Bringing Everyone to the Table: Accommodating Special Diets During the Holidays

by Kathleen Nay

Thanksgiving is over and the leftovers are dwindling, but there is more holiday eating and meal prep on the horizon. As food and nutrition professionals, we understand that emotions can run high when it comes to sharing meals, traditions, and dietary restrictions with a crowd. So what can a holiday meal that balances a variety of special diets look like?

In my family, every shared meal requires some logistical acrobatics. We have vegetarians, vegans, people with nut allergies, and people with Celiac disease. Some of the dietary restrictions are self-imposed—my husband and I choose not to consume meat, and he prefers to extend that choice to eliminating all animal products, including eggs and dairy. (Me? Well… I enjoy cheese and sour cream, and the occasional fried egg.) But the dietary restrictions of others in our family are not by choice. My brother has a severe tree nut allergy; my mother in law has Celiac disease and must be careful to avoid even a crumb of gluten. Most in our extended families also abstain from alcohol. Needless to say, communal meals can be a challenge.

This year our guests included some friends from undergrad, one friend's dad and cousin, and my husband's parents. We tried to make our meal both vegan-friendly and gluten-free where possible. Photo: Kathleen Nay

This year our guests included some friends from undergrad, one friend’s dad and cousin, and my husband’s parents. We tried to make our meal both vegan-friendly and gluten-free where possible. Photo: Kathleen Nay

Last November, the New York Times published an article about the ways in which special diets can heighten tensions at the holidays. The article focuses its attention on teenagers and children who use dietary restrictions to exert their budding independence. While I think it misses its mark in this regard—there are plenty of adults, young and old, who have legitimate reasons for their specific dietary needs—this doesn’t change the fact that tensions often run hot around holiday food traditions, regardless of the reasoning.

Though the article itself was published over a year ago, the comments section is still active—and telling. There is much hand-wringing, with recent comments ranging from, “Why make Grandma cry? Eat it and say thank you!” to “Welcoming people into your home involves actually being welcoming. When I invite people over I always ask about food restrictions…” to “Sounds awfully complicated to be required to chart everyone’s restrictions.”

So how do you plan a holiday meal that is inclusive of every eater’s needs? In our household, we’ve figured out a few strategies that work for us and our loved ones.

Be up front about your needs, and ask guests if they have special diets.
When sending out invitations for the holiday gatherings, we tell guests up front that we’re a vegan/vegetarian household. Giving people forewarning about the foods you personally cannot eat gives them a chance to plan accordingly, and saves you both from embarrassment at the dinner table. Likewise, as you plan your meal, ask your guests for advice about any foods they avoid and alternatives they prefer. This will give them some assurance that there will be something they can eat.

Barring any severe allergies, invite guests to bring what they like (even if you might not eat it yourself).
Although we’re vegetarian, turkey has been served at our table! A benefit of hosting potluck-style meals is that everyone gets to bring at least one dish they know they’ll be able to eat. When we’ve hosted holiday meals in the past, we usually make most of the dishes, but include a list of suggested sides that people might bring to complement the meal. At Thanksgivings past, I’ve always told guests that they should feel free to bring a turkey if they’d like to have it (because I know that most people are thinking, what’s Thanksgiving without turkey?) One year, a friend felt up to the challenge of roasting his own bird, so he brought it to share with our other omnivore guests. (Our cat was also very happy to have real meat scraps thrown her way.) Not only does this make guests feel more welcome in our home, it also gives people the space to cook what they’d like.

Emma wonders hopefully whether anyone brought turkey this year. Sadly, no one did. Photo: Anna van Ornam

Emma wonders hopefully whether anyone brought turkey this year. Sadly, no one did. Photo: Anna van Ornam

Make sure to include at least a few dishes that everyone can eat (and be clear about which dishes have hidden ingredients someone may wish to avoid).
Remember that not everyone will necessarily eat everything—and that’s okay. At our recent holiday gathering, everything was vegetarian, but not everything was vegan or gluten free. There were “meatballs” made from quinoa and black beans—gluten-free, but not vegan. However, we also had Portobello mushroom patties on our table—both vegan and gluten-free! If there are dishes that are not made from scratch, be sure to read labels for hidden ingredients.

A sampling of what was on our table this year. Photo: Kathleen Nay

A sampling of what was on our Thanksgiving table this year. Photo: Kathleen Nay

If you can use a substitute, do.
Not every recipe lends itself to being easily converted to a nut, gluten, or dairy-free dish. But try to make simple swaps. Toss veggies in olive oil instead of butter to go dairy-free. Use vegetable stock instead of chicken or beef stock to make a dish vegetarian. Consider using a plant-based milk like nut, seed or soy instead of cow’s milk. Use gluten-free cornstarch to thicken the gravy. Try crushed ginger snaps to make a gluten-free crust for your pumpkin pie.

Leave the toppings on the side.
We have a recipe for lemon green beans that we absolutely love. The toasted pistachios sprinkled on top gives them just the right nutty flavor and crunch. But when my nut-allergic brother visits? Leaving the pistachios in a dish on the side is an easy fix.

Don’t question what is or isn’t on a guest or family member’s plate.
Whatever people chose to eat or not eat while at your house—just don’t worry about it, and don’t be offended! A friend of mine in recovery from anorexia recently reminded folks on her Facebook page to be sensitive to friends and family who suffer from eating disorders, which might not be outwardly obvious. She advised that comments about weight, talk about having to diet or exercise to work off your holiday meal(s), and general comments about not “needing” to have seconds or dessert can be triggering for folks with eating disorders. What a person decides to put on or leave off their plate is their choice. If a guest isn’t into a particular dish you’ve made, just remember that whatever their reason, it probably isn’t about you.

I'm thankful for friends who let us try out sometimes-unusual recipes on them! Photo: Kathleen Nay

I’m thankful for friends who let us try out sometimes-unusual recipes on them! Photo: Kathleen Nay

Finally, share your recipes!
We’ve hosted lots of friends and family at our place over the years. Most of our friends don’t typically eat strict vegan diets, but thankfully all of them have been willing to try our sometimes-weird recipes. (Not a holiday food, but jackfruit carnitas, anyone?) Sometimes they’ll even ask how we make a particular dish. I believe that good food is meant to be shared, and I’m always happy to do so if it means making future meals together a little more inclusive.

Kathleen Nay is a third-year AFE/UEP dual degree student who’s been vegetarian for nearly eight years (though she admits to the occasional sneaky turkey sandwich). Her cat Emma, seeing her humans eat only vegetables, thinks human food is utterly bland and will stick to her kibble, thank-you-very-much.

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You’ve Got to Love Your Tree

by Hannah Meier

“Love Your Tree.” It’s a directive inspired by Eve Ensler, the writer and activist behind the one-woman play, The Good Body (you may also know her as the playwright for the wildly popular Vagina Monologues). “Love Your Tree” is also the foundation of a creative arts eating disorder prevention campaign that started at the The Center for Eating Disorders at Sheppard Pratt in Maryland in 2006 and has since expanded nationally. Today, organizations across the country, including Massachusetts, are invited to participate in the 2018 campaign and submit artwork that illustrates body diversity, acceptance and positivity.

“Eve, look at that tree? Do you see that tree? Now, look at that tree (pointing to another one). Do you like that tree? Do you hate that tree ’cause it doesn’t look like that tree? Do you say that tree isn’t pretty ‘cause it doesn’t look like that tree? We’re all trees. You’re a tree. I’m a tree. You’ve got to love your body, Eve. You’ve got to love your tree.” (Excerpt from The Good Body, 2004 by Eve Ensler). 

In the Baltimore-based Center for Eating Disorders at Sheppard Pratt, art therapy is a main component of recovery—helping patients approach body image struggles in a non-threatening way. Friedman alum, Christine Diven (Nutrition Communication, ‘12), assists with communications for the center where Julia Anderson, a Certified Eating Disorder Art Therapist created the Love Your Tree (LYT) Campaign in 2006. LYT is inspired by the metaphor in Ensler’s play, and is designed to cultivate an appreciation for the natural diversity of body sizes and help young people fight against society’s narrow and marginalizing standard of beauty and worth.

Love Your Tree Like a tree…my body is similar to no other. Lily D. Sudbrook Magnet Middle School 2016

As someone who personally struggled with an eating disorder that stemmed from dysmorphic body image throughout my childhood and adolescence, I emphatically understand how important it is to build an acceptance and appreciation of all bodies—especially in childhood. With increased attention drawn to childhood obesity and even weight loss in youth, establishing a sense of body trust and acceptance in childhood is of the utmost importance for educators today to prevent the development of eating disorders for these kids down the road.

What We Know About Eating Disorders

Unfortunately, research on eating disorders is anything but well-funded. Current statistics estimate that between 0.5 to 3.7 percent of American women suffer from anorexia nervosa at some point in their lifetime, and about 1 percent of female adolescents currently have anorexia[i]. Bulimia nervosa affects an estimated 1.1 to 4.2 percent of women in their lifetime. Binge-Eating Disorder, one of the most recently codified eating disorders in the diagnostic manual for psychiatric illnesses, is the most common, affecting 3.5 percent % of women and 2 percent of men in the United States, according to the latest statistics[ii].

Clearly, these numbers are conservative, and they do not account for the millions of individuals who may suffer from disordered eating but do not meet one or more of the required criteria for a clinical diagnosis. These numbers also assume that those with eating disorders seek treatment, which is sadly not always the case. Also worth noting, most of our understanding of eating disorders comes from research conducted on women, since anorexia and bulimia are traditionally perceived to affect women more than men; however, men are no less likely to suffer from eating disorders[iii].

Dieting and disordered eating often come back to poor body image or a desire to alter one’s body to better fit societal norms, putting thinness above real physical health. Results from a  2008 Canadian study found that 40% of Canadian girls in tenth grade and 37% of girls in ninth grade thought of themselves as “too fat,” and 19% of those with a normal BMI considered themselves to be overweight. Twelve percent of those with a normal BMI admitted to trying to lose weight[iv].

All Different, All One
Like a tree, my body…is unique and part of a whole. Melissa B. Bel Air High School 2017

Body dissatisfaction has a lot of other negative effects on kids and teens beyond increasing the risk for developing eating disorders. Some studies have shown that when students feel badly about their bodies, their GPAs are likely to be lower than students who don’t feel badly about themselves. And while we might think these types of issues arise in adolescence, body dissatisfaction and body anxiety may begin as young as second grade across varying racial and ethnic backgrounds, in both boys and girls.

How does Love Your Tree fight back?

According to current program director Brianna Garrold, the LYT campaign is currently in its 12th year. It was originally structured for middle and high school students in the Baltimore and surrounding area, but now reaches outside the state with organizations in New Jersey, Massachusetts, and Connecticut. Schools and organizations that host programs invite students to submit artwork representing their response to the Tree metaphor.

The campaign is even expanding overseas and across age groups. “In 2014, an organization in Australia picked up the message and contacted the creator of the program for more information about LYT and tips for hosting their own show and awards ceremony,” Garrold explained. “Over the years, Love Your Tree has expanded to include college students, and as of 2016, kindergarten and elementary-aged students. LYT has also started branching out beyond school-based workshops and into community organizations as well.”

Just Beginning “Like a Tree…I am full of so much potential.” Katherine H (Dulaney Middle School) 2015 

For school participants and eating disorder patients alike, the metaphor of a tree helps to explore healthy body image and self-image in a non-threatening way. According to Garrold, art therapy often feels “easier and safer” for participants than other approaches.

What are the common risk factors we can focus on to prevent eating disorders?

Garrold points to the biopsychosocial model of development—an understanding that biological, psychological and social factors all can play key roles in determining whether someone will develop an eating disorder.

“Unfortunately, we live in a society that is comparative, image focused, and perfectionism driven—all things that fall under the ‘social’ part. Body dissatisfaction and body anxiety are beginning at younger ages due to exposure to these messages, and as our society becomes more connected and ‘plugged in,’ it is getting seemingly harder to ignore them,” she says. Frequently, comparison to peers and media influence are major factors that contribute to the development of low self-esteem and poor body image.

“It can feel like an uphill battle to help reach out and provide support for kids,” Garrold admits.  “Keeping an eye out for warning signs, like social withdrawal, critical or comparative comments about or related to peers or celebrities, fixation on being ‘the best’ or feeling the need to be perfect, [and] fixation with weight or food can offer insight into areas kids and teens might be struggling with.”

“Body of a Tree”
Like a tree…my body is as healthy as it can be.
Ethan S. (Pine Grove Middle School) 2015

What can we do in Massachusetts to get involved?

Garrold invites those of us outside of Maryland to participate as an out-of-state chapter, especially if we work with students or young adults. “Outreach programs like Love Your Tree are designed to combat negative messages by educating students about the effects of the media on self-esteem and body image. Allowing space and time for conversation around topics like body image can be empowering for students […] and providing education about media literacy (understanding some of the dynamics of advertising, [and] the use of photo alteration programs) is a great topic to include as well.”

Even if we can’t fully participate fully in LYT, the website offers resources and support, and Garrold stresses that the most important part is to help kids feel like they have someone to talk to and activities to engage in. She recommends the online gallery at www.loveyourtree.org to spark the conversation.

“Our culture seems to spend a lot of time discussing criticism and flaws and not enough time discussing successes and positive attributes. Encouraging kids and teens to get involved in activities they enjoy, engage with peers, feel comfortable and safe enough to explore their talents, and celebrate what makes each individual unique are all ways we can help foster healthier students, which in turn, fosters healthier communities. The hope is that starting on a small scale will snowball into larger messages of healthy self-esteem and body acceptance.”

Bringing it back to Friedman

As part of a school focused on nutrition science and policy, we are well aware of the health challenges our nation faces, and the role proper nutrition can play. Decades of research associating overweight and obesity with increased risk for disease and lower quality of life has called us to lead the crusade for health—to prevent or reduce overweight and obesity by empowering individuals and communities to prioritize nutrition and its downstream health benefits. We know that obesity and disease disparately affect those of low socioeconomic status, and understand that it takes a multi-pronged intervention to make a dent in reshaping a community.

“Love Every Tree, Love Every Body
Like a tree…my body is unique and beautiful.
Amelia R. (Patterson Mill High School) 2015

But have we been paying enough attention to weight stigma? The American Academy of Pediatrics very recently released a policy statement about weight stigma experienced by children and adolescents with obesity, which is a must-read for anyone working with this population (likely all of us, in some regard). In it, they point out that weight stigma is widely tolerated because our society believes it will motivate people to lose weight, despite its counterproductive contribution to behaviors such as binge eating, social isolation, avoidance of health care services decreased physical activity and ultimate accelerated weight gain over time[v].

Instead of focusing on reversing weight gain trends, perhaps we should focus on reversing the plague of weight stigma. Health behaviors exist outside of body mass index, and focusing wholeheartedly on weight has proven to be undeniably ineffective, and perhaps harmful, in cultivating healthy behavior change[vi],[vii],[viii].

As Garrold encourages, “helping establish a healthy (or healthier) self-image is essential to prevention of and recovery from eating disorders.” Everyone can benefit from feeling more connected to and proud of their body.

If you are interested in getting involved in the Love Your Tree campaign, visit www.loveyourtree.org for more information. The 2017-2018 campaign is NOW OPEN and accepting poster submissions from students of all ages. Visit the website to view past submissions and learn how to submit an entry.

Hannah Meier is a Registered Dietitian, second year Nutrition Communications student, aspiring eating disorder specialist and an advocate for healthcare that does not stigmatize based on weight. Her favorite ways to honor her body include twisting and balancing in yoga poses and wearing extra soft pajamas as often as possible.

Resources

[i] The Renfrew Center Foundation for Eating Disorders, Eating Disorders 101 Guide: A Summary of Issues, Statistics and Resources, 2003.

[ii] Hudson, J., Hiripi, E., Pope, H., & Kessler, R. (2007) “The prevalence and correlates of eating disorders in the national comorbidity survey replication.” Biological Psychiatry, 61, 348–358.

[iii] Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. (2012). Eating Disorders in Men: Underdiagnosed, Undertreated, and Misunderstood. Eating Disorders, 20(5), 346–355. http://doi.org/10.1080/10640266.2012.715512

[iv] Boyce, W. F., King, M. A. & Roche, J. (2008). Healthy Living and Healthy Weight. In Healthy Settings for Young People in Canada.

[v] Pont, S. J., Puhl, R., Cook, S. R., & Slusser, W. (2017). Stigma Experienced by Children and Adolescents With Obesity. Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/early/2017/11/16/peds.2017-3034.abstract

[vi] Thompson JK, Stice E. Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science. 2001;10(5):181-3.

[vii] Pelletier LG, Dion SC, Slovinec-D’Angelo M, Reid R. Why do you regulate what you eat? Relationships between forms of regulation, eating behaviors, sustained dietary behavior change, and psychological adjustment. Motivation and Emotion. 2004;28(3):245-77

[viii] Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptance and intuitive eating improve health for obese, female chronic dieters. Journal of the American Dietetic Association. 2005;105(6):929-36.