Koru Springs

Eating Disorder Recovery Center from Lakeview Health

It´s time to heal

Lakeview Health is excited to announce the opening of Koru Spring.
Taking patients April 2023


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At Koru Spring, we offer a restorative environment for adult women of all identities to address and heal from the impacts of eating disorders.

High staff-to-resident ratios

Highly trained MD care team

Dual-diagnosis care

On-site, medically monitored detox care

24/7 medical care with nasogartic (NG) tubes

RTC, PHP, IOP, & Supported Living

Nutrition education:
wkly meal planning, meal exposure, & cooking experientials


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OUR PURPOSE

Breakdown barries so that recovery is possible

Helpful Articles​

Masha Sardari MS, RD, LDN

When a loved one is struggling with an eating disorder (ED), family and close friends often feel helpless and overwhelmed.  

When you try and take action, you’re often not sure if you’re helping or harming the situation. You worry all the time. 

You want to help, but you just don’t know how. 

That’s why family and chosen family education is such an important part of eating disorder treatment, and we put a lot of effort into it here at Koru Spring. The more you know, the calmer and more empowered you feel, which makes you better equipped to help your loved one.  

Here are eight things to know about EDs that will help you do exactly that.  

  1. You are important to them. Undergoing eating disorder treatment is challenging and individuals struggling require continued support. They still need you, and we still need you. The alliance between you, your loved one, and clinical staff forms a powerful treatment team that is critical for a successful recovery.  
  2. You’ll become an extra set of eyes. As you learn about EDs and how your loved one’s ED presents itself, you’ll be able to recognize warning signs that your loved one may be experiencing a lapse once they leave residential care. You’ll know what to look for that is positive and negative, and can help them stay on the path to long-term recovery. 
  3. The ED is separate from your loved one. This is such an important distinction for family members and friends to learn. By the time their loved one enters treatment, many families are at the point where they can no longer separate their loved one from the eating disorder. But the two are separate. Your loved one is living with the ED, they are not the ED. 
  4. The ED acts as a coping mechanism for your loved one—albeit a deeply flawed and destructive one. Again, hearing this often comes as a surprise to family members. Eating disorders are not a choice or phase, understanding this allows families to better support their loved one. Research shows that an ED is the way a person may deal with difficult emotions, depression, trauma, severe anxiety, or any highly disruptive aspect of their daily life that can’t be processed more directly or constructively.
  5. EDs share common characteristics. It’s often a relief when families learn that other people have the same condition that their loved one has and exhibit the similar behaviors. That’s what the disorder does to people! It also means families can learn how others in their position cope, and how they support their loved ones. 
  6. Coping with your own frustrations can be challenging. When families learn about EDs, they often realize that anger isn’t the best response to their loved one’s behaviors. Eating disorders can lead to conflicts and frustrations among family members. Remember the individuals suffering may feel out of control and helpless against the behaviors. Validation and compassion are key in the recovery process. You are a powerful ally on their journey of recovery. 
  7. EDs thrive in isolation. Knowing this has important practical applications for families. Consistent, empathetic engagement with your loved one is essential. For example, we often counsel family members to make the effort to eat together once their loved one returns home after residential care. Going from never eating together to eating every dinner together is unrealistic, but doing so once or twice a week can be a highly therapeutic way for families and their loved one to re-integrate after being apart. 
  8. Look after your own mental health so you can better support your loved one’s ED treatment and recovery. When work with moms, dads, siblings, or close friends in family group therapy, they’re often struggling emotionally. 

The great news is, the ED information families take away from these therapy sessions—including some of the things I’m covering in this post—can make a difference to their mental state. They feel less anxiety, more empowerment, and are better able to face their loved one’s ED in a positive, constructive manner.  

Other proven ways to boost your mental health include time in nature, adequate sleep, mindfulness and relaxation exercises, individual and group therapy, and spending time with loved ones.  

Final thoughts  

There’s no magic formula for helping your loved one in treatment. I wish there was, but each treatment journey is different.  

Eating disorders are complex and relentless mental illnesses, and supporting a loved one is hard work.  

Two final things to consider: education and communication. 

We touched on that first one with this blogpost. The more you can learn about eating disorders, the better positioned you’ll be to understand and support your loved one. (It’s also going to put you in a much better head space.) 

It’s also important to be able to communicate with your loved one about what they’re going through. That means listening, and responding without judgement.  

Good communication is also about making informed suggestions when appropriate, and letting your loved one know what you are seeing and feeling. That input can be very helpful to someone whose thoughts are sometimes clouded by their condition.  

Education and communication. Together, they go a long way to help your loved one on their journey back to health.   

 

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Masha Sardari MS, RD, LDN

Let’s start with the definition of this life threatening and increasingly common eating disorder.

People with atypical anorexia nervosa (AAN) have all the symptoms of anorexia nervosa, except for low body weight. These may include restriction of energy (food) intake, intense fear of gaining weight, hyperfocus on body weight or shape, recent and extreme weight loss, and severe nutritional deficiencies.

The one difference: A person with atypical anorexia is within or above the “normal” weight range. Because of that, the condition is often missed by medical providers, the person who is living with it, and their loved ones.

Assessment and treatment

At Koru Spring eating disorder center, we don’t see this condition as “atypical,” in fact it is a significant portion of the eating disorders we treat.

In assessing a resident who may have it, we ask the full spectrum of eating disorder related questions to accurately identify and diagnose the particular disorder an individual might be battling. Using a transdiagnostic approach, we focus on understanding the specific behaviors and thought processes of each resident in addition to the general eating disorder diagnosis they may have.

Our first priority is nutritional restoration for the resident. This may take several forms. Some residents need to restore micronutrients, for example, while others may have avoided entire food groups and have lived in a deficit for an extended period of time.

We evaluate each resident’s medical and clinical data which can include high blood pressure, low heart rate, electrolyte abnormalities and other conditions that require medical nutrition therapy.

The problem with the concept of “atypical”

Historically, “atypical” anorexia nervosa was understood as a less severe version of anorexia nervosa (AN). This is problematic as patients with AAN can be just as medically ill as their peers with AN and present with even greater symptom severity. Understanding the disorder as “atypical” may lead to delayed diagnosis and limited access to appropriate treatment.

Evidence suggests that AAN is in fact more common than AN, but individuals experiencing it are less likely to receive timely care. Due to weight stigma, severity may be missed and individuals may suffer longer.

The provider lens: Diagnosing this condition is challenging for medical professionals. Most don’t receive adequate training in eating disorders and may not know the signs. Weight loss is also often praised and individuals may be wrongly encouraged to continue engaging in behaviors such as dieting and restriction which may exacerbate disordered behaviors.

Also, many providers face heavier-than-ever patient loads, so they’re getting less time with their patients. This means less time to ask the kinds of questions that lead to clarity with this challenging condition.

That’s why it is so important to see an eating disorder expert when you or a loved one is exhibiting new and problematic behaviors around food and eating.

These professionals are trained to recognize the signs, ask the right questions, and use the appropriate screening tools necessary to make an accurate diagnosis and recommend the best treatment plan.

The patient lens: Atypical anorexia is a difficult condition to recognize even by those who are living with it. On the one hand, a person might be severely restricting their food intake and be terrified at the thought of gaining weight.

Yet on the other hand, every time they look in the mirror, they’re not medically underweight, so how can they possibly have anorexia?

At Koru Spring residents with this condition will sometimes say they don’t have a “textbook” eating disorder. In saying this, many are implying that they don’t think they’re that sick. Some people feel like they need to be sicker, and significantly thinner, to “deserve” ED treatment.

In response to that, I will sometimes gently challenge the resident with this: Okay, if you had anorexia nervosa, why is that more legitimate? Why would that make you more deserving of treatment?

This all gets back to what I said earlier about the “atypical” aspect of this condition. We don’t prefer that term because it leads some residents to believe they don’t have “real” anorexia.

But they do, because it’s not about what the condition is called, it’s about the behaviors they’re engaging in. Eating disorders exist on a spectrum and are serious conditions with a variety of presentations that often to do not fall under a single diagnosis.

For those who are living with an eating disorder or suspected eating disorder, please remember: Conditions and diagnoses are compiled by researchers who are not living your life. Everyone’s ED presents differently, and symptoms can be fluid over time. Just because your symptoms don’t fit a textbook diagnosis doesn’t mean you’re not sick.

The loved one lens: The “atypical” aspect of this condition can also pose challenges for the family and friends of the person who is struggling.

My advice: As much as you don’t want to believe there’s a serious problem, be open to that possibility. If your loved one is restricting portions, eating alone more often, replacing foods with no-calorie beverages, is preoccupied with their weight or body shape, and so on, don’t disregard those signs just because they’re still at a “normal" or higher weight.

Rather, offer judgement-free support, and assure them you’re there to listen and help.

If you’re pretty sure something is going on, ask your loved one if they would consider seeing an ED specialist. You might also offer to help them do that, and ask if it’s okay to go with them to their first visit. Note: You’ll find listings of eating disorder providers here.

Final thoughts on atypical anorexia

If you or a loved one are struggling with this condition, it is vital to seek help as soon as possible. Early diagnosis and treatment provide the best chance for recovery.

Remember, eating disorders do not discriminate based on age, gender, wealth, job status, sexual orientation, ability, neurodiversity, body shape and size, race, or ethnicity. They are capable of affecting anyone, and require ongoing support and, in some cases, medical treatment to recover from.

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Masha Sardari MS, RD, LDN

When a person comes into residential treatment for their eating disorder (ED), the simple act of eating a meal can be quite stressful. As can preparing a meal in a kitchen, and going out for a meal at a restaurant.

In a minute, I’ll explain how we help our Koru Spring residents in all three of those areas. But first, a general observation about the meal-support process.

When residents arrive at residential care, their food perceptions and eating habits have often been erratic for months or even years. With that experience as their norm, the balanced, consistent, group meals they have in treatment can be anxiety-inducing events. Early on especially, mealtimes don’t feel like safe spaces.

After a while, however, all of that flips. The new habits they learn during meal prep and mealtimes make these occasions feel safe and normal, and the old ways seem increasingly abnormal and stressful to think about. That’s progress!

Here’s how Koru Spring residents accomplish this turnaround in three key areas.

Daily meals

At mealtimes in our dining room, a resident is usually paired with staff. This might be a dietitian, therapist, or other clinician. Often other residents from the resident community are there as well.

Mealtimes are generally calm occasions, very normal, and light-hearted. The key early on is to help the resident restore their nutritional balance so they regain their physical and mental resiliency.

In the state that many people come to us, talk therapy would have little to no effect. That’s why nutrition is the first priority, as it helps build the foundation for therapeutic healing.

During meals, we clinicians do a lot of observing at first. If issues come up during the meal, we talk through them, and try to resolve them on the spot.

Afterwards, we review how things went for the resident. What were the anxious parts, what did the resident struggle with, what was easy, and so on. That information helps us make adjustments and a plan for the next meal.

It’s really important for clinicians to share these meals with our residents. For one thing, we sometimes see things at mealtimes that the residents aren’t aware that they’re doing. That’s important information for their treatment.

This time together during meals is part of what’s great about residential treatment. It gives us the opportunity to really get to know our residents and to see them in real-world situations. In an outpatient setting where you have much less time with patients, that’s just not possible.

Meal preparation

We use an off-site teaching kitchen that we book for our resident visits. This works great for us, as it’s a neutral spot for the residents. We drive to it, so they get a chance to get away from their day-to-day surroundings.

The chefs we work with at the teaching kitchen are trained in the basics of eating disorders, so they are very much a part of our treatment team. They’re a big asset for us.

Before we leave for the kitchen, residents are briefed on who will be going, and what the menu will be. Once there, everything’s organized and broken down into steps. We often play music that matches the cuisine we’re preparing that day.

Newcomers to the program frequently have high expectations for themselves at these meal-prep sessions. They worry they will make mistakes, or won’t prepare food the right way.

We sometimes see two extremes. At one end, there are residents who have done almost no meal preparation before they come to us. They’ve been eating a lot of packaged, processed foods that only require you to open a box or a bag.

At the other end are residents whose preparation process got off track at some point, and they need to re-learn the process. Some got in the habit of taking several hours to prepare for a single meal because of the shopping time it took plus elaborate, over-the-top prepping habits.

We stress that everyone makes mistakes in the kitchen, and we can all learn more.

In the kitchen, residents get exposed to different food tastes and smells, the feel of flour on our hands, the sound of butter or olive oil “popping” in a frying pan, and so on. Along the way, residents learn new cooking techniques. Afterwards, we review how things went, and we brainstorm strategies to try next time.

These meal-prep sessions are meant to bring joy to the cooking process. We have a lot of fun with them.

Going out to eat

This exercise usually comes after residents have become more comfortable with daily meals and meal preparation. There tends to be more unknowns and variables when you go out to eat, so we’re careful about when to do it.

If it’s a resident’s first time out with us, for example, we’ll often aim for a smaller, quieter place like a café, rather than a noisy restaurant. With these exposures, we never want to do more than the resident can handle.

Before heading out, we let residents know who is going to be eating with us and where we’re going. We discuss what triggers we may be dealing with, and prepare for those situations by having a plan in place.

At the restaurant, center staff will guide residents during the food-ordering process if needed, and we’ll often take a minute or two to practice mindfulness before the meal starts. (A few deep breaths can really help ease anxiety.) Then we share the meal.

If issues come up, a therapist is always there to support and guide. If a follow-up discussion is needed back at the treatment center, we try to do that right away if the resident is amenable.

Most of the time, these meals out are super enjoyable.

Final thoughts

The aim of food-related exposures is to improve our residents’ relationship with food. We help them acquire the skills and habits they need so they can take those skills with them when they leave residential treatment.

With all of these situations, we ask the residents to try and keep reasonable expectations. We let them know it’s going to be hard on some days, and that occasionally progress stalls or even reverses itself. That’s okay!

That’s how ED recovery works in general—it isn’t always a straight line. In fact, it’s rarely a straight line. The great news is, with each setback comes a learning opportunity to develop the skills to maintain a strong recovery.

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