Reflection #1 Todays lecture definitely put a lot of thoughts on my mind.

I always knew I struggled with eating issues and I knew what I was doing for the few years of my life was called bulimia. I also knew up until recently, I had been struggling with binge eating disorder. Having this issue messed with my school, social life, and my own identity. But until, I had always blamed the cause of this disorder in myself to my ex-boyfriend, whom I loved very much but was always making me feel as if I wasnt good enough, just a tiny bit short of the type of girl he needed me to be. However, as I learned more factor that leads to eating disorders I realized that there had been much more signs that had been leading me to be a probable target of this mental illness. I know I developed earlier than other girls physically. Now I have accepted the fact that I have a body shape that is different from the typical Asian girls but back then, having more developed body figure made me feel insecure in so many different ways. I was not skinny enough among the girls and I was the target of crude jokes made by many young boys who really didnt know better. I knew I felt sexually harassed even back then, but I had blamed everything on myself as at the time I could not accept the fact that development of womans body is something not only natural but beautiful and God had created us in such a way for a reason. I can also relate to the family background of many who have eating disorders because growing up under a single mom, I felt the constant pressure to look perfectly fine or even better than other kids because my mom didnt want anyone to think that I was missing out on something by not having a father figure in my life. I always knew I had high standards to live up to, but never considered those high standard to be unnatural and unhealthy for a child. When I came to college and started gaining much weight, the pressure of being not beautiful and attractive sucked me into a cycle of binge eating and dieting.

Reflection #2 Todays lecture was on the brain and personalities of eating disorder patients. We also went over the life experiences of a likely eating disorder patient and I was once again taken back by the large number of similar traits I shared with such patients. I feel like Ive always been on a constant move since I was a young child. Even making a move as big as moving to America after living in Korea for 10 years, there has always been a large number of changes in my family structure and such as I grew up with basically my single mom for most of my life. Being in a new school is nothing new for me, however, when I moved to UCSD for the first time it felt different. I felt more lost and out of place than Id ever felt before. I think this is where the major transition-separation/individuation/identity issue applied to me. Whereas the moves Id made before had always been at least with my mom, transitioning into college and really given the job of making new friends and making my own choices had stressed me out in ways I hadnt realized. Along with my move into college, I picked up depression. I started seeing a UCSD psychologist but he wasnt much of a help. I would feel depressed and eat, or I would eat and feel depressed. I was on this cycle for a very long period of time since the beginning of my college. My parents had gotten divorced when I was less than 10, and Ive always been teased for my English or looks when I had just immigrated to US. I found the studies done with Fiji and media very interesting because I feel that being raised as a Korean girl had always put me under the stress of beauty growing up. Ive always felt so much pressure to be thin, perfectly beautiful, without even understanding why I needed to be such a way. Being thin is a trait expected of girls in Korea, and you are at often times not even treated as a girl when you dont meet their expectations of thinness. Being raised in a culture where plastic surgery is now almost part of growing up, and not being raised in a very stable environment has had much influence on me.

Reflection #3 Todays in class we went over body image and the way eating disorder patients deal with distorted body image. Todays lecture was personally very interesting for me because I was able to relate to how distorted our views of own body can be. I had started throwing up and binge eating a few years back and I never really understood the reasons why. But going through the lecture with professor, I realized that I myself also had distorted view of myself over the years. On the surface level, I lived a typical life of an Asian American teenager. However, there were several risky factors that the professor addressed that were also present in my life. First off, I started physical maturation early on. In junior high, my friends, including my guy friends would tease me about my developed body. Thinking back, it was a form of sexual harassment, but as a child I simply thought that the early maturing of my body was my fault. I blamed myself for being fatter than other girls my age, and suffered from lowered self-esteem as a consequence. Also, I was a cheerleader in high school. Being a cheerleader meant that I had to constantly keep in shape as well as looking good in my uniform. Being a dancer also meant that I had to keep sensitive control of my body figure. Also, growing up under a single-mother, I had to suppress my emotions in high school. I couldnt add to the burden in her heart by acting out and constantly expressing my frustrations. This also links onto the family typologies, as a family of two, mom and I always had to keep up the image of a perfect family. Being the only daughter of a single mother, my mother was also pretty protective over me. Also, my family has always been very particular about beauty and physical appearance. Therefore, it was easy for me to develop a negative body image for myself as I kept comparing myself with those around my year. What didnt occur to me at the time was that I was simply naturally built with more curves then typical Asian teenagers.

Reflection #4 Todays lecture was extremely informative. Of course, Ive heard of the good pyramid and had seen nutritionists myself in the past, but having the recommended values broken down to the percentages helped me to understand why one food diets are not recommended and why it is important to have a balanced diet. The macronutrients consist of protein, fat, and carbohydrate and micronutrients consists of things that do not provide energy for the body. Micronutrients include vitamins, minerals, and water which are all very important for the body. I thought that the quote from Dr. Laura Pawlak was very interesting. It was Hungry people dont eat apples, they eat apple pies. I couldnt agree with this more. I know that even myself, I tend to grab things that are high in calories and try to fulfill that hunger with things that are high in fat and sugar rather than picking foods that are more nutrient-rich. This is an ongoing mistake I recognize as a pattern in my life yet it seems to be too difficult for me to break out of that habit. Ive tried to change my habits all at once, waking up really early to hit the gyms, eating fruits and veggies instead of the junk I was eating. But its only a couple days until I get back to my normal habits. Needless to say, it is difficult to eat healthy when one is so used to eating whatever. Especially following my binge eating habits, eating healthy seems almost impossible. After this lecture, I hope to have a better sense of the nutrients I need and start making smarter choices with the food that I eat. Even with water, I barely take in maybe a bottle of water per day which is not nearly enough fluid to take in. Electrolytes are needed because they regulate hydration as well as keeping a balanced pH level of blood. It also helps to control nerve impulses and control muscle impulses. Because I was throwing up when I was in high school, I probably suffered from dehydration, meaning I was in danger of osteoporosis. I can also relate to the calorie restriction, because I also hoarded food and binge ate.

Reflection #5 I thought it was interesting how turtles were used for comparison for anorexic patients. It makes sense that those with personalities that are anxious, shy, and cautious would make the choice of starving themselves rather than eating a lot of food and then throwing up. The prevalence of anorexia nervosa was also striking because it was more than I expected. For almost 3 out of 100 women to have suffered from at least a partial disorder is shocking because it reflects how critical this issue is in our society. We have such high prevalence of both eating disorder and obesity. It shows that America does not have a healthy relationship with food as a nation. I thought that learning the warning signs of eating disorder was interesting because I would have seen some of them in myself if I had known about them beforehand. Some includes reduction in food intake, denial of hunger, and hiding feelings. The one that stood out to me the most was critical and intolerant of others. Definitely, I have to admit that I was not very tolerant of those around me at the time. I was very critical especially when it came to things like physical appearance and beauty I have to admit that I probably made those around me feel even more secure by making unnecessary comments. The situation was even worse in my own mind. I would constantly pick on the areas I thought other girls needed to work on, from thighs to skin, I kept finding myself expecting perfection in everyone. Also, I remember constantly Nosaying that I was fat even thought I knew I was fit. I just needed affirmation at all times. But there came a point when what one person said about me really got to me and I started thinking that I was too fat and ugly. Now that I think about it, Im not doing anyone any good by lingering in my weight gain and insecurities I let someone hurt me and change the way I viewed myself and I kept allowing myself to live in the shadows of his lies for a long time now. I want to change, I want to lose weight and be fit.

Reflection #6 The criteria for anorexia bulimia is quite interesting. The two specific types of AN are the restricting type and binge-eating/purging types. First is the restricting type, meaning that the patient not getting enough food also without any type of purging behaviors. The bingeeating/purging type of AN is when the person is regularly engaging in binge or purging behavior. Up to here, it may sound very similar to the criteria for BN, but it differs in that An patients refuses to maintain body weight at or above a minimally healthy range for age and height. Also AN patients have a big fear of weight gain, which is different from BN patients in that bulimic patients are usually at a normal body weight unlike the AN patients who tend to be underweight. Naturally, being thinner than is healthy cases some issues such as amenorrhea, meaning the absence of periods. Being underweight causes shutting off of the sexual reproductive system because this is the most unnecessary one for survival. Also, there is the disturbance in the way ones body weight or shape is experienced, as well as a denial of the seriousness of the situation. The medical complications of such disorder include problems in the heart, missing periods, anemia, osteoporosis, slowed gastric activities, and others. All such medical complications display the seriousness of anorexia nervosa. Just as there has been warning signs of BN, some warning signs includes excessive exercise, says they are fat even when this is not true, hides feelings, and denial of hunger. Im a little concerned about my friend at the moment. I have a gay befriend who came out of the closet just a couple years ago. Until high school, he had been a tall but otherwise typical chubby Asian teenager. But in the recent months I realized that there has been a dramatic change in his weight as well as the way he dresses and eats at restaurants. I saw that people were pointing out his dramatic weight loss, and his only response to them was that it isnt enough still.

Reflection #7 I want to go over the DSM criteria of bulimia nervosa for my reflection today. The DSM states that binge eating is characterized by either eating in a short period of time a large amount of good or sense of lack of control while eating, feeling as if one does not have control over what or how much one is eating. Yes, for both. I would buy up a lot of food, for an example, 3 to 4 dollar bags of chips, a 6 pack of ice cream, 3 to 4 pieces of pastries from a bakery, and a set of break sticks from a restaurant. I would devour all these things within an hour, until I finished everything or I was way too full to stuff another bite down my throat. I was the purging type, using my fingers to chock myself to a point where I felt like I had no choice but to throw up everything I ate. I kept forcing the fingers down my throat until I felt like there was nothing left in my stomach. Of course this often left me in a state of fatigue, disgust, and regret. However, I started developing a regular habit of doing this, more than a few times a week. There were days when I would throw up after binge eating two times in a row, for lunch and dinner. I kept trying to make time to binge eat on my own. This is why when I started eating and throwing up, I started to lose friends and people around me because all that I was doing was in secrecy. This became a horrible habit that has caught to me over 5 years now. Now I am constantly locked away in my own room, doing things on my own that does not leave me in a happy place. The personality traits of those with binge eating disorders is also very interesting because I can relate to some of the things listed. At the time I was dramatic, unable to commit to a relationship because I kept looking for things that were more and more exciting. Also, I was impulsive and easily bored, I had to keep finding stuff to do. But with this horrible habit of eating disorder Ive come to be pretty passive as I kept having to hide myself away from people because I was feeling insecure about myself.

Reflection #8 Todays lecture was on EDNOS and binge eating disorder. This is the subject to which I can relate to the most in my current state. The condition I am in is the second example given in class, that the criteria for BN may be met except that binge eating and compensatory behavior occur at a frequency less than twice a week for duration less than three months. I find it interesting how EDNOS also include a condition where someone can eat and spit out the chewed food. I knew an adult who this this when I was younger. I remember seeing her eat during lunch time at church and spitting the food back out a little at a time into a ball of tissue. The things is, I never considered the EDNOS conditions to be as nearly as severe as those of AN and BN. In class, it was addressed that the severity of comorbid psychopathology, psychosocial impairment, behaviors and attitudes, and levels of disability associated with EDNOS are comparable to those with AN and BN. It is a bit frustrating that though it is stated that the severity of such disorders can be as bad as AN and BN yet insurance does not cover treatment for such eating disorders. LOC, loss of control, is associated with increased stress and emotional disturbance. This can be explained in my life by my first heartbreak, which honestly led to my cycles of eating and throwing up. It brings tears to my eyes to remember how out of control I felt about my life and myself at the time. Maybe it was the lack of control over my own life that led me to act out in such a way, finding the need for control through my eating. I also fit the research criteria for BED, I have always dealt with the distress from my binge eating. I never enjoyed doing it, only time I was free from this stress of binge eating was when I as actually eating. I also binge ate pretty regularly, almost 4 to 5 days a week. Also, I would try to go to extreme diets on days when I wasnt binge eating, I dont think this helped either. I was abusing my body by taking things into two different extremes continually.

Reflection #11 I always found myself fixed on the idea of beauty growing up. Perhaps it is my Korean heritage, as Koreans tend to be very particular about our ideas about beauty. A certain type of nose, a certain type of face, and definition one type, a very skinny type of body figure is considered to be beautiful in Korea. Naturally, being a Korean-American, I feel the pressure of beauty I both countries. But to be quite frank, I think the pressure to be skinny and pretty is a lot worse coming from my Korean heritage. I remember as a child my aunt and mom would always nag me about how I need to lose a few more pounds. Looking at my pictures, I realize now that I was at a perfectly healthy weight looking perfectly fine. But compared to the other girls my school and church I was a little bigger than them. At the times I didnt realize that the difference was due to my body that just developed a little earlier than other girls my age. I had continued to blame myself for my natural body shape, how ridiculous is that? And as I started to grow older I started finding myself looking up pictures of Korean celebrities that I wanted to look like. It never occurred to me that I may be built different from them. I had breasts and hips that usually cannot be seen in a Korean woman and what I wanted for myself was a super skinny and straight line body shape just like my friends. It saddens me to think that I spent such long years of my childhood being uncomfortable with myself and blaming myself for something I couldnt have changed and didnt have to change. I think culture has way too much influence on the way people view themselves and forces the younger generation to view themselves in ways that may not necessarily be true.

Reflection #12 Todays lecture was on eating disorders and cultural considerations. Cultures is a group of shared knowledge that includes things like communication, thought, customs, rituals, courtesies, beliefs, expected behaviors, practices, and others. All these shared culture influences food, body image, and even disordered behaviors. Some cultures have rituals and behaviors that includes things like fasting and cleansing. Because all cultures are to its own, the norms about body image and dieting can vary according to each culture. For an examples, issues with body image occurs with African Americans and Hispanics only bother them when they are considered to be overweight, but European Americans report dissatisfaction with their body even when they are not considered to be overweight. Another reason for eating disorders to vary with cultures is because this can be a way to deal with discrimination and racism. Things to keep in mind is that cultural distinctions can be arbitrary and vary much between sub-cultures. Also there may be a bias in studies because the samples tend to be taken from college-aged populations. Also there are individuals who are not diagnosed and those who are in denial of their disorder. Another reason for inaccurate studies includes that most surveys are based on self-reports. There has been found similarities in the frequency of certain behaviors across culture groups that does not indicate clinical profiles and predisposing factors. I thought that the prevalence of BN in European-Americans was pretty interesting as they are 8 times more likely to have bulimia nervosa than other groups. The predictors of such pattern includes depression as the strongest predictor of binge-eating, whereas weight is a stronger predictor in some cultural groups. Also, there has been found a higher rate of binge-eating for Hispanic population. Researchers believe that this may be due to the cultural centrality of food and how the culture relates food to love. This is interesting because they love both curvy and skinny models.

Reflection #13 men and eating dis I thought this topic was very interesting. Today the TA talked about males with eating disorders. For the majority of this class, we have focused almost explicitly on younger females with eating disorders. This was because of the pressing prevalence of such group in the world of eating disorder so it was refreshing to study the take on males and eating disorders in this class. It makes sense that males would have a greater denial of any problems with food and eating because eating disorders can come off as not masculine enough. It may even make sense for them to work out a lot to reach a goal or stay in shape for a certain sport. Doctors who deal with male ED may also not recognize it as it is because one, they are unaware or two, biased in their diagnosis of ED. In class we watched a video on a young boy obsessed with working out and not gaining weight. He had the restricting type of eating disorder, only eating chicken breast with all fat removed and working out for hours a day. Yes, he has a very muscular body after all that work but hes so young and his obsession with food and weight is not good for him. It broke my heart to hear him say that he came out on the show because he admits that he has a problem and he doesnt want other kids to go through what he goes through because it is mentally weighing him down. It also makes sense that gay males would be an open target for ED because they also may feel the pressure to look in the certain way to be found appealing to men. Also the need for control in homosexual men because settling down in so difficult hurt my heart because my gay best friend may be going through the same issue for the exact same reasons right now. Eating disorders in the military was also very interesting as one would consider soldiers to be one of the most fit occupation in America yet there is a shocking percentage of prevalence of disorders with food.

Reflection #14 Todays lecture was interesting because it went over the special cases rather than talking about the general disorder and likely behaviors. The term orthorexia means an unhealthy obsession with eating healthy food. Unlike AN, an obsession with body and starving oneself to an idealistic body and BN, an unhealthy obsession with food and purging oneself of everything they stuff themselves with. One can actually die from an excessive fixation on healthy food. One would assume that eating healthy would lead to a good health, but its interesting to study that too much obsession with it can actually lead to death. It was also good to learn that ED tends to be omitted during pregnancy. Many factors add to this symptom, including psychological factors such as feelings or responsibility of being a good mother, changed body perception as one learns to accept and learn to love their growing stomach, differentiation of pregnancy from eating disorder because one is supposed to gain weight instead of losing during pregnancy. The social factors including having network of family and friends for support, support from the father of the baby which I would assume would be very comforting for the insecure woman who has struggled to win the love of others by keeping herself thin, and involvement of healthcare providers. And considering that the patient willingly became a mother, I would think that they would welcome the input of a professional at this period of their life. Sadly, there are exceptions and consequences of women who had ED includes miscarriages, low birth weight, premature delivery, birth defects, and perintal mortality. To be honest, this is a really scary phenomenon. For a mother of a child to be so overcome with obsession with ones body that they would neglect the needs of the child.

Reflection #15 Definitely I can agree with the study that civilization and industrialization does mean a lot less activity of the human body. Also yes, definitely our food environment has increased our need for exercise a lot more. The food that Americans consume today does call for a lot more movement and exercise to keep from becoming obese. This explains why there is such an increase in eating disorders in our society today. I believe that moving to America has definitely affected me in a negative way when it comes to body. I started eating a lot of junk food, so called American food which includes things like pizza, burgers, fries, chips, and ice cream. Also the transportation in America is so convenient. In Korea, I would have to walk around everywhere. I would have to walk to school, to go eat, when going to the market, and just about everywhere. Especially when I went to the market, I would buy groceries with my mom and they carry them back home together with her. Speaking for myself today, I can say that I am underexercised. The lack of movement in myself has made me unhealthy and overweight but now that Ive fallen into the pattern of not moving around very much I feel like I also cannot remove myself from the habit of not moving. I remember back in high school when I would exercise for at least an hour and half each day. I would be pretty fanatic about weight and diet, my school work suffered because I would be so worn out from exercise but I would make sure that I got in my daily amount of work, I didnt have much fun doing it but I really felt the obligation to do it each day, and I was never satisfied with the work that I put in. I also counted the seconds to make sure that I did more work than I had done the day before. I dont think that was a wise things to do now that I think about it.

Reflection #16 I can definitely agree with the study that overweight and obesity can lead to early death. Being overweight comes with much consequences. And yes because overweight and obesity are big contributors to chronic disease, it only makes sense that obesity leads to early death. Because obesity often also means that the person is not getting much exercise, the blood streams are going to get clogged with cholesterol and eventually lead to organs that are not performing at their best. Obesity is defined by weight 20 percent above the desirable weight while morbidly obese means that the BMI would fall above 40. I have a hard time believing that 2/3 of the adults and 1/3 of children are obese and overweight. It seems unlikely that so many adults would be overweight. But I can agree that this rapid rise on the number of obese people can relate back to the evolution. As we no longer live in food shortage, people have access to the type of food that they want to consume. We are not forced to rely on vegetables and fruits and humans are predisposed to prefer sweet and fatty tasters and reject sour and bitter tastes. It makes sense that people would be gaining weight at an age where there are so much food that tastes good. We also take in a lot of simple carbs. Eating a lot of sugar and white rice means that the food that we intake are quickly digested and absorbed, meaning it leaves us hungry for more food more quickly. Also getting diet used to fatty foods leads to cravings of more fatty foods. Especially as working adults, it is possible to live without moving almost next to nothing. Driving back and forth from work and driving to groceries and back means that there is no time for regular adults to work in exercise without making a conscious effort too. Also eating healthy tends to be more effort and time on people in our society today.

Reflection #17 It is a good reminder to know that the symptoms of binging, purging, excessive exercise are all outward expressions of complex of inner self and emotions. Because eating disorder is about more than just eating a lot or little. Which is why the patient must want to recover and make conscious choices to walk away from eating disorder. The treatment goals of eating disorder includes weight restoration, establishment of healthy eating habits, increase mood regulation and decrease pursuit of thinness, decrease thoughts, beliefs, and feelings that perpetuate ED behavior, treatment of physical complications and psychological problems, and relapse prevention. To help myself from my current condition, I want to go over the list and compare myself to see if Id made an progress since taking this class. Yes I have admitted this problem to myself, I also have told my good friends about it even when my mother forbid me to because she thinks this is something very shameful that should never be shared with anyone else. No I have not found a clinician because last time I tried to talk to one, they just told me I had to lose weight and that got me so frustrated because thats what Id been trying to do all along. As far as finding treatment, well, I dont even know if I want to because finding treatment would mean that I would have to accept myself for who I am rather than really wanting to lose weight. That is so hard for me even though I can admit to myself that one of the reasons I am not losing weight is probably because I keep feeling the great pressure to and when I try and fail, it sends me into another rail of binge eating only to feel disgusted about myself again afterwards. I actually do not recommend CAPs because the counselor I talked to during my freshmen year actually did not help. He spent most of the time talking about himself and his family and I felt like I was wasting my time sitting there with him.

Reflection #18 I realize that to work with a dietician, the will of the dieter is even more important that what the dietitian does. Yes they can give you tips and tell you what to eat, but the one who will be doing the eating and the not eating with the dieter himself. Writing meal logs take time and effort as well as honesty and for someone with an eating disorder, being honest about what he eats may be difficult. For me, I couldnt eat in front of people for the longest time. Starting from around the time when I started binge eating and gaining weight as a consequence, I could not stop obsession about what people must be thinking when they saw me ate. Even as I type this Im feeling uncomfortable as I remember how I felt like everyone was judging whenever I ate out of the line so I at the minimum I can get by with when I was in public only to binge eat again when I was alone. This made me feel really uncomfortable when I was with people because I felt like I couldnt be myself around them. This kept me in my room more and more until I wouldnt even come out of the house two times in one week. In class we went over how the dietitian teaches how to feel comfortable eating in social settings, but I cannot imagine feeling completely free from how Ive viewed by other people. I believe that my eating disorder has brought me to a place where I have a difficult time enjoying the things of this life. I tend to count myself out of a lot of opportunities and situations because of my body. I also cannot enjoy myself at events and things because Im so upset about how much Ive gained. Then I come home to work off the stress by binge eating again only to feel horrible about myself again. I wish treatment was possible It would be one thing to convince a normal sized girl that they are fine and to make someone who has gained as much weight as I have that I am ok and that I will be ok.