“My husband has no conception of it. He knows a little bit about that I had an eating disorder and that I’ve yo-yo dieted and things like that, but he really doesn’t understand the mental processes that go behind it, and the constantly being, I’m going to say obsessed.” ~ Ruby, mother of one.
Family and loved ones are an essential area of support for individuals who have an eating disorder or are in recovery from an eating disorder during pregnancy or postpartum. However, it can be challenging to know exactly how best to support your loved one. This page is designed to provide you with resources to help you navigate that complex relationship.
Watch Family and Loved Ones’ Sensitivity Training Here
Talking with a person who has an eating disorder might look different than other conversations. For instance, using words that directly reference appearance can be triggering for those with eating disorders. It has been shown that women with eating disorders spend longer time focusing on words that deal with appearance in comparison to women who do not meet the criteria for an eating disorder (Myers, Ridolfi, & Crowther, 2015). Learn More
Conversations with People and Their Eating Disorder
Recognizing Body Shame & Fat Talk
By Elizabeth Claydon
Body shame comes in so many forms and can manifest itself internally or externally. With the many nuances involved in body shame, I thought it time that it was broken down into a more easily-understood graphic depicted above. Learn More
Many women who are recovering from an eating disorder or still have an eating disorder are very concerned about their children picking up on their behaviors or modeling their eating. Additionally, given the complicated relationship that someone has with food whether they have an eating disorder or are recovered from one, it is challenging to figure out how best to talk about eating and weight with children. Learn More
Creating a healthy relationship with food for your child
Weight Gain Distribution
Weight gain and body shape changes can be very daunting during pregnancy especially for women who have an eating disorder or eating disorder history. However, it can be helpful to understand how the weight is attributed to the baby and how it is distributed. Being able to connect that weight gain specifically to the baby or pregnancy components can help the woman reframe the weight gain positively. Learn More
It can be frightening when you are confronted with the possibility your loved one or family member has an eating disorder. However, it is important to remember that they are probably frightened too, and that this is when they will need you the most. The following recommendations are related to how to help for eating disorders in general and then a few specific to eating disorders and pregnancy. Learn More
How to help a loved one
Relevant Blog Posts
Parenting Concerns and Eating Disorders
By: Jillian Catalano
West Virginia University
Mothers with an eating disorder or history of an eating disorder often face challenges related to parenting and want more resources in this area. However, it is important to note that navigating parenting concerns associated with eating disorders is often under-studied and over-generalized. There has been limited research regarding the associations of eating disorders with parenting. There are other factors that play a role in parenting behaviors, but they too, have been overlooked. While every mother’s experience and relationship with their child is different, common parenting concerns have been suggested. Treatment and intervention can often assist in the parenting process, but a better understanding of a mother’s situation can help determine the best approach to seeking those resources.
A common misconception about eating disorders is that they can inhibit a woman’s ability to conceive. However, research suggests that anorexia nervosa (AN) and other eating disorders may not always hinder a woman’s fertility. However, eating disorders can cause a variety of physical and emotional challenges postpartum. Pregnancy has been associated with remission for some eating disorders but eating disorder symptoms can return after childbirth. Once a child is born, the desire to lose weight may reintroduce body image concerns, factoring into a mother’s relapse.
As a child continues to grow, a mother with an eating disorder or history of an eating disorder may emphasize the child’s well-being. These mothers have had their own body image concerns, and may try to instill body positivity or neutrality in their child’s mind. In doing so, they work alongside their child to reject society’s narrow belief of the “perfect” body. Mothers hope these behaviors can encourage their child to feel comfortable in their own skin regardless of their view of their own body. As a result of their history with eating disorders, mothers pay close attention to eating disorder signs within their children. These experiences allow mothers to detect symptoms early and guide their children to seek help.
However, there are times where this focus on a child’s well-being may lead to an overemphasis on feeding practices. Because of the mother’s history with body image concerns and eating struggles, they may feel that their child is eating too much or too often. This maternal apprehension may cause increased risk of food restrictions. Studies suggest that mothers may limit a child’s food intake, or use food as means of reward or affection. There can also be an increased focus on a child’s size and weight. Emotional eating is also a concern, as stressful events and emotional difficulties can trigger these behaviors.
For mothers with an eating disorder history, intergenerational transmission is a valid concern. Women often seek treatment for their eating disorder as a result of these concerns. While there has been some research on the genetic influence on eating disorder development, there are other factors that come in to play. A child’s environment and upbringing can also trigger that genetic predisposition for an eating disorder. Raising a child in a household that emphasizes on treatment and intervention may decrease the risk of an eating disorder. Similarly, valuing support and coming together in the face of adversity is also beneficial for eating disorder prevention. Ultimately, a mother’s eating disorder does not directly predict the development of an eating disorder in a child.
While every woman’s journey to motherhood and approach to parenting is different, studies suggest that eating disorders can have an association with parenting, either positive or negative. In cases where a mother has an eating or history of an eating disorder, the possibility of a child developing an eating disorder may increase. However, environmental factors, such as emphasizing treatment and intervention can change the trajectory of eating disorder development. The associations of eating disorders with parenting methods are complex and continue to evolve through further research.
Allen, K. L. et al. (2014). Maternal and family factors and child eating pathology: Risk and protective relationships. Journal of Eating Disorders, 2(11), 1–14. doi:10.1186/2050-2974-2-11
Claydon, E. et al. (2016). Parental reflective functioning among mothers with eating disorder symptomology. Eating Behaviors, 23, 141–144. http://dx.doi.org/10.1016/j.eatbeh.2016.09.002
Mazzeo, S. E. et al. (2005). Parenting concerns of women with histories of eating disorders. International Journal of Eating Disorders, 37, S77–S79.doi: 10.1002/eat.20121
Family and Loved Ones’ Sensitivity Training
By: Jillian Catalano
West Virginia University
During the month of February 2021, the Healing Bodies Healthy Babies research team released their first ever Family and Loved Ones’ Sensitivity Training. The virtual seminar has been much anticipated, as members of the team have spent months researching, creating, and producing visual content to optimize the viewer experience. Dr. Elizabeth Claydon laid the groundwork for this project but received support from her student research assistants. Zoya Khan, Ruke Asagba, Hattie Rowe (acting) and Taylor Shultz (filming) contributed to the video component of the training. Zoya Khan also created the slide deck for the presentation. The Family and Loved Ones’ Sensitivity Training is now available for public viewing on the Healing Bodies Healthy Babies Website.
The sensitivity training was designed to educate others about eating disorders and pregnancy. It also provides insight on how to better support a family member or loved one who may have an eating disorder during pregnancy or in postpartum. Individuals with eating disorders can benefit from family and loved ones who foster a supportive framework during their care and treatment. It is immensely beneficial for someone with an eating disorder to have advocates and allies in close emotional proximity. Dr. Claydon used her past research which interviewed several women to better understand their personal experiences with eating disorders and pregnancy to inform and ensure the effectiveness of this sensitivity training.
The training establishes a common understanding of the main types of eating disorders, as family and loved ones may have had different experiences in the past. It shifts from a general discussion of eating disorders to providing information about the complex issue of eating disorders and pregnancy. Despite the intricacy of eating disorders and pregnancy, the training outlines specific recommendations for family and loved ones to support an individual with an eating disorder. One of the most simplistic and crucial ways to support a loved one is by using sensitive word choices; for example, using positive affirmations instead of negative assumptions. Educating yourself and encouraging your loved one to seek help were among some other recommendations mentioned in the training.
The Healing Bodies Healthy Babies team has conducted prior sensitivity trainings and research projects, but this virtual seminar is the first of its kind. Zoya Khan, an active student researcher, provided insight about working on the Healing Bodies Healthy Babies Team. “My favorite part of being a part of this project was definitely getting to work with a team made up of so many different students and working with Dr. Claydon,” stated Zoya Khan. She has been a student researcher for a year and a half and has been given the opportunity to work independently, as well as gain extensive public health knowledge working alongside Dr. Claydon. Zoya hopes that more families and loved ones will utilize the resources offered by Healing Bodies Healthy Babies in the future. “We often think about providing resources for patients, but we should also remember their loved ones may also like to learn how to support the patient.” Zoya reported.
Additional resources for family members and loved ones can be found on the Healing Bodies Healthy Babes website.
Claydon, E. Family and Loved Ones’ Sensitivity Training. (2021, February 4). Healing Bodies Healthy Babies. http://healingbodieshealthybabies.com/family-loved-ones/
February 2020 Sensitivity Training
By: Malerie Razzis
West Virginia University
This past February, the Healing Bodies, Healthy Babies research team was able to conduct their very first sensitivity training. There were months of preparation prior to the first session with considerable work from team members including Zoya Khan, Caterina DeFazio, Taylor Shultz, Oghenerukeme Asagba, and Hattie Rowe. During Summer 2019, the team worked in the WV STEPS lab to film examples of patient-clinician interactions. These videos have been made available for the public to view on Youtube. Prior to the first sensitivity training, all members of the Healing Bodies, Healthy Babies team also underwent the sensitivity training.
The sensitivity training that was developed for the clinicians provided various clinical strategies that would be reasonable to integrate into their daily treatment of patients, particularly those with eating disorders and pregnancy. Previous studies have laid some groundwork about the prevalence and characteristics of eating disorders in pregnancy, indicating a greater need for clinical understanding of eating disorder symptomatology and appropriate screening tools to be incorporated into prenatal and postpartum care. Pregnant women with a history of eating disorders or an active eating disorder have a greater risk of giving birth to a child with lower birth weight, smaller head circumference, microcephaly, and small for gestational age (Kouba, Hällström, Lindholm, & Hirschberg, 2005). Due to these health risks, it is important for clinicians to learn how to properly treat patients with eating disorders.
A questionnaire was administered prior to the sensitivity training, as well as after the completion of the sensitivity training. Prior to training, only 76% of clinicians indicated that a patient’s eating disorder history would be extremely relevant to their treatment. Upon the end of training, this number increased to 96% of clinicians indicating that it would be extremely relevant to their treatment. When asked about their comfort when treating patients with eating disorders, 61% of clinicians expressed being less than comfortable providing treatment. After undergoing the sensitivity training, this number shifted to 84% of clinicians indicating that they were either somewhat comfortable or extremely comfortable with treating patients with eating disorders. These results were promising to the Healing Bodies, Healthy Babies team.
Since this was the first sensitivity training, the results are preliminary. “I am hopeful that once we conduct more trainings, we will have more data to analyze! This will allow us to investigate the significance of our data and how the sensitivity training can be implemented to better aid clinicians,” reported Zoya Khan. Khan is an undergraduate student that is an active member of the Healing Bodies, Healthy Babies team. She would like to be able to administer the sensitivity training to a variety of clinicians including physicians, physician assistants, nurses, etc. in the future. “Every person has a unique insight to offer, which will allow us to determine how we can provide clinicians with resources to treat patients with eating disorders,” she says. Another goal that she has for the team is to continue developing free resources that are made available on the Healing Bodies, Healthy Babies website. “I look forward to continuing to work with Dr. Claydon and the rest of the Healing Bodies, Healthy Babies team!”
Khan, ZA, DeFazio, C, Claydon, EA. “An evaluation of weight sensitivity training for clinicians” Poster presentation at the Spring Undergraduate Research Symposium, Morgantown, WV, April 2020.
Kouba S, Hällström T, Lindholm C, Hirschberg AL. Pregnancy and Neonatal Outcomes in Women With Eating Disorders. Obstetrics & Gynecology. 2005;105(2):255-260. doi:10.1097/01.aog.0000148265.90984.c3.
Terminology for Mental Health Professionals
By Hattie Rowe
West Virginia University
As medical knowledge increases, so does responsibility. We are continually enlightened of more sensitive ways to approach conversations with patients. People with eating disorders can be sensitive to others and the vocabulary directed towards them (Kuipers, G., den Hollander, S., van der Ark, L.A., & Bekker, M. 2017). Research has shown that people who have eating disorders focus more on appearance-related words (Myers, Ridolfi, & Crowther, 2015). Staying up-to-date on positive and person-oriented terminology for patients is a responsibility for all who work with individuals who have eating disorders.
The following terms have been proposed by researchers and professionals as more appropriate terms to use in conversation with patients who have eating disorders.
Kuipers, G. S., den Hollander, S., van der Ark, L. A., & Bekker, M. H. J. (2017). Recovery from eating disorder 1 year after start of treatment is related to better mentalization and strong reduction of sensitivity to others. Eating and Weight Disorders, 22, 535–547. doi: 10.1007/s40519-017-0405-x
Lilienfeld, S.O., Sauvigne, K.C., Lynn, S.J., Cautin, R.L., Latzman, R.D., Waldman, I.D. Fifty psychological and psychiatric terms to avoid: A list of inaccurate, misleading, misused, ambiguous, and logically confused words and phrases. Frontiers in Psychology. doi:10.3389/fpsyg.2015.01100
Media Resources. Retrieved from https://suicidepreventionlifeline.org/media-resources/
Myers, T. A., Ridolfi, D. R., & Crowther, J. H. (2015). Reaction times to appearance-related or non-appearance-related word choice among women with and without eating psychopathology. Cognitive Therapy and Research, 39, 204–214.
Nielsen, E., Padmanathan, P., and Knipe, D. (2016) Commit* to change? A call to end the publication of the phrase ‘commit* suicide’. Wellcome Open Research, 1:2.
Puhl, R. M., Peterson J. L., Luedicke J. (2013) Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. International Journal of Obesity. 37: 612-9. doi: 10.1038/ijo.2012.110
Spencer-Thomas, S. (2018). Language matters: Why we don’t say “Committed suicide”. International Risk Management Institute, INC.
Retrieved from https://www.irmi.com/articles/expert-commentary/language-matters- committed-suicide
Weissman, R. S., Becker, A. E., Bulik, C. M., Frank, G. K. W., Klump, K. L., Steiger, H., … Walsh, B. T. (2016). Speaking of that: Terms to avoid or reconsider in the eating disorders field. International Journal of Eating Disorders, 49, 349–353.
Options for Weighing
Since weight and body image concerns are areas of concern for pregnant and postpartum women with eating disorders, it’s important to know the options around weighing whether you’re a patient or a clinician. Clinicians make these decisions around weighing on a case-by-case basis or have a conversation about weighing preferences at an early prenatal appointment. Patients may want to review this list to determine what options they feel most comfortable with and then engage their clinician in a conversation about their preference. (more…)
Weight Gain Distribution
Weight gain and body shape changes can be very daunting during pregnancy especially for women who have an eating disorder or eating disorder history. However, it can be helpful to understand how the weight is attributed to the baby and how it is distributed. Being able to connect that weight gain specifically to the baby or pregnancy components can help the woman reframe the weight gain positively. (more…)
Shifting the Eating Disorder Voice During Pregnancy
By Hattie Rowe
West Virginia University
Major changes in life can be stressful for anyone. But for women who have struggled with eating disorders, adapting to changes may look more difficult. People who suffer from an eating disorder have unhealthy coping strategies related to their body. Whether these life changes induce stress or excitement, adjusting to something new can elicit anxiety at the unknown. (more…)
Family & Loved Ones Quotes (all names are pseudonyms to protect the women’s real identities)
My husband has no conception of it. He knows a little bit about that I had an eating disorder and that I’ve yo-yo dieted and things like that, but he really doesn’t understand the mental processes that go behind it, and the constantly being, I’m going to say obsessed.~ Ruby, mother of one
I even told my mom, like you will never say that to my daughter. Ever. I do not want you saying anything like that to her. My mom, even to this day, still makes comments like, “Well, it’s a good thing she’s a skinny baby because she could be more active that way.” It’s like, you know, she’s got fat cheeks, she’s got fat thighs now, I’m happy.~ Ruby
Fortunately, my husband, when they were second grade and third grade, my husband, because I was making like bizarre food. He completely took over food. He brought in chips. He normalized food for my girls. I think that probably saved them, considering that my own biological mother had an eating disorder and then I did. I had one.~ Ann