Athletes and Eating Concerns

Eating concerns among athletes are both common and complicated. While sport can be a protective factor in motivating the athlete in caring well for the body, there are also sport-related risk factors that must be considered. These include felt pressure to conform the body to strict and narrow parameters in order to enhance performance. When a concern about proper nutrition occurs, a comprehensive team approach, including coaches, trainers, therapists, physicians, and dietitians provides the athlete with the best opportunity to retain activity safely, or return to sport strengthened and renewed when withdrawal and/or treatment is necessary.

Sport Related Risk Factors

Many in sport believe that weight or body fat reduction enhances sport performance, and so there can often be pressure to lose weight. Unfortunately, sometimes unhealthy and risky eating behaviors may be encouraged for weight loss. These behaviors more typically damage performance rather than enhance it. Due to the focus on leanness in many sports, athletes may develop competitive thinness with peers, and may feel added pressure to lose weight. This is known as the contagion effect and may include subcultural expectations to look a certain way, known as the "sport body ideal." Another concern, especially common among female athletes, is the revealing nature of sport uniforms, which in turn increases body image concerns. Individuals who participate in the Aesthetic/Lean/Judged sports, such as gymnastics, diving, and figure skating, are at the highest risk for unhealthy body image and eating difficulties. Further, there seems to be a parallel between "good athlete" traits and eating disorder characteristics, so that coachable, perfectionist, and compliant athletes may be at greater risk for the development of eating concerns. Finally, identification of eating concerns in sport is more challenging and may delay early intervention and treatment.

Determining Unbalanced Exercise

There are many indicators that "unbalanced", "unhealthy", "compulsive" or "damaging" exercise is occurring. Excessiveness can show up in frequency, duration, or intensity of exercise. Exercise should be considered unbalanced if: Exercise continues despite illness or injury, Exercise interferes with balanced activities and relationships, Exercise is rigid: must exercise in a narrowly defined way or at a certain time, Exercise is a rigid obligation: must happen regardless of any life circumstance of higher importance, Exercise is the primary and only means of coping with stress, Exercise reduction leads to withdrawal symptoms such as: agitation, anxiety, anger, insomnia, appetite changes, feelings of guilt, etc.

Unbalanced exercise can be observed in patterns of activity and in patterns of exercise versus appropriate nourishment to sustain the activity level. Asking specific questions about exercise can reveal patterns and asking specific questions about the physical, social, mental, and emotional consequences of exercise or not exercising can also shed light on unbalanced exercise. It is not only external or behavioral patterns which indicate "unbalanced" exercise, but also "internal" responses and motives which illuminate the depth of potential problems with exercise.

How Does One Know if an Athlete is Struggling With an Eating Disorder?

When someone is struggling with an eating disorder, the signs and symptoms will show up in all areas of life: physical, social, mental, emotional, and spiritual. The symptoms are straightforward and many of them are observable, yet those suffering with eating disorders are most often experts at hiding their struggles and minimizing their symptoms. They have many reasons to keep their struggle secret. Athletes have additional motives in keeping the illness hidden, as they don't want their participation restricted. Some eating disorder signs and symptoms in an athlete are as follows: Actions suggesting need for perfection, Low self-esteem, which motivates need for achievement & perfection, Extreme sensitivity, Obsessive & compulsive behaviors, Over-achievement, Lack of self-confidence, Drastic weight changes, Changes in eating habits, Excessive exercising or over-training, Frequent trips to the bathroom, Refusal to share feelings, Frequent excuses, Lying, Chewing a lot of gum, Excessive drinking of liquids, especially diet drinks, Avoiding food or serious restriction, Guilt feelings after eating, Social isolation, Watching what others eat, Loss of interest in enjoyable activities, Binge-eating with no weight gain, Comments about purging food or calories, Weakness, fainting, etc., Red eyes, Calluses & blisters on knuckles, Comparison of body, beauty, etc., Comments of body dissatisfaction or body hatred, Depression, Tendency to order food in small and insufficient amounts, Solving other's problems, but ignoring one's own, Avoiding any contention at all, Self-harm or suicidal thoughts, Wearing baggy clothes to hide body, Avoiding responsibility, Preoccupation with food, Defensiveness about food, weight, etc., Obsession with dieting, calorie-counting, low-fat foods, diet pills, laxatives, etc.

How Do I Know if I am an Unbalanced Exerciser?

Do I exercise at inappropriate times or settings? Does exercise negatively impact my relationships? Do I exercise despite illness or injury? Does exercise negatively impact my psychological or physical health? Does exercise interfere with everyday activities, such as work or school? Do I exercise in order to create an energy deficit despite normal or low weight? Do I feel significant anxiety or guilt if I don't exercise?

Consequences of Unbalanced Exercise

The consequences of unbalanced exercise can be serious. Consequences include development of compulsive exercise disorder, impaired balance in life and consequent reduction in general quality of life, premature loss of career as an elite athlete, physical, skeletal, and internal organ damage, including cardiac arrest and death. These potential consequences outweigh the temporary consequence of potential and illusive fear of loss of "peak performance." Some of the many consequences of unbalanced exercise include the following: Decreased bone density (Osteopenia or Osteoporosis, depending on severity), Stress Fractures: Overuse injury that occurs when muscles are fatigued & unable to absorb added shock, which then transfer overloaded stress to the bone, resulting in a fracture, Hormonal Changes: Loss of menstrual period for females, low testosterone level for males, Recurrent injuries (Soft tissue strains), Decreased immunity (Intense exercise for extended periods of time decreases the strength of the auto-immune system), Overtraining Syndrome or Staleness (failure to make expected training gains), Female Athlete Triad: Low energy availability, menstrual irregularities, & bone loss, Dehydration, Heat Stroke, Hyponatremia• Potentially lethal cardiac events (Sudden Arrhythmia Death Syndrome, Prolonged QT Interval), Added stress when responsibilities & relationships are sacrificed for exercise, Depression, anxiety, irritability when exercise is sole coping behavior, Rationalize exercise for "health" when actually putting health at greater risk, Isolation or withdrawal due to exercise compulsion• Depression due to Overtraining Syndrome, Exercise to compensate for or legitimize eating, Exercise to maintain negative energy balance (despite hunger, intentionally eat less if unable to exercise), Increased risk of development of eating difficulties or eating disorders

Tips for Coaches in Protecting the Athlete From the Damage of Unbalanced Exercise

Coaches play a critical role in not only the performance of the athletes they coach, but in the general health and development of those under their tutelage and example. Their impact is on the "person," not just the "performance." The importance of development of character as an individual transcends the importance of performance as an athlete. With this great opportunity and power comes responsibility to watch out for the health and welfare of the athlete far beyond performance. That balance between "pushing the performance now" versus "longer term performace" and overall health is a fine line. To aid in this difficult yet rewarding responsibility, coaches may consider the following: Do pre-athletic screening exams for eating disorders, Focus on the whole athlete, not just athletic performance, Know that weight loss does not equal performance enhancement, Loss of menstruation is a sign of physical dysfunction, not a sign of effective training, Avoid comments and comparisons on weight, body image, and appearance, Focus on health, not weight, Know that quick weight loss results in loss of lean muscle which equals decreased performance, Don't be afraid to talk to an athlete about your concerns, Enlist support within the community (athletic trainers, sports psychologist, ED specialists, dietitians, physicians), Assure the struggling athlete gets professional help, Allow time for athletes to eat and hydrate, Don't encourage extra or excessive training or workout sessions, Don't allow sick or injured athletes to train or compete, Provide sound nutrition education, Don't encourage crash or fad diets in preparation for competition, Don't do body composition tests or group weigh-ins. These shame individuals!, Provide ongoing education; the coach's perspective has a critical impact on athletes' perceptions, Use common sense education; convey the seriousness of eating disorders without highlighting war stories, Don't glamorize eating disorders or place them on a pedestal, Address emotional, social, & physical aspects of eating disorders, Focus on sport-specific information (nutrition, sports performance, & body composition). Use your positive influence to nurture the athlete towards healthy living in addition to athletic performance

Approaching an Athlete: What Not To Do

Don't confront the athlete in a group of people or in the presence of others, Don't be judgmental; don't tell the athlete that what he or she is doing is "sick" or "crazy", Don't follow the athlete in an effort to "catch" them in eating disorder behavior, Don't give advice about weight loss, exercising, or appearance beyond your own expertise in sport training, Don't label someone with an eating disorder because there are some signs. Leave that to diagnostic experts. Don't get into an argument or battle of wills, Don't promise to keep secrets, Don't try to police the athlete's eating or force the athlete to either eat or not eat, Don't let the athlete monopolize your time & energy, Don't try to fix the athlete's problems and don't attempt to help them by yourself. Expand the circle of support.

How to Approach the Athlete

Who: Who should approach the athlete when a potential eating or "over exercising" concern is identified? An individual in a position of authority as part of the Sport Management Team is best equipped to approach the athlete. The individual who has the best rapport and closest relationship with the athlete is ideally positioned to address concerns. A fellow teammate should NOT be the one to approach an athlete as there is no power behind the intervention, it may create a dependent relationship, and it could exacerbate an already competitive relationship or contribute to the development of a competitive relationship. Be prepared for a negative response, including denial, when first approaching an athlete with concerns.

When: As soon as an individual close to the athlete identifies a potential problem, based on the presence of a number of signs and symptoms. Early identification results in fewer and less severe complications, less resistance to treatment, and faster, easier, and more positive treatment outcome.

How: In approaching an athlete, express concern and ask how the athlete feels, both physically and psychologically. The athlete needs to know that people care and that others will not criticize or embarrass them. Focus on the athlete's well-being, and approach the athlete gently, with no accusations. Ask, rather than tell. Assess, rather than judge. One goal of intervention includes maximal sensitivity and minimal invasiveness.

Speak to the athlete privately and allow time to talk. Express your concern to the athlete and calmly share the specific observations that arouse your concern. Allow the athlete time to respond, and listen in a non-judgmental manner. Keep your focus on the concerns you have observed. If the information you receive suggests an eating disorder and/or excessive exercise, share with the athlete that a) you think the athlete may have a problem, and b) you are concerned about the athlete's health and well-being.

Be prepared to offer resources, including counseling, dietary, physician, and community referrals. Assist the athlete in making parents and other support systems aware of the concern.

Refusal of Treatment

It is imperative that the athlete be encouraged to accept treatment as soon as reasonably possible. However, sometimes despite best efforts, athletes may refuse treatment. If the athlete initially refuses treatment, don't push too hard unless you suspect the athlete is at risk medically. Make continued sport involvement contingent on the athlete seeking and complying with treatment and physical health. Allow the athlete to remain a part of the team by attending practices and competitions. Don't "kick the athlete off the team."

Suspension from the team is the last resort as the athlete may continue to train on their own, which may be more dangerous as there is no monitoring. Suspension may deprive the athlete of their primary source of positive feelings and self-esteem. The athlete may view suspension as an attempt by others to control, and thereby respond with frustration and increased resistance. If all attempts to persuade an athlete to evaluation and treatment fail, there is no alternative but suspension.

Enlisting a Support Network

The Sport Management Team has a responsibility to inform parents of concerns, ensure the athlete is seeking treatment, and use athletic participation as appropriate leverage for seeking treatment. Comprehensive Release of Information forms for the full treatment team (therapist, dietitian, physician, athletic trainer, coach) should be in place to ensure coordination of care.

Ongoing communication between team members is essential as the support network becomes a united front against the eating disorder illness - not the athlete. A treatment plan devised through ongoing communication should include criteria for athletic participation. Ongoing communication also ensures appropriate boundaries are maintained throughout treatment. Each team member supports and encourages the treatment approach and clear communication ensures that various treatment team members are not undermined. Abiding appropriate boundaries also prevents the athlete from receiving mixed messages. When there is a concern or question, support network members defer to the treatment team for consultation.

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Gain Self-Care Skills, Lose the Weight

It makes me crazy when I hear supposed weight loss experts preach that the road to weight loss begins and ends with calorie counting, daily weigh-ins and intense workout regimens. This kind of advice couldn't be farther from the truth and, in fact, it encourages us not to listen to the wisdom of our bodies.

You were born with a phenomenal machine. It already knows how to calculate the caloric density of the food you eat. It even takes into account how much fat is stored in your fat cells and your energy requirements on any given day. It tells you when to eat, via hunger pangs, what to eat, via cravings, when to stop eating, via fullness sensations and when to move, via a sense of restlessness. We can and must learn to listen to and trust the wisdom of our bodies to guide us.

If you've been a chronic dieter, counting calories is probably engrained in your psyche. In order to begin the process of trusting the wisdom of you body, let me suggest you follow two very important body-balancing principles:

1. Pay attention to Hunger and Fullness Signals. Begin eating each day when you feel true hunger signals--you know, that grumbling, empty sensation in your stomach, remember that? See if you can stop eating before you're full. Remind yourself that you get to eat again when you get hungry. Whoo Hoo! There's no deprivation.

2. Eat foods consistent with your human design: unprocessed, whole, plant-based foods. This will most likely be the more difficult principle to follow. One of the reasons you've adopted the habit of calorie counting is because you've been eating the Standard American Diet, loaded with man-made processed foods and animal foods. Processed foods and animal foods are devoid of fiber and your body can't get an accurate calorie count when you eat a predominantly fiber-less diet. Without fiber, it's really easy to eat an abundance of calories before you feel full. Try to eat something wholesome, with fiber, at each meal or snack. Foods full of fiber include fruits, vegetables, legumes, potatoes, grains, nuts and seeds. Try an apple with peanut butter, a potato with hummus, beans and rice or oatmeal with blueberries--you get the idea. As you add more wholesome fiber-full plant-based foods to you diet, your palate will change and you will find it easier to release foods that no longer serve your body.

If you're an emotional eater, you may be thinking "that's great, but how do I stop overeating my favorite junky comfort foods and lose some weight?" This is where the self-care skills come in. In order to lose the weight, you'll need to gain self-care skills. Let me share with you two self-care skills you can begin to practice right away. These skills can definitely take a bite out of your emotional eating.

1. Establish the Habit of Self-Connection. This means "going inside" when you want to eat emotionally and identifying your emotions and needs. If you want to eat when you're not hungry, eat when you're already full or you just want to choose unhealthy comfort foods, ask yourself: "How do I feel in this moment?" After you identify your feelings with three word statements, e.g. "I feel sad" or "I feel overwhelmed," ask yourself "What do I need" or "What am I truly longing for in this moment?" See if you can access a wise, nurturing voice within that can soothe and comfort you and help you meet your true non-food needs.

2. Catch and Reframe Self-defeating thoughts. While you're "inside," catch any negative, critical, pessimistic thoughts you're aware of. These kind of thoughts do a lot of damage and they can fuel emotional eating. For each negative thought you identify, see if you can think of a more positive replacement thought, or at the very least, a more neutral thought. So, for example, "I've gained back some weight--I'll never lose the weight" could be reframed into "I've gained back some weight--I've lost weight before and I'm sure I can do it again." More positive thoughts lead to hope which can curb emotional eating.

With consistent practice, these body-balancing principles and self-care skills will help you re-connect to the wisdom of your body and over time, they will help you reduce your emotional eating. For more information and additional principles and skills, stay tuned for my new book which will be out this Fall, "The Emotional Eater's Repair Manual: A Practical Mind/Body/Spirit Guide for Putting an End to Overeating and Dieting."

Julie M. Simon, MA, MBA, MFT is a Licensed Psychotherapist with a full-time private practice specializing in the treatment of overeating and associated mood disorders. In addition to her education and twenty years experience as a psychotherapist, she is a Certified Personal Trainer with twenty-five years of experience designing personalized exercise and nutrition programs for various populations. Julie is the creator of The Twelve-Week Emotional Eating Recovery Program, an alternative to dieting that addresses the mind, body and spirit imbalances that underlie overeating. Julie offers individual, couple, family and group psychotherapy as well as classes and seminars. She is author of the upcoming book The Emotional Eater's Repair Manual--A Mind/Body/Spirit Guide to Putting an End to Overeating and Dieting. Visit her website at http://www.overeatingrecovery.com/.

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School, Eating Disorders, and Academic Achievement: A Formula for Failure

Most parents don't like to watch their children suffer. When parents encounter a suffering son or daughter they become solution-oriented, looking for the quickest means of alleviating the problem. Parents who have a child with an eating disorder are the same. Unfortunately, the problem in using this tactic with a child who suffers with an eating disorder is that the sufferer develops complicated and often distorted thought processes. As a result, what appears to be the logical and quick solution to a problem may produce the opposite effect in an individual with an eating disorder. In fact, an individual with an eating disorder can twist perfectly normal and loving statements into negative affirmations of self that trigger greater entrenchment into the eating disorder. Thought distortion in an eating disorder sufferer affects every aspect of their life, especially behavior and achievement in the socially intensive environment of school. One of the ways parents unknowingly promote increased entrenchment in their child's eating disorder is to encourage their continued and even enhanced involvement in school with hopes that it will eliminate the problem when, at the same time, the child is actively distorting the messages they receive because of the eating disorder.

THE PROFILE OF A TYPICAL EATING DISORDER SUFFERER

An eating disorder sufferer is a contradiction in behaviors. An individual who is deeply entrenched in a disorder displays a set of characteristics diametrically opposed to their behavior when not suffering with the disorder. They become listless, withdrawn, emotionally numb, unexpressive, disinterested in activities, anti-social, and incapable of concentrating. Once they work through their distorted thinking they revert back to their real selves - sensitive, intelligent, outgoing, involved in many activities that reveal their many talents, able to focus on multiple projects, and very giving and loving.

Amy is a beautiful and gifted senior in high school. She is a cheerleader, the English Sterling Scholar from her school, writes beautiful poetry and stories, and is very active in school affairs. Amy has rebounded from an eating disorder that completely disrupted her life. She writes,

"Eating disorders are born, raised, and sustained by negativity; it is the bitterness I experienced with my eating disorder that allows me to appreciate and savor sweetness much more than I did before... Like any addict or substance abuser...I refused to think I had a problem. Not until I had been hospitalized for nearly three months...did I realize the horrific consequences brought about by my eating disorder. It had made me into the person I strived NEVER to become: I fought with my parents, I said things I will forever regret, I lied, I stole, I slipped in my studies, I isolated myself, twice I was tempted with suicide....ultimately, everything I had worked for and wanted was either gone or going as a result of my eating disorder. I lived in a grey haze which never cleared and allowed the little light left in my life to wane systematically."

The contrast between ED behaviors and healthy behaviors are drastic and frightening. Parents who witness this transformation in their child's behavior, from a bright, energetic, and out going person to the opposite, react with a swift desire to alter the trend. Unfortunately, very often the tried and tested methods of eliminating suffering and changing undesirable behaviors are the very things that make the disorder worse. Telling a daughter, "You are beautiful and don't worry!" usually is interpreted as, "She feels she needs to say that because I am so ugly," and the command, "Eat all the food on your plate!" may be interpreted as, "My parents want me to be fat and unpopular at school."

THE SCHOOL ENVIRONMENT

One of the most obvious evidences of something going wrong in the sufferer's life is the impact the disorder has on school achievement. The sufferer's normally very good grades start to slip. They begin to withdraw from activities and become more antisocial. They lose interest in school subjects and extracurricular activities. They lose their ability to focus on important projects, papers, and tests. They become much more sensitive to what is going on around them and what others may be thinking about them.

"I could not stay focused on my school studies. My concentration level was terrible and I could never read book assignments without my thoughts wandering. I was always too tired to stay awake, and more often than not my head was on the desk top sleeping. All of my energy went towards my eating disorder. It was first priority." - 19-year old woman

"My concentration level decreased, I skipped classes, isolated myself from friends, and didn't care about grades. I went from A's and B's to D's and F's." - High School Junior

School is a quick-paced, unrelenting, socially competitive, and demanding environment. When you combine this with the changes that are taking place in the lives and bodies of young men and women, it becomes a potentially threatening and frightening place. If an individual starts to wonder and worry about their social and intellectual status, the school environment can become a very intimidating place. For an individual suffering from an ED the school environment is filled with messages that can be twisted and confused. The whole experience can become too overwhelming to bear.

"My anorexia destroyed my concentration, my drive, my love of school, and my performance in classes. Education no longer played a vital role in my life. My anorexia preoccupied and consumed all of my time, leaving little time for school and studies. Anxiety-producing stress only exacerbated my anorexia, which, in turn hindered my performance." - College Freshman

Parents looking for the quickest and most logical means to alleviate the disruption of anorexia or bulimia causes in the family encourage their eating disordered child to become more involved and to work harder to display their natural talents and abilities in their school settings - Talents they know their children have because they have observed them for years. The child unable to cope with the negativity they sense all around them in school, reacts in the opposite manner and starts to withdraw and shut down even more. They know what they feel and are confused about their inability to cope with the seemingly simple solutions their parents offer. They very naturally start to believe that something is wrong with them, i.e., that they are a social outcast, unable to fit in, and undeserving of good things.

"My eating disorder destroyed school for me. I hate school and I sleep through anything. My focus isn't on anything but my eating disorder and so school is a waste of time." - 21-year-old woman

UTAH STATISTICS

Over the last year approximately 4000 junior and senior high school students in Utah County and Las Vegas Nevada have filled out an eating survey designed to assess ED behaviors. The results of the survey suggest that approximately 6% to 13% have already developed a diagnosable eating disorder; 30% to 35% have attitudes and beliefs about food and weight that fall into the abnormal ranges and that put them at risk for eventually developing an eating disorder. These findings document that there is a great need for effective education and prevention programs.

A TEACHER'S DILEMMA

It is important for teachers to understand the impact of anorexia and bulimia so they can pick up on the signs and consequences among their students. Since most students with anorexia and bulimia are very bright and talented it can be difficult for teachers to pick up student's subtle changes in feelings and attitudes before their academic performance suffers. Consequently, knowing that 2 out of 10 girls in their classes are at risk for developing an ED presents a dilemma about when to raise concerns about anorexia and bulimia. Thus, it is helpful to raise the subject matter at different times throughout the year in general fashion. Doing this will encourage students struggling silently with the pressures and stresses of life and school to talk to you or a school counselor in private before they develop eating disorder behaviors that disrupt academic performance. The fact that a teacher is willing to broach this subject in an open and general fashion can be perceived as a safe invitation for students afraid of negative consequences of an eating disorder to do something for themselves.

Another dilemma for teachers is often in how to approach a student about a suspected eating disorder that is disrupting personal and academic performance. Most girls with a disorder will deny, minimize, or lie about the problem when confronted directly. They often feel ashamed of who they are and their behaviors. It is important to not make direct accusations about concerns, but rather, gently talk about what you are seeing as a teacher and encourage them to talk to you, or someone else, when they feel more ready to do so. Raising the concern in their presence and then giving them room to come back to you, whether they are struggling with an eating disorder, depression or some other personal problem, will let them know that you have noticed, cared, and have offered a kind invitation to do something about it.

For the student more entrenched in the ED, another dilemma for a teacher is whether to tell other school personnel or the parents about their concerns. Sometimes parents are the last to see the eating disorder because they want to believe their daughter's responses to their questions. It is important to first talk to the student in private. Explain that you need to do something to help them rather than ignore or avoid the problem. Then give them some time to get back with you about who they are willing to let you talk to about the problem. For many girls with eating disorders it was the persistence and honesty of a significant other that led to their decision to seek treatment. For those girls who are too afraid or angry to admit to or address the eating disorder, it is very important to make more people aware of their problem including the parents so that teachers do not become silent collaborators of the disorder. The student may not be ready to change but they will know the secret is out.

POSITIVE STRATEGIES FOR TEACHERS

There are a number of things teachers can do to help their students:

Encourage counselors in schools to start support groups for those who struggle with eating problems and body image concerns. Develop working relationships with counselors who can do one-on-one work with students and who can refer to outside professionals. Encourage the school to have assemblies or combined classes where outside professionals and recovered eating disorder sufferers can do presentations for the students. Provide materials and information that students could review on their own. Conduct a school-wide awareness program during national eating disorder awareness week in February. Be sensitive to the reality that eating disorders are about psychological and emotional pain and conflict and not about food and weight. Actively give invitations and encouragement to students to get help to overcome their eating fears or disorders. Talk to other teachers informally to develop a network who can identify at-risk students and offer support to those identified students.

POSITIVE STRATEGIES FOR PARENTS

Parents can help their daughters by doing the following: Do not treat this problem as just an academic issue, but rather recognize the emotional roots of anorexia and bulimia. Be open to feedback from teachers, counselors and others who can help. Educate yourself on the causes, impacts, and treatments of eating disorders through literature, books, seminars, and the Internet. Talk to your daughter about what's underneath the disordered eating behavior, don't just focus on the eating patterns. Recognize the need for proper assessment, dietary counseling, medical consultation and outpatient and inpatient therapy treatment. Get involved in a parent support group. Talk about the issues and possible solutions to eating disorders with the whole family. Don't be fooled by a daughter's attempts to minimize and ignore the real problem, be firm about the need for recovery while being sensitive to not forcing the issues. Be a good role model around food, take care of yourself, don't blame yourself, and be patient. Recognize that recovery takes time and don't place unrealistic demands for a quick fix for your daughter's eating disorder.

THE EDUCATIONAL PHILOSOPHY AT CENTER FOR CHANGE

A fundamental belief at Center for Change is that education is a basic right and opportunity for all human beings. Eating disorder sufferers are inhibited in their ability to take advantage of academic education opportunities. An individual with an eating disorder can forfeit their right to an education because of a basic belief in their inability to do what is necessary to meet educational goals and cope with the educational environment. At Center For Change we recognize that fundamental to the gaining of an education is the ability to: (1) take advantage of educational opportunities (i.e., have appropriate social, coping and learning skills), (2) maintain personal motivation for educational activities (i.e., learn to love education), and (3) believe in one's personal ability to achieve educational goals (i.e., believe in one's ability to cope with the environment in addition to meeting class requirements).

Center for Change incorporates an educational philosophy and program designed to help participants become able, motivated, and self-efficacious learners and continue their academic educational development. The goals of the educational program are designed to augment the intensive care the Center utilizes to overcome an eating disorder, thus providing a powerful and synergistic therapeutic and academic experience.

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