11842 bhn winter 2011 news for web:68645-post fnce nl …from trauma. depression and anxiety, along...
TRANSCRIPT
WINTER 2011
INSIDEthis issue2From The ChairKathy Russell, MS, RD
2BHN DPG Slate ofCandidates for Office for 2011-2012
6BHN Priority Session aHuge Success
7Cooking with Addicts
9National SurveyConfirms YouthDisproportionatelyAffected by MentalDisorders
10Student Corner: EatGood Food - A FrenchParadox
10Public Policy Update
11BHN DPG 2009-2010Annual Report
14BHN DPG ExecutiveOfficers
NewsletterBHSetting the Standard for Nutrition in Behavioral Healthcare
continued on page 3
Integrating Yoga-Based Treatment into a MedicalModel for Eating Disorder Treatment By Beverly Price, RD, MA, E-RYT
In their lifetime, an estimated 0.6 percent of the adult population in the U.S. willsuffer from anorexia, 1.0 percent from bulimia, and 2.8 percent from a binge eatingdisorder (1), the diagnoses of eating disorders have been made in children lessthan 12 years of age and as old as age 75. Eating disorders are considered spec-trum disorders ranging from anorexia nervosa, to bulimia nervosa, to binge eatingdisorder. Eating disorders are symptoms of depression and anxiety, along with ahost of other psychological issues, including mental health conditions resultingfrom trauma. Depression and anxiety, along with personality disorders, includingborderline personality disorder, are consistently found in individuals with eatingdisorders. Obsessive-Compulsive Disorder (OCD) is often found in individuals witheating disorders along with substance abuse disorders. Further information on thediagnoses and classifications of eating disorders, along with co-occurring disorders, may be found in theDiagnostic and Statistical Manual of Mental Disorders (DSM) IV-TR (2).
Cognitive-Behavioral Therapy (CBT)(3) is widely used in eating disorder treatment; although a widerange of eating disorder therapists have adopted the family based Maudsley(4) approach. Progressiveoutgrowths of CBT include Dialectic Behavioral Therapy (DBT)(5), Mindfulness Based Cognitive Therapy(MBCT)(6) and Acceptance Commitment Therapy (ACT)(7). Yoga-based therapy is a new modality in eat-ing disorder recovery, which is body centered vs. talk therapy.
Review of Literature Yoga and Eating Disorder Recovery
Research in the area of yoga and eating disorder recovery is quite limited. Douglass (2009) exploredthe uses of yoga as an experiential adjunct to other forms of therapy in the treatment of eating disordersin residential and outpatient settings. This article indicated that supported by other treatment modalities,yoga can be an effective method for increasing self-awareness, reflection and the ability to self-soothe.Suggestions were also made as to how therapists can support the practice of yoga in residential and out-patient eating disorder treatment settings (3).
Boudette (2006) taught yoga in a class designed specifically for eating disorders and discovered thatbulimics and compulsive eaters found a deep sense of peace and freedom, were able to integrate posi-tive coping strategies and connect with their physical bodies. The article concluded that yoga offers anon-verbal, experiential adjunct to talking therapy. The author discussed the importance of goal settingwithin the yoga practice designed for eating disorder recovery and cautioned about using the yoga prac-tice for physical measurements (i.e. getting your foot behind your head, etc.)(4).
In a 12-week, randomized study of 90 women ages 25 – 63 years of age with binge eating disorder, byMcIver et al. (2009), the yoga-intervention group reported small but significant reductions in binge eat-ing activity and body mass index (BMI) compared to the control group (5). On the other hand, Mitchell, etal. (2007) found no significant post-intervention differences in 93 college women studied that were treat-ed with a discussion-based group vs. a yoga intervention group (6).
According to the Journal of Adolescent Health (Carei, 2010), yoga treatment significantly reduced foodpreoccupation immediately after the yoga therapy sessions. The study included a total of fifty girls andfour boys aged from eleven to twenty one. Patients were treated over eight weeks time. Twenty-sevenpatients received standard care, and twenty-six patients participated in yoga in addition to their standardcare. The yoga group showed a greater decrease in eating disordered symptoms when compared to thegroup that only participated in standard treatment. Food preoccupation was measured before and aftereach session of yoga and decreased significantly after all sessions. The results of this study showed thatindividualized yoga therapy could be an effective addition to standard eating disorder therapy (7).
Beverly Price
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BHNewsletter is published quarterly (Winter,Summer, Summer, Fall) as a publication ofBehavioral Health Nutrition, a dietetic practicegroup of the American Dietetic Association. TheSummer and Fall issues are published electroni-cally; members receive an email announcementand link for direct access. Newsletters are avail-able on the BHN Website at www.bhndpg.org.
Address Changes and Missing Issues: ContactADA with your new address information. If youmissed an issue, contact [email protected] the newsletter editor.
Advertisement Policy: BHN accepts adver-tisements for the quarterly newsletter. Ads aresubject to approval of the editorial board. Forguidelines and fee schedule contact the editorat [email protected].
Advertisements should not be construed asendorsement of the advertiser or product bythe American Dietetic Association or by BHN.
Submissions: Articles about successful pro-grams, research, interventions and treatments,meeting announcements and educationalprogram information are welcome and should beforwarded to the editor by the next deadline.
Future Submission Deadlines Spring 2011 . . . . . . . . . . . . . . . . . February 1, 2011
Summer 2011 . . . . . . . . . . . . . . . . . . . . May 1, 2011
Editor:Diane M Spear, MS, RD, [email protected]
Assistant Editors:Sharon M Wojnaroski, MA, RD
Stephanie Joppa, Student
Newsletter Review Board:Kathy Russell, MS, RD
Charlene Dubois, MPA, RDAnne Czeropski, ADA Manager
Individuals not eligible for ADA membershipmay apply to become a “Friend of BHN” for thesubscriber cost of $50.00. A check or moneyorder should be made payable to ADA/DPG #12and sent in care of the BHN Treasurer (see officer contacts in this newsletter).
Copyright 2011 BHN. All rights reserved. The BHN Newsletter may be reproduced onlyby written consent from the editor. Direct allrequests to [email protected].
From the ChairKathy Russell, MS, RD
WOW! The membership year is half over! Time sure flies when you’re having fun. A commonsaying, but in this case it’s a fact. I have been having a great time so far working with a wonder-ful group of volunteers!
Many of us were at ADA’s Food & Nutrition Conference & Expo (FNCE) in November. I hope youtook advantage of the several opportunities to participate in a BHN activity. BHN donated a won-derful bag of resources to the ADA Foundation Auction. Thanks to members who contributedbooks and resources for this! We had the privilege of honoring four of our members for theirmagnificent contributions to BHN’s practice areas at our member award ceremony and reception.
2010 BHN Distinguished Member: Marion Baer, PhD RD
Excellence in Practice:Paula Cushing, RD, LDN - Intellectual and Developmental Disabilities
Jessica Setnick, MS, RD, LD, CSSD - Eating DisordersRuth Leyse-Wallace, PhD, RD - Mental Illness
We met many current and potential members at the DPG/MIG Showcase. We were thrilledwith the attendance at BHN’s Spotlight Session “Overcoming Barriers to Eating DisorderTreatment” presented by Dena Cabrera, PsyD and BHN member Debra Johnston, RD fromRemuda Ranch. The room capacity was 727 and there were people standing in the back, alongthe walls, and sitting on the floor!
Our webinar series has started. In November, BHN member Mary Kuester, MA, RD, LD pre-sented on Addictions and Eating Disorders. Coming in February we have another BHN member,Eileen Stellefson Myers, MPH, RD, LDN, FADA presenting on PKU and Motivational Interviewing.Look for another webinar from member Evelyn Tribole, MS, RD on Motivational Interviewing tofollow soon. Other topics will be added. Make sure to take advantage of these webinars. Theinformation is very valuable to our practices. In case you have missed them, all of our previouswebinars are available on our website www.bhndpg.org. The webinar cost for members is $25and $40 for non-members.
BHN membership is on the rise! As of this writing we have 1441 members. At the end of lastyear there were 1371 members. Anexciting trend is the increase of studentmembers. We hope that you all findyour membership to be a value. If thereis anything that you feel we can do bet-ter or if there is a need for somethingthat we don’t offer, please let me knowat [email protected]. Our mem-bers are our most important asset.Please encourage your colleagues tojoin BHN. The more members we havethe more our voices are heard whenadvocating for the nutrition care of ourclient populations!
We have a terrific ballot for theupcoming membership year. Make sureto exercise your right to vote. Lookingforward to a great new year!
Yours for good health,Kathy Russell MS RD
BHN Chair, Kathy Russell, RD, LD (front, left) and PaulaCushing, RD, LDN (front right), IDD Resource Professionaland 2010 award recipient pose for pictures surroundedby Executive Committee at the BHN Member Reception.Standing (from left to right): Sharon Lemons, MS, RD, LD;Diane Spear, MS, RD, LD; Julie Lovisa, RD, CD; CharlotteCaperton-Kilum, MS, RD, CSSD, LD; Therese Shumaker,MS, RD, LD; and Charlene DuBois, MPA, RD.
BHN DPG is pleased to present the slate of candidates for office for the 2011-2012 year:
Chair-elect: Therese Shumaker, MS, RD, LD
Treasurer: Cynthia A. Rutkowski, MA, RD, FADACary Kreutzer, MPH, RD
Nominating Committee: Marilyn Ricci, MS, RDMinh-Hai Tran, MS, RD, CSSD
On-line voting begins February 1, 2011
www.bhndpg.org
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Yoga and Body ImageIn a study by Jennifer Daubenmier (2002,
2005), Hatha yoga participants reported thegreatest degree of body awareness and trustduring exercise as well as in daily life. Theyalso reported greater levels of self-accept-ance than the baseline condition but equal tothe aerobic condition, partially confirmingthe hypothesis. Hatha yoga participantsreported the least amount of internalizationof the thinness ideal, the least amount of ten-dency to compare their physical appearanceto those of others, the smallest discrepanciesbetween actual and ideal physical attributes,the least amount of self-objectification, andthe most body satisfaction. Hatha yoga partic-ipants reported fewer eating problems com-pared to the aerobic condition. The greaterthe number of hours a woman practiced yogain a week was associated with even less self-objectification and greater satisfaction withher body, while the more hours a womanspent performing aerobic activity was linkedwith greater disordered eating (8)(9).
Dittmann and Freedman (2009)evaluated attitudes about bodyimage and eating in women prac-ticing postural yoga. Results showedsignificant improvements in body satisfac-tion and disordered eating due in part toyoga and its associated spirituality (10).
Scime and Cook-Cottone (2008) studiedthe impact of a primary prevention pro-gram for eating disorders in 75 fifth-gradegirls. The curriculum incorporated interactivediscussion, yoga, and relaxation into 10 week-ly sessions. Pre- and post-test data from fivegroups conducted over two years comparedwith 69 control group participants indicatedthat the intervention group had a significantimprovement on scores from the EatingDisorder Inventory-2 measuring body dissatis-faction and bulimia, as well as on the Socialscale of the Multidimensional Self-ConceptScale (11). Scime et al. (2006) looked at threegroups, in a similar intervention over 13months that showed a significant improve-ment on scores measuring body dissatisfac-tion and drive for thinness, as well as mediainfluence (12).
Yoga Therapy for EatingDisorder Treatment – BestPractices
Yoga therapy is conducted in small or one-on-one groups conducted by a Yoga thera-pist. Emphasis is on integrating breath andmovement with traditional medical or psy-chological interventions. A Yoga therapist’straining incorporates the traditional training
requirements of a registered Yoga teacherthrough a 200 or 500 hour Yoga Alliance (YA)registered Yoga school. However, their train-ing goes beyond the Registered Yoga Teacher(RYT) certification to incorporate several heal-ing modalities with specific populations inwhich the yoga therapy school is gearedtowards. Legitimate Yoga therapy programsare credentialed by the InternationalAssociation of Yoga Therapists (IAYT).Practitioners entering Yoga therapy programsare generally licensed professionals (physi-cians, psychologists or other ancillarylicensed or registered health professionals) ortrained peer coaches, who have been inrecovery, for the specific disease that they aretreating, for greater than two years.
In contrast, a Yoga “class” is generally held atYoga studios or gyms in a larger group setting,conducted by a Yoga teacher. Classes empha-size moving from one pose to the next, oftenin a sequenced method. Many Yoga classes
today are quite westernized, emphasizing thephysical body and often accompanied bymusic typically found in an aerobics class.
Reconnect with Food® Yoga Therapy is asystematic program specifically designed forthe population of eating disorders across thespectrum—anorexia, bulimia and binge eat-ing, and tailored to meet individual needs.Reconnect with Food® Yoga Therapy programcombines a unique healing modality of Yogaphilosophy and a sequenced flow inter-twined with traditional psychotherapy. Thefocus is not exclusively on the Yoga postures.The chakras, along with the eight limbs ofYoga are intertwined as themes in the heal-ing process over a seven week time frame.Yoga Therapy may be conducted in smallgroups along with one-on-one sessions andcan be incorporated into inpatient/residen-tial, day treatment, support groups or individ-ual counseling sessions for eating disorderrecovery. The following is a suggested, best
practices integrative Yoga therapy model oftreatment that can be incorporated into eat-ing disorder treatment programs:
The therapeutic Yoga asana practiceYoga Therapy for eating disorder recovery
begins with the asana practice with the light-ing very dim, or devoid of light, along withany curtains closed. The temperature is mod-erate, approximately 75 – 80 degrees. Spaceheaters are available to warm the room on acool day or for those who need extra heat toloosen up muscles. There is very little musicplayed, if any, except for possibly light, new-age background music. There may be a songplayed in savasana (resting pose at the end ofthe Yoga asana practice), which aligns withthe theme of the Yoga therapy session.
The first five minutes of the asana session isspent in meditation, with guidance from theYoga therapist. Foundations of meditation arebrought into the session. Clients are invited toclose their eyes and encouraged to keep themclosed throughout the entire session. The Yogatherapist will begin to bring in the theme forthe session in these first five minutes.
Following this introduction, clients areencouraged to move their body in any
way. This may include “cat-cow” pos-tures, “cobra”, “downward dog” or justwiggling their hips from side to side.
Whatever feels right to the client isencouraged in these few minutes to warmup the body.
A dynamic sequence of postures is thenbrought into the session, which is designedto bring clients to their edge quickly. Theedge is defined, while clients are also encour-aged to soften around their edge. The flow,following this sequence, involves long hold-ing and challenging postures, teaching to thestrongest student in the room, while offeringmodifications. Clients are encouraged to take“child’s pose” at any time or simply sit on theirmat and breathe if that is what serves themon any given day.
Clear and simple directions are given bythe Yoga therapist, while modeling is notdone. This is why clear and simple directionsare imperative. The flow of long holding pos-tures covers one side of the body, followedby the other side of the body over 35 – 40minutes. The remaining 5 – 10 minutes of thesession ends with Yin Yoga postures, followedby savasana (pose of total relaxation). Seatedmeditation is also offered as an alternative tosavasana by the Yoga therapist.
Dialogue and word choicesContinuous dialogue is brought into the
session, by the Yoga therapist, honing thetheme and relating the theme to what theclient might be experiencing in the postures.Analogies and metaphors are used, alongwith studies and benefits explained during
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the flow. The Yoga therapist links the breathwith postures in every movement and contin-ually reminds the client to come back to theirbreath. In addition, the Yoga therapist usesthe phrases, “Your arm,” “Your leg,” or “Yourbody,” vs. “the” or “that” limb/body in order tohelp the client connect more with his or herbody. Moments of silence are also given bythe Yoga therapist in order to give the clientspace. Adjustments are given to make “con-nections” vs. “corrections” and to assist theclient in going deeper if the Yoga therapistsenses that the client is holding back. In addi-tion, an “adjustment” may consist of the Yogatherapist sitting next to a client during thesession and listening for his or her breath.
At the close of the session, the Yoga thera-pist will offer words of wisdom that bring thetheme home. The Yoga therapist may alsochoose to read a poem to the group. It isimportant for the Yoga therapist to assesswhat they see in the client during the entireflow, to not react to any acting out on a givenday by the client and to not take anythingpersonally. Feedback is always importantfrom the client along with peers to continual-ly improve the skills of the Yoga therapist.
Connecting the asana practice with alllimbs and facets of Yoga
In the PHP and IOP programs, the practiceof Yoga is held at the start of the day. Thetheme of the Yoga practice parallels theHindu chakras and Patanjali’s eight limbs ofYoga, where each chakra and limb of Yoga iscovered in order on a weekly basis. The day’sactivities (group therapy, lunch experiential,creative arts therapy) are held following theYoga practice and integrate the particularchakra and eight limbs of Yoga of that respec-tive week into all facets of the day’s program.
The chakrasCaroline Myss, PhD, developed the field of
Energy Anatomy, a science that correlatesspecific emotional/psychological/physical/spiritual stress patterns with diseases.Caroline Myss has devoted the majority ofher life to learning and teaching others aboutspirituality, human consciousness, energymedicine, and the mystical art of healingusing the seven Hindu chakras to create amap of the human "energy anatomy”.
Chakra means "wheel" or "circle", andsometimes referred to as the "wheel of life".The chakras are aligned in an ascending col-umn from the base of the spine to the top ofthe head. In modern age practices, eachchakra is associated with a certain color andis associated with multiple physiologicalfunctions such as aspects of consciousnessand other distinguishing characteristics.These are seen as lotuses with a differentnumber of petals in every chakra.
The chakras not only vitalize the physical
body but also regulate the interactions of aphysical, emotional and mental nature. Thechakras are the locus of life energy (prana),which flow among them along pathwayscalled nadis. The main function of the chakrasis to keep the spiritual, mental, emotionaland physical health of the body in balance byspinning and drawing energy.
The modern world has drawn inspirationfrom the chakras and draws a parallelbetween the position and role of the chakrasand those of the glands in the endocrine sys-tem. The modern world also recognizes thatthere are additional chakras which exist suchas ear chakras.
The different parts of the world use differ-ent models of chakras such as Chinese medi-cine, Tibetan Buddhism, western world, etc.The western world mainly adheres to theshakta theory of seven main chakras as trans-lated versions of the Sat-Cakra-Nirupana, andthe Padaka-Pancaka, which are two ancientIndian texts.
The body’s chakras parallel two chains ofnerve bundles located on each side of thespinal cord. By activating these chakras, theemotional pain imprisoned in the body asphysical pain around the spinal cord can bereleased. Yoga involves spinal movementsthat activate the body’s chakras and can easi-ly release a person’s physical pain, which thenin turn can help rid the body of emotionalpain. The chakras are also very useful to helpthe recovering individual get to the root ofeating disordered behavior. Often, whenemotional pain is unresolved, this emotionalimbalance manifests itself through physicalpain based on the emotional energy or blockand is associated with a specific chakra. Aninteresting parallel may be created with thechakras to incorporate discussion on a physi-cal, emotional and spiritual level as it relatesto eating disorder behavior (13).
Eight limbs of YogaPatanjali, a physician who lived in India
between 200 B.C. and 200 A.D., compiled 195sutras or concise aphorisms that are essential-ly an ethical blueprint for living a moral lifeand incorporating the science of Yoga intoone’s life. The heart of Patanjali's teachings isthe eightfold path of yoga. It is also called theeight limbs of Patanjali, because they inter-twine like the branches of a tree in the forest.The eight fold path is helpful for individuals togain insight as to how they treat themselvesand others, while working towards personaldisciplines and attitudes, withdrawal of thesenses, inward focus and letting go of oldattachments—including attachment to ill-nesses—that keep one “stuck” (14). The Yamasand Niyamas (first two limbs) particularlyintertwine nicely with eating disorder recov-ery as many individuals with eating disordersoften have other related addictions. In work-
ing with the eight fold path of Yoga, individu-als may gain insight into relationshipsbetween themselves and others, along withthe parallel relationship food.
ConclusionMost eating disorder treatment facilities
and professionals interviewed have notlooked at Yoga beyond a class or basic“stretching” in their respective facility. Nonereport integrating Yoga and its philosophy tofacilitate healing as most programs are verycompartmentalized. Although a model forbest practices in integrating Yoga-based ther-apy into comprehensive eating disordertreatment has been outlined in this article,further research is needed in the effective-ness of Yoga-based therapy on the treatmentof eating disorders and is currently underwayin our treatment program.
In addition, further studies are warranted inorder to understand how the exact mecha-nism of Yoga affects intricate brain centers andhow Yoga can be beneficial in eating disorderrecovery along with the many co-occurringdisorders involved. Yoga can be a very benefi-cial adjunct to treatment as illustrated in thisarticle, in order to facilitate healing on a deep-er level. Yoga therapists can be a significantadjunct to the eating disorder treatment teamas can a licensed psychotherapist and dietitianwho are also trained as Yoga therapists. Theintegration of Yoga into the medical treatmentmodel of eating disorders can make Yogamore powerful in the healing process.
References1. Hudson JI, Hiripi E, Pope HG, Kessler RC. The
prevalence and correlates of eating disorders inthe National Comorbidity Survey Replication.Biol Psychiatry. 2007; 61:348-58.
2. Diagnostic and Statistical Manual (DSM) IV-TR.2000; 584-5.
3. CBT - Bowers WA, Ansher LS. The effectivenessof cognitive behavioral therapy on changingeating disorder symptoms and psychopatholo-gy of 32 anorexia nervosa patients at hospitaldischarge and one year follow-up. Annals ofClinical Psychiatry. 2008; 20(2):79-86.
4. Maudsley - Rhodes P, Brown J, Madden S. TheMaudsley model of family-based treatment foranorexia nervosa: a qualitative evaluation ofparent-to-parent consultation. The Journal ofMarital Family Therapy. 2009; 35(2):181-192.
5. Dbt resources: What is dbt?. (1996). RetrievedJanuary 4, 2011 from http://www.behavioral-tech.com/ resources/whatisdbt.cfm
6. Your guide to mindfulness-based cognitive thera-py. (2007). Retrieved January 4, 2011 fromhttp://www.mbct.com/
7. Heffner M, Sperry J, Eifert GH, Detweiler M.Acceptance and commitment therapy in thetreatment of an adolescent female with anorex-ia nervosa: A case example. The Journal ofCognitive and Behavioral Practice. 2002; 9(3):232-236.
8. Douglass L. Yoga as an intervention in the treat-ment of eating disorders: does it help? EatDisord. 2009; 17(2):126-39.
9. Boudette R. Question & answer: yoga in thetreatment of disordered eating and body imagedisturbance: how can the practice of yoga behelpful in recovery from an eating disorder? EatDisord. 2006; 14(2):143-55.
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For access to information on Complementary and AlternativeMedicine (CAM), including mind-body practices of yoga, The NationalInstitutes of Health, U.S. Department of Health and Human Services pres-ents an overview of the types of CAM, summary information on safetyand regulation, the mission of the National Center for Complementaryand Alternative Medicine (NCCAM), and additional resources. This infor-mation is available on the “Health Information” page of the NCCAM Website (http://nccam.nih.gov/health/). Materials include: • Fact sheets designed to help you think about the issues involved in
deciding whether to use CAM. • Fact sheets on specific CAM therapies (e.g., Yoga for Health: An
Introduction) and on CAM for specific health conditions (e.g., CAMand Hepatitis C: A Focus on Herbal Supplements) including infor-mation on safety, the status of evidence-based research on effec-tiveness, and points to consider in deciding to use the therapy.
• Herbs at a Glance: Information on more than 40 of the most com-mon herbs in popular dietary supplements. Available in a bookletand in individual fact sheets.
The NCCAM Clearinghouse provides information on CAM andNCCAM, including publications and searches of Federal databasesof scientific and medical literature. The Clearinghouse does notprovide medical advice, treatment recommendations, or referralsto practitioners.
Toll-free in the U.S.: 1-888-644-6226 TTY (for deaf and hard-of-hearing callers): 1-866-464-3615 Web site: http://nccam.nih.gov/E-mail: [email protected]
Office of Dietary Supplements (ODS) ODS seeks to strengthen knowledge and understanding of dietary
supplements by evaluating scientific information, supportingresearch, sharing research results, and educating the public. Itsresources include publications and the International BibliographicInformation on Dietary Supplements database.
Web site: http://ods.od.nih.gov/
U.S. Food and Drug Administration (FDA) Center for Food Safety and Applied Nutrition Web site:
www.fda.gov/aboutfda/centersoffices/cfsan Toll-free in the U.S.: 1-888-723-3366
Information includes “Tips for the Savvy Supplement User: MakingInformed Decisions and Evaluating Information”(http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/default.htm) and updated safety information on supplements(http://www.fda.gov/Food/DietarySupplements/Alerts/default.htm.)Adverse effect from a supplement can be report to the FDA’sMedWatch program, which collects and monitors such information (1-800-332-1088 or www.fda.gov/safety/medwatch).
PubMed® A service of the National Library of Medicine (NLM), PubMed con-
tains publication information and (in most cases) brief summaries ofarticles from scientific and medical journals. CAM on PubMed®, devel-oped jointly by NCCAM and NLM, is a subset of the PubMed systemand focuses on the topic of CAM.
Web site: www.ncbi.nlm.nih.gov/sites/entrezCAM on PubMed®: http://nccam.nih.gov/research/camonpubmed/
NIH National Library of Medicine’s MedlinePlus To provide resources that help answer health questions,
MedlinePlus brings together authoritative information from theNational Institutes of Health as well as other Government agenciesand health-related organizations.
Web site: www.medlineplus.gov
Source: What Is Complementary and Alternative Medicine? National Institutes ofHealth, U.S. Department of Health and Human Services. Updated April 2010;http://nccam.nih.gov/health/whatiscam/D347.pdf ; accessed January 03, 2011
Information on Complementary and Alternative Medicine . . . . .
Phenylketonuria (PKU) and Motivational Interviewing WebinarDate: February 4, 2011 at 11:00 AM (CST)
Presenter: Eileen Stellefson Myers, MPH, RD, LDN, FADA - Private Practice, Eileen Myers Nutrition and Wellness Consulting
Webinar Description: Providing education and resources to patients and families with PKU may not be enough for them to follow theirstrict diet. Motivational Interviewing is a style of communicating and interacting that increases the likelihood of compliance while decreas-ing the RDs frustration. In this webinar, you will learn how to incorporate motivational interviewing into your assessment and counseling ofpatients and families with PKU.
10. McIver S, O'Halloran P, McGartland M. Yoga as atreatment for binge eating disorder: a prelimi-nary study. Complement Ther Med. 2009; Aug;17(4):196-202.
11. Mitchell K, Mazzeo S, Rausch S, Cooke K.Innovative Interventions for Disordered Eating:Evaluating Dissonance-Based and YogaInterventions. International Journal of EatingDisorders. 2007; 40(2):120-128.
12. Carei TR, Fyfe-Johnson AL, Breuner CC, BrownMA. Randomized Controlled Clinical Trial ofYoga in the Treatment of Eating Disorders. TheJournal of Adolescent Health. 2010; 46(4):346-351.
13. Daubenmier JJ. A comparison of Hatha yogaand aerobic exercise on women's body satisfac-tion. Dissertation Abstracts International. 2003;63(9):4415.
14. Daubenmier JJ. Objectification theory.Psychology of Women Quarterly, 2005; 29(2):207-219.
15. Dittmann KA, Freedman MR. Body awareness,eating attitudes, and spiritual beliefs of womenpracticing yoga. The Journal Eat Disorders. 2009;17(4):273-92.
16. Scime M, Cook-Cottone, C. Primary Preventionof Eating Disorders: A Constuctivist Intergrationof Mind and Body Strategies. The InternationalJournal of Eating Disorders. 2008; 41:134-142.
17. Scime M, Cook-Cottone C, Kane L, Watson T.Group prevention of eating disorders with fifth-grade females: impact on body dissatisfaction,drive for thinness, and media influence. TheJournal of Eating Disorders. 2006; 14(2):167-70.
18. Caroline Myss. Anatomy of the Spirit: The SevenStages of Power and Healing. New York, NY:Harmony Books; 1996, pp. 288-90
19. Iyengar BKS. Light on Yoga. Schocken Books;1979.
About the Author: Beverly Price, RD, MA,RYT is the owner and operator of Reconnectwith Food® at Inner Door Center, a compre-hensive Yoga-based eating disorder treat-ment center offering a day and intensive out-patient programs along with individual coun-seling. For more information on Reconnectwith Food® see http://www.reconnectwith-food.com/index.asp . She is also the Principalof Jump Start Consulting, LLC specializing inmanagement and marketing strategies forregistered dietitians, along with seminars anddistance learning products for continuingprofessional education and students.
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BHN’s priority session at Boston,“Breaking Down Walls: OvercomingBarriers and Obstacles in Eating DisorderTreatment” was a huge success! The roomwas packed and the speakers were excellent.Dena Cabrera, PsyD, and Debra Johnston , RDfrom Remuda Ranch spoke of the ways toovercome the barriers and obstacles patientsand care providers face in treating eating dis-orders (ED).
Four obstacles were identified that theycommonly encounter in treating theirpatients with eating disorders.
Obstacle One: Complexity - Eating disor-ders are the most frustrating and recalcitrantforms of psychopathology. Patients with EDare notorious for denial and resistance. Eatingdisorders evoke strong reactions from profes-sionals and treatment for the disorder is oftenvoluntary.
The ED recovery environment is viewed ashostile by the pro ana and pro bulimia websites and the media often promotes the ideathat thinness is what makes you a better per-son. In part, this mentality often sets an eat-ing disorder in motion if the person has apredisposing factor to the disorder (genetics).A combination of nature and nurture factorscause eating disorders.
Obstacle Two: Resistance andMotivation - Patients who are resistant totreatment should represent a signal for thecounselor to shift the approach or strategy intreatment. It is a signal of dissonance in therelationship, and a mismatch of the counsel-ing strategy to the patient’s readiness level.Resistance is an “interpersonal phenomenonand how the counselor responds will influ-ence whether it increases or diminishes”. Oneneeds to provide treatment matched to thereadiness level of the patient.
The stages of change can be compared inrelationship to traffic lights. The pre-contem-plation stage is like the RED light. The patientis not currently considering change andunable to move forward.
The contemplation stage is similar to theYELLOW light. The patient undertakes a seri-ous evaluation of considerations for oragainst change, choosing whether or not toenter the change arena.
The action stage is like the GREEN light.The patient moves forward to implementspecific behavioral change.
The majority of anorexia patients receivinginpatient treatment at the Remuda Ranch arein the pre-contemplation stage. So how thendoes one help the patient to shift to contem-plation? The pre-contemplator is most influ-enced by the negative factors of the eatingdisorder to push them into contemplation.The focus is on losses: physical, emotional,relational, and spiritual. It is associated withincreasing the understanding of ED func-tions, decreased distress, and shifts in self-concept.
Eating disorders can be viewed as themountain that needs to be climbed and con-quered in order to gain a new perspective ofwhat life might be like at the top. Recovery isgradual, not a straight path to the top, andthere will be slips and slides along the way.
A discussion ensued of how dialecticalbehavior therapy (DBT) can be used as a wayto move patients from one stage to the next– hopefully getting the patient to acceptanceand change. “Change cannot happen withoutacceptance, and acceptance cannot happenwithout change.”
Helping the patient learn skills in mindful-ness, distress tolerance, emotion regulationand interpersonal effectiveness is an impor-tant part of the work that is accomplishedwith patients at Remuda Ranch.
Obstacle Three: Differing Philosophy -working with a team that includes the thera-pist, family, patient, dietitian, and psychiatrist,treatment goals are not always the same andothers may have different nutrition philoso-phies. The philosophy at Remuda is that allfoods fit in a healthy meal plan when it incor-porates: Balance, Variety and Moderation.
Obstacle Four: Treatment Cost, Drop-out Rate and Relapse – according to treat-ment response rates, one third of patientstake two to three years to recover from ED,another one third of patients take seven toeight years toward recovery, and the remain-ing one third of patients receiving treatmentdie.
Given all of these impending obstacles,after all is said and done, the presentersagree that one of the most important treat-ment concepts is to let the ED patient knowand affirm that there is hope! Hope for a lifeof recovery. As specialists in ED, we need tochange our thinking and instead of saying"What are you recovering from?” it should be"What are you recovering to?" We need tovalidate our patients more often, and getconnected with them.
Our speakers received an overwhelmingresponse to the invitation for questions fromthe audience, allowing for excellent interac-tion and discussion. A huge “Thank you!” tosuch talented speakers and to the manymembers who attended this session! BHNmembers are the best!!
The BHN Priority Session for 2011 willfocus on nutrition practice in mental illness.Stay tuned for more information on this out-standing session aimed at setting the stan-dard for nutrition in behavioral healthcare.
BHN Priority Session a Huge Success!By Therese Shumaker, MS, RD, LD
Change cannot happenwithout acceptance, and
acceptance cannot happen without change.
Save the Date!International Association of Eating Disorders Professionals
March 3 – 6, 2011, Phoenix, AZwww.iaedp.com
Binge Eating Disorder Association National ConferenceMarch 31 – April 2, 2011 in Scottsdale, AZ
http://www.bedaonline.com/
National Council Mental Health and Addictions ConferenceMay 2 – 4, 2011 in San Diego CA
www.thenationalcouncil.org/cs/conference
Nutrition & Health Conference Nutrition and Health: State of the Science and Clinical Applications
May 9 - 11, 2011 in San Francisco, Californiahttp://www.nutritionandhealthconf.org/agenda.html
National Alliance on Mental Illness Convention July 6 - 9, 2011 in Chicago, IL
www.nami.org
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As Registered Dietitians we know thatgood nutrition is essential to recovery fromsubstance abuse. Eating well replenishesnutrients enabling the recovering alcoholic oraddict to function at their optimum mentallyand physically, thus able to avail themselvesof the cognitive aspects of the rehabilitationprogram, fully engage themselves emotional-ly in the process, and bolster their shot atrelapse prevention by keeping their moodand emotions on an even keel. In an effort tomotivate and empower our residents to makepositive food choices, we have been conduct-ing hands-on, interdisciplinary (OccupationalTherapist and Registered Dietitian) nutritioneducation as an integral part of theSubstance Abuse Residential RehabilitationTreatment Program (SARRTP), at the VeteranAdministration Medical Center in Gainesville,Fl, since 1997. Until recently, residents of this20-bed, 90-day program prepared most oftheir meals as a community. This allowed usto reinforce didactic classes on the role ofdiet in recovery with actual menu planning,functional, as well as educational, shoppingtrips, and weekly hands-on cooking classes.Although our residents are now temporarilyhoused on a hospital ward, the cooking(albeit scaled down) and shopping classescontinue.
Indeed, hands-on nutrition education canbenefit any patient population. As the adher-ence literature reveals, most patients fail tofollow dietary and other lifestyle advice. Viahands-on nutrition education, adults (most ofus learn best by doing) can master basic foodskills, thus boosting their self-efficacy (per-ceived capability), and hence likelihood ofsucceeding in the behavior change process.Edible lessons are literally internalized; resist-ance to trying new foods relaxed andpatients are empowered with practical toolsto actively participate in their own healthcare – the hallmark of patient-centered care.Plus rubbing elbows in the kitchen trans-forms the RD-patient dynamic in ways thatfoster a therapeutic alliance.
For those in recovery, nutrition can serveas an aspect of life in which they can practiceself-control and self-determination, and as ameans for nourishing oneself, both literallyand emotionally. From the perspective of myOccupational Therapist partner in thisendeavor, substance abuse also leads to “roledeficiency” – the loss or lack of developmentof the many roles that usually anchor ourlives in the realms of relationships, work,leisure and schooling. Such problems in roleperformance frequently serve as the catalystfor people to enter recovery programs. Thehands-on approach reinforces those rolesproviding successful experiences which assistin the development of motor, process andcommunication skills and a sense of compe-
tence, thus imparting the sense of mastery,purpose, and structure necessary to mean-ingful living and successful recovery.
My first “taste” of hands on nutrition edu-cation was during my CoordinatedUndergraduate Program (CUP) internship,during a stint with a DTR on the psychiatryward. She shepherded an assortment ofpatients through a food preparation exercise.What inspired me is that even though somebelieved themselves to be Joan of Arc,Napoleon and the like, when they startedgrating that cabbage for coleslaw, normaliza-tion reigned. Remarkable!
In our SA work we have found that foodissues often provide “grist for the mill”:opportunities to deal with interpersonal andother issues such as control, deprivation andgender, in a therapeutic environment.Cooking and taking meals together alsoallows residents to develop leadership skillsand those with food backgrounds to “shine”by contributing their expertise , lends a senseof family and normalization, and can be avenue for all staff team members to modelappropriate “dinner” conversation and inter-act in less formal ways with residents. Thecooking classes have also been a terrific vol-unteer experience for dietetic students,advantageous to both them and us.
Here are some general, practical guidelinesfor setting up and conducting hands-on cook-ing classes with your patients/clients (whichmay or may not apply to your situation).• Wrangle the support of your “higher ups”
with the logic (and hard data) that adher-ence is cost-beneficial in both human anddollar terms and that active participation,increases the overall quality of care andimproves customer satisfaction.
• Identify your target population.Participants can be out-patients with simi-lar diagnoses, folks interested in eatingwell on a tight budget, or just stayinghealthy. Whoever they are, including fami-ly members multiplies the effect.
• Ideally, you want a well-lit kitchen whereyou can store your equipment securely,with enough elbow room and work sur-faces, at an easy to find location with park-ing.
• In terms of equipment it is best to approxi-mate your standard participants’ basickitchen so they feel at home and recog-nize that they don’t need to get fancy toeat healthy. That being said, I do makesuggestions for healthy cookware and tryto inspire people to use a second genera-tion pressure cooker. Once you get thehang of a pressure cooker, I’m convincedthat it increases your repertoire of deli-cious foods (beans!!) and cuts down ontime spent in a hot kitchen.
• A key element inrunning a cookingclass is having apatient–centeredapproach. Keepingthe atmospheresupportive, non-judgmental, gentleand fun will inspirecreativity, confidence and ownership.Include participants in the planning byasking them to submit recipes for “redux”,survey their likes, dislikes, medical needsand interests.
• Limiting class size to 5 -10 (depending onspace and staffing) and the number ofdishes prepared helps to maintain the san-ity of all involved. Having more than onestaff person plus student volunteers allowsyou to work in smaller groups on severalrecipes simultaneously. Preparing thespace in advance by setting up “stations”with each written recipe and its correspon-ding ingredients, utensils, etc. streamlinesthe process. Beginning by gathering theentire group, explaining what they aregoing to prepare and the nutritional con-cepts/benefits to be presented, sets theintention, putting the lesson into a largerframework. You may want to have a pre-class on kitchen sanitation and safety (weuse a video and quiz). Obviously, everyonemust wash their hands before gettingdown to work.
• Our overall learning goal is to demystifythe process of putting food on the table(as Chef Gustave in Ratatouille proclaims,“Anyone can cook!”). Along the way weimpart general kitchen skills (e.g. measur-ing ingredients, use of knives), techniquesand shortcuts, use of equipment, sanita-tion and safety, following and modifyingrecipes, preparing food from scratch forcontrol of nutrient content, preparinglower fat and sodium, higher fiber, lessprocessed, less expensive, better tastingfood, overcoming fear of trying new foods,and reducing our carbon food print. Thespecifics will be predicated by participants’interests and dietary goals.
• It is best to introduce new “weird” foods(tofu, quinoa, and the like) by weaving thefamiliar with the less familiar. For example,being in the South we prepare collards(seasoned with lemon juice or sesame oilinstead of fatback), BBQ tempeh (with ahomemade low sodium sauce), a glorifiedversion of macaroni and cheese (sneakingin some tofu), and an oriental stir fry withgluten (affectionately dubbed “ChineseChitlins”). Presenting healthy foods in thecontext of phytochemicals and otherhealth issues specific to your audience
Cooking with Addicts (and Others)By Renée Hoffinger, MHSE, RD, North Florida/South Georgia Veterans Health System
Renée Hoffinger
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(e.g. isoflavones and prostate cancer) alsohelps to pique interest and increaseacceptability.
• Other hands-on nutrition education activi-ties can include field trips to farmers’ mar-kets, “health food” stores, supermarkets,restaurants, and farms, menu planning…you are only limited by your imagination.
• Glean some outcome data with simplepre-and post tests of objective knowl-edge, food habits, attitudes, and/or self-efficacy. Do the participants still think“tofu” is a four-letter word? Take yourresults back to your administrators so youcan get support to expand your program.So whether your patients are diabetic,
hypertensive, overweight, HIV+, in cardiac ordrug rehab, or simply interested in optimiz-ing their health, incorporating hands onnutrition education into your RD toolbox canenhance customer success, broaden yourskills, job satisfaction and fun quotient.
About the Author: Renée Hoffinger, MHSE,RD is BHN’s resource professional for theaddictions practice area and recipient of theBHN 2008 Excellence in Practice Award. Sheis employed at North Florida/South GeorgiaVeteran Health [email protected]
Book Review: Let’s Cook! Healthy Mealsfor Independent Living Reviewer: Paula Cushing, RD, LDN
“Let’s Cook! Healthy Meals for Independent Living” is a cookbook designed by and foradults with special needs to learn how to cook simple and healthy meals, gain confi-dence in the kitchen, and build self worth. This cookbook, which contains over 50 healthyrecipes, began as a collaborative project between Anne Kissack, MPH, RD, and ElizabethRiesz, PhD, a professor and mother of a young woman who has Down Syndrome. Theobjectives of this book are to assist teens and adults with developmental disabilities tolearn basic concepts of creating nutritious dishes, plan healthy meals, respect food andkitchen safety, and to eat well. Editor Linda Hachfield, MPH, RD, beautifully enhanced theoriginal text to pictorially show cooking steps, meal planning tips, and how each recipecan “fit” on the plate.
The easy-to-make recipes are in large print and written at a third grade or lower read-ing level. Each recipe is written in an easy-to-follow fashion, including “what I need”,“what I use”, and “what I do” and contains step by step food preparation photos as well asa large color photo highlighting the finished product. Recipes are organized byMyPyramid food groups and include meal planning guidelines, healthy meal tips, andnutrient information. Additional tools and guidelines include healthy serving sizes, theMy Plate approach, shopping list, healthy restaurant choices and healthy snacks.
“Let’s Cook!” according to the authors is a result of many voices with recipes that reallywork. The recipes were triple taste tested and prepared by a number of individuals at var-ious ability levels. This cookbook is highly recommended for use in supported living resi-dences with individuals with intellectual and developmental disabilities and their staffwhose goals are to improve health and wellness through improved cooking skills andhealthy meal planning. The book is very user friendly and proven to help increase theenthusiasm of individuals and their staff regarding cooking healthy meals and helpincrease their comfort level in the kitchen. An added plus - it helps to promote and rein-force life skills for independent living.
For more information, visit www.appletree-press.com or call 507/345-4848.
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About 20 percent of U.S. youth during theirlifetime are affected by some type of mentaldisorder to an extent that they have difficultyfunctioning, according to a new NIMH surveypublished in the October 2010 issue of theJournal of the American Academy of Child andAdolescent Psychiatry. The data support theobservation from surveys of adults that mentaldisorders most commonly start in early life.
BackgroundMany regional surveys conducted in the
United States have indicated that about onein four to five children experience a mentaldisorder sometime in their life. But until now,no nationally representative surveys hadbeen conducted to determine if these preva-lence rates of a wide range of mental healthproblems hold true across the nation.
Kathleen Merikangas, Ph.D., of NIMH andcolleagues analyzed data from the NationalComorbidity Study-Adolescent Supplement(NCS-A), a nationally representative, face-to-face survey of more than 10,000 teens ages 13to 18. They used standard diagnostic criteriaset by the American Psychiatric Association'sDiagnostic and Statistical Manual (DSM-IV) todetermine lifetime prevalence of mental disor-ders among the teens. To follow up on theteens' responses, they also collected data viamailed questionnaires completed by one par-ent or guardian of each teen surveyed.
Results of the StudyOverall, nearly half of the sample reported
having met diagnostic criteria for at least onedisorder over a lifetime, and about 20 percentreported that they suffered from a mentaldisorder with symptoms severe enough toimpair their daily lives. In addition,
• 11 percent reported being severelyimpaired by a mood disorder (e.g., depres-sion or bipolar disorder),
• 10 percent reported being severelyimpaired by a behavior disorder such asattention deficit hyperactivity disorder orconduct disorder,
• 8 percent reported being severelyimpaired by at least one type of anxietydisorder.In addition, about 40 percent of those who
reported having a disorder also met criteria forhaving at least one additional disorder. Thosewith a mood disorder were more likely thanothers to report having a coexisting disorder.Underscoring the notion that mental disordersmanifest early in life, the researchers alsofound that symptoms of anxiety disorderstended to emerge by age 6, behavior disordersby age 11, mood disorders by age 13, and sub-stance use disorders by age 15.
The researchers also noted strong linksbetween parental characteristics and theirteen's disorders. For example, children of par-ents with less education (e.g., no collegedegree) were at an increased risk for havingany kind of mental disorder. And comparedto teens with married or cohabiting parents,those with divorced parents also were athigher risk for a disorder, especially anxiety,behavior and substance use disorders.
SignificanceThe NSC-A results provide a broader and
longer-term outlook compared with last year'sNational Health and Nutrition ExaminationSurvey (NHANES), which asked respondents
about diagnosed disorders and service usewithin a 12-month window only, and was lim-ited to six disorders.
According to the NCS-A researchers, thepercentage of youth suffering from mentaldisorders is even higher than the most fre-quent major physical conditions in adoles-cence, including asthma or diabetes. Theresults reiterate the importance of develop-ing prevention strategies and promotingearly intervention for at-risk children andadolescents.
What's NextMore research is needed to better under-
stand the risk factors for developing a mentaldisorder in youth, as well as how to predictwhich disorders may continue into adulthood.In addition, the researchers acknowledge theneed for more prospective research to teaseapart the complex interplay among socioeco-nomic, biological and genetic factors that maycontribute to the development of mental disor-ders in youth.
ReferenceMerikangas KR, He J, Burstein M, Swanson SA,Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J.Lifetime prevalence of mental disorders in U.S. adoles-cents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of theAmerican Academy of Child and Adolescent Psychiatry.2010 Oct. 49(10):980-989.
The above information can be found onthe NIMH website. The public may reproducewithout permission information from theNational Institute of Mental Health website,except for documents that state anothercopyright policy applies.
National Survey Confirms that Youth are Disproportionately Affected by Mental DisordersThe National Institute of Mental Health (NIMH) is part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services. Science Update • September 27, 2010http://www.nimh.nih.gov/science-news/2010/national-survey-confirms-that-youth-are-disproportionately-affected-by-mental-disorders.shtml
New! Do you have a product or service youwould like to publicize?
BHNewsletter now offers one-time FREE ad space (business card size,1/12 page ad) to members who submit an original article that is subse-quently published.
All ads must be reviewed and approved by BHN DPG and ADA prior topublication in the BHNewsletter.
For information on this and other advertisement opportunities inquireat [email protected].
BHNewsletter reaches more than1400 members quarterly!
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As American waistlines have ballooned,there has been a corresponding boom in self-help books and diet products for people totone their tummies. Despite this, newsreports tell us that we are still as overweightand artery-clogged as ever. With one of theworld's largest market of diet aids, how canthis be?
How can the French, conversely, eat noto-riously rich food (e.g. wine, cheese, and oils),yet live longer and be healthier than us? Partof the answer lies in their health system,which is ranked #1 in the world by the WorldHealth Organization (the U.S. for compari-son's sake, ranks 37th) (1). However, it isarguable that their diet also plays a stronglyfundamental role in their health. It appearsthe French live by a few generally healthyfood rules: 1.) Eat good food. If one eats real food (i.e.
minimally processed foods, which can bepronounced without a chemistry degree),one will be more likely to be satisfied andless likely to eat more food later. Forexample, traditional French meals alwaysinclude a dessert. Typically, desserts arenot overly processed versions, nor are theylow-fat or low-sugar. In essence, choosequality over quantity.
2.) This leads us to the next point: portions,portions, portions. This is usually a goodrule to follow in general. If you are goingto indulge, eat a small amount of a versionthat is going to cure your craving. Forexample, eat a small piece of rich darkchocolate rather than having a king-sizedcandy bar.
3.) Consume large amounts of fruits and veg-etables. From personal observation, thereappears to be a huge difference betweenFrance and the U.S. on the quantity andquality of vegetables consumed. It’s myexperience that produce in France hasincredible flavor. Not only this, but it is lessexpensive than the produce in the U.S.and cheaper than the junk food in France.For example, a locally-grown Gala applemay cost 0.37 Euros (about 50 cents),whereas a medium bag of chips mightcost between 2 and 3 Euro (2.8-4.2 USD).
4.) Eat slowly. Eating is a social experience inFrance, and traditional meals take a lotlonger than they do in the U.S. This allowsyour brain the time it needs to registerthat you are full.
5.) If you are of legal age, drinking red wine inmoderation may have a beneficial impacton artery health. Research is reportedlybeing done to find out what the apparentbenefits of drinking wine or alcohol in
some populationsmay be due to,including the roleof antioxidants, anincrease in HDL("good") choles-terol or anti-clot-ting properties.These differences
can be incorporatedinto any diet (even ona college budget!).Here are a few simplerules to lead a lifestyle more in line with theFrench diet:• Start frequenting farmer’s markets if they
are offered in your city. Not only will you besupporting local farmers, but there is ahigher likelihood that the produce will befresher and of higher quality.
• Start gardening yourself! If it is winter,many herbs can be grown in a small poton your windowsill indoors. If you live inan apartment, many cities now have com-munity gardens, where you can go to gar-den. The bonus is that it will be easier onyour wallet!
• Throw away the diet gimmicks and con-centrate on eating real food. Don’t depriveyourself (which can lead to bingeing), buttry and focus the bulk of your diet onfoods rich in vitamins and minerals.
• Reduce your plate and glass size. This willmake eating smaller portions easier.
• Slow down while eating. Take time to putdown your fork and knife and conversewith those around you. Savor your foodand make eating an enjoyable experience.
• Start cooking for yourself more often.When you cook for yourself, you knowexactly what goes into the preparation.
Bon appétit! (Enjoy your meal!)About the Author: Stephanie Joppa is a
pre-med student at the University of NorthDakota with a double major in French andminors in nutrition and psychology. Shestudied abroad at the Université de CaenBasse-Normandie, France during fall semes-ter, 2010.
References:(1) The World Health Report 2000 – Health systems:
Improving performance. Published by the WorldHealth Organization, Geneva, Switzerland ISBN 92 4156198 X. Full report on www.who.int/whr
STUDENT CORNER . . . . Eat Good Food - A French ParadoxBy Stephanie Joppa, Student Assistant Newsletter Editor
Stephanie Joppa
PUBLIC POLICYUPDATE
While much is unknown about the112th Congress, one thing that is certainis that the “Face of Congress” as currentlyknown will change as a result of therecent Mid Term elections. The 111thCongress has adjourned after passingnumerous bills that help advance ADA'smission and goals.• Child Nutrition Reauthorization funds
the jobs of many ADA members,including those working in schoolnutrition, WIC and SNAP-Ed. ADA willcontinue to monitor changes in thesework environments as regulationsimplementing new laws are written.
• The "Doc Fix" bill halted a scheduled 25percent cut in Medicare payment ratesand guarantees physicians stableMedicare reimbursement through2011.
• The FDA Food Safety ModernizationAct will overhaul the nation's food sys-tems and provide more safeguards toprevent illness and deaths from food-borne illness.
• The Special Diabetes Program wasrenewed, ensuring that much-neededresearch will continue throughSeptember 2013 along with funding forthe Special Diabetes Program forIndians and the Special DiabetesPrograms for Type 1 Diabetes. Thanks to all ADA members for their
efforts in making ADA's voice heard, espe-cially during the closing days of the cur-rent Congress.
The 112th Congress begins January 5.Once Congressional committee appoint-ments are made and as other breakingnews happens, they will be communicat-ed to ADA members via the Eat RightWeekly and the Take Action link on thePublic Policy section on the ADA MemberCenter page.
Do you know the US Senators that rep-resent your state? The member of theHouse of Representatives from your dis-trict? If you don’t know or are unsure,access the Grassroots Manager on thePublic Policy section on the ADA MemberCenter page to find out. In order for ADAto be successful in getting effective legis-lation passed, it’s up to each of us asgrassroots activists to get to know ourCongressional Representatives and tocommunicate to them the importance offood & nutrition.
Submitted by Cinde Rutkowski, MA, RD, FADABHN Public Policy Liaison
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Strategic Plan Goal 1: The public recognizes, trusts, andchooses our members as the experts inbehavioral health nutrition.
Strategies (Objectives) 1. Establish Registered Dietitians as preferred
providers of Behavioral Health Nutritionservices mandated/paid for by govern-ment entities by 2014.
Tactical highlights met in 2009-2010: • The Public Policy Liaison and the Public
Relations Director began the search for a
Joint Commission Speaker to provide awebinar for BHN.
• The Public Policy Liaison and the PublicRelations Director made contact with TheJoint Commission to identify opportunitiesfor BHN members.
• The Public Policy Liaison and the PastChair collaborated with ADA and additionalBHN Members to provide insight inEating Disorders and the need for theRegistered Dietitian in Legislation withthe United States.
2. Establish eight strategic alliances afteridentifying opportunities for BehavioralHealth Nutrition Registered Dietitians tocollaborate with other Behavioral Healthorganizations and broaden system of pub-lication by 2014.
Tactical highlights met in 2009-2010:• Appointed a Public Relations Director to
the Executive BHN Committee and createda job description for the Public RelationsDirector position.
• Contacted desired organizations to intro-duce Behavioral Health Nutrition and pub-lications (Applied Nutrition, AmericanSociety of Addictions Medicine,International Confederation of DieteticsAssociations [ICDA])
• Investigated the opportunities to sharethe BHN Newsletter and BHN members asspeakers at national/local BehavioralHealth meetings (brochures handed out atOklahoma Dietetic Association SpringConvention; Anne Hatcher, RD spoke at anAddictions Conference; and CharlotteCaperton-Kilburn, MS, RD, CSSD, LDN atthe American Overseas DieteticAssociation; two speaker stipends weregiven – Marilyn Ricci, MS, RD to speak atthe National Alliance on Mental IllnessConvention and Joan Medlan, MS, RD tospeak at the Idaho Dietetic AssociationConference)
• The Publications Chair investigated addi-tional methods to promote publicationsales to the public via Amazon.com,Borders, and Barnes & Noble.
• The Chair and Public Relations Directordeveloped a sponsorship prospectustemplate.
• The Student Liaison and Volunteer TeamMember created the official BHN FacebookWebPage.
3. Introduce Behavioral Health Nutrition toone health care professional organizationper year (i.e. nurses/practitioners, MDs,Pas, OTs, etc.)
Tactical highlights met in 2009-2010: • Chair submitted proposal to ADA for pod
cast development.
4. Optimize sponsorship opportunities togain income of $6000 per year and eachyear thereafter.
Tactical highlights met in 2009-2010: • Created sponsorship job description in
order to appoint Sponsorship Chair. • Developed sponsorship prospectus tem-
plate to facilitate sponsorship. • Encourage increased Executive Committee
and BHN DPG membership participationin seeking sponsorship via conferencecalls, Food & Nutrition Conference & Expo
Behavioral Health Nutrition (BHN) Dietetic Practice Group (DPG)2009-2010 Annual Report
BHN Organizational Chart
Fiscal year 2009-2010 was prosperous for BHN. In addition to carrying out the traditional workof our practice group, it was a year of investment in our mission, vision and new strategic goals. New BHN Vision: Impact the nutrition of the behavioral health populations we serve. New BHN Mission: Empower Behavioral Health Nutrition (BHN) members
to be the food and nutrition experts in the areas of: • Intellectual and Developmental Disabilities • Eating Disorders • Mental Illness • Addictions
New BHN Tag Line: BHN: Setting the Standard for Nutrition in Behavioral Health Care To begin reaching the Goals of the 2009-2010 BHN Strategic Plan
a BHN Organizational Chart was created.
* = Voting Board Member
*Secretary *Treasurer
*PublicationsChair
*Public RelationsDirector
*MembershipChair
*PastChair
*ChairElect
*Chair
BHN HOD Delegate(reports to Chair)
Publications Team:• *Publications Chair• *Newsletter Editor
- Assistant NewsletterEditor
- Student AssistantNewsletter Editor
• Website Editor
Public Relations Team:• *Public Relations Director• Sponsorship Chair• Webinars Coordinator• Public Policy Liaison• Symposium Chairs
Nominating Committee:• *Nominating Committee Chair• Volunteer Coordinators (formerly
nominating committee members)- Volunteers
Membership Team:• *Membership Chair• Resource Professionals• Members• Student Committee Chair
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(FNCE) DPG Membership Showcase, andelectronic listserv.
• Increased sponsorship income gained forfiscal year.
5. Introduce/Expose 10 Didactic Programsfor dietetic students to Behavioral HealthNutrition per year.
Tactical highlights met in 2009-2010: • Student Assistant Newsletter Editor posi-
tion was appointed with an approved jobdescription.
• Student Assistant Newsletter Editor sub-mitted an article from the fall 2009 BHNNewsletter edition and it was publishedin the Student Scoop March edition.
• BHN Resource Professionals participatedin the March Student Community ofInterest via EML.
• Produced four BHN Webinar series foreach of the four practice areas to marketto ADA Members, non-members and stu-dents.
• Conducted August orientation for theStudent Committee for Behavioral HealthNutrition via conference call.
Goal 2: Members and prospective mem-bers view Behavioral Health Nutrition asessential to their professional success. Strategies (Objectives) 1. Listserv membership will increase to 50%
in five years. Tactical highlights met in 2009-2010: • Listserv was advertised in the BHN
Newsletter on “Why? BHN Listserv.” • Provided directions for logging on to the
listserv via the BHN Newsletter on “Why?BHN Listserv?” as well as via the Web site.
• Publicized the daily digest format avail-ability in newsletter on “Why? BHNListserv.”
• Listed topics discussed on the listserv intwo issues of the BHN Newsletter via“From the Listserv” and “Practice Tipsfrom the Listserv.”
• Increased listserv members to 448 (~50%from last year of ~300 members on thelistserv)
2. Increase member participation throughvolunteerism (20% of total members areactively engaged in Behavioral HealthNutrition volunteer opportunities)
Tactical highlights met in 2009-2010: • Identified BHN Members to blog on the
ADA Eatright.org website along withapproved BHN Blogger Job Description(Therese Shumaker, MS, RD, LD; GaleMaleskey, MS, RD, LDN; Evelyn Tribole,MS, RD; Jacqueline Larson, MS)
• Established the Nominating Committeeas the Volunteer Coordinator Team withupdated job descriptions.
• Posted and identified opportunities forvolunteering through the BHNNewsletter, listserv and e-blasts.
• Anne Hatcher volunteered to be a BHNspokesperson to aid ADA with theSubstance Abuse Section in the NutritionCare Manual (NCM).
• BHN member, Les Rosenzweig, MS, RDvolunteered to aid ADA in the NCM foradult development disabilities section.
• ED Standards of Practice/Standards ofProfessional Performance(SOP/SOPPs)committee volunteers: Mary Tholking,Med, RD, LD; Suzanne Girard Eberle, MS,RD; Roberta Pearle Lamb, MPH, RD, LDN;Amanda Comstock Mellowspring, MS, RD,LD; Eileen Stellefson Myers, MPH, RD,LDN, FADA ; Christina Scribner Reiter, MS,RD, CSSD; Reba Faye Sloan, MPH, LRD;Karen Balnicki Wetherall, MS, RD, LDN;
• BHN members who offered their assis-tance in reviewing the ED SOP/SOPPs: B."Lynn" Kasper, MS RD, LD, ; GaralynneBinford, MS, RD; Paula Van Aken, MS, RD;Charlotte Caperton-Kilburn, MS, RD,CSSD, LDN; Beverly Price, RD, MA; PamKelle, RD, LDN, CDE; Dodi Wicks, RD; LeslieSchilling, MA, RD, CSSD, LDN.
• IDD SOP/SOPPs committee volunteers:Patricia Novak, MPH, RD; Joan Medlen,MS, RD; Lee Wallace, MS, RD, LDN, FADA;Diane Spear, MS, RD, LD; Sharon Lemons,MS, RD, LD; Catherine Conway, MS, RD,CDN, CDE; Lester Rosenzweig, MS, RD;Wendy Wittenbrook, MA, RD, CSP, LD.
• IDD Resource Tool volunteers: SuzanneGeerts, MS, RD; Kathy Humphries, MS, RD;Melody Rankin, RD, LD; Andrea Shotton,MS, RD, LD; Diane Spear, MS, RD, LD;Sarah Thompson, MS, RD, CDN; and LeeWallace, MS, RD, LDN, FADA.
• FNCE 2009 Volunteers: Ruth LeyseWallace, RD, LD, Anne Hatcher, EdD,RD(ret), CACIII, NCACII
• BHN EatRight messages review panel vol-unteers: Cynthia Van Riper, MS, RD, CSP,LMNT; Kim Fox, RD, LD, CDC (two wereneeded but many others offered theirassistance, thank you members for theabundance, it is greatly appreciated.)
• SCAN Symposium BHN Liaisons: JessicaSetnick, MS, RD, LD, CSSD and RobertaPearle Lamb, MPH, RD, LDN
• Research Toolkit Liaison: Susan J Arnold,MS, RD, LD
• HOD BHN Representative: Leslie Schilling,MA, RD, CSSD, LDN.
• All appointed BHN committee positionsand elected positions for ballot (21 posi-tions filled.)
• BHN’s donation to ADAF Silent Auction atFNCE 2009 was put together by four vol-unteers
• Increased volunteerism to ~64 BHNMembers (~4.6% of total members)
3. Behavioral Health Nutrition DPG is viewedas creating the future of behavioralhealth nutrition practice as evidenced by80% retention rate annually.
Tactical highlights met in 2009-2010: • Produced webinars in each of the four
Behavioral Health Nutrition practice areas(Binge Eating Disorder and Night EatingSyndrome, Nutritional Interventions inAutism, Addictions and Nutrition, andNutrition and the Brain.)
4. Increase membership by 10% per year forfive years.
Tactical highlights met in 2009-2010: • Marketed BHN at FNCE DPG Showcase. • Highlighted upcoming BHN events on
DPG Officer listserv to reach otherDPG/MIG listservs and on the ICDA.
• Marketed BHN to other ADA groups byoffering products that are of mutual interest(Addiction and Nutrition Webinar in collabo-ration with the Weight Management DPG.)
• Increased membership to 1371 (~17%increase from last year at 1172).
5. At least 10% of membership will partici-pate in BHN educational opportunities toincrease expertise in Behavioral HealthNutrition
Tactical highlights met in 2009-2010: • Became a CPEU provider for one CPEU
per credit hour of each live webinar. • Produced four live webinars with a
recording of each via the website. • Included advertisement on the listserv
and newsletter educational opportunitiesin the four practice areas.
• Paid BHN Webinar and BHN MP3 Audioattendees increased member participa-tion in educational opportunities a. Binge Eating Disorder and Night
Eating Syndrome ~45 attendees b. Nutritional Interventions in Autism:
the Role of the FD ~53 attendees c. Addictions and Weight Management -
unknown attendee count d. Nutrition and the Brain ~44 attendees e. What Dietitians Need to Know about
Psychiatric Disorders ~10 attendees
6. Increase student participation by 10%annually for the next five years.
Tactical highlights met in 2009-2010: • Added the “Student Corner” to the
newsletter. • Advertised to provide article written by
BHN members to the ADA studentNewsletter “Student Scoop” – StudentAssistant Newsletter Editor submitted anarticle from the fall 2009 BHN Newsletteredition and it was published in theStudent Scoop March edition.
• Provided information to the student net-working reception at FNCE with BHNStudent Liaison Committee Chair, Chair,and Membership Chair in attendance.
• BHN Resource Professionals participatedin the Student Community of Interest dis-cussion.
• Student Membership increased to 177(~41.6% from last year).
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Additional Highlights of the Year include: Publications • Thanks to the Newsletter Editor Diane Spear Diane Spear, MS, RD, LD
and all of our member contributors, published four newsletters, eachfeaturing original research by RDs. Two were in print via mail andtwo were sent electronically.
• Continued sales of Psychiatric Nutrition Therapy: a Resource Guide forDietetic Professionals Practicing Behavioral Health Care (CD ROM) - 68sold 2009-2010
• Continued sales of The Adult with Intellectual and DevelopmentalDisabilities: A Resource Tool for Nutrition Professionals (CD ROM) 92sold 2009-2010
• Continued sales on the book Nutrition and Addiction = 104 sold2009-2010
• Began updating publication Children with SpecialHealth Care Needs, Pocket Guide for RDs in collab-oration with the PNPG DPG
Member Services • Continued member networking via Listserv. • Continued updating and adding member bene-
fits to the BHNDPG.org Web site. • BHN Student Committee Chair, Sarah Hoffman,
and Sharon Lemons, MS, RD, LD implemented aFaceBook Page for BHN Members usage ~110fans at the end of May 2010.
• Presented member awards to Sharon Wojnaroski,MA, RD; Ann Overmyer, RD, CD; Anne Hatcher,EdD, RD(ret), CACIII, NCACII and Roberta PearleLamb, MPH, RD, LDN at the FNCE Reception andAwards Ceremony
• Continue to donate funds to attain membershipin ADA Foundation 21st Century Club dedicatedto nutrition research and scholarship
• Hosted member social at FNCE 2009. Administration • Changed DPG mission, vision, tag line and strate-
gic goals by earning an ADA grant to cover thecosts involved in the creation process.
• Conducted monthly Executive Committee tele-phone conferences.
• Trained Executive Committee on strategic plan-ning.
• Updated Web site services to include credit cardpayment option for webinars, MP3 audio andother publications.
• Updated Guiding Principles and severalExecutive Committee job descriptions.
• Initiated the development of the IDD SOP/SOPP. Meetings • Spotlight Session: Nutritional and Sensory
Processing Factors that Affect Mealtime at FNCE2009
• Open Forum Session at FNCE 2009: ProcedureDevelopment and Implementation of BehavioralHealth Nutrition Practice Standards:
• BHN members donated ADAF Silent Auctionitems for FNCE 2009.
• Participation in ADA Leadership Institute: DianeSpear, MS, RD, LD and Paula Cushing, RD, LDN(2009)
• Charlotte Caperton-Kilburn, MS, RD, CSSD, LDNrepresented BHN via ADA Public Policy Workshop
• Collaborate with SCAN DPG for the SCAN
Symposium, Myths, Mysteries & Realities of Eating and Metabolism –Research to Practice (March 2010)
Financial Report for June 1, 2009 – May 31, 2010: Actual Budgeted
Expenses Totaled: $42,562.00 $42,579.00 Revenues Totaled: $48,079.00 $40,750.00 Net Profit/ (Loss): $ 5,517.00
Thank you to all who contributed to forwarding the work of thisDPG. Special recognition is extended to BHN Executive Committee forleading and implementing the 2009-2010 Strategic Plan.
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The Adult with Intellectual and Developmental DisabilitiesThis resource tool is designed toprovide an overview of nutrition inindividuals with intellectual anddevelopmental disabilities. Theresource guide is contained on oneCD-ROM as a 209 page PDF file. BHN Member Price: $28.00
Psychiatric Nutrition TherapyThis resource guide is intended foranyone working in the 4 practiceareas within Behavioral HealthNutrition: mental illness, eatingdisorders, addictions, and thosewith intellectual and developmentaldisabilities who also requirepsychiatric care. The resource guide is contained on oneCD-ROM as a 170-page PDF file. BHN Member Price: $28.00
Nutrition & AddictionsThis is a 244-page manual of infor-mation about addiction and drugs ofabuse, including legal, illegal andpharmaceutical drugs, alcohol, nico-tine, caffeine, and more. Patient edu-cational handouts on nutrition andrecovery topics are also included.BHN Member Price: $24.95
To order, visit http://www.bhndpg.org/publications/index.asp
BHN PUBLICATIONSChairKathy Russell, MS, RD Michigan 734/[email protected]
Chair-Elect Charlotte Caperton-Kilburn, MS, RD,CSSD, LDNSouth Carolina 901/[email protected]
Past-Chair Andrea Shotton, MS, RD, LDNOklahoma 918/[email protected]
Treasurer Janice L Scott, RD, CSP, LDTexas 972/444-8611 [email protected]
SecretaryCharlene Dubois, MPA, RDMichigan 616/[email protected]
Nominating Committee Chair Sharon Lemons, MS, RD, LDTexas 817/[email protected]
Membership Chair Milton Stokes MPH, RD, CDNConnecticut 917/[email protected]
Publications ChairShannon Longhurst, RD, CDWisconsin 414/[email protected]
Public Relations DirectorTherese Shumaker, MS, RD, LDMinnesota 507/[email protected]
DPG Delegate:Leslie P. Schilling, MA, RD, CSSD, LDNTennessee 901/[email protected]
Manager, DPG/MIG Relations:Anne CzeropskiAmerican Dietetic Association312/[email protected]
Resource ProfessionalsAddictionsRenee Hoffingeer, RDFlorida 352/[email protected]
Eating DisordersKaren Wetherall, MS, RD, LDNTennessee 865/[email protected]
Intellectual and DevelopmentalDisabilitiesPaula Cushing, RDTennessee 615/[email protected]
Mental IllnessLinda Venning, MS, RDMichigan 248/[email protected]
Student LiasionStudent Liaison Committee ChairCrystal [email protected]
A complete list of BHNExecutive Committee
members and volunteers is available at
www.bhndpg.org
Behavioral Health NutritionExecutive Officers 2010-2011
Join us, won’t you?Sign up and gain FREE access to hundreds of mem-
bers and their expertise through the member-only BHNElectronic Mailing List (EML)!
We have a wonderful exchange of information, ideas,and resources.
Find practice support and prompt responses tochallenging questions.
To subscribe to the BHN EML:
• Send an email to BHN Membership Chair, MiltonStokes, MPH, RD, CDN at [email protected]
• Include First Name, Last Name, Email Address
• Please title the subject of the email as BHN LIST SUBSCRIBE
Are You Seeking a GreatOpportunity?
BHN is offering the opportunity to get involved in the future of Behavioral Health Nutrition.
If you want to advance skills in the following areas, now is the time!
Volunteers needed immediately to fill non-elected positions:Sponsorship Chair
Assistant Newsletter Editor
If you would like to volunteer please contact Sharon Lemons, RD, LD, Nominating Committee Chair at
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