Welcome! This Blog is run by two amazing lady runners who don't fit into a box.

Chrys:
I am a runner who does NOT fit into the stereotypical body type of a runner. I have hips, a bum, thighs, and breasts. I jiggle all over the place no matter how much spandex I put on, and my gut usually hangs over my shorts. I work in the mental health field, and have a passion for inciting outrage regarding the media's portrayal of women, their bodies, and their abilities. I am a beautiful woman who sometimes struggles to remember it. I am a runner who sometimes feels more like a slogger.

And

Rachel:
I have the spirit of a runner inside me that just won't let me quit- no matter how much I sometimes would like to! Physically, I certainly have many of the things Chrys mentions up there- hips, thighs, bum, boobs, tummy, all of it- and Lord knows all of it likes to jiggle around while I do just about anything, especially running! I am passionate about body image, the Health at Every Size & Size Acceptance movements, and love finding inspiration in as many places as possible. Working as a therapist, one of my personal goals is to live as in-line with my values as I possibly can- this blog is one of the ways I figure all that out.

Join us on out adventures in running and ramblings on Body Image.

Friday, February 28, 2014

Eating Disorder Q & A with Rachel

I am posting this for my co-blogger, Rachel, as I really think they are worth sharing and I happen to have the time and energy to post these right now, and she doesn't.  Silly hard worker, she is.  She HAS given me permission to take these and re-post them to the blog though, I promise!  I will not be editing this stuff except to take out a few things that may not make sense in this format (i.e. "stay tuned for more Q&A later today!" when I am compiling these later in the week!) and a little bit of formatting. I also added my own two cents to a few of the answers.

As I mentioned in my post earlier today, it is National Eating Disorder Awareness Week.  This is a topic close to my heart AND to Rachel's, which is one of the reasons we started this blog in the first place.  Please enjoy her knowledge!





This week is National Eating Disorders Awareness Week! And, as my career passion is the treatment of eating disorders, it's always a time I want to offer resources and information to people. This year, I decided I would do something different and see if people had any questions I could answer, and these are the fantastic questions I got! I'll answer them to the best of my knowledge. Please feel free to ask follow ups! Or brand new questions! 

From Crystal:
Maybe it's just me, but whenever I hear eating disorder, all I think of is anorexia or bulimia. Are there official names and other disorders? I'm thinking mostly about those that go in the opposite direction from not enough to overeating.

Short answer is YES! There are other disorders. Anorexia and Bulimia are certainly the most researched of eating disorders at this point, and are the most commonly known- but not necessarily the most *common*. In this iteration of the DSM, Binge Eating Disorder (BED) was given it's own diagnostic code and acknowledged as it's own diagnosis. According to the Binge Eating Disorder Association (an organization I trust run by people I admire and trust), BED is the most common eating disorder in the US. One of the stats I find most notable is that it impacts 30-40% of people who seek weight loss treatment- that's right, nearly HALF! Binge Eating Disorder is characterized primarily by out of control eating, and the amount of food that may be in a  binge is highly subjective. As with all mental health diagnoses, it's important to remember that the symptoms must cause distress if it's going to be diagnosed. What distress means is also somewhat subjective. BED is also incredibly damaging to health- and NOT because it can result in a higher weight. People with BED are not necessarily overweight or obese, and are often/always malnourished.

One thing that is really important to remember about this and all other eating disorders is that you cannot simply look at someone and diagnose them with an eating disorder. People come in ALL different shapes and sizes, so just because someone is below, at, or above average weight does not mean we can make a health diagnosis.

There are also other eating disorders that are identified. Another newly acknowledged one is Avoidant and Restrictive Food Intake Disorder. This most commonly starts in youth/adolescence, and is not my area of expertise. What I do understand about it, though, is that it's something like highly selective, picky eating that results in nutritional deficits and often significant weight loss. It differs from Anorexia in that the drive for thinness and body shape distress aren't present.

Two other unofficial diagnoses that can cause distress are Orthorexia (obsessive about eating clean or organic or following certain guidelines- may or may not be underweight) and Diabulimia (use of insulin to purge/control weight). Neither are things I know enough about to really talk about, though I have seen more cases of Orthorexia than Diabulimia. Again, these are not official diagnoses.

There are more, but those are the ones I feel I can speak about in an educated way, and they are the major diagnoses.





Julia asked:
What do we know about the risk factors for eating disorder development? And while I know that they require treatment, what does treatment entail? And, since I'm asking questions, what are the warning signs that folks should look out for in others and themselves.

First question: What do we know about the risk factors for eating disorder development?
GREAT! Short answer is "Not nearly enough." Much longer answer is "But still a lot, and here it is:"
We know that eating disorders are biologically based illnesses with genetic underpinnings. People are genetically predisposed to them, generally. The common saying is that Biology loads the gun, Environment pulls the trigger. It is *exceptionally* important that this next thing is understood: Biology & genetics do not mean FATE- just because someone is predisposed to the development of an eating disorder does not mean they develop an eating disorder. And "environment" can be large scale (media, social pressures, etc) and can be small scale (family, peer group). Eating disorders are nobody's FAULT and a person does not choose to have one. So, some basic risk factors:
  • Family history of an eating disorder. I would also bet that a family history of addictions would merit some closer attention, but I don't know that based on research. More just a gut feeling. :)
  • If a child is excessively or unusually focused on his or her weight/shape, commenting on his/her own or other's bodies, wanting to go on a diet, etc, etc. These are the sorts of things that should raise an eyebrow.
  • Participation in sports that are particularly appearance focused can also warrant some extra attention. If I was a parent, and my child was participating in cheerleading or dance or ice skating, I would want to know their coach and his/her methods very well, and I would pay extra attention to what my child was eating and saying about food/body image. (Note From Chrys: I would also include any sports that focus highly on weight in this, including gymnastics, wrestling, and distance running.  I do not know much about pole vaulting, but I have a feeling that might be included as well. )
  • Picky eating can certainly be a warning sign, but also should not be forced. We're learning a lot more in that area of research (that whole "sit there until you clean your plate" method isn't good), but I don't know enough to speak more about it.
  • And then there are physical warning signs. Extreme weight loss or gain. Yellowing teeth, scabs on hands. Person being always cold, dressing in lots of layers constantly. Things like that can be a sign that someone may be struggling with an eating disorder.


Next: what does treatment entail?
It can entail a lot of different things. I'll go through the levels of care as laid out by the APA:
  • Acute inpatient hospitalization: This is for someone who needs constant medical monitoring, may be on some sort of life preserving or life saving technology, very medically unstable.
  • Inpatient hospitalization: This is for someone who is not quite as unstable as the previous, but still needs access to 24/7 medical care, needs frequent labwork, may need tube feeding. Suicidal ideation (active, with plan & intent) is often seen at this level of care.
  • Residential Treatment: This is what I do! =D Residential treatment (RTC) is 24/7, but the patient is stable enough that they don't need frequent labs. Some RTC will accommodate tube feeding and do more frequent labs (Renfrew did when I worked there, for instance). Others (such as Carolina House) require more stability than that and do not do tube feeding, and generally speaking don't draw labs often. This is for a medically stable patient that is behaviorally in need of 24/7 supervision and intervention in order to do things like weight restore, stop binging, stop purging, stop compulsively/excessively exercising. It's a very therapeutic environment, ideally.
  • Partial Hospitalization: This is a partial day of treatment. It's kind of like a job- you go in during the day, and stay at home at night (generally- all treatment facilities I know of that offer both RTC & PHP have a hybrid of the two, where a patient's insurance company pays for PHP, but they pay a room and board rate to still get 24/7 care). Their day is filled with therapy, groups, nutrition and medical appointments, and, of course, meals/snacks.
  • Intensive Outpatient: This is even less of a day than PHP. IOP can mean a variety of different things, but usually means at least 3 days/week, at least 3-4 hours/day. It can mean more; I have not really known it to be less. A patient may also get therapy and nutrition counseling at an IOP program, or they might have outpatient therapy/nutrition services they use in conjunction with the IOP and just use it for groups and 1-2 meals/snacks.
  • Comprehensive Outpatient: This is what people will often do if an IOP is not available. This would be a full treatment team of therapist, nutritionist, psychiatrist, medical doctor that they saw 1+ times/week, and there would also usually be an outpatient group or 2 in there, as well. Meals aren't often included in this unless one of the providers does meal support therapy.
  • Outpatient: Now, this is something that can go on for years. This is probably what most people traditionally envision if they think of going to therapy. Seeing a therapist 1-2x/week, having a nutrition appointment once/week to start with, and medical and psychiatry appointments as needed. Sometimes there are groups. The amount of OP you do would depend on the level of need- it may be that you start out at basically a comprehensive OP plan, and then move on to less and less as recovery gets stronger. For best prognosis, someone will engage in some level of care for about 5 years.


People start at lots of different places. Starting at the least restrictive level necessary is definitely considered best practice. Now, "necessary" seems to mean something different to providers than it does to payers, but that's probably to be expected. ;-)

Finally, what are the warning signs that folks should look out for in others and themselves?

I pretty much covered this accidentally in the first question! :) OOPS! If you find yourself, or your friend, excessively focusing on weight/shape/food/etc, if you see someone restricting their food intake (naked salads, never eating when you get together, etc), if you notice that every time you eat with a friend, they get up and go to the bathroom immediately, if you notice that whenever you see them/eat with them, they get multiple large servings or eat very fast... these are all things that could indicate a problem. If they are constantly at the gym or out exercising (and it's not necessarily in accordance with, say, a training plan for an athlete)... those are also potential hazard signs.





Catie asked:
What's your take on the whole gluten free/organic/dairy free/restricted eating? For the record, I know some people have allergies and such, but it seems like some of it is more choice. Just curious.

I have 2-3 initial thoughts. First and foremost is that if someone feels they have a physical need for a restriction in their diet, or have a problem that needs further exploration, then they should absolutely get a full work up, not just from a PCP, but from specialists, such as endocrinologists. There are real needs for these restrictions, and missing those needs can have horribly detrimental effects.

Second is that the diet & weight loss industry (A TERRIBLE BEAST) saw something that was a genuine problem for a small subset of people and realized that they could use our weight/thinness obsessed society and profit from that problem by turning the phrase "Gluten free" into a diet catch phrase. And, because the diet industry is very good at playing into people's fears and insecurities, it worked wonderfully. Every new diet craze probably started similarly - a real medical need for some people co-opted to make money for the diet industry.

Third, the diagnosis of Orthorexia I briefly mentioned in my answer to the first question comes to mind. This particularly type of mindset- the obsession with organic, clean, "healthy" eating and the petrification that can come with the mere idea of BREAKING those eating rules- is very susceptible to these diet crazes, particularly since so many of them ARE based in a medical need for some people. The individuals who struggle with this mindset will often overgeneralize these sorts of rules from "good for a certain subset of people" to "good for everyone and necessary to prevent problems."

Note From Chrys: This is something that I care a lot about, as I know many people, including family members, who genuinely need to have restrictive diets due to some really funky allergies and sensitivities.  These include to gluten, soy, certain proteins in milk, fructose, and eggs.  They also include diseases such as Arthritis, Rheumatoid Arthritis, and Gastro-Esophogeal Reflux Disease, which can require avoidance of certain foods in order to avoid flare-ups of disease and significant discomfort.  I ALSO know many people who have gotten caught up in the low carb diets, the low-fat diets, the gluten free diets, Paleo diets, Atkins diets, the dairy free diets, who avoid soy due to fear of the affect is has on hormones, etc, etc, etc that are, in essence restrictive of certain foods/food groups.  I agree wholeheartedly with Rachel that one should seek consultation with a SPECIALIST if they feel they need to be on one of these diets.  People need to remember that you can cause sensitivities by cutting out certain food types from your diet, and some discomfort is expected when re-introducing foods to their diets.  For example: I was vegetarian for 6 years as a teen/in my early 20s.  When I re-introduced meat, especially red meat, my body didn't really know what to do with it at first!  After a few months of slowly re-introducing these things, though, my body loves, and sometimes craves, these things and the nutrients that they give me.  IF a person is engaging in a restrictive diet of any sort, it is important to look out for a shift towards a "good food, bad food" mentality, as this can be something that precedes the onset of an Eating Disorder.  It is also very important to talk to a nutritionist and learn about the nutritive deficits that can be associated with particular restrictions and to replace those in your diet via other foods or via supplements.  Whenever you can replace it via food, it is better for your body, more accessible to your body, and, often, cheaper.  Supplements can certainly be used, too.  





Finally, Amelia asked:
How do you differentiate compulsive exercising from non-pathological training? For instance, it is (mostly) a joke among triathletes that training for an ironman is like getting a second, part time job. And I'm sure the hours they put in would rival some of the time seen in compulsive exercising, but (while I wouldn't call them normal) I would not consider most of the ironmen I know to be ill. Or as my friend Julie put it once, "I'm not exercise addicted, I'm exercise overscheduled."

This is something that is hard for a LOT of folks to understand. The over use and abuse of exercise is one of the absolute most socially reinforced behaviors for people. And, for some people (such as the ironpeople Amelia mentioned), they are exercising in a way that is, for them, acceptable and healthy. Endurance, professional, elite, collegiate athletes- these are all people who are VERY likely to exercise multiple hours a day, often every day.

What sets off "Compulsive" is actually that word- the WHY of the exercise. Are they following a training program so they can achieve a particular goal, and that's the end of it? That's probably not so compulsive. But imagine if an ironperson missed a training day due to an illness or a death in the family or a catastrophe or just being unable to get themselves to do it that day. Hopefully, he or she would not spend significant time feeling guilty or ashamed or like something bad was going to happen. With people for whom exercising is compulsory, they *will not* miss a scheduled day, and often if they absolutely MUST miss a day or session, they will spend time wracked with guilt and fear that "All is lost."

Additionally, compulsive exercise is different from excessive exercise or compensatory exercise. I imagine that the endurance athletes many people know would be more closely associated with excessive exercise rather than compulsive. What defines excessive, for me, is "to the detriment of all else and without adequate nutritional support." Also, excessive would be over and above what a training schedule or program would call for, and outside of what a coach might want. Compensatory exercise is when someone uses exercise as their form of purging- used to compensate for food already eaten or used to justify food yet to come. This is seen and heard ALL THE TIME in our society. Think any time someone eats something and says "I'm going to have to work out extra tomorrow!" or something like that... but, again, taken to unhealthy extremes.

Finally, disordered exercising patterns are most often focused more heavily on changing body weight or shape rather than achieving particular goals related specifically to the activity (i.e., "Finish Ironman, don't die"). They also frequently exist without adequate nutritional support, so that your body is not remotely maintained through this exercise.

I have had a great time answering these questions, and hope those of you who asked the question feel fully answered! If there are any follow up questions, those are very welcome here! I hope those of you who read this stuff feel more informed and knowledgeable about eating disorders, and I would be absolutely happy to continue answering questions all week!

Eating Disorder Awareness

This week is National Eating Disorder Awareness Week.

This is a topic close to my heart, so I thought I would share some of the "fun" facts that you might not know about Eating Disorders.


  • There are more people in the US right now who are struggling with an Eating Disorder than there are people with green eyes. 
  • Eating Disorders have the highest mortality rate of any psychiatric disorder - many people die of suicide, malnutrition, or heart attack.  Eating Disorders can kill even during periods of recovery/after a person is recovered, due to the damage that it can cause to the heart and other organs. 
  • Despite the common belief that Eating Disorders are a disease that affects "rich white girls," 1 in 3 or 4 people with an Eating Disorder is male.  It is believed that non-white Americans suffer Eating Disorders at similar rates to white Americans, with the exception of Anorexia Nervosa, which does, for some reason, seem to affect Caucasians more so than minorities.  
If you want to learn more, check out the NEDAwareness Articles posted on the NEDAwareness website.  

Sunday, February 23, 2014

Why I Run Part V and VI: Agony and The Void

Oatmeal Comic Response Part V and VI: Agony and The Void

Agony:

OK.  So I don't really have a whole lot to say about this one.  I haven't really experienced this.  I have certainly experienced pain while running.... dehydration, sore muscles, MY version of crazy hills (which are definitely NOT an actual mountain.)  I definitely know that feeling when you finally get some sugar, some water, some beer, though.  And I love the Godzilla-like monster's big ol' tall glass of nope.

The Void:

Again.  I haven't really had such a deep and amazingly life-full moment as this via running (yet.)  I have had tiny little snippets of something similar, though. The AMAZING feeling when you conquer a hill that has always beasted you.  The JOY of a well timed afternoon shower, or realizing that you DO have another bottle of water stashed in the car.  One of my first longer runs in the summer heat, where both my running partner and I were woefully under prepared hydration wise, only to discover an organized running group's water stop and encouragement at our turnaround point.  Again - the feeling as the finish line came in to view at the end of my first half marathon.  GREAT feelings, all.  Feelings that made me forget any job stress.  Forget if my pace wasn't what I wanted.  Forget that I hurt.  Forget that I am x number of years old and haven't met x, y, and z goals yet.  Escapism isn't a super healthy coping mechanism as a general rule.  But, man... if I can find that in running - if it can help me focus on the positive, focus on what I can accomplish, focus on gratitude towards people, and weather, and happenstance.... all while improving my cardiovascular fitness, building muscle, and improving the probability for a long, healthy life?  I WILL TAKE IT.

I don't run very fast.  I run with distractions, and love listening to podcasts (especially NPR, which allows me to connect with the larger world around me and increase my knowledge) while running.  I, too, have the same noise in my head - to the point where I NEED the distraction of music, podcasts, etc, when I run, because otherwise I WILL think too much about my life, about my job, about my relationships, about world peace and starving children and the whales.   Along with the voice(s) in my ear (I only run with one earbud in, for safety reasons), running also helps me to forget those demons.  It helps me slay the Krakens.  It helps me to silence that damned Blerch.  This comic brings together so eloquently some of the amazing, intangible reasons I run.  Some of the reasons that I KEEP coming back to it, time and time and time again when life gets in the way or the Blerch wins for a few months or whatever it is that takes me away from the habit.

Today I was "supposed" to run the Disney Princess Half  Marathon.  I didn't.  I didn't even GO to Disney, due to lack of training and lack of funds.  I got it in my head that I "should" try to run 13.1 miles over the race weekend to commemorate it, however.  It took 5 runs over the course of 3 days, but I did it.  I BEASTED that goal, partially due to the fact that I should not try to do math at the end of a run.  I ran 14.9 miles over the course of 3 days, when I wasn't sure  I could manage 13.1.  I got to spend a beautiful weekend at the beach with my husband.  I got to run at the beach, which I hate because it is hard but I LOVE because it is beautiful and it is calming; because there are people and there are puppies and there are piers and dunes and lighthouses.  Take THAT Blerch.  Take THAT Kraken.  Take THAT doubts and demons.

THIS is why I run.

Friday, February 21, 2014

Why I Run Part IV: Vanity

Oatmeal Comic Response Part IV: Vanity

While vanity has been, admittedly, a part of my reason for running at times, it has never really been my primary reason.  I run to feel strong, I run to feel like I am in shape.  I run to improve my cardiovascular endurance for dance and other activities.  I actually get REALLY annoyed with the focus on weight loss and looks.  Would I like to lose some weight right now?  Yes.  Is that why I run?  No.  I certainly didn't expect any major changes in my body when I first began running.  I still LOVE this comic.

I love core work, but I hate crunches.  I love the idea of them being an attempt to head butt ones' crotch.  I find it amazingly humorous.  Amazingly awesomely humorous.  And I will think about it every time I do crunches (which is about once a week.)

I love the idea of falling into something real, something of consequence, even if it's a hole.  Real life hurts sometimes.  Real life isn't always fun.  But it's real.  And it's life. And if you don't do something of consequence, what is it worth?

Please.  Let's not be Baked Potatoes.

Monday, February 17, 2014

Why I Run Part III: Selfishness and the Krakens

Oatmeal Comic Response Part III: Selfishness and the Krakens

While I actually REALLY like paying bills (it's super strange, I know), I totally get this.  I ran 5 miles yesterday and almost 6 today.  This is why I am totally okay with the laundry being undone, the vacuuming undone, and the house in a general state of madness, as it already is.  Despite a significant lack of employment at this point in time.  But it's all good, because I RAN, BITCHES!!!!

This part of the comic also makes me immensely happy, as it reminds me of the feeling I had near the end of my very first half marathon when I turned the corner into the final stretch and SAW THE FINISH LINE!!!!  
One of my friends managed to catch a photo of me in that last stretch, and I can't believe the smile on my face.  It matches how I felt inside, but I am amazed my body even had the energy to use those facial muscles.  Man.  That feeling was AMAZING.  Months of training.  Pain.  Early Mornings.  Rain.  Heat.  Cold.  Dehydration.  Blisters.  Aching Joints.  They were ALL worth it.  They were all worth it and the joy and pride I felt was overwhelming when I saw that finish line and realized that yes - I WOULD actually finish.  I COULD actually do it.  THAT is the feeling that can keep me going.  

I felt the same thing when I crossed the finish line of my second half marathon.  My time may not have been as great, but I was not getting old at 30.  I got up at 4am on my 30th birthday to run a freaking half marathon! I completely assume to feel the same way as I come upon the end of my next half marathon (which I am currently training for, though I haven't actually picked a target race yet, lol!)

Sunday, February 16, 2014

Why I Run: The Feeding

Oatmeal Comic Response Part II: The Feeding

So yes.  I DO know runners that are like the first panel.  Who LOVE leafy greens and tofu and chia seeds and green weird smoothies.  I am not one of them.  I am ok with many of those things.  But I also love me a good juicy steak.  I am always up for Taco Bell or for Mexican food.  I don't keep cookies or chocolate in my house as a general rule because I WILL EAT IT ALL.  I ALWAYS want cheese and/or cheese dip. I would probably dip cheese in cheese dip if I thought it would work.  nomnomnomnom.

I love that this person comes out as an "I run to eat" sort of person.  I am TOTALLY a "reward myself with food after a run" sort of person.  I am aware that this is not a super healthy way of thinking about food.  I am also aware that I am in a place in my life where I can do that safely.  I might say "you know, I really want desert, but I have been slacking on my runs.  I probably shouldn't."  But if I have a super mad crazy craving, I will listen to my body.  If there is a celebration, a special occasion, etc, I will certainly partake.  If I have a long run, though, I will also totally reward myself with food.

What I find amusing, however, is that my diet IS affected by my running.  I find I drink less beer and eat less ultra-processed, high-fat, high-salt, fried food when I am running, because I know it will affect my run the next day.  I don't want that all sitting in my stomach as I try to slog out 5 miles plus (which I WILL get back to one day! I am actually planning a 5 mile run today!)  I am less likely to go out (which often means over-eating and drinking beer), on a Friday, because I have to get up to run on Saturday.  I am more likely to eat lean proteins to fuel my run.  I am more likely to eat granola, nuts, or cliff bars because that is what makes sense to have between work and a run.

My sister is a different story.  She has a favorite type of tofu, I am sure.  She has about a million different kale soup and spinach smoothie recipes, I am sure. I am NOT like that.  I will NEVER be like that.  I am TOTALLY okay with that.  This does NOT make me less of a "real" runner.  WTG on dispelling that myth, Oatmeal!

Saturday, February 15, 2014

Why I Run: The Blerch

One of these days, internet..... One of these days, I will manage to make this blog the priority that I WANT to make it.

Today, and over the next few days, I want to share a comic that my co-rabble runner shared with me.  It gets inside my head, and I can't believe I never found it earlier.

Part I: The Blerch

Now.  I do NOT run distances like the writer of this comic does.  As you know, my running is on-again-off-again, and the farthest distance I have done is a half marathon.  This will likely be the farthest distance I EVER do.  But this comic speaks truth to my brain.

The Blerch is a part of my life as well.  The Blerch convinces me that it is more important for me to finish watching that NCIS marathon, or to play another round (or 20) of Tetris, or to finish off that bag of chocolate, than it is to run.  The Blerch tells me it's ok if I only run one mile, even if I planned to run 4.  It's too hot.  It's too cold.  It's too rainy.  It's allergy season.  The dry is bad for your asthma.  The Blerch never runs out of reasons.  But when I give in, The Blerch is not silenced.  When I listen to the The Blerch, it also then tells me I am a terrible person and berates me for being lazy.  The Blerch, is, to put it nicely, a world-class jackass.

The Blerch may not shut up when I listen to it.  The Blerch may not be quieted when I am caught in the hands of inertia and cheese dip.  The Blerch is not all-powerful, though.  The Blerch can be outrun.  The Blerch can be silenced.  The Blerch can be outwitted with logic and knowledge. The Blerch can be quieted through self-love and acceptance.  The Blerch can kiss my pale, round, jiggly, tookus.