Tips for Traveling 

By Lauren Muhlheim, PsyD.and Therese Waterhous, Ph.D./L.D. 

During vacation, parents may be tempted to give in more easily to the eating disordered thinking and behaviors because they do not want to upset other diners in a restaurant or because they "don't want to ruin" the vacation after they've invested a lot of money in getting there. The food may be different than that available at home, or it may be difficult to get the types of foods on which the family has been relying. Children and young adults with anorexia may be inflexible or easily stressed; if the food is different than that to which they are accustomed, anorexics may refuse to eat at all and those with bulimia may purge to reduce stress associated with traveling. Sightseeing often involves a lot of walking, which can burn a lot more calories and require even greater caloric intake to offset. Many vacations occur in warm climates, where health problems related to malnourishment or dehydration may be magnified. If families do travel during Phase 1 or Phase 2, they should be cautioned that it may cause a setback and prolong the recovery process.

If due to family emergency or some other reason travel cannot be avoided, then parents and caregivers need to have confidence they can feed the way they have been feeding (similar foods, meals timed in the same manner, supervision of the child for the duration of each meal, not allowing for any slip-ups such as skipping a snack), can provide oversight after meals to prevent purging and be able to limit exercise. There must be a plan in place for contacting the treatment team, if needed.   Following are some ideas for preparing for travel.  

Many parents ask about dangling out the promise of a trip as a reward. It is better to tie consequences to behaviors (e.g., 100% meal completion, no purging, etc.) versus outcome (pounds gained). Also, those consequences need to be ones experienced exclusively by the person diagnosed with an eating disorder, not everyone in the family. It is unfair to set up a child in recovery to be responsible for the loss of a vacation perhaps at the expense of other children. The journey toward health is not fully in a person's control. If they are perceived by other family members as "being responsible" for the loss of a vacation, they will undoubtedly feel bad and this will not contribute to their success in becoming healthy. It is better to postpone the trip entirely until the child is healthier

Travel may be attempted late in Phase 2 or preferably not until Phase 3.

Signs that your child or young adult is ready for travel: 

• Eats most meals and snacks willingly on a predictable schedule
• Eats a wide variety of foods and does not get upset when there are changes or new foods are presented.
• Can handle eating at restaurants in public and can eat "fast food"
• Has handled a shorter overnight trip away successfully
• Comfortable eating in front of others
• Comfortable having others comment to them about how "well they are doing" and has discussed their reaction to this situation with their therapist.
• Not bothered by seeing others eat, or seeing what foods others choose in social situations (being around a lot of people choosing foods with which they are uncomfortable can be a trigger)
• Purging is under control and occurring infrequently
• Parents feel empowered to step back in if there is a regression during travel 

How to prepare for travel: 

• Set expectations appropriately - expect that even a dormant eating disorder may reemerge in an unfamiliar setting
• The family and treatment team should discuss ahead of time what could happen, when it could happen, and the appropriate response. Consider writing a contract about expected behaviors and consequences if behaviors cannot be maintained
• Discuss in advance about how to ask others to treat an eating disordered child, and be aware that you will have to coach well-meaning friends and relatives in how to talk with the child. This can feel very awkward and even cause friction with relatives, so if the family is not confident they can handle this they should reconsider whether the risk of the trip is justified
• Talk with the child: how do they feel about travel, being in front of other friends or family, going to restaurants? Discuss the child's concerns with the treatment team. This is a great opportunity to expose other fears, faulty thinking, and worries - and to create plans to combat them.
• Talk to others who will be part of the trip to make sure they understand the plan and can help in handling a difficult situation.
• Before embarking on a long trip, observe how the child copes with a practice mini-vacation (an overnight to a nearby destination, allowing an easy retreat to home if things are not going well)
• Research the cuisine and get menus ahead of time -the treatment team can help adapt the current meal plan to the cuisine at the destination, if this seems necessary
• Before the trip begins, have the child practice eating the type of the cuisine that will be available at the destination
• If travel will involve long car trips, plan out the rest stops and meal locations beforehand. Pack a cooler with the family's regular foods for the trip.
• Plan airplane and airport meals ahead of time and pack extra snacks in case of delays (remember that liquids are not normally allowed through security)
• If dealing with time changes, discuss with the treatment team how to arrange for this. It is recommended to maintain consistency in the intervals between meals and snacks despite any changes in time zone
• Set consequences for uneaten meals and/or purging: finishing food back in the room with a parent, restriction of activities until all food is eaten, more supervision and so on. The family should discuss a plan with the treatment team and feel confident that they will be able to follow through on the plan. They must not be intimidated by the eating disorder, even if it means making a scene in front of others. 
• Buffets may be especially overwhelming to a child with an eating disorder - parents should consider either eating at restaurants with a menu option or making their child's plate if a buffet is unavoidable.

 How to feed on vacation: 

• Maintain as consistently as possible the feeding routine established at home. Keep a regular structure of meals and snacks. This is the number one priority
• Provide the same supervision during and aftermeals as at home
• Follow through on any consequences that have been established, even if it means "ruining the vacation"

 Try to remember that putting your child's recovery first and putting off all nonessential travel until your child is weight restored will go a long way to improving their chances for a full and faster recovery. Once they are well, you will be able to better enjoy your vacations. Much further on in recovery, travel can be a great opportunity to expose him/her to new foods, new routines and increased flexibility.

About the authors:

Lauren Muhlheim is a clinical psychologist who specializes in evidence-based cognitive behavioral psychotherapy and family-based therapy (FBT) in the Los Angeles area. Therese Waterhous is a licensed dietician who also is a F.E.A.S.T. advisor.  Both have trained at the Train2Treat4ED Institue and specialize in FBT as private practitioners. 

 . 

New on the Website 

The  F.E.A.S.T. website's exclusive articles now includes the article,  "Dangers of Dieting a Body Adapted to Famine" by Shan Guisinger, PhD, Clinical Psychologist. "Genetic studies have found that weight is as heritable as height, yet many people wake up every day hating their weight and scorning those who are fatter. Although tallness and thinness are both valued, there isn't widespread contempt of short people; height is seen as beyond the individual's control. If a short person woke up every day hating her height we would question her sanity and values."

Thanks to new member, Giada Zichittella from

www.labicidirosalina.com, we can now offer translation of

F.E.A.S.T.' s mission statement and principles

in Italian. Thank you, Giada!

Task force member, Marybeth, represented F.E.A.S.T. at the Academy for Eating Disorders table at the American Academy of Pediatrics Conference.   F.E.A.S.T. resources and materials were well received by conference attendees. The new AED booklets on eating disorders have been so popular among physicians that F.E.A.S.T. is financially assisting in printing more copies for circulation. To obtain booklets for distribution in your area, contact Annie Cox at acox@aedweb.org with "AED Guide" in the subject line and indicate how many copies you need along with the shipping address.  

Mom, It's Not Your Fault

By Jenni Schafer

I am sitting here eating a piece of cake my mom made for my birthday. I am enjoying it. Zero guilt. Why is eating cake a matter of discussion? Because eating --- for me --- used to be a matter of life or death. For much of my life, I was afraid to eat cake and everything else. I struggled with anorexia and bulimia.

For those of you wondering --- and I have heard it many times before --- my eating disorder was not caused by my mother. My mom was not overly controlling or absent from the home. She was not abusive in any way --- no, not even a little. My mom did not put pressure on me to be a perfect student. I did that to myself. My mother is loving, nurturing, and supportive. She is the kind of mom who encouraged me to believe in myself and chase after my dreams; the kind of mom who supported my decision to pursue music in Nashville. She is a mom who will drop everything to celebrate her child's birthday.

However, my mom and I are different in many ways, and she encouraged that too. Like most mothers, she wanted her daughter to find her own voice even if that voice opposed her personal view. As a result, I am not much of a birthday cake maker, and she would never write an article to make a point, this point: Historically, mothers have been falsely blamed for eating disorders. This must stop.

Remember when we thought that autism and schizophrenia were caused by moms? We were wrong to blame mothers then, and we are wrong to blame them now. My mom did not cause my eating disorder, but she did a whole lot to help me get better.

Eating disorders are complex, biopsychosocial illnesses. Leading researchers agree "Genetics loads the gun, and the environment pulls the trigger." Researchers don't believe that there is a specific eating disorder gene but that people inherit a latent vulnerability in the form of traits like anxiety, compulsivity, and perfectionism that can lead to the development of an eating disorder. I definitely have all of those traits, and I believe the environment that pulled the trigger for me was a Western culture that glamorizes thinness. To answer other common questions: No, my mom never dieted, never owned a scale, and never talked about her weight. She has always been a normal weight and had a healthy body image.

Of course, there are other aspects to the "environment" that doctors reference --- life experiences, peer relationships, and yes, even familial components. But this does not mean that families (moms included) cause eating disorders. In my work as a speaker and writer about recovery, I have met individuals with the illness who came from dysfunctional families and suffered unspeakable abuse. But the majority of people --- and I have connected with thousands across the globe --- have loving families who did their absolute best with the information they had at the time.

To fully recover from my eating disorder I found professional help. My mom and dad supported me emotionally and financially. I changed my way of thinking in almost every aspect of my life. I learned to love my body in a culture that doesn't. I learned the value of rest and relaxation in a workaholic's world. I learned that food is just food and does not have a moral value like "good" or "bad." And, my mom's cake tastes very good.

Let's all do less blaming and more thanking. To the moms (and dads) out there, thank you.

Find a video representing this article.