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Of mice and 'mindfulness': Fighting eating disorders

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A new storybook by clinical psychologist Dina Zeckhausen introduces young children to mindful eating. (courtesy of Dina Zeckhausen)

It didn’t look good for Billy Blue and Sally Rose. At any moment, they were likely to be batted by a boy with a broom, chased out of their home by a dog or snatched up by a mean cat.

To cope, Billy gorged himself on food and Sally Rose stopped eating altogether, which gave them a whole new set of troubles.

The cute mice of a new storybook, “Full Mouse, Empty Mouse: A Tale of Food and Feelings,” aren’t your ordinary childhood heroes. Instead, they are foot soldiers in a budding campaign led by medical professionals, like author and clinical psychologist Dina Zeckhausen, who contend the scourge of eating disorders in North America should be addressed at the earliest age. Zeckhausen believes her storybook delivers a “mindful eating” message that even young children can digest.

“Some children are not good at distinguishing between boredom and hunger, or sadness and hunger,” said Zeckhausen, of Atlanta, who said the book’s theme stresses the purpose of food is primarily nourishment, not as a means to cover up emotions. Zeckhausen also developed a weeklong program for grade-school students to explore the themes in “Full Mouse, Empty Mouse" that has been implemented in two Atlanta schools; she hopes to spread the program nationwide.

Zeckhausen’s initiative is part of a mindful eating approach to fighting eating disorders that is being used widely around the country. Mindfulness techniques promote a body-mind connection, and have been found to be effective in helping sufferers restore an awareness of their body's signals of hunger and fullness in order to re-establish healthy eating behaviors.

At an event in New York City in early March, a group of women gathered for an evening of “Fearless Eating.” They were served foods they might normally reject, like hamburgers, pizza, and macaroni and cheese.

“These are foods our minds might label as bad,” said Susan Weiss Berry, the certified nutrition specialist and mindfulness educator who led the event.

“When you learn to trust your gut, literally, you find you maintain a healthy weight with little thought and effort, and you don’t have to spend your life worrying,” said Berry.

Forty-two percent of girls in first through third grade want to be thinner, and 81 percent of 10-year-olds are afraid of being fat, according to some of the more recent studies addressing these issues, published in the 1990s in the International Journal of Eating Disorders and the Journal of Adolescent Health.

“I go to schools, I talk to the kids, and I would say the number is even higher than that now," said Amy Gerberry, an eating disorder counselor and director of administrative services at Remuda Ranch, an inpatient facility in Wickenburg, Ariz. and Milford, Va., that treats children as young as 8.

“Babies are born hard-wired knowing how to eat," Berry told her Fearless Eaters in New York City. “You came in with a perfect mechanism to know when you're hungry and when you've had enough,” she said.

But for a variety of reasons, including difficulty handling fear and anxiety, as well as conflicting messages from family and a society that overvalues physical appearance, some people disconnect from their innate bodily cues. This can lead to unhealthy relationships with food, which can turn into full-blown eating disorders.

Mindful eating is about cultivating a connection with your own level of hunger, learning to differentiate physical hunger from emotional hunger, and being aware of what types and amounts of foods are satisfying, said clinical psychologist Jean Kristeller. She is co-founder of the Center for Mindful Eating and director of the Center for the Study of Health, Religion, and Spirituality at Indiana State University, in Terre Haute.

In a mindful-eating intervention program for adult binge eaters that she and researchers from Duke University administered in 2006, Kristeller found that, on average, the number of binges per week was reduced to one per week, from four. And for those who were still binging at the end of the program, less food was being consumed.

Drawing on Kristeller's work, doctors in San Francisco are incorporating similar concepts in an eight-week intervention program for obese children and their parents. “We don't train them to be Tibetan monks, but all of them, including the children, are saying mindfulness is becoming part of their days,” said Dr. Michele Mietus-Snyder, associate professor of pediatrics at the University of California, San Francisco.

Elsewhere, in St. Paul, Minn. Kathy Kater, a social worker and author, developed a curriculum in 1998 that is used in elementary schools nationwide, called Healthy Body Image: Teaching Kids to Eat and Love Their Bodies Too! “To teach children about intuitive eating is teaching them to hang on to what was there from birth. It’s their birthright,” said Kater.

When her own children entered elementary school, Zeckhausen, who founded the nonprofit Eating Disorders Informaton Network in 1996, was struck by the stories she heard: A 3-year-old girl who would not put on her winter coat because it made her look fat; a 5-year-old boy who refused a cookie, calling it a “bad food”; and an 8-year-old girl who tearfully reported to her teacher that none of her friends had eaten her birthday cake. In August 2007, she would publish “Full Mouse, Empty Mouse” with Magination Press in Washington, D.C.

“The kids totally get into it,” said Sydney Shipps, who helped implement Zeckhausen’s program at the Warren T. Jackson Elementary School in Atlanta, where Shipps's two children, ages 10 and 7, are enrolled. She said she knows she cannot shield her children from body image and beauty messages in the media, but at least she feels better about it. She said her 10-year-old is now able to detect inappropriate uses of teenage models as she flips through magazines.

Whether eating disorders can be prevented is a controversial topic, according to Doug Bunnell, a clinical psychologist and director of an outpatient eating disorder treatment program in Wilton, Conn. “What we've learned is that any program that really sets a goal of deterring an eating disorder needs to be going at an early age. And the age keeps sinking. Most people believe that middle school is too late.”

“I used food to stuff anger and any uncomfortable emotions down,” said Margaux Laskey, 33, who attended the Fearless Eating event in New York. Laskey, who for many years obsessively controlled the foods she ate, started struggling with an eating disorder at age 13.

“I ate the bun, that’s very unusual for me,” she said. “I stopped when I was full. I wondered, if I don’t eat it all, will they think I’m not eating because I’m scared? But no, it was because I’d had enough. I remained true to what I was feeling. It was not about what other people are going to think.”

E-mail: dro2102@columbia.edu