September 9, 2012

"Obesity" and Health at Every Size Workshop

My next Eating Disorder CEU series workshop is approaching! Friday, September 14, 2012, 9:00am to 11:00am, Topic: “Obesity” and Health at Every Size, $10 for 2 CEUs, RSVP by e-mailing me at 

I am looking for one volunteer to help me out with set-up and clean-up. If you're interested let me know! Volunteers can attend the workshop for free!

August 13, 2012

Jenni Schaefer Event

This event is not too be missed! Author of Life Without ED is coming to San Diego. Be sure to register if you plan on attending.

May 30, 2012

Costco Connection: The Skinny Rules

Yesterday I went to get the mail and was deeply disturbed by what I found.  I am a Costco Member so I receive The Costco Connection in the mail. On the cover was Bob Harper, trainer, chef. The featured article, “The Skinny Rules: Bob Harper’s Take on a Healthier You.” The skinny rules? Really?!

After reading the article I was even more frustrated. Harper admits that health is sickness, wellness, and fitness. He never talks about how being skinny is healthy and yet that is the name of his new book The Skinny Rules: The Simple Nonnegotiable Principles for Getting to Thin.  I believe the words skinny and thin are used more to get attention and to lure people into buying the book. This approach enforces the myth that if you are skinny you are healthy. We know too much to keep perpetuating this false belief. Anorexia nervosa is a clear example of when someone is skinny and very unhealthy. Additionally, someone without an eating disorder can be skinny and unhealthy. 

Another frustration I had with Costco and the publicizing of Harper’s book was the fact that Costco sells The Hollywood Cookie Diet.  This diet promotes the idea that you can eat four cookies a day and a light dinner and lose weight! Once again if this is all really about health, where do the skinny rules and the cookie diet fit in? The answer is they don’t. It is not really about health, it is about profit.

What are other products or companies that support the skinny myth? 

May 11, 2012

Review of Weight of the Nation, Part 4: Challenges

On Wednesday May 9, 2012 I attended a screening of the upcoming HBO four-part series Weight of the Nation. During the screening the audience was only shown Part 4: Challenges.  I went to the screening knowing I would be angry, however I attempted to have an open-mind. I left feeling both impressed and disappointed. 

I was glad to see an acknowledgement of the complexity of the health issues facing America. The episode reviewed the largely subsidized corn and soy industry and made references to food deserts in low income areas. A lifespan disparity of 20 years within a 10 miles radius between affluent and poor neighborhoods was informative and disturbing. The lack of safe and appropriate playgrounds, sidewalks, and areas to bicycle were also emphasized.  A corner food market/liquor store in a low income area was visited to exemplify the food choices for the people living in the community. A small bag of potatoes chips was 25 cents while a banana and an apple were one dollar and 25 cents all together.  This particular community did not have access to a supermarket.  The corner food market/liquor store was their only affordable access to food.  However, within this review of social, governmental, and economic factors there continued to be a complete lack of regard for body size diversity and fat acceptance. 

As I watched the screening I fidgeted in the small, hard, uncomfortable chairs as once again “obesity” was identified as a problem and the cause of chronic illnesses.  Obesity was being used beyond its’ actual definition. Obesity is typically defined by BMI standards (30 or greater) and is commonly used to describe a particular appearance related to body size and type.  BMI is used as a statistical measure and should not be used as an individual health assessment. Additionally, obesity is not a word that should be used to describe social, economical, or nutritional problems. Obesity was still partly targeted for the major health and economic problems facing America today. However, coming back down to reality, obesity is a word from an archaic categorical system that describes a group of people with a BMI of 30 or greater.  Unfortunately, the people within this category have now become the scapegoat and consequently the perceived problem. 

I found it ironic that the campaign against smoking was related to the fight against obesity. The message was along the lines of “we did it before, we can do it again.” The film ignores a crucial difference between smoking and obesity. Smoking is the cause of health problems, obesity is sometimes a symptom of health problems. The fight against smoking was not led by the tagline “to win we need to whiten our teeth,” or “to win we need to gain the weight lost by the appetite suppression of smoking.”  The campaign was about a behavior, it was anti-smoking. Why is it that the current fight for health is so narrow and misguided?  We call it anti-obesity or really anti-larger body types.  If it is really about health shouldn’t we be looking at the issue through a different lens all together?  Let’s have a campaign for health promotion!

At the beginning of part four, various large body types are displayed as if on an assembly line with a white background.  During this introduction the possibility that some of these individuals are healthy is never broached. As the audience is shown one large person after another, the camera cuts to an interview with each person as they review their list of health problems. Not one person is presented as being both large and healthy. Additionally, there is a complete lack of diversity of body types. For example no one on the assembly line would be considered thin or of average weight by the outside observer. The only message to walk-away with from this introduction is obesity equals illness and early death, while thinness equals healthy. 

As a therapist who specializes in eating disorder treatment I was gravely saddened by this message.  Weight-loss is horrifically glorified in the film’s tagline “to win we have to lose.” We know that the majority of eating disorders are partly influenced and developed through body dissatisfaction and dieting.  In the episode a young boy is playing in a parking lot while his mother sadly watches.  The boy tells the woman interviewing him that he would like a park to play in. He whispered his reason for justifying a park in his neighborhood while he stood half-way behind his mom.  His reason: “you know...I am fat.”  Is this the message we really want to be sending? You should play to lose weight and avoid gaining weight? Weight-loss would make the multi-billion dollar dieting industry happy, but does it really make Americans happy?

Although I know a big part of the reason this series is missing ideas from the Health at Every Size movement is due to profit for some I am still shocked and disappointed that an opportunity to spread awareness was passed up by all those involved in the Weight of the Nation series: Institute of Medicine (IOM), Centers for Disease Control and Prevention (CDC), the National Institute of Health (NIH) and Kaiser Permanente.  As I have not seen the other episodes yet, I am not sure what they will specifically review, however if anyone next week happens to only view the “challenges” episode they will walk away with more awareness of the social and governmental factors related to the health problems of America, but also a strengthened belief that obesity is wrong and inherently bad.

For additional responses to the Weight of Nation series, Deb Burgard provides an exceptional review of critical thinking skills to arm yourself with as you watch the program next week. She also provides facts to dispel the myths and false information that the episode “challenges” continues to propagate. 

March 19, 2012

Six Ideal Times To Seek Couple Counseling

by Marianne Miller, PhD

As a marriage and family therapist and educator, I have found that couples often come to counseling too late. Either they are so ingrained in destructive patterns that it takes Herculean effort to unravel, or one partner already has one foot out the door.

I would like to share six times that may be challenging for couples and therefore ideal to seek help through counseling.

Time #1: Before a big commitment.
Whether a coupleis planning a wedding or a commitment ceremony, or they are moving in together,the change represents a difference in how they, their families and friends, and the rest of society views their relationship.
There will be new pressures on the couple, such as managinga household, negotiating finances, and interacting with parents and extended family.
It is helpful to receive counseling from a couple therapist or a clergyperson trained in couple counseling. Not only will the counselor assess the strengths of the partners, she or he will address areas in which these couples often struggle, such as finances, in-laws, sex, and children.
Families with step-parenting situations especially benefit from therapy, as many common pitfalls can be avoided by having an experienced guide to help you through it.
Time #2: Before a significant family transition.
All couples experience important transitions throughout their lives. Situations such as having a child,returning to work, facing empty nest, and retiring can be tumultuous on the entire family.
Couple counseling can help partners openly acknowledge the new stressors and normalize the adjustment the family will be facing so that they can better prepare for the transition.
Often couples think of the logistics of the change, such as financial adjustments and the effect on schedules, but partners do not discuss (and often do not know) how such transitions will influence their relationship.
Couples therapists are trained to create a safe space to help the partners explore any fears and concerns that may be present.
Time #3: During financial stress.
Many couples are struggling with serious financial burdens, whether it is unemployment for one or both partners or significant debt. Financial stress is one of the top reasons for conflict for couples(along with children, in-laws/family, and sex).
Partners may think that they cannot afford counseling, but there are many low-cost, sliding-scale options that do not require insurance.
Local universities may have family therapy graduate programs with community clinics where masters and doctoral students work, closely supervised by faculty with cutting-edge knowledge of family issues.
Also, if you plug “lowcost” or “sliding scale” and “couple counseling” and the name of your city/town into a search engine, several names of clinics and individual therapists should come up.
Time #4: After a loss
Sometimes the death of a child or loved one is anticipated, other times it comes unawares and the shock is unreal. Either way,the experience of losing a family member, especially a child, is often traumatic, and it is very hard on the couple relationship.
It may feel as though you and your relationship will never recover. It will never be the same, but many couples do get through it and find that their relationship is the stronger for it.
One of my former students, Kerry L. Essakow, PsyD, interviewed eight people in resilient marriages who had endured a violent death of a child. One of her male participants shared:
That marriage, that broken plate, was shattered and it was shattered by the murder. And eventually because it’s a family heirloom you pick up all the pieces, you glue them backtogether.
You can put the plateback on display again, but the cracks will always be there.
Having a therapist walk couples through this devastating experience was one of the resources that helped the parents recover.
Their relationships were broken; however, the partners were able to grieve, look to each other for support and safety, and repair their relationships.
Time #5: When enduring chronic pain or illnesses
As a therapist,I treat individuals and couples who struggle with chronic pain and illness. I also suffer from chronic pain, which has affected my relationship with my husband over the years.
Before I injured my back, I was a very active participant in our marriage. I would cook, clean, and participate in other household management activities.
After myinjury, my husband had to take over all of my responsibilities while I was bedridden. He essentially took the roles of both partners so that our family could keep functioning.
It was very difficult on him and quite burdensome; however, it’s what we had to do to survive. Family, unfortunately, lived in other states.
Over time, wewere able to recruit outside help, and friends came over periodically with foodor to help drive me to doctors’ appointments.
I eventually improved, and my pain lessened to the point at which I could do some of what I used to do, albeit not everything.
During that difficult time, we sought couple counseling to help work through the trauma of my injury and subsequent challenging medical treatments.
With our therapist, we worked through difficult emotions and resentments that had emerged, even though we had a very strong marriage. Therapy helped us move past the stuckness we felt so we could reorganize our relationship and move on with our lives.
Time #6: When facing death
Couples often don’t like to talk about the possibility about one partner dying, but having assistance when dealing with a terminal illness can be a lifeline.
Hospice often provides free counseling for couples and individuals.
These counselors have specific training in grief work, and they will help both the dying and surviving partners work through the anticipatory grief, as well a scope with the physical challenges of dealing with the pain of dying.
Hospice therapists also co-ordinate with hospice medical workers, and together they can provide an integrated treatment team to the couple.
Final Tips
When people I know seek couple counseling, I give them three tips.
First, gather the names of three therapists and make initial appointments with all of them. See who you like of the three, and continue working with that person.
Second, find therapists other people recommend—it’s the best consumer report out there. It is helpful to have counselors who have specific training in couple therapy.
Third, trust the process. Couple counseling can take a while, so be patient. The rewards will be worth the work.

About the author
Marianne Miller, PhD, is an Associate Professor in the Couple and Family Therapy Programs in theCalifornia School of Professional Psychology of Alliant InternationalUniversity, San Diego Campus.
Dr. Miller is a California Marriage and Family Therapy Registered Intern#62559, employed by Sally LeBoy, MFT#14768.
She is also a Licensed Marriage and Family Therapist inTexas, #5209. See her website at

February 28, 2012

February 3, 2012

Miss Representation Aims to End Sexism in the Media and Empower Women

Sponsored by Eating Disorder Treatment Centers: 
A New Journey, Rosewood, and Montecatini
Newest Miss Representation Trailer (2011 Sundance Film Festival Official Selection) from Miss Representation on Vimeo.

Miss Representation first premiered in the documentary competition at the Sundance Film Festival where it caught the eye of OWN: Oprah Winfrey Network. It made its television debut as part of the OWN documentary film club in October 2011, with over 1.3 million people tuning in to its multiple airings. Additional screenings with corporations, non-profits, religious groups, government organizations and communities are happening every day all over the world.

Local Screening:  There will be a free screening of Miss Representation on February 29th, 2012 at UCSD’s Ida and Cecil Green Faculty Club in San Diego.  The event begins at 6:30 pm and movie will begin promptly at 6:50 pm.  For ticket information please send an email to  For location information please visit website: Parking is $4.  After the screening, there will be panel discussion with Gurze Books owner Leigh Cohn, psychologist, Dr, Divya Kakaiya, and pediatrician, Dr. Christine Wood.

February 2, 2012

Dieting: The Path to an Eating Disorder

  When parents are first in the grip of their child’s eating disorder, they tend to ask, “how did this happen?” Parents want to know; why their little girl? There are several important factors that contribute to an eating disorder. Genetics, family dynamics, personality traits, life experiences, and media influences can all combine to set someone up for an eating disorder. However, even with all these factors present, someone may still go through life without an eating disorder. What sets the eating disorder off then? Dieting. Dieting starts the rolling snowball of weight loss that turns into the avalanche of an eating disorder. 
  Dieting is any attempt to lose weight.  Generally, dieting begins when someone develops dissatisfaction with his or her natural body.  The person than decides to actively change his or her body weight or shape. Many dieters seek rapid weight loss without having to make major changes in their lifestyle. The dieter denies the body essential, well-balanced nutrients and calories in exchange for dieting products and counting calories. 
  According to the National Eating Disorder Association (NEDA, 2005) Americans spend more than $50 billion dollars a year on dieting and diet-related products. Half of American women are trying to lose weight at any point in time (NEDA, 2005). Additionally, researchers estimate that 40% to 60% of high school girls are on diets (Sardula et al., 1993; Rosen & Gross, 1987) while 42% of 1st to 3rd grade girls surveyed reported wanting to be thinner (Collins, 1991).
  Dieting is a very dangerous game to play; hunger cues are ignored, the body can become malnourished and be forced into starvation mode, mood can significantly change and lead someone to depression, an anxiety disorder, low self-esteem or increased stress. Focusing on weight-loss takes the joy out of eating and leads one to a chronic feeling of hunger and emptiness.  Dieting can also lead to an obsession with food and weight and eventually start an eating disorder (Isomaa et al., 2010; Johnson, 1984). After years of failed dieting attempts, dieters may take more extreme measures for weight loss such as fad diets, diet pills or even weight-loss surgeries such as the lap-band. 

  What is even more astounding than all the dangers, is that dieting rarely works and people still take the risk! Only 5% of dieters keep the weight off for a year, while 95% of all dieters regain their lost weight and more within one to five years (NEDA, 2005).  So, why do the majority of Americans diet when the odds are stacked against them? Why do so many risk their health, their happiness, and their life for a diet that only has a 5% chance of working? The answer is the dieting snare.
  Many people fall into the dieting snare due to the allure and promises of weight-loss advertising. Advertisements consistently claim faster weight loss with better long-term results.  They market acceptance, beauty, success, and happiness. A susceptible dieter begins to think, “this is the one, this is the diet that will work, this diet will be different.”  The diet snare keeps people consumed by the idea that they will only be accepted by others if they are always on a diet and trying to look better.  Anytime someone wants to escape from the diet snare there is a diet product or advertisement to pull them back.
  Dieting advertisements have drastically increased over the years. Between 1992 and 2001, weight-loss advertisements in magazines increased by 129% (Cleland et al., 2002). The mean number of diet articles increased from 17.1 to 29.6 (Cleland et al., 2002).  Americans are inundated with weight-loss products, advertisements, before and after photos of diets, and billboards claiming surgery is the answer for their problems.
  Dieting offers the illusion of control and success.  In reality people do not lose the weight, they lose interest in things that used to bring them pleasure, they lose their ability to concentrate and think clearly, and they lose focus of what is really important in their life. Dieting really only helps someone gain both weight and an obsession with food. Dieting helps someone gain an eating disorder.
An eating disorder is a severe, biologically based mental illness according to the Academy for Eating Disorders (Klump, Bulik, Kaye, Treasure, & Tyson, 2009).
  Emerging science affirms that eating disorders significantly impair cognitive functioning, judgment, and emotional stability (Klump et al., 2009). After being diagnosed with an eating disorder, individuals must go through extensive treatment for several years.  Knowing that an eating disorder could be just around the corner, people still choose to diet.   
  Fortunately, dieting does not have to be the answer anymore. Dieting behaviors can be prevented and replaced with healthy choices. NEDA (2005) offers effectives ways to prevent dieting, the drive for thinness, and body dissatisfaction.

-Examine your own attitudes, beliefs, prejudices, and behaviors about food, weight, body image, physical appearance, health, and exercise.
-Replace extreme eating and exercise habits with more moderate ones.
-Encourage balanced eating of a variety of foods in moderation.
-Allow all foods in your home.
-Become a critical consumer of the media-pay attention to and openly challenge media messages. 
-Develop a value system based on internal values.
-Do not use food as a reward or punishments. It sets food up as a potential weapon of control.
-Do not equate food with positive or negative behavior. 

Most importantly, love your body! Body acceptance stops the cycle that begins with body dissatisfaction, leading to dieting, and finally an eating disorder. Start a new cycle beginning with body acceptance, healthy self-esteem, and healthy choices!

Cleland, R. L., Gross, W. C., Koss, L. D., Daynard, M., & Muoio, K. M. (2002). Weight
Loss Advertising: An Analysis of Current Trends. A report of the Staff of the
Federal Trade Commission. Available at:
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Collins, M. E. (1991). Body figure perceptions and preferences among preadolescent
children. International Journal of Eating Disorders, 10, 100-108.
Isomaa, R., Isomaa, A., Marttunen, M., Riittakerttu, K., & Björkqvist, K. (2010).
Psychological distress and risk for eating disorders in subgroups of dieters.
European Eating Disorders Review, 18, 296-303.
Johnson, C. (1984). Journal of Youth and Adolescence, 13, 15-26.
Klump, K. L., Bulik, C. M., Kaye, W. H., Treasure, J., & Tyson, E. (2009). Academy for
eating disorders position paper: Eating disorders are serious mental illnesses. The
International Journal of Eating Disorders, 42, 97-103.
National Eating Disorder Association. (2005).
Rosen, J.C. & Gross, J. (1987). Prevalence of weight reducing and weight gaining in
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Sardula, et al. (1993). Weight control practices of U.S. adolescents and adults. Annals of
Internal Medicine, 119, 667.