Nutrition & Physical Activity

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Will skipping breakfast and lunch lead to weight loss?

Dear Trying to be a good friend,

Although your friend may have good reasons for losing weight, you are right in saying that skipping meals is not the way to do it. Even though skipping meals might mean your friend is eating fewer times a day, it doesn't mean that she will lose as much weight as she thinks she will. Eating at regular intervals is important because it helps keep the metabolic rate up. If a person goes all day without eating, the body goes into starvation mode. This means her/his metabolic rate will slow down, and her/his body will conserve energy and expend fewer calories. When s/he does eat, s/he may have problems being able to stop when full. When someone ignores the hunger and satiety signals for an extended period of time, it can be difficult to tell when s/he is hungry or full when eating. This could cause your friend to overeat and possibly even gain rather than lose weight.

Additionally, going for hours without eating deprives the brain of glucose, which is needed for normal functioning. Lack of glucose to the brain can lead to irritability, dizziness, and fainting, as well as more serious conditions like hypoglycemia. Not eating regularly throughout the day puts your friend at a higher risk for long-term nutritional deficiencies including anemia, stunted growth (depending on her age), loss of bone or incomplete bone development, decreased immune function, amenorrhea (loss of menstrual periods), decreased thyroid function, increased susceptibility to colds and infections, low energy levels, poor concentration and cognitive development, and gum infections and poor dental health, just to name a few. This is because one meal a day, no matter the size, is unlikely to provide a person with all the nutrients s/he needs to function properly.

If you are comfortable with it, you can tactfully let your friend know how eating only one meal a day, regardless of size, is detrimental to her health. Advise her to try several small meals or snacks over the course of the day, rather than only one meal once a day. Physical activity should also be incorporated into her daily routine in order to encourage healthful and safe weight loss. Your friend could also consult with a registered dietitian or health care provider for guidance on safely achieve her weight loss goals. If she is a Columbia student, she can contact Medical Services (Morningside) or the Student Health Service (CUMC) to make an appointment with a dietitian and/or a health care provider. For more of the skinny on healthy eating, feel free to check out Alice!’s Nutrition & Physical Activity archives and the Get Balanced! Guide to Healthier Eating Your concern and thoughtful question shows that you are a good friend indeed.

Alice

Time-release dietary supplements

Dear Reader,

It's easy to become confused with the whole array of dietary supplements on the shelves nowadays. One form may claim superiority in advertisements, but how are you to know for sure which ones are right for you?

First of all, vitamins and minerals are needed in our bodies in relatively small amounts. Vitamins may be present in our blood, organs, or other tissues. Although each micronutrient (scientific term for vitamins and minerals) has a specific function, here's a brief overview by category:

  • Water-soluble vitamins (all the B vitamins and vitamin C) and many minerals act as co-enzymes, meaning they aid in chemical reactions in the body. Excessive amounts don't make reactions occur faster or more efficiently than adequate or recommended amounts. Plus, too much of one mineral may actually inhibit the absorption and effectiveness of another.
  • Fat-soluble vitamins (vitamins A, D, E, and K) are involved in specific roles of maintenance and repair of body cells and tissues. Unlike water-soluble vitamins, extra amounts of fat-soluble vitamins are not excreted, so over-saturation of these may lead to toxicity.
  • Minerals have a variety of functions, ranging from water and acid-base balance, to bone structure and co-enzyme activity, as mentioned before.

As long as you consume a sufficient vitamins and minerals, a constant influx is not necessary, and may also be harmful. For example, time-release niacin is not recommended because it can cause liver damage. Time-release iron supplements are ineffective because the point of release in the intestinal tract does not absorb this mineral efficiently. Some time-release supplements contain coatings that prevent the absorption of fat-soluble vitamins. As you can see, time-release nutritionals are certainly not worth the extra money manufacturers often charge for them. Besides, Mother Nature has already provided us with a way to time-release our nutrients... by getting them from a variety of foods, eaten at various times throughout the day.

To get to your last question, you are among quite a number of men and women who have expressed concern over whether their multi-vitamin "works" or "doesn't work"; that is not really the point of these supplements. Their purpose is to help certain people fill in nutritional gaps when they are unable to eat enough food or obtain adequate vitamins and minerals from their diet. Multi-vitamins also might be recommended for some vegetarians, dieters, and others who have food allergies, intolerances, or other problems associated with eating particular foods. A supplement may benefit the elderly, too, because sometimes older people can't absorb nutrients as well as they did in their youth. Remember, the meaning of a dietary supplement is to add to a diet, not to take the place of food!

Alice

Coach withholds water during practice — Help!

Dear Thirsty one,

Yo, what's up with your coach? We're talkin' school sports, not the Marine Corps. Perhaps your coach thinks that drinking water during practice will cause cramps and impair performance, or maybe s/he does not want to take time away from practice by having water breaks. Or, is s/he withholding water as a form of cruel and unusual punishment? Either way, withholding water from the team players is unhealthy and unethical. From your description, you and your teammates are exhibiting signs of dehydration. By the time you are thirsty, you already need fluids.

Water is vital to life for many reasons. Adult bodies are made up of about 55 to 60 percent water — children's bodies have an even higher percentage. This fluid is needed to:

  • Transport nutrients to organs and muscles
  • Carry waste products out of the body
  • Provide an environment for chemical reactions to occur
  • Act as a lubricant around joints
  • Work as a shock absorber inside the eyes and spinal cord
  • Serve as the solvent for minerals, vitamins, amino acids, glucose, and lots of other substances
  • Help regulate body temperature

In carrying out our normal body processes, we lose about 2.5 quarts of water a day. That's why we need to drink eight to ten cups (one cup = 8 ounces) of water every day. You need more if you exercise and sweat. The good news is that any non-caffeinated beverage counts, too.

To determine how much more fluid you need, follow this simple advice: weigh yourself before and directly after practice. Any difference reflects your fluid loss from sweating. For each pound you lose, you need two to three cups (16 to 24 oz.) of liquids. Even a modest two percent loss of body weight results in impaired sports performance. For a 125 lb athlete, this is as little as 2.5 pounds! A four to five percent loss in body weight (e.g., five to six pounds for a 125 lb person and six to seven pounds for a 150 lb person) can result in flushed skin, nausea, difficulty in concentrating, and an increased effort to be able to run, jump, and do just about anything physical. Once you lose more than six percent of your body weight in sweat, you risk dizziness, slurred speech, mental confusion, increased pulse rate, and other signs of heat illness. These effects are additive, meaning that dehydration can occur over time if you don't rehydrate on a daily basis.

You don't have to lose six percent of your body weight in one day. Your best strategy is to spread out your fluid intake over the course of a day. Some of this may be in the form of juice or milk. Ideally, drink two cups of water before exercise, then about two ounces every ten or fifteen minutes during exercise. Stay away from caffeinated beverages, which increase fluid loss.

Now that you're in the know, you can bring this data to your coach. If y'all are still denied the water you need and deserve, speak with your parents, teachers, athletic director, and physician about your coach's philosophy. Enlist their help in insisting that water or other sports drinks be available to you and your teammates during practice. If your coach is concerned about time, bring a bottle of water with you to practice, taking drinks during five-second breaks or whenever you have a chance.

Alice

Breakfast ideas for thirteen-year-olds, and everyone else

Dear Student & Parent,

Bravo to eating breakfast! It's fairly well known as this point that a healthy breakfast is a great way to start each day — especially when it's made from scratch. Taking into consideration that, just sometimes, younger people are a little picky about what they'll eat, not to mention the energy it can take a groggy chef to whip up something in the A.M., here are a few easy, interesting, and nutritious breakfast recipes:

Creamy Apple-Cinnamon Oatmeal (makes two servings):

2 c. skim milk
1 c. rolled oats
1 T. Brown sugar
1 T. Maple syrup
1 apple — peeled, cored, and chopped into cubes

Directions:

  1. In a medium pot, heat the milk over medium heat, almost to a boil.
  2. Add the oatmeal, reduce the heat to low, and cook for about 5 minutes, or until all of the milk is soaked up by the oatmeal.
  3. Add the brown sugar, maple syrup, and apple pieces. Stir well and serve.

Berry Parfaits (makes two servings):

2 containers of yogurt (vanilla, lemon, or peach)
2 c. mixed berries: strawberries, raspberries, blueberries, and/or blackberries
1 c. low fat granola

Directions:

  1. In 2 glasses or plastic cups, add a layer of yogurt to the bottom. Cover with a layer of berries, and then sprinkle on a layer of granola.
  2. Repeat the layers until the glasses or cups are full, ending with a sprinkle of granola.

Egg Scramblers (one serving):

1 or 2 eggs
1 toasted whole wheat pita or toasted English muffin
Optional item(s): mushrooms, peppers, grated cheese, chopped tomatoes, onions, salsa, or whatever else you like!

Microwave Directions:

  1. Crack eggs into a glass measuring cup and beat well. Mix in any other ingredients you like.
  2. Cover tightly with a microwave safe plastic wrap.
  3. Microwave at 70 percent: 1 minute for 1 egg; 1-½ minutes for 2 eggs — slightly longer if you add other ingredients, or if you like your eggs more well done.
  4. Spoon into a pita, or onto a toasted English muffin.

Stovetop Directions:

  1. Crack eggs into a bowl and beat well. Mix in any other ingredients you like.
  2. Pour egg mixture into a non-stick pan. Cook over low heat, stirring occasionally, until eggs are cooked through, not runny.
  3. Spoon into a pita or onto a toasted English muffin.

Banana Smoothie (makes one serving):

1 banana cut into 1-inch chunks (works great if already frozen)
½ c. yogurt
½ c. milk or soy milk
2 T. honey or jam
¼ t. vanilla extract

Directions:

  1. Put all of the ingredients into a blender. Mix until all of the fruit is pureed.
  2. Pour into a glass, and drink immediately.

You can freeze this beverage overnight, then toss it into a blender, and pour it back in the plastic cup you froze it in. If you run out of time in the morning, you can bring your smoothie with you on the way to school.

Regardless of what you make, consider involving your breakfast companion in both the decision process and making the breakfast. This way you can both enjoy some time together and a nutrient-filled morning. Eat up!

Alice

Nuts about nuts: Are some better for health than others?

Dear Nuts for nuts,

What did one squirrel say to the other squirrel? "I'm nuts about you!" One variety of nut isn't necessarily healthier or better than another. All nuts are healthy, unless you have an allergy or sensitivity to one or more kinds. While individual types vary in nutrients, most nuts contain an array of vitamins and minerals, such as iron, magnesium, zinc, vitamin E, and small amounts of folate, copper, phosphorous, and calcium. Nuts may also contribute to one's daily protein and fiber needs.

The following chart provides nutritional information for some popular nuts. All numbers are for dry roasted, unsalted nuts. Some nuts are roasted in oil, which adds fat and calories without adding additional vitamins or minerals. In addition, some nuts are salted, which may greatly contribute to one's daily sodium intake. Based on that information alone, it seems that dry roasted, unsalted nuts are the way to get the best bang for your buck.

Nut type Calories(per oz.) Fat (g) Sat. Fat (g) Unsat. Fat (g) Protein (g) Fiber (g) Calcium
(% DRI)
Zinc (% DRI) Vit. E (% DRI) Magnesium (% DRI)
Peanuts 166 14 2 12 7 7 1.5 9 19 12
Walnuts 182 18 2 16 4 4 3 7 7 11
Pecans 189 19 2 17 2 2 1 15 8 9
Almonds 167 15 1 14 6 6 7 9 11 20
Cashews 163 13 3 10 4 4 7 15 1 18
Macadamia 200 21 3 18 2 2 2 4 1 7

Nuts are calorie dense foods, meaning they pack a lot of calories into a small amount of food. This can be helpful for people trying to gain weight, but also need not make them off limits to those watching their waistlines. For example, one ounce of most nuts equals about 18 to 24 nuts (a small handful for many, and a tiny handful for larger-handed folks), and contains between 165 and 200 calories. The majority of the calories in nuts is derived from their unsaturated fats — specifically, monounsaturated fat — which is more healthful than saturated fat.

Nuts offer so many valuable nutrients, and can be enjoyed in small servings as well. Why not try to:

  • Mix sliced nuts into plain rice, rice pilaf, or couscous.
  • Sprinkle slivered nuts onto vegetables or into salads.
  • Use slivered or chopped nuts as a yogurt topping.
  • Substitute diced nuts for croutons in salads.
  • Add chopped nuts to vegetable dips or soups.

In conclusion, it's great that you're nuts about nuts. No ifs, ands, or nuts about it!

Alice

A sweetener called stevia

Dear Skeptical,

Your skepticism is warranted, considering the label "all natural" does not have one, standard definition or imply “risk-free.” In order to be approved by the Food and Drug Administration (FDA), sweeteners marketed as “Stevia” may contain only one highly refined component of the stevia rebaudiana plant, called Rebaudioside A. Due to potential health risks, no other components of the stevia plant have been approved by the FDA as food additives or sugar substitutes. Non-food products (often labeled as dietary supplements) containing less refined stevia ingredients are available, and some are even deemed “safe for consumption.” However, the FDA recommends waiting for more conclusive research before consuming large quantities of supplements containing stevia-derived ingredients other than Rebaudioside A.

In addition to Rebaudioside A, most FDA-approved stevia sweetener products also contain fructooligosaccharide, a sugar extracted from non-stevia fruit sources. Some studies show that fructooligosaccharide may actually promote the growth of healthy bacteria, relieve constipation, regulate lipid metabolism, and promote immune system health. Additionally, these sugars may be less detrimental to oral health than table sugar, and may help to treat glucose intolerance. Rebaudioside A and fructooligosaccharide are both approved by the FDA as food additives.

Although some empirical studies show no negative side effects of consuming unrefined stevia plant products and deem them “relatively safe” and “nontoxic,” the FDA has expressed safety concerns related to these products. Such concerns include negative effects on the reproductive, cardiovascular, and renal systems as well as blood sugar regulation issues. Other concerns include the stevia plant’s potential ability to damage genetic material, but independent scientific studies have determined that this type of gene damage is only possible in a laboratory environment, not in the human body. Stevia proponents also cite the plant’s inability to be digested (hence, the reason why it is calorie-free) as evidence that it simply passes through the body without causing any damage.

When it comes to sweeteners and food additives, Rebaudioside A is the only FDA-approved component of the stevia plant. Considering the inconclusiveness of existing research, unrefined stevia supplements and other non-food products should be consumed cautiously. Good work keeping yourself informed before you ingest!

Alice

Eating tips when heartburn hits (acid reflux)

Dear Reader,

Gastroesophageal reflux disease (commonly referred to as GERD) occurs when the contents of the stomach back up into the esophagus. Since the esophagus doesn't have the same protective lining as the stomach, these acidic substances cause irritation and discomfort. Although this has nothing to do with the heart, it is frequently called heartburn because a burning sensation is felt just behind the breastbone.

The reflux, or burning, is a symptom of a malfunction of the digestive tract — specifically, the muscle connecting the esophagus to the stomach isn't working properly. In normal digestion, this muscle, called the lower esophageal sphincter, opens to allow food into the stomach, then closes. In GERD, this muscle is weak and relaxes, allowing backflow of the stomach's contents since it is not shutting properly.

In the digestive process, the stomach secretes strong acids that are needed for enzymes to do their job. Some people produce more acid than is needed, which contributes to the problems of GERD. It is often believed that spicy or citric foods cause GERD, which is not exactly true. More accurately, they often cause the acidic contents of the stomach to be more irritating to the esophagus. In any event, people who have GERD are usually recommended to stay away from these irritating foods:

  • Citrus juices
  • Tomato products
  • Coffee
  • Spicy foods
  • Carbonated beverages
  • Any other food that regularly causes heartburn for them (this varies from person to person)

Other strategies for people with GERD center on increasing the pressure of the lower esophageal sphincter to prevent backflow of the stomach's contents, including:

  • Increasing consumption of lean proteins (these help the sphincter to close)
  • Decreasing dietary fat intake (fat remains in the stomach for a long time, keeping the sphincter open longer)
  • Not smoking
  • Avoiding peppermint and spearmint
  • Staying away from both regular and decaffeinated coffee, strong tea, and chocolate

Keep the contents of the stomach small to help close the sphincter. People can eat small, frequent meals, and drink fluids between meals, rather than with meals. It's also a good idea to avoid lying down for two to three hours after eating. When people do lie down, some find relief in elevating the head of their bed by six inches, or by sleeping on a specially designed wedge to help clear the stomach's contents from the esophagus.

Excessive use of antacids is not a good idea because they can interfere with the absorption of some vitamins and minerals. Chronic acidic irritation to the esophagus can cause permanent swallowing difficulties, so it is important to seek treatment. In rare cases, esophageal cancer can result. If none of these strategies help, prescription medications may be needed to help reduce acid production, hasten stomach emptying, or increase the strength of the lower esophageal sphincter. Your health care provider will be a valuable resource.

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Service (CUMC)


What's that growing in the refrigerator?!? A guide for storing and eating leftovers

Dear Leftover lover,

Enjoying holiday leftovers is a favorite tradition. However, food-borne illness resulting from eating leftovers long past their prime can dampen holiday cheer. Typical symptoms of food-borne illness, caused by bacteria, include abdominal pain, diarrhea, and vomiting.

Two different families of bacteria are found in food: pathogenic bacteria and spoilage bacteria.

Pathogenic bacteria cause food-borne illness. Leaving food out at room temperature (about 72° F or 22° C) for extended periods of time encourages growth of these types of pathogens. These bacteria grow rapidly when in the "danger zone," which is between 40° to 140° F (4 to 60° C). They are difficult to detect, because they don't affect the taste, smell, or appearance of food. Safe food handling and proper food storage are the best defenses against pathogenic bacteria. For detailed instructions on how to keep food safe for consumption, check out the Partnership for Food Safety Education web site.

Spoilage bacteria can grow at lower temperatures, such as ones found in refrigerators. These bacteria cause food to taste, look, and/or smell badly. Most of the time, spoilage bacteria won't cause illness, but they do make food much less appealing to eat.

Leftovers need to be kept in airtight containers recommended for reuse and food storage in the refrigerator and/or freezer. Leftovers can also be wrapped in two layers of plastic wrap and/or foil or in a plastic storage bag (with the food inside wrapped in a layer of plastic wrap or foil) to maintain moisture and prevent absorption of odors from other foods. When freezing leftovers, adding freezer tape also helps keep air and moisture out, and protects from freezer burn. Here are some safe time limits for keeping some common meat and poultry leftovers:

Food Item

Refrigerator Storage Temp.
(40° F / 4° C)

Freezer Storage Temp.
(0° F / -18° C)

Cooked turkey or chicken, plain

3 to 4 days

4 months

Cooked turkey or chicken dishes

3 to 4 days

4 to 6 months

Turkey or meat broth, gravy

1 to 2 days

2 to 3 months

Lunch meat

Unopened, 2 weeks
After opened, 3 to 5 days

1 to 2 months

Cooked fried chicken

3 to 4 days

4 months

Cooked chicken nuggets or patties

1 to 2 days

1 to 3 months

Cooked meat and meat casseroles

3 to 4 days

2 to 3 months

For more information on the safe keeping of most foods, visit the U.S. Department of Agriculture (USDA) Food Safety and Inspection Service web site. Enjoy your holiday meal today, tomorrow, and the next day,

Alice

Food preservatives and additives

Dear Jeeeeaaan,

Food additives help maintain the freshness and shelf life of such food products because without them, they would spoil quickly due to exposure to air, moisture, bacteria, or mold. Either natural or synthetic substances may be added to avoid or delay these problems.

Food additives may be used in a variety of ways, including:

  • To maintain consistency or texture — to sustain smoothness or prevent the food from separating, caking, or clumping.
  • To improve or retain nutritional value: Enrichment replaces nutrients lost in processing — this occurs with grains, as some vitamins and minerals are lost in the milling process. Fortification adds a nutrient that wasn't there before and may be lacking in many people's diets. Iodized salt is an example. This has proven useful in preventing goiter, a thyroid disease caused by a deficiency in iodine. Enriched and fortified foods are labeled as such.
  • To delay spoilage
  • To enhance flavor, texture, or color

Preservatives are centuries old. Since ancient times, salt has been used to cure meats and fish, and sugar has been added to fruits to conserve them. Herbs, spices, and vinegar have also served as preservatives. Today, the U.S. Food and Drug Administration (FDA) regulates food additives and preservatives. Granted, mistakes have been made, which have resulted in taking some food additives and preservatives off the market. That is because at the time of approval, prevailing testing methods proved the substances as safe. As science continued to evolve and testing methods improved, changes were made. Technology has also assisted in the approval process as it has become more sophisticated over the years as well. In addition, Food Additive Laws are reviewed and revised according to advancing scientific research.

Food additives in and of themselves don't connote something "bad." For example, ascorbic acid refers to vitamin C and alpha-tocopherol is actually vitamin E. Some uses and examples of food additives are:

Anti-Oxidants: prevent spoilage, flavor changes, and loss of color caused by exposure to air. Vitamin C and Vitamin E are used as antioxidants.
Emulsifiers: used to keep water and oil mixed together. Lecithin is one example used in margarine, baked goods, and ice cream. Mono- and diglycerides are another found in similar foods and peanut butter. Polysorbate 60 and 80 are used in coffee lighteners and artificial whipped cream.
Thickening Agents: absorb water in foods and keep the mixture of oil, water, acids, and solids blended properly. Alginate is derived from seaweed and is used to maintain the texture in ice cream, cheese, and yogurt. Casein, a milk protein, is used in ice cream, sherbet, and coffee creamers.

For a complete guide to information about food additives, including the approval process, click onto the FDA web site.

Another useful link describing many food additives and their uses can be found on the Center for Science in the Public Interest web site.

Hope this provides you with lots of useful information,

Alice

I have an eating disorder and need to gain weight, but how?

Dear Slim,

It sounds as though you are interested in recovering from your eating disorder, but aren't receiving the guidance and help that would benefit you. Does your physician know that you have an eating disorder? What about your family? If you are dealing with recovery on your own, it would greatly benefit you to seek out support from experienced professionals that your family or others might help you find. Other resources are listed at the end of this answer.

Gaining weight without resolving the underlying issues is not a cure. Weight gain can help alleviate some of the medical complications that are caused by malnutrition and being severely underweight. However, one of the difficult parts about weight gain during eating disorder treatment is that as a person increases his or her food intake, his or her metabolism increases, requiring even more calories. This is further complicated by the fact that eating disordered persons need more calories to gain weight than non-eating disordered, underweight individuals. This could be due to the fact that a person's metabolic rate is depressed in anorexia, and so is the thermic effect of food (the amount of calories being burned during the digestive process). As anorexic persons get well, and eat more, both their metabolism and thermic effect of food increase, raising their caloric needs. Levels of growth hormone, leptin, and other hormones are also lower in eating disordered people and become more normalized during recovery, which may also contribute to changes in calorie needs. The same disproportionate rise in metabolic rate to body weight is not seen in non-eating disordered individuals.

In order to gain weight, you need to follow a schedule of steadily increasing your calorie intake until you reach a level that is appropriate for you. Since you are fifteen and possibly still growing, you may need to account for this factor as well. Weight gain (termed "re-feeding") is a process that often requires help and guidance. Your calorie needs for weight gain need to be assessed by a registered dietitian specializing in eating disorders. S/he can help you gain weight at an appropriate rate for you. Many factors are considered when developing re-feeding plans. Some of these include your current medical status, body frame, weight history, current food intake, and eating patterns, just to name a few. In addition, on-going nutrition counseling can help you to understand and cope with the changes that happen to your body as you succeed in gaining weight.

You mentioned that you are not really in treatment. Are you seeing only your medical doctor, or are you seeing other health care professionals, too? It is well documented that the most effective treatment for eating disorders is to work with a multidisciplinary team consisting of a medical provider, psychologist, and nutritionist. Gaining weight is not the only answer. Dealing with the problems that are central to the eating disorder is vital for recovery. A therapist experienced with eating disorders can help you with this. Learning how to eat properly and handling issues around food can be addressed with a qualified nutritionist. If your current treatment doesn't include all three areas of care, you may want to consider it.

At the Columbia Morningside Heights campus, the multidisciplinary Eating Disorders Team has nutritionists and psychotherapists on board who are able to work with students with eating disorders, and, when appropriate, can offer referrals to in- and outpatient treatment centers in the area. At the Columbia Health Sciences campus, The Eating Disorders Clinic of the New York State Psychiatric Institute and Columbia Presbyterian Medical Center is a nationally recognized treatment/research program that offers free treatment to eligible women who have anorexia nervosa and bulimia nervosa, and to men and women who have binge eating disorder. The Clinic also has inpatient and outpatient facilities staffed by a multidisciplinary team of health care providers.

Outside of Columbia, a health care provider or local hospital may be able to refer someone to a nutritionist and therapist or a treatment center that can assist him or her. If they are unable, here are some resources to help a person find ones in his or her area:

Academy of Nutrition and Dietetics: 1.800.877.1600

National Association of Anorexia Nervosa and Associated Disorders: 847.831.3438

Eating Disorder Referral and Information Center

Alice

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