I am ashamed of liking girls. I came out in residential and the nurse told me that was gross."
We tell our children that calorie counting, rigidity, shaming, black and white thinking and rules are something we can no longer do... and then we are taken out of our homes and placed in a program run by these very concepts.
Now I know, I've heard it before.. there are reasons for everything these medical centers do! I am not bashing Residential treatment centers, but I am calling out issues that need change. Perhaps it is compassion fatigue, or short-staffed factors, or the old treatment models. Perhaps it's the complexity of this illness. We recognize that the nature of many ED's is to create secrecy, avoidance and often comes with lying. Structure is needed. Guidelines are needed. We believe there can be more of a balance though, particularly for those who are entering partial treatment or return to activities of daily living.
Residential treatment centers offer a variety of programming:
DBT- Dialectical Behavioral Therapy
CBT- Cognitive Behavioral Therapy
FBT- Family based treatment, our personal favorite.
Art Therapy- YES
These are great! We love the more holistic approach these methods take... but how are they used in practical application? Well, we don't like this as much.
Our clients note that their DBT and CBT classes taught them some good tools. They learned awareness, how to stop thoughts from spiraling and how to communicate when things are feeling bad. Such a good foundation! This is highly needed! But there is so much more work past the foundation that needs to be taught.
Our clients reflected that, 3 hours of sitting in front of a computer learning about meditation wasn't effective. In fact many have stated something similar to one of our 17 year old girls, " Meditation is the last thing I want to do when I am raging or feeling like my body isn't a safe place to be."
Empowered RX is changing the status quo. The healthcare system is broken and neglects a MAJOR part of health that we believe is the missing piece to healing and reclaiming your life after an Eating Disorder: Exercise Physiology & Empowerment.
Historically Exercise has been deemed off limits during Eating Disorder Recovery. While this is important and necessary during the initial phases of recovery when health and weight are being restored, Empowered RX believes that exercise can be used as an adjunct intervention in later stages of treatment. We see wellness and health re-education intervening in all stages of recovery. We take a bottoms up approach and rebuild beliefs, practices, habits and relationships with food, body image and deep health.
Empowered RX believes in the Holistic and Transformative Powers of exercise for Eating Disorder patients for the following reasons:
Empowerment
Restoring Weight
Decreasing BMD loss
Strengthening body and Mind
Stress outlet
Teaching Healthy Habits
Improving Relationship to Exercise and body image
Increasing window of tolerance
Embodiment
Peer:peer support and communication/community
Injury Prevention with return to sport and activities of daily living
Increased Confidence and Autonomy
A healthy hobby to focus on that is not based on looks
Graded Exercise model to prevent chronic fatigue or further muscle loss
Exercise Supervision for reversing exercise as a compensatory behavior
Altered pathological exercise, diet culture and body image attitudes & beliefs
Increased family-based wellness efforts
*We recognize that Exercise will not be appropriate for everyone, however we do believe that weightlifting is a necessary and pivotal component in preventing relapse for both the short and long term.
Exercise as Medicine- Empowered Guidelines for the Use of Exercise as an Adjunct Intervention to Eating Disorders
Historically Exercise has been deemed off limits during Eating Disorder Recovery. While this is important and necessary during the initial phases of recovery when health and weight are being restored, Empowered RX believes that exercise can be used as an adjunct intervention in later stages of treatment. We see wellness and health re-education intervening in all stages of recovery. We take a bottoms up approach and rebuild beliefs, practices, habits and relationships with food, body image and deep health.
*We recognize that Exercise will not be appropriate for everyone, however we do believe that weightlifting is a necessary and pivotal component in preventing relapse for both the short and long term.
Empowered RX Exercise Prescription & GUIDELINES:
Pre-Screening for exercise related or psychological pathologies that could be made worse with programming and for expectations of program:
Discovery Call/Meeting: This 1:1 introduction is mandatory to make sure Empowered RX is a good fit for the client and vice versa. We will go over our program and what it might entail for your specific needs. Those under age 18 need to be accompanied by a guardian for this initial meeting.
Prescriptive Model: Our Coaches will take all the information you give them at the discovery call into consideration when planning the best path forward for restoring health and confidence. We may require a commitment of a certain amount of time if health is severely declined or newly out of inpatient treatment. This is on a case-by-case basis.
Medical Clearance: Potential Clients MUST get medical clearance to participate in our program if in ED recovery. It might occur that a client is cleared for the Empowerment coaching but not yet for exercise. We can custom design the best path forward.
Liability Waiver: All participants MUST sign our liability waiver taking 100% responsibility for their health and wellbeing and disclosing of other conditions or medications that may contraindicate certain movement.
Disclosure of Contraindications/Comorbidities: Participants must fully disclose medical conditions, medications and comorbidities that could contraindicate or impact one’s workout experience.
Allied Health Team approach: We believe in an allied health team approach and so often communicate with Therapists, Doctors and Dieticians to give our clients the most well-rounded and holistic experience possible. This continuity provides transparency and ensures consistency across the board with practices, recommendations and beliefs. We ask that you connect us with a primary support role if you haven’t already done so. Exercise is a complex behavior when intertwined with body image and food relationship beliefs. Understanding one’s relationship to food and exercise across domains will allow us to give the best and most safe service possible.
Nutrition Considerations: We recommend that each girl in recovery have nutritional guidance whether it is through another treatment program, dietician or through Empowered RX Services. After EDs there is an increased risk for cardiac complications and Nutrition is especially important to have adequate intake of micronutrients, minerals and electrolytes that play a key role in heart function.
In addition to cardiac concerns adequate nutrition is needed for muscle contraction, nerve conduction, respiratory and oxygen demands, immune system function, bone health and hydration.
IF these sources are deficient it can lead to increased loss of mass, increased loss of bone mineral density and increased risk of injury. IF nutrition is adequate AND resistance training is implemented, weight restoration can be accelerated due to the anabolic nature of muscle repair post exercise.
If we see red flags or signs of nutritional deficiency, this will need to be addressed before resuming activity.
Red flags
Loss of strength
Loss of weight/muscle mass
Increased Illness
Dizziness or Low blood pressure
Tachycardia
Increased Body Image Struggles
Increased fear of weight gain
Increased aversion to specific foods and/or food groups
Guardian disclosure of nutritional decline
Self-reporting
Signs of Self-harm
Bruising Easily
Loss of coordination and motor control
Avoidance
Graded Exercise Model based on individual recommendation:
We use clinical exercise physiology methods and a graded-exercise model to transition girls and women from various stages of healing into new levels of strength. At times it may seem difficult or like a step back BUT it is imperative that we progress slowly to stave off fatigue and to support the refeeding/healing journey.
A graded exercise model is a predetermined plan that is implemented based on health, time, availability, symptoms, and dose-response to exercise. This is highly individualized and specific to one’s lived experiences and prevents us from prescribing too much or too little exercise.
Beginning exercise is typically a benign and healthy activity for most individuals in a non-clinical setting. For those in certain phases of recovery, it can be risky and dangerous if not supervised. Goals will be created based on a personal basis and progressions will occur as new levels of health are reached. Maximum health effects in the general population are achieved through a combination of cardiovascular, resistance training and flexibility. There are risks associated with each mode and so we defer to Doctor clearance and this hierarchy listed below.
To begin a new level of movement clients must achieve certain check-points to ensure it aligns with their phase in recovery. This is largely determined by biometrics and communications with Allied Health Team Members.
Mindfulness/Mindful Movement
Stretching/Yoga
Preventative Rehabilitation for Injury Prevention
Resistance Training 1x/week
Resistance Training 2x/week
Resistance training with shorter rest periods and tempo work
Higher volume weightlifting
Short aerobic training
Metabolic Conditioning
Return to Sport
Long duration running
Tailored Mode of exercise for individuals:
Goals
Worries
Medical Status
Interests
Comfort
Exercise/Food/Body Image Beliefs
Health at Every Size Model: We are a weight stigma free service. We do not help individuals lose weight. We help them find balance, moderation and assist in building strength, confidence and healthy habits.
Educational Component Mandatory:
The appropriate use of exercise for health benefits
Body Image Work
How to recognize when exercise is becoming problematic
Developing healthy attitudes and exercise behaviors
Body awareness (i.e., understanding physiological states, injury, and pain)
Enjoyment of exercise and exercising for fun rather than as a behavior that may serve a functional role in maintaining an ED
Exercise identity
Identifying factors related to overtraining or burnout (Hackney et al., 1990)
Focus on Positive Reinforcement
Sports Nutrition
Bio-Psycho-Social Model:
Because EDs are so complex and multifaceted we take our approach to Empowered the same way with a focus on Mind/Body/Spirit. We debrief during and/or after sessions to check in with emotions, lived-experiences and thoughts evoked by our work. We are not therapists. We do not diagnose.
We seek to disempower the voice of the ED by strengthening the girl/women’s inner voice enough to:
Discuss her situation and experiences shame free
Understand her beliefs on body image, exercise and nutrition
Educate on Diet Culture
Family Food Dynamics
Feel like they have a safe/inclusive environment
Freedom to express their emotions
Experience Embodiment and Somatic Experience
Exercise is amazing! It is Empowering and healing. It is also complex and potentially dangerous in recovery. We are here to help you through each and every single phase. Sometimes in the early phases of recovery we just focus on integrating discussions surrounding exercise beliefs and behavior patterns. As a client progresses in recovery, we begin to help them build healthy and sustainable lifestyle habits.
We are here to help! We are here to change the status quo. We are here to get a barbell in the hands of every woman! We are here to show the world RECOVERY IS POSSIBLE and so is SELF-LOVE! ⚡️
For more information book a discovery call with us on our website HERE
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