Mental Health Concerns and Eating Disorders During Perimenopause

What is Perimenopause?

Perimenopause is the life stage when a woman’s body transitions toward menopause (the end of her reproductive years, when the body no longer produces eggs). Perimenopause typically begins sometime in a woman’s 40’s, but there can be significant variance with some women noting changes in their 30’s, and some not until their 50’s.

The perimenopause period usually lasts between 5-10 years, and in Australia the average age for reaching menopause is 51 years.

Menopause is most often a natural life event, but it can also be triggered by gynaecological surgeries or the use of certain medications (including some treatments for cancer). Perimenopause can be experienced by all people assigned female at birth (AFAB) who sill have their ovaries, including trans-men.

Why is it important that we know about Perimenopause?

Perimenopause can bring a variety of physical and emotional changes which significantly impact on wellbeing and quality of life. These changes vary in severity from person to person, and across the perimenopausal period. There’s a lot that can be done to support women during perimenopause, and it’s important that everyone is aware of the symptoms associated with this time, considering how they can support women during the transition. Some of the compounding factors which can exacerbate the experience of perimenopause are isolation, misinformation, judgement, and a lack of care or support.

There are numerous mental health concerns which women transitioning through menopause may experience, along with increasing risk of cardiovascular disease and reduced bone density. Women at midlife also have significantly increased risks of mental health concerns such as depression and anxiety, and an increased risk for the development or re-occurrence of an eating disorder.

Common symptoms of Perimenopause

According to a 2023 study conducted by the Jean Hailes Foundation for Women’s Health, approximately 20% of women experience no symptoms of perimenopause at all. For those who do experience symptoms, these can be triggered by fluctuating hormone levels, which often coincide with major life changes and stressors associated with midlife. The range of symptoms which may be attributed to perimenopause can include, but are not limited to, those below.

Some possible physical symptoms of perimenopause:

• Irregular or missed periods, or changes in menstrual flow

• Changes in ovulation patterns

• Hot flushes and night sweats

• Sleep disturbance

• Fatigue and headaches

• Muscle and joint aches

• Vaginal dryness and breast tenderness

• Bladder weakness and more frequent urge to urinate

• Skin dryness and sensitivity

• Loss of libido or reduced sexual pleasure

• Altered digestive patterns and tolerance of foods

• Changes in body shape, size and composition

Some possible mental and emotional symptoms of perimenopause:

• Feeling anxious or irritable

• Low mood or mood swings

• Forgetfulness or ‘brain fog’, difficulty concentrating

• Difficulty coping with life events

• Challenges adjusting to your changing body

Perimenopause and Mental Health

The emotional challenges of perimenopause should not be underestimated. Hormonal fluctuations associated with this life phase are linked to an increased risk of anxiety and depression, even for those without a prior history of mental health issues.

Research has found an increase in suicidal thoughts for women at midlife, and completed suicide rates for women in Australia are highest in the perimenopause period.

Physical symptoms like night sweats, brain fog and fatigue can exacerbate mood disturbances. Additionally, perimenopause often coincides with major life changes such as retirement, family and relationship changes, increased caregiving responsibilities, and personal loss, which can all contribute to increased stress.

The changing relationship with the body during menopause can also present a significant change for many women. There may also be a period of adjustment as women come to terms with no longer experiencing monthly reproductive cycles, which can impact on identity and the experience of femininity.

Body size and shape changes during Perimenopause

Perimenopause often brings significant changes in body weight, shape and composition. While hormonal changes contribute to these shifts, other factors such as lifestyle changes also have an impact. Women transitioning through menopause may also notice changes in their appetite and digestive patterns. The aging process, which naturally decreases lean muscle tissue, can make it more challenging to maintain muscle mass and manage weight. Additionally, weight cycling, or repeated dieting, can lead to further muscle loss and fat gain over time.

All of these factors can add more stress for women in perimenopause, especially when faced with diet culture messaging about body ideals and fear of weight gain.

A balanced perspective on understanding and accepting the naturally occurring body changes, while also focusing on nutrition and activity levels for optimal wellbeing is important, particularly to avoid extreme or all-or-nothing responses to the changing body.

Eating Disorders and Perimenopause

Eating Disorders can be experienced by people of all ages and all genders. Traditionally thought of as conditions impacting young women, we now know that the rates of eating disorders being experienced by older women are increasing, and are a significant concern at midlife. These mid life eating disorders can be triggered by the changes of perimenopause, and may be either a first presentation at midlife, or a re-occurrence of a condition which had been experienced earlier in life.

According to the Butterfly Foundations ‘Paying the Price’ report (2024), almost one in four people experiencing an eating disorder in Australia each year are aged between 40-59. When sub-threshold eating concerns are included, 15% of perimenopausal women report at least some elements of disordered eating.

Major hormonal shifts experienced by women during perimenopause, like those experienced during puberty, pregnancy and postpartum periods, combine with pressures on women to meet cultural ideals of thinness and ‘anti-ageing’ to create a high risk period for the development of an eating disorder. Significant life events and stressors such as increased caregiving responsibilities or significant lifestyle changes can also trigger challenging eating behaviours and body image dissatisfaction in midlife.

Eating disorders during perimenopause are often overlooked by health professionals, who may not be aware of the prevalence of these conditions for women at midlife.

This is particularly notable when the full range of eating disorder presentations is considered, including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Other Specified Feeding and Eating Disorders. Midlife eating disorders can have complex and serious health consequences, as the body is more vulnerable to complications such as digestive issues, osteoporosis, and dental problems, and fluctuating eating patterns can also exacerbate many of the symptoms of perimenopause.

“Drawing on a summary of evidence by Samuels, Maine & Tantillo (2019), factors which contribute to body dissatisfaction and eating disorder prevalence in midlife include:

• Stress and anxiety in relation to the physiological changes of ageing, which can contribute to feelings of loss of control in the context of a culture that valorises youthfulness

• The impact of weight suppression and disordered eating over many decades of life

• The lack of older women role models amidst ageist social norms which frame ageing as something to defy and combat with diet, exercise and medication regimes

• The ongoing impact of diet culture, where disordered eating is framed as normal behaviour from a young age

• High levels of body dissatisfaction among women aged 50 and over

• Experiences of shame, stigma and isolation, given that eating disorders are stereotyped as illnesses affecting young people, and health professionals may perceive older people as ‘too old to have an eating disorder’.”

(From The Butterfly Foundation: ‘Eating Disorders and Body Dissatisfaction During Menopause’.)

Seeking help during Perimenopause

The hormonal and life changes associated with perimenopause can be challenging, with the difficulties exacerbated for people who feel isolated and unsupported during this time. If you or someone you know is struggling with the symptoms of perimenopause, or may be experiencing body dissatisfaction or eating disorder symptoms during midlife, the team at Mind Body Well can offer support and guidance to help navigate this phase. We also recommend the links below for further information.

• Australasian Menopause Society

• Jean Hailes Foundation for Women’s Health

• Perimenopause Symptom Checker

• Eating Disorders Victoria free online course - Menopause and Eating Disorders

• Butterfly Foundation - ‘Paying the Price for Eating Disorders’

Our Director Janet Lowndes reflections after attending the Asia Pacific Conference on Women’s Mental Health in October, 2024. (General information only, please consult your health professionals for individualised medical or psychological advice).

Weight Stigma Awareness Week

Weight Stigma Awareness Week is an annual campaign aiming to eliminate weight bias and ‘end the resulting stigma, shame, trauma, and discrimination around body shape and size’. This post explores the impacts of weight stigma and what we can do to change it.

What is Weight Stigma?

Stigma occurs when an individual or group is viewed in a negative way or treated differently because of a particular characteristic they possess. Weight stigma refers to discrimination against people based on body weight and size. This stigma is a result of weight bias, which involves prejudicial attitudes and beliefs about people based on their their weight. Weight stigma and bias can show up in a multitude of ways, including:

• Stereotypical beliefs - e.g. making assumptions about a person based on body size and attributing certain personality traits / characteristics to people based solely on their weight

• Negative attitudes - e.g. a dislike of people because of their weight

• Discriminatory behaviours - e.g. social exclusion, bullying

Internalised weight stigma occurs when people hold negative and critical beliefs about their own body weight, which can happen regardless of actual body size. This is however more often experienced by people who have bodies larger than the cultural ‘ideal’.

Note – we’re using the word ‘fat’ throughout this post as a descriptor of a bodily characteristic. This neutral use of the term represents an acceptance of all body sizes, and is free from judgement.

Where does weight stigma come from and what does it look / sound like?

Like other biases that result in stigma (e.g. racism, homophobia, ableism etc), weight stigma is the result of conditioning from exposure to common negative messaging about weight and fatness which leads us to think about weight and larger bodies in unhelpful ways. People aren’t born with inherent weight bias; it’s learned, usually in families and communities from a young age. Weight stigma can be perpetuated in many areas, including:   

Healthcare settings

• ‘Diagnosis fat’, where a health practitioner attributes symptoms purely to a persons weight, often causing them to not investigate further, potentially missing underlying / other causes

• The ‘War on Obesity’, with a the push to categorise certain body weights / shapes as a disease, using BMI as a marker of individual health

• Health concern about behaviours exhibited by fat people, while thin people are given a pass for engaging in similar behaviours

• Under-recognition of the impact of genetics and broader environmental factors influencing weight and body size, and overemphasis of the role of individual behaviours and a perception of the ability to control body weight and size

In the media

• Fat bodies are often dehumanised in news stories, shown as ‘headless torsos’, or exhibiting stereotypical behaviours, e.g. eating certain foods

• In movies and books fat characters are rarely portrayed positively, often relegated to being the villain, the comedic relief, or with a storyline of their weight as a struggle to be overcome

• Social media algorithms promoting content of people with thinner bodies, and limiting the reach of fat content creators  

In public spaces

• Shops only stocking larger clothing sizes online rather than in store (or not supplying larger sizes at all)

• Seating which limits who can comfortably use it, e.g. airplanes, lecture theatres, cinemas, booths / tables with unmovable chairs

In workplaces & social settings

• Weight has been shown to influence hiring decisions and affect career progression / promotions

• Diet talk which often shows up in lunchrooms or at social events involving food, e.g. good / bad food talk, complimenting weight loss and talking negatively about weight gain

• Colleagues encouraging others to diet and offering unsolicited weight loss advice

In eating disorder treatment settings

• Outdated weight criteria built into diagnostic labels, e.g. continuing to differentiate between anorexia nervosa and ‘atypical’ anorexia nervosa, despite a growing body of evidence which shows there are few if any differences between these presentations (beyond body size)

• Perpetuating the fear of fatness by setting weight restoration targets too low, encouraging weight loss in higher weight people with eating disorders, or promising people that they wont gain weight in recovery

What’s the impact of weight stigma on individuals and communities?

While weight stigma can negatively impact the health and wellbeing of a range of individuals and communities, the impact is disproportionately felt by people in larger bodies. As with other forms of stigma, these negative impacts are typically the results of the accumulation of repeated common experiences of discrimination (micro-aggressions) rather than a single event.

The negative impacts of weight stigma can include:  

• Poorer mental health, e.g. changes to mood, development of mental illness, use of coping strategies which further impact mental health

• Impacts of prolonged exposure to stress and stress hormones on physical health 

• Isolation, both from social exclusion by others and fear / anticipation of rejection based on previous experiences impacting behaviour

• Delaying medical care due to concern about weight based discrimination experiences from healthcare providers, or having illness missed due to ‘diagnosis fat’

• Perpetuating dieting and disordered eating behaviours in an attempt to try and control weight which often leads to weight cycling and poorer physical health

With all this in mind it’s important to remember that we shouldn’t only care about weight stigma because it’s bad for people’s health – but because everyone, in all bodies - deserves to be treated with respect.

What can be done about Weight Stigma?

Like other forms of stigma a multifaceted approach is needed which includes advocating for structural change, e.g. legislating to protect people from weight-based discrimination, education campaigns to help challenge weight bias, identifying and eliminating weight bias in healthcare education settings etc.

Individuals can also act to address weight stigma by:

• Interrogating your own beliefs about weight, and understanding where these beliefs come from. This blog is just a starting point, we recommend taking a ‘deep dive’ into some of the resources listed below

• Pushing back against weight-based discrimination whenever you see or hear it (and not only when you’re around fat people)

• Ditching food and body talk and weight / appearance based compliments - there are many more interesting things to talk about than commenting on a persons appearance

• Requesting that public spaces are accessible for all bodies, and not leaving this up to fat people alone to advocate for this, e.g. cinema / airplane seating, chairs in waiting rooms, clothing accessibility

• Supporting and consuming media content produced by fat people, and content which includes positive representations of fatness

• Being an ally to people who experience weight based discrimination

Want to learn more?

Body Image and Eating Disorders Awareness Week 2024

September 2-8, 2024 is Body Image and Eating Disorders Awareness Week

Body Image and Eating Disorders Awareness Week (BIEDAW) is an annual health promotion campaign raising awareness about body image concerns and eating disorders. This year the focus is on communication - assisting people to consider the impact of what they say about bodies - both their own and others.

The following statements from The Butterfly Foundation provide some helpful alternatives to diet culture talk.

Head over to The Butterfly Foundation website to see more information and helpful resources including a very useful script to help you advocate for yourself when visiting health professionals, including Doctors.

Acknowledging NAIDOC Week

NAIDOC week (7th-14th July 2024) is a time to recognise and celebrate the history, culture and achievements of Aboriginal and Torres Strait Islander peoples. This year’s theme is ‘Keep the Fire Burning! Blak, Loud and Proud’, which celebrates the resilience and vitality of Indigenous cultures, ‘inviting all Australians to listen, learn, and engage in meaningful dialogue, fostering a society where the wisdom and contributions of Indigenous peoples are fully valued and respected’.

As an eating disorder focused team, we at Mind Body Well are aware of the need for our professional community to recognise, understand and better respond to eating disorders occurring amongst First Nations people. To date there has been a significant lack of research into the presentation, assessment, and treatment of First Nations peoples’ mental health, including eating disorders. The limited available research indicates the following:

• Eating disorders are prevalent at similar or higher rates among First Nations people compared to non-Indigenous Australians (1,2)

• One study showed that 30 per cent of Indigenous adults met the criteria for an eating disorder, compared to 18 per cent of non-Indigenous adults (1)

• Other Specified or Unspecified Feeding or Eating Disorders have been the most prevalent among First Nations people, often including behaviours around binge eating or night eating (1,2), and purging behaviours can be twice as likely in Indigenous youth

• Approximately three in ten Aboriginal and Torres Strait Islander young people are extremely or very concerned about their body image, and First Nations peoples have reported higher levels of weight/shape overevaluation (1,3)

• Eating Disorders in First Nations people have been associated with lower levels of overall mental health related quality of life (1) and poorer psychosocial quality of life (4)

• There are currently no culturally appropriate eating disorder screening and assessment tools which have been validated for Aboriginal and Torres Strait Islander Peoples

• First Nations people experience multiple risk factors and vulnerabilities which can increase the likelihood of developing an eating disorder, such as intergenerational trauma, food scarcity, discrimination, minority stress and systemic racism

The eating disorder field urgently needs culturally safe eating disorder research and targeted treatment options for Indigenous Australians. Eurocentric model of mental health care have traditionally focused on symptom resolution, often at the expense of holistic wellbeing and harm reduction strategies. Understanding and working to dismantle intersectional oppression is core to providing inclusive eating disorder care and body liberation for all people.

While acknowledging the harms and oppression experienced by First Nations people, we also celebrate the resilience and strength of the world’s oldest continuous living culture.

We’ve listed some supports for First Nations people below:

• 13 YARN: Phone counselling provided by Aboriginal and Torres Strait Islander Crisis Supporters

• Gayaa Dhuwi (Proud Spirit) Australia: National Aboriginal and Torres Strait Islander social and emotional wellbeing, mental health and suicide prevention leadership body

• National Aboriginal Community Controlled Health Organisation (NACCHO): national leadership body that provides advice and guidance to the Australian Government and advocates for community-developed health solutions that contribute to the quality of life and improved health outcomes for Aboriginal and Torres Strait Islander people.

References

1. Burt, Adam et al (2020) ‘Prevalence of DSM-5 Diagnostic Threshold Eating Disorders and Features amongst Aboriginal and Torres Strait Islander Peoples (First Australians)’. BMC Psychiatry, 20(1)

2. Burt, Adam et al (2020) ‘Eating Disorders amongst Aboriginal and Torres Strait Islander Australians: A Scoping Review’. Journal of Eating Disorders, 8(1)

3. McCabe MP, Ricciardelli L, Mellor D, Ball K. (2005) ‘Media influences on body image and disordered eating among indigenous adolescent Australians’. Adolescence, 40(157)

4. Burt, Adam et al (2020) ‘Prevalence, Features and Health Impacts of Eating Disorders amongst First-Australian Yiramarang (Adolescents) and in Comparison with Other Australian Adolescents’. Journal of Eating Disorders, 8(1)

International Day Against Homophobia, Biphobia, Interphobia and Transphobia

The International Day Against Homophobia, Biphobia, Interphobia, and Transphobia (IDAHOBIT) is celebrated on May 17th each year. BegiNning in 1990, the date was chosen to mark the removal of homosexuality as a disorder from the World Health Organisations ‘Classification of diseases and related problems’.

According to the IDAHOBIT website, the day has two main purposes:

1. To celebrate the pride and allyship of the people who work to build equality around the world, and

2. To raise awareness of the discrimination LGBTQIA+ people continue to face today

LGBTIQA+ people experience higher rates of mental health challenges than the general population. The Private Lives 3 report found a greater prevalence of psychological distress, anxiety, and depression among all groups within the Australian LGBTIQA+ community, with transgender and bisexual+ people particularly at risk.

What causes this higher prevalence of psychological distress?

LGBTIQA+ people are more likely to experience prejudice and discrimination than the general population. Over time repeated exposure to negative attitudes and distressing situations can start to affect the physical and mental health of minority groups – a process known as minority stress. Minority stress can make it harder to engage in health promoting behaviours and can lead to increased drinking, drug use, and attempts to control eating or body weight/shape as coping strategies.

A growing body of research points to higher rates of disordered eating and eating disorders among the LGBTIQA+ community, particularly trans and gender diverse people. While there are many common eating disorder risk factors minority stress certainly plays a part as well as the pressure that some LGBTIQA+ people feel to fit in with rigid body standards and gender norms to feel accepted and avoid discrimination. 

Discrimination can sometimes occur when people are attempting to access healthcare services, and this can lead to LGBTIQA+ people being reluctant about reaching out for help. At Mind Body Well we are committed to providing safe and accessible healthcare to people from LGBTIQA+ communities.

We also recommend the following services for LGBTIQA+ Victorians seeking additional support for mental health concerns:

• QLife - provides free daily peer support from trained members of the LGBTIQA+ community Australia wide via anonymous phone and webchat

• Rainbow Door - a free helpline providing information, support, and referrals for LGBTIQA+ Victorians

• Eating Disorders Victoria BLOOM support group - BLOOM is a fortnightly group run by Eating Disorders Victoria for LGBTIQA+ people with eating disorders

More information about IDAHOBIT can be found on the IDAHOBIT website.

Rethinking Diet Culture and Embracing International No-Diet Day

May 6th marks International No-Diet Day (INDD) – an important occasion to reflect on the potential harms caused by weight loss dieting. Initiated by feminist groups in the UK in 1992 under the leadership of Mary Evans Young, INDD provides an opportunity for a number of important reflections:

• Challenge cultural ideals: INDD encourages us to challenge societal norms surrounding body shape and size

• Raise awareness: Shedding light on weight discrimination and fat phobia, advocating for greater acceptance and inclusivity

• Combatting diet culture: iNDD prompts us to question the industries profiting from body dissatisfaction and dieting norms

• Prioritising body liberation: The day emphasis the importance of freedom and liberation from societal beauty standards

As we acknowledge INDD this year, we’re reflecting on the bigger picture - the context in which diet culture (the pervasiveness of dieting norms and the perceived value of weight loss dieting) manifests in our communities. Weight loss dieting, often considered a solution for many grappling with body image issues, actually poses significant risks and harms, including:

• Eating Disorders: Weight loss dieting is a significant risk factor for the development of an eating disorder

• Health Issues: It can compromise nutritional adequacy and lead to multiple adverse health effects

• Social Isolation: Dieting can be isolating, causing people to exclude themselves or withdraw from social occasions which involve food

• Mental Health: Weight loss dieting exacerbates body dissatisfaction and distress, which has a cause-and-effect relationship with poor mental health outcomes such as depression and anxiety

• Mind-Body Disconnection: Weight loss dieting teaches us to be at war with and to disconnect from our bodies - which has multiple adverse physical and psychological implications

• Perpetuating Stigma: Weight loss dieting perpetuates weight stigma and weight bias

• Financial Costs: Additionally, weight loss dieting incurs significant financial expenses *

It is essential though to acknowledge that many people turn to dieting as a means of regaining control in a world inundated with conflicting messages about nutrition and body image. Simply advising people to ‘stop dieting’ isn't enough; they need viable alternatives. Dr. Rick Kausman's question, ‘If Not Dieting, Then What?’ (also the title of his 2004 book) prompts us to explore alternatives which prioritise wellbeing over weight loss and recognise and respect the diversity of body types.

Zooming out to the societal level, it becomes evident that diet culture thrives within a context of weight stigma, bias, and weight normativity.

• Weight bias – negative assumptions and judgements about people in larger bodies

• Weight stigma – social devaluation and discrimination based on weight and shape

• Weight-normativity - emphasises weight and weight loss as central to defining health and wellbeing (ie. Assumes health based on weight)

• Weight-inclusivity – emphasises health and wellbeing as multifaceted and related to many aspects of a persons life (ie. Recognises social, emotional, physical and spiritual aspects, the importance of the whole person and the context in which they live)

It’s not enough to merely recommend to someone that they stop dieting… when we live in a weight-normative culture which tells us that thinner is better, and that we’re ‘wrong’ for existing in bodies which are anything other than the cultural ideal. Assumptions about weight and size need to be continually challenged and addressed, recognising that for many people, weight loss dieting makes sense as a response to the culture they exist within. It’s not enough to put the pressure on someone to change – it’s the culture that needs to change, to make it safe for people to exist in a diverse range of bodies, and to be valued and treated with respect without any expectation of a need to shrink their body in order to be OK.

Zooming in again to the individual level, we offer the following suggestions for potential alternatives to weight loss dieting. These are just suggestions… think about what works for you, and how you can ‘opt-out’ of diet culture… even if just for today:

• Focus on taking care of your body, nourishing and nurturing it in ways that feel good for you. Go for a walk in nature, lay under a tree, have a long bath…

• Explore your relationship with food, try to understand all the different motivations you have for eating, and bring self-compassionate awareness to those motivations

• Eat for both pleasure and nourishment – consider the importance of nourishing yourself both physically and emotionally in many different ways

• Celebrate and enjoy a wide range and variety of foods – allow yourself to really dive into the sensory pleasure which comes from fully experiencing food

• Spend time with people who value and recognise you for who you are, seek out communities in which you feel safe

• Expose yourself to diverse messages about bodies – do a social media audit and be ready to unfollow any accounts which perpetuate the ‘thin is best’ ideal, especially those which suggest there is any right’or wrong way of eating

• If this is a particularly tricky issue for you seek out a Psychologist, Dietitian, or other health professional who can assist you to untangle and address the ways weight stigma and weight bias effects you, and who can help you explore alternatives to diet culture

Importantly… recognise messages of weight bias and stigma in your environment, and chose not to perpetuate them. If you have the energy to challenge these messages, then by all means do so - be a social justice campaigner and advocate for respect and inclusion for all people, regardless of the characteristics of their body.

All bodies are worthy of care and respect.

(* The global weight loss and weight management market value in 2021 was USD $224 billion USD, and by 2030 is predicted to be $405 billion USD (Source – Global News Wire February 9, 2023). This ‘market value’ is being paid for by the people who are driven by body dissatisfaction and distress to purchase products and methods they’re sold under the guise they will make them thinner, and happier. And this is just referring to the direct costs associated with dieting. It’s impossible to put a price on the costs of poor nutrition caused by restrictive eating, eating disorders triggered or exacerbated by the pursuit of thinness and body dissatisfaction which the diet industry profits from, and other mental health challenges exacerbated by weight stigma and weight bias.)

Related past articles:

• Wellness program or diet in disguise?

• What does it mean to be a ‘Non-Diet Dietitian’?

• Breaking up with weight loss

• What is Intuitive Eating?

• About mindful eating

• What is the ‘non-diet approach’?

• Love your body

Navigating Diet Culture During Easter

While Easter is often viewed as a time to get together with loved ones and celebrate by sharing food, it can also be a challenging time for people with lived and living experience of an eating disorder, and/or those who are actively working to challenge the impact of diet culture on their lives. Similar to Christmas or any other holiday period, it may feel difficult to navigate Easter for the following reasons:

• Traditional or common Easter foods (e.g. chocolate, hot cross buns) may be feared foods, or foods associated with dietary rules

• Due to the short-term availability of these foods, there can be a sense of ‘last supper’ eating, as they will only be accessible for a limited period of time

• There’s an increase in diet talk, often including comments around ‘indulging’ and being ‘naughty’ or feeling guilty for eating particular foods

• Changes in routine due to the long weekend, and other activities such as seeing family or being away from home

• Reduced or different availability of usual support systems

All of these factors can increase the risk of engaging with challenging eating behaviours such as food restriction, bingeing and/or compensating behaviours, as well as experiencing higher levels of distress or preoccupation around food or body image. The following suggestions may assist in navigating the Easter period:

• If you’re in eating disorder treatment, make a plan with your treatment team, e.g. whether you want a more structured and purposeful approach, or whether you are feeling ready to approach it more spontaneously

• Continue eating regularly, and maintain some structure around consistent food intake even amidst different routines and activities

• Remember this is just another day (or few days), and any increased pressure associated with this time will pass

• If you’re struggling with ‘last supper’ eating, practice allowing yourself these foods now, and remember you can enjoy them again next year. It might also be helpful to find equivalents, e.g. different types of chocolate or fruit buns which are available the whole year

• Refocus on your values by connecting to what feels important to you around this holiday, e.g. connection, rest, adventure, family, spirituality, creativity etc

• Be curious as to whether this period presents an opportunity to challenge some of your existing food rules and beliefs

• Plan ahead where you can, enabling you to manage your expectations and prepare for some of the challenges you may face. Having some of your ‘safer’ foods available may assist in maintaining regaular eating

• Talk to your loved ones ahead of time, let them know about any particular concerns you have, and brainstorm some of the ways they can support you

If you are in eating disorder recovery and you’re working on food challenges, try the following suggestions:

• Build up your challenges in a graded manner to give yourself the best chance of success, e.g. start with smaller or individually wrapped chocolates and build up to larger portions

• Explore your beliefs both before and after eating, e.g. ‘what am I afraid of / what do I think will happen as a result of eating this food / how strongly do I believe this thought?’. Try to access your recovery mindset in challenging these thoughts

• Remember that all foods are neutral, and labelling foods as good/bad only gives the foods and our fear or avoidance of them more power

• Push back on diet culture by putting these thoughts where they belong, e.g. rather than thinking ‘I’m bad for eating an Easter egg’, reframe it to recognise ‘This is diet culture talking’. Remember that the eating isn’t the problem, but diet culture is

• Plan strategies or supports which can help you challenge yourself, e.g. sharing Easter baking with a friend, or planning a distraction afterwards to reduce rumination

• Remember that compensatory behaviours undo the hard work you put into challenging a food rule, and to get the most out of challenging yourself it’s important not to dilute the challenge by engaging in eating disorder behaviours before or after eating

• Practice self-compassion - remember it’s okay if challenges feel harder than expected, allow the emotions to be present and explore self-awareness and self-kindness. Try to remember the helpful strategies you have in your toolkit to manage any tricky situations that arise, and set aside some time for yourself to engage in self-care activities that allow you to feel safe, grounded and calm.

Remember, celebrations such as Easter are about much more than food. This may be an opportunity to get together with loved ones, or it may be a time for rest and relaxation. Focus your attention on things that have meaning for you, and create some wonderful Easter traditions of your own.

Exploring Endometriosis and the relationship with food and body image

In the realm of women’s health, there has long been an understanding of the impact of conditions such as Polycystic Ovary Syndrome (PCOS) on women’s mental health. More recently there is also growing awareness of the impact of Endometriosis symptoms on body image and eating concerns.

Endometriosis is a chronic condition where cells similar to the lining of the uterus grow outside the uterus, causing inflammation in areas such as the abdomen, and in some cases quite debilitating pain. This pain, along with other symptoms like bloating and digestive issues, can result in people feeling discomfort and disconnection from their bodies.

Everyday activities can become challenging as people seek to cope with chronic pain, deal with bloating and discomfort, and navigate unpredictable digestive patterns. These uncertainties can significantly impact on how people perceive and relate to their bodies, creating vulnerability to seek out ways to feel better and cope with difficult sensations and emotions.

Research into the psychological impact of endometriosis also reveals possible impacts on body image and self-esteem, with some people feeling ‘broken and inadequate’, or struggling with the sense that their bodies are outside their control.

Of course there is an abundance of dietary information available which offers strategies to alleviate endometriosis symptoms. Unfortunately this information is often misguided and not scientifically based, encouraging people to adopt restrictive dietary patterns which can exacerbate the conflict with and confusion about their bodies, contributing to further body image distress and eating concerns.

Additionally, cultural messaging regarding body image, physical activity, and dietary choices can add pressure and contribute to this body confusion, especially when compounded by challenges from hormonal therapies, difficulties with sexual arousal and intimacy, recurrent surgeries, or fertility concerns.

Research from 2021 explored why some people with endometriosis experience higher levels of emotional distress. The findings pointed to negative body image and self-criticism as major factors contributing to psychological distress. These self-critical patterns were described by one person as ‘a vicious cycle of feeling like one's body is constantly falling short’, leading to increased feelings of failure and self-criticism.

We do however know that improving self-esteem and emotional coping strategies can contribute to improved psychological outcomes for people with endometriosis. Emphasising body acceptance and reducing self-criticism are also powerful tools in coping with any chronic illness, and this is especially so for women’s health issues and menstrual concerns.

Endometriosis and Eating Concerns

Currently there is little research on the relationship between endometriosis and eating concerns or eating disorders. Research does however show that people with endometriosis regularly make dietary changes in an effort to assist with pain management and gastrointestinal issues.

Turning to clinical and lived experience, health professionals working with women and AFAB (assigned female at birth) people with endometriosis often describe the desire to control their eating behaviours in an effort to control their body, contributing to complex relationships with eating and body image.

What Can Help?

1.     Prioritise a Healthy Relationship with Food and Body Image: While dietary changes may help manage endometriosis symptoms for some, it's important to prioritise overall health and well-being and to avoid restrictive or highly controlled eating behaviours

2.     Seek Support from Health Professionals: Consult with healthcare professionals who understand both endometriosis and eating concerns – especially if you’re considering dietary changes, it’s always best to speak to a qualified Dietitian for professional nutritional advice

3.     Emphasise Body Acceptance: Work on improving your relationship with your body and developing body acceptance to enhance overall well-being, irrespective of any physical challenges. Focus on taking care of and nurturing your body, prioritising it’s needs

4.     Develop Self-Compassion: Chronic health conditions are complex and challenging to navigate. Self-compassion involves the ability to be kind to yourself in response to health concerns, focusing on changing the relationship you have with your body, even in response to things which are outside your control. Mental health professionals can assist with strategies to enhance your self-compassion.

Navigating Social Media to Promote Positive Body Image

In our digitally driven world, social media has become an integral part of our daily lives. From connecting with friends to staying updated on the latest news, it's a tool which has immense influence on our lives. Alongside the convenience and benefits, social media also presents a number of challenges, particularly in relation to body image.

The prevalence of unrealistic beauty standards portrayed on social media can have a big impact on how we perceive ourselves. Repeated exposure to these perfected images can cause us to feel inadequate, and may contribute to body dissatisfaction.

Social media can also be a great tool to assist in promoting positive body image, fostering self-acceptance and encouraging inclusivity. The key factor is how we choose to engage with social media. Here are some tips on how to use social media in a way which promotes positive body image and can protects us from dissatisfaction or potentially disordered eating behaviours.

1. Check in with Your Feelings

Notice how you feel during and after being on social media. If certain pages, accounts or images leave you feeling negative about yourself or trigger comparison, consider whether following them is beneficial to your well-being. Your mental health should always be the priority.

2. Curate Your Feed

Follow accounts and people who promote body diversity and inclusivity, and unfollow those which perpetuate harmful beauty standards. Exposure to a broad variety of body types, shapes, ages, genders, and ethnicities can reshape your perception and foster inclusivity.

3. Remember: It's Not Reality

Keep in mind that what you see on social media is often a curated portrayal of someone's life… the highlights reel. Remember also that images may be edited, filtered or enhanced, so what you’re seeing may be not be real. Remind yourself of this when comparing your life to others. Share authentic moments from your own life to contribute to a more genuine online community.

4. Combat Comparison

As the saying goes, ‘Comparison is the thief of joy’, and this is especially so on social media. Remember that you’re comparing yourself to the best possible version of another persons life, and if you begin to slip into critical self-talk, it’s probably time to move away from social media for a while to do something which focuses on your own life, your own opportunities and achievements.

5. Prioritise Health and Well-being

Move your focus away from appearance, to instead pay attention to your overall health and well-being (which is much broader than just the things we’re able to photograph and share on the socials). Embrace discussions about what makes you feel good physically, mentally, and emotionally.

Social media can either perpetuate harmful beauty standards or serve as a platform for promoting positive body image and inclusivity. By curating our feeds, being aware of our emotional responses, and fostering empowering content, we can contribute to a healthier and more accepting online community.

Ramadan and Eating Disorders

What is Ramadan?

Ramadan is a holy month of significance for Muslims. It is a period of 29-30 days where Muslims are challenged to increase in all forms of worship, revive their awareness of God and in turn, achieve a deeper connection. An integral expression of this is demonstrated through spiritual fasting (sawm).

Spiritual fasting involves abstaining from eating or drinking from dawn until sunset. The intention behind spiritual fasting distinguishes the act from other forms of fasting which may be intended for weight control or influencing metabolism.

For Muslims, fasting in Ramadan is a shared experience and therefore increases community connection. It is obligatory on all those who are capable (physically, financially, mentally etc) and of mature age (passed age of puberty). There are many conditions and circumstances, however, that exempt followers from needing to fast, especially if it poses a significant threat to a person’s health and well-being.

Every year, there will be millions of Muslims around the world who are unable to or struggle to fast due to their situation (including an active eating disorder). There are concessions that exist and can be verified by local religious leaders (e.g. an Imam). Nevertheless, the nature of an eating disorder is inherently encouraging of fasting and restriction and an eating disorder gaining control can be seamlessly disguised as religious practice. This can make seeking help extremely difficult and lead to feelings of shame, dismay and isolation.

Things to consider around Ramadan and eating disorder recovery

Eating disorders exist in all community groups and Ramadan can be a challenging time for Muslims who have an active eating disorder, or a lived experience of one.

A daily cycle exists of waking up early to eat, fasting during daylight, followed by breaking the fast at sunset. For a person who is unwell with an eating disorder, this cycle can trigger eating disorder thoughts and can even be contrary to their prescribed treatment. If this is the experience for you or someone you know, it is important to consider the following:

• You are not alone

• Speak to your GP about accessing professional support if you’ve not yet done so

• It is recommended to discuss your concerns with your treatment team and religious leader (e.g. an Imam) ahead of time in order to plan for Ramadan

• You may be able to decide on an adapted fasting schedule according to your needs and progress in recovery (e.g. fasting alternate days or fasting on shorter days of the year)

• Reflect on your intention behind fasting – are you fasting to express your religious beliefs or are you intending weight loss? Are you finding it impossible to eat sufficiently before dawn? Are you feeling this urge to delay breaking fast at sunset?

• If there is a supportive person in your family or community that you can talk to, it can be helpful to do so. There can be a lot of focus and conversation around food during Ramadan which is anxiety-provoking and having someone to turn may help you navigate that.

• It may be that you are not medically safe to participate in fasting at your current stage of recovery and that’s OK. Focusing on recovery today can mean that you can observe Ramadan more fully in the future.

Even if you are currently unable to fast, you can choose to explore the many other ways of practicing your faith that are also encouraged in Ramadan.

Other ways to participate in Ramadan

• Prayer and practicing mindfulness

• Donating time/clothes/food/money to people in need

• Preparing meals for others

• Attending Friday or night prayers at the local Mosque

• Appreciating that seeking treatment, taking steps towards recovery is honourable and an act of worship itself

Eid celebrations

As with Ramadan, Eid can be wonderful celebration with family and friends for millions of people worldwide. However, for people with an eating disorder, it can be a challenging time. They may even dread the day.

Festivities like Eid, will almost always involve special food in abundance and cultural traditions which can be triggering. In the lead up to Eid, it’s important that you express any fears you have with your support network (e.g. your treatment team, partner or family member). This can help you feel prepared and provide a sense of safety.

Journaling is a great way to put words to some of the emotions we feel and a useful release in addition to voicing our concerns with others. We can also use a journal to plan ahead for the festive day which could involve setting reminders to eat regular meals and snacks, scheduling time to check-in with ourselves and rest.

If there are some aspects of Eid that are more confronting for you (e.g. menu planning/cooking), then you might like to involve yourself with other aspects instead (e.g. decorating your home or organising gifts).

We can accept that some level of anxiety is to be expected and that it’s okay to have these feelings. Remind yourself that, like any other day, the day will pass. Try your best to be kind to yourself.

Blog post written by Aneela Panhwar, Accredited Practising Dietitian at Mind Body Well.

Navigating 'Pride' when you have Body Image Concerns

Each year LGBTIQA+ pride events happen around Australia, typically coinciding with warmer weather and sunshine in the southern states, and dry season up north. Depending on where you live, your closest event might vary from a small march or fair day, through to a multi-week festival of LGBTIQA+ arts, culture, and parties.

The first Australian Pride march happened in Sydney in 1978 on the anniversary of the New York Stonewall riots. It was organised to promote gay and lesbian rights and to push back the against widespread discrimination and prejudicial laws of the time (homosexuality was still illegal). The first march was met with police resistance resulting in widespread arrests, but has continued each year since then with increasing support and acceptance. Over time the vibe has shifted from resistance to one of celebration.    

Pride and Body Image 

Despite the air of celebration at Pride events, not all LGBTIQA+ people feel comfortable attending. The Butterfly Foundation #BodyPride survey found that:  

• Over half (54%) of LGBTIQA+ people believe there are expectations to look a certain way within LGBTIQA+ communities 

• Nearly half (47%) of LGBTIQA+ people experience body image pressures in the lead up to Pride events like Mardi Gras 

• Over a third (36%) of LGBTIQA+ people engaging in dieting or disordered eating behaviours in the lead up to Pride events like Mardi Gras 

• You can read more about the survey and their #BodyPride campaign HERE

These findings are likely to be related to the impacts of minority stress, and pressure to conform to broader heteronormative gender and body norms. Minority stress results from exposure to anti-LGBTIQA+ prejudice and discrimination. This can create internalised shame within LGBTIQA+ people about their gender, sexuality, or differences in sex characteristics and increase sensitivity to rejection. Attempts to change ones body weight or shape might be used to gain external validation from others to try to overcome feelings of shame and increase feelings of acceptance/reduce rejection in LGBTIQA+ communities after coming out. Disordered eating behaviours are also sometimes used as tools to regulate emotional distress.  

Navigating Pride Events if you’re Experiencing an ED or Body Image Concerns 

Pride is a subjective experience and there is no right way to celebrate it. Choosing not to participate in marches or events doesn’t automatically make you less proud than anyone else. If you’re someone who wants to get involved but negative body image is getting in the way, then consider these suggestions: 

• Consult the program to find events that de-emphasise bodies or are explicitly inclusive and fat/body positive, e.g. queer history talks/tours, family friendly fair days, panel discussions about aspects of identity, bear parties 

• Try a social media cleanse – mute or unfollow any accounts that make you feel worse about your body or yourself and moderate engagement with photos of people added to Pride event hashtags  

• Wear something you feel comfortable in - clothes that constantly pinch, grab, or bunch up can keep your attention on your body and stop you from being present and enjoying the moment 

• Gather supports – if you have supportive friends, family, or partner(s) create a plan together for what to do it you start to feel anxious, overwhelmed, or shamed

• While dieting behaviours can sometimes provide short term relief from body/weight concerns, dieting ultimately leads to increased preoccupation with food and body, and potentially feeling out of control when eating. Focus on self-care in the lead up to events by eating foods you feel comfortable with regularly rather than restricting, particularly if you plan on drinking alcohol or using drugs 

• Embrace the rebellious spirit of Australia’s first Pride march and reject heteronormative body ideals. Showing up as your authentic self is an act of resistance in the face of an unjust rigid body and gender norms.    

If your relationship with your body or food is getting in the way of you living your best life reach out for support.  

The Importance of Professional Supervision for Dietitians

Professional supervision has long been recognised as an integral part of practice for psychologists and other mental health clinicians. Outside of student placements and perhaps some within workplace arrangements, supervision is likely to be less familiar to Dietitians (where a culture of mentoring is more common). This is however changing, thanks to the work of Dietitians Supervision Resources Australia, and the mandatory supervision requirements for maintaining Credentialed Eating Disorder Clinician (CEDC) status with the Australia and New Zealand Academy for Eating Disorders. This blog post will help to clarify what professional supervision is, how it differs from mentoring, and explain why it’s important for Dietitians to include supervision in their professional development plan.

Supervision vs mentoring – what’s the difference? 

Dietitians undertake mandatory mentoring (for 1 year) as part of the provisional Accredited Practicing Dietitian (APD) program. The goal of the mentoring program is to build the mentees knowledge and help brainstorm ideas and find solutions to career challenges. This may provide some crossover with aspects of supervision (e.g. facilitating reflective practice) but Dietitians Australia makes a clear distinction between the two. Once the mentoring program is complete there’s no ongoing requirement for mentoring to maintain APD status, but Dietitians are encouraged to seek out mentoring needed. Mentoring in this capacity may be ad hoc or a longer-term relationship, and there are no requirements for becoming a mentor.  

What is supervision? 

Hawkins & Shohet provide the following definition of supervision in ‘Supervision and the helping professionals’ (2012): 

“Supervision is a joint endeavour in which the practitioner with the help of a supervisor, attends to their clients, themselves as part of their client practitioner relationships, and the wider systemic context, and by doing so improves the quality of their work, transforms their client relationships, continuously develops themselves, their practice and the wider profession”.

Effective supervision is: 

• a structured and formal process with a clear purpose of developing the learning and growth of the supervisee  

• outlined by clear boundaries agreed upon by the supervisor and supervisee 

• dedicated to facilitating reflective practice of the supervisee rather than just providing answers to questions (although there is space for teaching too when needed) 

• built around providing learning, support, and accountability for the supervisee 

• a relationship that helps to improve Dietitians competence & wellbeing, improve career longevity, ensure that patients/clients of the supervisee receive high quality and safe care, and that dietetic practice aligns with the professional code of conduct      

• a skill that requires the supervisor to undertake training and an ongoing commitment to their own growth and development as a supervisor e.g. supervision of their supervision practice  

Dietetic supervision at Mind Body Well

Mind Body Well Dietitian Team Leader Tom Scully provides professional supervision (via Telehealth), which is particularly suitable for Dietitians who:

• have an interest in, or are already working with people with body image and weight concerns or a history of dieting 

• are interested in improving their confidence and competence in working with eating disorders or other areas of mental health including mood disorders and substance use disorder  

• are a Dietitian working within a minoritised community/group that you are a member of and would like a place to discuss the rewards and challenges that this can pose 

• work with LGBTIQA+ clients and would like to increase your confidence in providing culturally appropriate and affirming care 

You can read more about supervision at Mind Body Well and make an enquiry via the link below.

Enjoying Carbohydrates and Debunking Diet Myths

In a world so strongly influenced by diet culture, carbohydrates are often labelled as something to be feared, with popular diet regimes like Paleo and Keto advocating for their restriction or avoidance. This demonisation of carbs fuels the belief that our worth is dependant on our dietary choices, and that certain foods or entire groups of foods are ‘bad’, and a judgement is attached to us consuming them.

Let’s debunk some of these diet myths, and remember that all foods serve a purpose in nourishing our bodies.

The Importance of Carbohydrates: Carbohydrates are a fundamental food group which serve as a primary source of energy. Carbs are the food group which breaks down most quickly in our bodies, providing a great source of ready energy. Athletes for example often rely on carbs for a quick energy boost before training or competitions.

Brain Health and Mood Stability: Carbohydrates play an important role in supporting our brain health, being its preferred source of energy. Without regular carbohydrate intake, you may notice fluctuations in mood, increased irritability, and difficulty concentrating. Including carbs in your diet can help maintain stable blood sugar levels, preventing fatigue and cravings.

Stable Blood Sugar for Overall Well-being: Regular carbohydrate consumption contributes to stable blood sugar levels throughout the day. This stability can help reduce cravings and prevent the feelings of tiredness and fatigue often associated with erratic blood sugar levels.

Breaking Free from Food Restriction: Avoiding any food groups can lead to all-or-nothing relationships with food - the more we restrict something, the more we crave it, and the more likely we are to find it difficult to pay attention to our hunger-fullness signals when eating. Incorporating carbohydrates into your regular diet can help alleviate cravings and foster a healthier relationship with food.

Balanced Meals for Satisfaction: A well-rounded approach to nutrition involves a mix of carbohydrates, proteins, and fats. This balance not only satisfies your hunger but also provides the necessary nutrients for sustained energy throughout the day.

Gut Health and Variety: Carbohydrates also contribute to gut health by providing essential fibre. A diet rich in fibre supports the growth of beneficial gut bacteria and helps prevent issues like constipation. Experimenting with different types of carbs adds variety to your meals, making the eating experience more enjoyable and diverse.

The Pleasure of Carbs: Let’s face it, carbohydrates are delicious. There’s a carb to suit everyone - bread, biscuits, rice, pasta, cake, fruit, yoghurt, sweet potato, chips, lollies, legumes, lentils… the list of delicious choices goes on an on.

Rather than succumbing to external food rules, it’s important to listen to your body's needs, embrace variety, and nourish yourself with a wide variety of foods, including carbs. If you’d like to learn more about your bodies nutritional needs, our team of non-diet Dietitians at Mind Body Well can help.