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Uploaded: Fri, Jun 24, 2011, 8:43 am
Stanford program takes aim at eating disorders
Researchers adjust their thinking about the causes and treatment of eating disorders
Stanford University research assistant Nandini Datta sits by the Wisconsin Card Sorting Task assessment, left, and Delis-Kaplan Executive Function System, right, which are used to study reactions, change and brain function in patients with eating disorders. Photo by Veronica Weber/Palo Alto Online.
Kristin began starving herself in eighth grade.
"I had low self-esteem," she said. "I was by no means fat, but my body developed before my other girlfriends'. I got it in my head that if I lost weight I'd like myself more and other people would like me more; I'd be more popular."
An avid reader of fashion and fitness magazines, she was dismayed by the differences between her body and those of the models she idolized. So first she began to choose health food over junk food, then she started reducing her overall intake, counting calories and weighing herself daily.
"Before I knew it, it became an obsession," the South Bay resident said. "I was terrified of gaining weight; I measured everything. The thought of not having that control was too scary."
In four months, she lost 15 pounds. After eight months, she had lost 40.
"It was beyond my control; my life was governed by this fear. It started as a control thing, and by the end I had no control. It was either the hospital or I was going to die."
The 'tween with the athletic body became drastically underweight and, at age 12, she was hospitalized in the Stanford ICU with a dangerously low heart rate. Kristin was diagnosed with anorexia nervosa and placed in the Comprehensive Eating Disorders Program at Lucile Packard Children's Hospital at Stanford.
Now 23, Kristin recently celebrated the 10-year anniversary of her hospitalization. In recovery, with health restored, she's one of the thousands of former patients who've been treated for an eating disorder or participated in research studies at Stanford.
Eating disorders are serious mental illnesses involving abnormal, unhealthy eating behaviors, including anorexia nervosa (self-starvation), bulimia nervosa (binging and purging) and other, non-specified conditions. Stanford's program was started in the late 1970s and involves staff from the Lucile Packard Children's Hospital's Center for Adolescent Health and the Stanford University School of Medicine divisions of Adolescent Medicine and Child Psychiatry.
Though eating disorders affect relatively few people, the impact on those suffering from them is severe. Anorexia has the highest mortality rate of any mental illness.
Treatment for eating disorders has changed since the '70s, with a shift toward family-based rather than individual therapy, care that is holistic and a majority of patients being treated as outpatients. Research, too, is evolving, with current Stanford researchers now exploring the tie between eating disorders and larger issues of cognition and thinking patterns.
Because eating disorders impact both mental and physical health, Stanford's joint approach is the key to its philosophy, Dr. Cynthia Kapphahn, medical director for the program, said.
Not only do adolescent patients work with therapists and physicians, but also nurses, nutritionists and others in a team-based, holistic approach to care.
"There's even a school teacher to help patients stay caught up. It's one of the few places in the country like that," she said.
The program offers a 15-bed inpatient unit (currently housed in rented space at Mountain View's El Camino Hospital) and an ongoing outpatient clinic, with offices in Palo Alto and Mountain View. Kapphahn said she hopes the inpatient clinic, which outgrew its original space, can eventually move back to Lucile Packard when the hospital undergoes its recently approved expansion.
Dr. James Lock, the psychiatric director for the program, said that on average 10 of the inpatient beds are filled at any given time, and that between 300 and 400 patients go through the outpatient clinic each year. New-patient evaluations are held three times a week, and around half of the patients come for treatment. About 10 times more girls are diagnosed with eating disorders than boys, Lock said, but that may partially be attributed to less awareness regarding eating disorders in the male population.
"The stereotype is the rich, white girl, but we see tons of boys, and lots of minorities," Kapphahn said. She said eating disorders seem to be increasingly common in Latino boys, for example, who've been overweight, then lose too much.
"We see eating disorders across all groups," she said. "But the unconventional people tend to get missed."
A misconception is that eating disorders in adolescents are the fault of controlling, pressuring parents or the fault of popular culture for emphasizing svelte body shapes and unrealistic beauty standards, Lock said.
"Mothers get blamed because we live in a culture in which lots of women worry about their weight, but in fact anorexia is very rare," Lock said.
"Everyone is exposed to the same media," he said, while relatively few develop an eating disorder. While media can be a trigger for unhealthy eating habits, it seems a person needs to have certain genetic and cognitive propensities to develop anorexia.
Kristin said she had problems with anxiety even prior to the onset of her eating disorder.
"I grew up experiencing a lot of anxiety, but it sort of went under the radar," she said. "I come from a family of 'Type A' personalities."
Lock said there may be similarities between those with eating disorders and those with other mental illnesses, such as anxiety and obsessive-compulsive disorders. Looking at the behaviors and personality of patients from before they were diagnosed with anorexia, as in Kristin's case, Lock said they "tend to be anxious, driven, perfectionistic people" -- the very type who also tend to be quite successful in school and at athletics.
Eating-disorder patients "very commonly have all those traits. If you want to get into Stanford you better have some of those qualities," Lock said. "I tell parents, 'If your child does not get straight As, they are very unlikely to have anorexia.'"
Kristin described herself as a regimented child who would "stress about anything," with even small mistakes such as missing the bus feeling like "the end of the world.
"I would make lists of things to do, and things had to be done a certain way," she added.
Might Palo Alto, with its culture of high academic standards and population of driven Silicon Valley go-getters see a higher rate of adolescents with eating disorders than other areas?
"It's a high-risk population," Kapphahn acknowledged. Lock added: "We don't have good data, but there is an association; the vulnerability is probably higher," since there are both genetic and environmental triggers. Plus, to be able to afford to raise a family in the area, local parents are often high-achieving, extra-driven personalities themselves. And family does play a role.
"Genetic data suggests that inheritability is very high," Lock said. But, he emphasized, as with media exposure, clearly not all straight-A students or teenagers unhappy with their weight develop an eating disorder.
"Particular people are more susceptible, ones with super-high expectations that spill into eating certain ways," Kapphahn said, of what happens when such a person turns all their drive and focus onto controlling their eating habits. "There's a disconnect between high expectations and low self-esteem," she said.
It's normal for adolescents to develop body-image concerns as they hit puberty, with girls generally experiencing more weight gain than boys, Lock said, but those who develop eating disorders take such concerns, along with their perfectionistic tendencies, to an extreme.
Kristin's perfectionism mixed with her low self-esteem created a "perfect combo for an eating disorder," she said.
There also seems to be a link between the sex hormones that control puberty, particularly estrogen, on brain development and risk for eating disorders. And by far the most cases of eating disorders are diagnosed by age 18, with onsets becoming rare after age 25, Lock said. Once the disease takes hold, "it's truly shocking how intractable it is, how absolutely compelling," he said.
"Even when I was at my lowest weight, I never thought I could have anorexia. I couldn't be thin enough. It was total denial. I was miserable, weak, felt awful, depressed," Kristin recalled.
Anorexia's mortality rate is about five to nine deaths per 100,000 sufferers, Lock said. Half of anorexia-related deaths are from cardiac arrests due to weakened, starved hearts, while the other half are suicides. In those cases, the patient "loses all perspective. They have nothing left, no energy for relationships. You just begin to feel like you don't want to live," Lock said. And with each passing year of having the disease, the risk of death goes up by 1 percent.
"People don't think they have a problem; they don't see it. They say, 'No, I'm fine,' even when they're on a heart monitor in the hospital because their heart rate dropped too low and they're a skeleton," he said.
For Kristin, "restricting was all I cared about. Counting calories and exercise was all I lived for. I thought about it 90 percent of the time," she said.
Bulimia is three to four times more common than anorexia, but comes with its own dangers and long-term health risks.
"It's equally worrying," Lock said of bulimia, "but with quite a different set of concerns," with bulimics struggling more often with appearance-related weight-loss attempts rather than the control issues common in anorexics. Patients with bulimia more often recognize they have a problem and want to stop, but they find themselves trapped in the binge-purge pattern, he said.
"One of the sad things is, eating disorders are still stigmatized," Lock said. "Families are blamed; patients are blamed; people think they're influenced by fashion or the media as opposed to having a psychological disorder."
Kapphahn concurred.
"People feel guilty, like it's seen as a volitional thing. If you had cancer you wouldn't be blaming yourself for having cancer. It really is a disease that needs to be treated," she said.
Though very dangerous, eating disorders are also highly treatable. Lock said in his experience it takes patients between nine months to a year to recover, with 80 to 90 percent able to say they no longer have the disorder.
In Kristin's case, her parents became concerned by her weight loss but for a while were at a loss as to how to deal with it. She saw a physician and a psychologist but kept losing weight.
"It was the elephant in the room, no one would talk to me about it," she said. Eventually, she recalled, her mother came up to her room to break the news that she'd need to go to the hospital.
"They want to take you by ambulance, but I'd like to take you myself," she remembered her mom saying. "I had to face the music."
Most of the patients who come to Stanford are, like Kristin, fairly local, from the Bay Area or Northern California, although some are referred from across the nation and even the world, Lock said. Traditionally, most eating-disorder patients were treated as inpatients, with months of hospitalization, "but in the last decade by far the largest number are treated as outpatients," Lock said. "It's a real movement forward."
When patients first arrive, medical stabilization is the first priority. Even outpatients are often hospitalized for the first nine to 12 days to make sure they're physically stable, Lock said.
Kapphahn and her medical team monitor patients' physical health, helping them recover from malnutrition and a host of side effects that can include low blood pressure, low heart rate or a racing pulse, seizures and more. Nutritionists advise on what meals are appropriate, while for inpatients nurses make sure patients are getting the nutrients they need.
"It's really hard for patients; they feel overwhelmed and fearful of eating. The nurses are supportive but firm," Kapphahn said, adding that rarely do Stanford nurses have to resort to the unpleasant nasal-gastric force feeding that sometimes characterized eating-disorder treatment in the past.
Kristin, thinking she'd only be in the hospital for a few days and packing accordingly, ended up staying there for a month and a half.
For a long time she wasn't even well enough to take solid food and was bedridden. Eventually she was able to use a modified wheelchair, then progress to walking and going to group therapy.
In the hospital, "I went in and out of acceptance. I was scared I was going to die. It was a really lonely time, although my family visited every day," she said. Finally, she gained 10 pounds and was able to be released.
While caring for the physical wellness of patients is crucial, Kapphahn said it's the psychological treatment that is essential for long-term success in treatment.
"Truly, recovery comes through the mental health side," she said.
For more than two decades, Stanford has been involved in eating-disorders treatment, with Lock as a proponent of what he called evidence-based, family-based therapy for anorexia nervosa, in which the parents and siblings of the patient undergo counseling with him or her and take an active role in the recovery process, including learning about nutrition, making sure the patient eats properly and trying to understand the complexities of the illnesses. Family-based therapy is counter to how anorexia used to be treated, Lock said.
In older days, "treatment left the family completely out," he said. The belief was that anorexics have parents who are over-controlling and that the disorder "is about defiance and autonomy," he said, so therapy focused solely on the patient.
"It seems completely crazy to me now," Lock said, adding that patients would do well at the hospital, but then continue losing weight once they were back home. Having family members involved in the treatment process is key, as the kids suffering from anorexia are initially too disturbed to handle the situation on their own, he said.
"Parents need help helping them. They need to know how to make sure the kid eats every meal, no cheating, no exercise on the side, and make sure their child gets the message, so it disrupts the behavior and it becomes less compelling," he said. Once well enough to return to school, "they need to be able to manage it in the peer environment, and the parents need to be able to pick up the pieces when it falls apart," he said.
Family-based therapy is now recognized as the treatment of choice, Lock said. According to a joint study by Stanford and the University of Chicago, published in the October issue of Archives of General Psychiatry, family-based therapy was found to be twice as effective as individual psychotherapy in producing full remission in anorexic teens.
Kapphahn said the medical side of the program was slower to embrace family-based treatments than the psychiatric side, but over the past eight years she's seen a paradigm shift.
"The hospital was stuck in an old-fashioned model, really contrary to the work Dr. Lock was doing. Now ... we really want the families to be there, our program has shifted," she said.
In Kristin's case, her parents tried the family therapy, but then dropped out, finding it too difficult.
"My family did everything they could to support me, but they never really tried to understand," she said. "But I would still recommend family therapy. I think it's really important; usually there is something there."
Cognitive remediation therapy (CRT), which focuses on patients' thinking patterns and styles rather on specific eating behaviors, is also now used in treating eating-disorder patients. The techniques of CRT are being used to study how the cognitive processes of eating-disorder patients may differ from healthy individuals.
CRT "is something patients tend to really like because it doesn't ask any questions about food or weight," Stanford School of Medicine Research Assistant Danielle Colborn said of the treatment, which has also been used in cases of head injury and schizophrenia. Tasks involving memory games, pattern matching and problem-solving quizzes are used to help patients improve brain flexibility.
"It still helps them work toward recovery but without those trigger issues," Colborn said.
"It's very new -- some as been done with adult women (with eating disorders) but very little has been done with adolescents. We're starting to change our way of looking at these illnesses, taking into account their cognitive functioning. Before our way of looking at them was specifically ideas about food and eating, but in addition we should look at addressing their thinking processes themselves," she said.
Colborn and Nandini Datta are two of several Stanford researchers currently conducting studies on the relationship between thinking processes and eating disorders. Though their studies are separate, both involve analyzing how a person's thinking may correlate to psychological illnesses such as anorexia.
Datta and her team are currently recruiting subjects for her study, titled, "Familial Aggregation Study of Anorexia and Cognition," specifically in females ages 14-19 with anorexia nervosa, and their family members. The study will focus on pairs of sisters close in age, in which one sister has anorexia and the other does not. She's also recruiting females from that age group with no history of anorexia to serve as controls in the study.
"We give them a neuropsychiatric assessment that shows their thinking processes with various tests," including IQ tests and games that test spatial and visual intelligence, Datta said. One such test is the Wisconsin Card Sorting Test (WCST), during which participants have to match cards using shape, color or number, with the criteria for matching continually changing. This measures what is called "set-shifting ability" -- flexibility in thinking. Other tests include copying an image from memory, matching a simple image with a more complicated one, and other computer-game-like tasks. The tests focus on central coherence, which Datta described as "the ability to see the big picture rather than just details."
Anorexics, she said, may be more detail-oriented, making them more successful at some of the tasks and showing cognitive deficiencies in some areas, such as adaptability. Some participants also undergo functional MRI scans, which provide images of their brains so that the potential effect of an eating disorder on brain anatomy can be seen.
"There are not many studies like this done on anorexia yet," she said, and the hope is that finding predictable cognitive correlations could help identify people who may be at higher risk for developing eating disorders.
"We're taking a biological view. It's pretty cool and very new," she said. "We're hoping if we can understand these correlates then we can explain it on a biological level."
Datta's study is in the early stages, with two families participating so far. The goal is to recruit 40 subjects with anorexia and 40 controls over the course of the five-year study.
No matter what biological and neurological implications researchers such as Datta and Colborn may discover, for those struggling with eating disorders, "It's really important to maintain therapy and support," Kristin said.
Kristin, who continued seeing a therapist on and off in the years since her release from the hospital, went on to study psychology in college and is now a graduate student, working toward her master's degree in counseling.
"It's been a slow journey, and I have this awareness when it comes to my health," she said.
Her weight fluctuated throughout high school and college, and she continued to struggle with unhealthy habits, including a binging-and-purging phase. She said she's now developed an understanding of her tendencies toward unhealthy thinking patterns.
"I'm definitely aware of my weight, and of my figure, but I don't count calories, I don't weigh myself and I don't stress about food. Food is a source of nourishment. I'm absolutely able to enjoy food," she said.
She's found support from the Eating Disorder Resource Center, based in Campbell. Janice Bremis, who herself went through anorexia treatment at Stanford in the 1980s and '90s, founded the center in 2006.
"I was familiar with the research Stanford was doing. They had all this knowledge but the community didn't," Bremis said.
The center offers information on treatments, therapists, insurance help, support groups and more. Kristin has been involved as a volunteer and said she'd like to eventually work as a therapist specializing in eating disorders, anxiety disorders and depression, as well as continuing to teach group fitness classes and advocating for eating-disorder education and prevention.
"Ever since going through it I have wanted to work with people with eating disorders," she said. "Educating other people about eating disorders and health really heals me."
More information on Stanford's research studies is available at edresearch.stanford.edu. More information on the Eating Disorders Resource Center is available at www.edrcsv.org. ==I More information on the Comprehensive Eating Disorders Program at Lucile Packard Children's Hospital is available at www.lpch.org.
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Posted by Enough!
a resident of Charleston Gardens
on Jun 24, 2011 at 12:13 pm
Just bring in the Paly classes of 2001 and 2002. You will learn quickly how a lot of the boys in those years called girls who were mere sizes THREE and FIVE 'thick' and worse. Many of the girls experienced eating disorders, and many said that to be considered 'thick' or 'fat' in high school was almost as bad, if not worse, than getting bad grades. It certainly lessened your popularity. It is a totally sad situation, and certainly reflective of the influence of the mainstream media on our young women.
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Posted by Decades of this
a resident of another community
Eating disorders deserve even more media attention than this, but this is a great start.
I'm glad Stanford's program has advanced from the rudimentary stages when they tried to help me back in the early 1980s. The treatment then was in its infancy and did nothing to help my well-established, heavily-entrenched bulimia disorder.
My original difficulty ten years prior was anorexia nervosa, and I was surrounded by high school friends with the same struggle. Few parents or even health care practitioners recognized such behaviors as something aberrant and potentially dangerous, and hadn't a clue how to deal with it.
After two three-week fasts, a physician told my mom to take me home and force me to eat. Period. No counseling. No follow-up. No nothing. In no time, I had given up my anorexia for bulimia.
If you have an eating disorder, or if you know someone who has an eating disorder, be very aggressive about getting the very best professional help that you possibly can. Stick with it. Read everything you can find. Talk about it. Go online. There are helpful websites. I like:
bulimia help.org
I believe that this article grossly under-reports fatality statistics from eating disorders. In addition, there are numerous permanent (as well as temporary) negative side-effects of binging and purging. Bulimia will cripple your body, your mind, your spirit, your family relationships, your friendships, your bank account, and your education.
Get help. Today. Or yesterday. Not tomorrow.
It can get better! It does get better! You need to deal with it early.
Thank you from one who's been there.
Oops, misplaced modifier:
The physician hadn't been on the two three-week fasts, I had!!!!!
Sorry, readers.
Posted by correct web address
bulimiahelp.org
(Check out the blogs. Very helpful.)
Posted by Therapist
a resident of Another Palo Alto neighborhood
on Jun 24, 2011 at 2:22 pm
Dr. Lock's comment "I tell parents, 'If your child does not get straight As, they are very unlikely to have anorexia.'" is misleading at best, and potentially dangerous if parents are uninformed about the numerous other factors and behaviors associated with this disorder. Hopefully he said this to emphasize the strong correlation between other cognitive and behavioral tendencies and anorexia. I have worked with many many adolescents with anorexia whose anxiety, drive, and perfectionism did not manifest in high academic performance.
Many straight A students at Paly suffered from both anexoria and bullimia. In fact, the overachievers seemed to suffer from the disorder in frighteningly high percentages! Typical food for the day would be: Breakfast, nothing. Lunch: Starbucks Dinner: a tiny amount of food. Later: alcohol, then throw up.
Posted by Alice
a resident of Los Altos
Thank you for this locally oriented article on EDs and the Stanford ED program. I'm glad to read others locals' experiences with EDs. I now live north of the Bay Area, and am stunned to come back to this area and see how almost universally slim people are around here. There is much greater size diversity where I live, and it makes me wonder how extreme the pressures are today in Silicon Valley to be thin. It reminds me of how much pressure I felt back in high school, and I wonder if it has intensified since then, given the even higher achievement pressures that go along with the higher cost of real estate.
I grew up in Los Altos, graduating high school in 1980. I was put on my first diet by my pediatrician, Dr. Richards, whose office was at Loyola Corners, in 1976. I write the doctor's name here because I would like to connect with other women who were patients of his who may have developed EDs as a result of his care, to compare notes. I wonder how many other teen girls were put on diets by him.
He told me, when I was a slim 14 year old (in the middle of the "normal" BMI range used today), that I had gained 10 lbs. but no height since my last check-up, and that if I kept "gaining weight this way," I would "be a blimp" by the time I was 30. He apparently didn't know (and nor did I, until recently), that it is normal for girls to gain around 10 lbs. at puberty, but no height.) He didn't even first ask how much I was exercising (4 hours/day: 2 sports teams), and put me on a 1000 kcal/day diet. (I have since been told by a college nurse that female college athletes at his school are told to eat at least 3000 kcals/day: I was being starved by my pediatrician.) Dr. Richards told me to return weekly for a weigh-in to confirm I was losing a pound a week. He said after I lost 10 lbs., he'd put me on a "maintenance diet."
As you might imagine, on the first day of 1000 kcal eating, I was "bingeing" by nighttime (1500 kcals eaten for the day total): "bingeing" for the first time in my life, because I'd never been restricted before. The next morning, I woke feeling stuffed and ashamed that I couldn't last even one day on a diet. I feared I should only eat 500 kcals on day 2, to make up for "overeating" by 500 kcals on day 1, to make sure I could show a 1-lb. weight loss by the end of the week. Again, I "binged," eating 1500 kcals on day 2. So on day 3, I thought I'd have to eat 0 kcals to make up for "overeating" the previous 2 days.
I spent the rest of the week trying to eat as close to zero kcals as possible. The last day of the week, I fasted, and showed a 1-lb. weight loss the next day at the doctor's office.
After a second week like that, I could no longer keep showing a weekly 1-lb weight loss, so I never went to my pediatrician again, throughout high school. I initially starved and exercised my way down by more than the 10 lbs, then quickly gained it all back, and have been stuck in the starve/binge pattern ever since.
The restricting/bingeing pattern had taken hold, starting from that first day on Dr. Richard's diet. I'm now 51, have gained over 200 lbs. (yes, you read that right), from the increasingly chaotic eating from numerous diets ever since, and am still struggling to stop that pattern of early-day restricting and late-day bingeing.
Being started on dieting and hatred of my then-thin size has been one of the worst things a doctor could do to a client. Dieting has been the most frustrating and painful experience, because the long-term effect of dieting for most people is *weight gain.* The research now shows that the more a person diets, and the more severely, the more they will likely gain weight over time. Unfortunately, I'm so tuned out to my hunger signals that for the past 26 years, I have not been able to *stop* dieting for part of the day (not even realizing I haven't eaten, or not being able to make myself eat), and then bingeing later.
My ED started the first morning of Dr. Richard's diet, because it is on the first day of a diet that a person learns she has to override her hunger in order to stick to the diet. That first day, when I was hungry by mid-morning, for the first time in my life, I had to go against what I had always done: eat when hungry. To stick to the diet (or risk being reviled and rejected by others), when hungry, I had to consciously *not eat* and get hungrier. The doctor-prescribed/doctor-approved diet taught me to ignore and go against my hunger signals and what my body was telling me to do: the hunger signals that are a product of evolution to perfectly guide us to eat as we need to. I learned to fear eating, fear hunger, and to fear even being aware of hunger. It is the perfect set-up for undereating and then overeating. All from the first day of being on a diet. And the irony is, the more weight I gain, the more I fear being aware of my hunger. It's a vicious cycle. The problem is one of *primary* restricting leading to *secondary* overeating (or more accurately, make-up eating.) The solution is to stop the restricting. But of course, going to most doctors exacerbates this, because most still advise weight loss and some form of restricting: even if I warn them I have an ED and to not go there, because I'm so sensitized, particularly to doctors criticizing my weight. (Fortunately, I have found some wonderful PCPs who understand. When I see them now, my eating does not get worse after the appointment, which is a huge relief.)
In addition to Dr. Richard's terrible advice, I, too, along with another commenter above, felt enormous criticism and judgment from males: my father, brother, and boys at my high school, all of which contributed to the eating disorder.
So if you can imagine, I am very frustrated when I read articles discussing the *media* role in the development of EDs, but not that of those who I believe are the biggest culprits: DOCTORS who advocate weight loss; and second in line, males judging and criticizing girls' and women's bodies, and our weight and size.
Parents need to raise boys from a very early age to reject the peer pressure and cultural nonsense and to not judge females (or males) by our bodies, and to not critize or reject females based on weight or size, or judge/criticize how we eat. It just makes it harder to listen to one's own body. (And the same should go for girls' parents, regarding boys or other girls.)
Any doctor telling patients to lose weight (by whatever method) is interfering with body image/esteem and one's ability to listen to hunger signals, and is contributing to disordered eating and eating disorders. They are inadvertently and inevitably *causing* the very weight gain they are trying to prevent.
Instead, doctors should be identifying clients who are caught in the dieting trap, help them to stop dieting and recover normal (3+ meals, hunger-based) eating (some may need to follow meal plans to recover, or for the rest of their lives), help them to focus on healthy lifestyle, and to love and accept themselves at whatever size they are (known as Health At Every Size-HAES(TM)) for best self-care and health outcomes.
My thanks to those doctors helping those of us with EDs and who teach their clients about HAES. And kudos to the men and women who accept and love people of all sizes.
Posted by Whatamess
My mother had been a model in her day, and was terrified of body fat. As a result, she had some strange notions about nutrition, and thought that dietary fats of any kind, as well as dairy products, were bad for children.
Basically, I was.starved throughout childhood. Once I was on my own, I began to eat more, but did not make good choices. Pathetically skinny as a child, I was now of normal weight, but thought I was fat. Having no knowledge of good nutrition, I began to cut out entire meals, eating one hot dog a day and nothing else.
A very disciplined person, having been an "A" student all through school, including college, I became pathetically thin again. To make a long story short, I ended up in the Woodside Women's Hospital ( no longer exists, thank God), after over dieting to the point of emaciation after the birth of my son.
Woodside Women's Hospital hired chefs from the Culinary Institute to entice women to eat, and to make another long story short, their methods turned anorexics into bulimics.
Eventually I was sent to Stanford, where I was drugged heavily against my will, and nurses would check my mouth to make sure I had swallowed the pills they gave me. My doctor, an Iranian woman named Mali Mann, threatened to take my son away from me and put him in foster care ( although I found out later that she never mentioned this to my husband). This woman never even saw me before committing me to Stanford, and made a diagnosis of major depression, sight unseen, to get me admitted.
When my husband realized that Dr Mann was doing things that were not entirely legal, and wanted to keep me in Stanford for months ( our insurance paid only 25%), he found he could not get me released. Finally, he told her we would not be able to pay her, and realizing this would not be profitable for her ( she had very few clients), she had me released.
I switched to a psychiatrist who saw me once per week, whose rates we could afford, and who practiced out of El Camino Hospital. It also came to light that I was not the first person with complaints about Dr Mann, which is why she had so few clients. Anyway, this new doctor helped me work through childhood issues and see that I was not mentally ill, but my mother was, and because of her influence I was clearly misguided. I was put on Zoloft temporarily, til my thinking cleared and the mental fog lifted, and have had no ED issues since. Eventually I needed no psychiatric help at all.
I wanted to mention Dr Mann's name, because I understand that she is still practicing in Palo Alto, and still doing illegal things to her patients. This woman is dangerous, and to be avoided at all costs!
I also want to say that the fashion industry is responsible for a lot of EDs, as evidenced by my mother and her passing this onto me. This industry, along with dance and gymnastics, encourages unhealthy food limitations that are especially dangerous for growing girls. They also pass onto society an unhealthy icon of what a woman should look like, an icon that is largely unattainable to most women, and is NOT NORMAL! For this reason, they are no better than the porn industry!


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Theatre & Live Events Around The World: January 2019
By Claire Hammond
Happy New Year! Start the year off right with some of these fabulous live events, entertainment, theatre and arts events we've found for you this month. What's happening around the world?
LONDON INTERNATIONAL MIME FESTIVAL, LONDON, UK
The London International Mime Festival is an annual theatre event in London. It features live art, new circus, clown, object and physical theatre, performed by companies from Belgium, Finland, France, New Zealand, Norway and Spain, at various central London venues.
OTHELLO, DUBAI, UNITED ARAB EMIRATES
The critically-acclaimed Shakespeare play Othello is coming to Dubai Opera. The production, reimagined and directed by Richard Twyman, will be performed in January 2019. It is the first time that Dubai Opera has hosted a play and it looks like it's going to be spectacular!
CHARLIE AND THE CHOCOLATE FACTORY, SYDNEY, AUSTRALIA
Experience the wonders of Willy Wonka when Roald Dahl's delicious tale, Charlie and the Chocolate Factory opens its factory doors in Sydney from January 2019. It's a delectable treat featuring songs from the original film, including Pure Imagination, The Candy Man and I've Got a Golden Ticket, alongside a brand new, toe-tapping and ear-tickling new score.
1ST IRISH FESTIVAL, NEW YORK, USA
The 2019 Origin Theatre 1st Irish Festival celebrates its eleventh anniversary this January. New York's only month-long theatre festival exclusively devoted to presenting contemporary plays from the island of Ireland. It shows fifteen events in total, originating from Belfast, Derry, Dublin, Cork, Limerick, Queens and Manhattan, and takes place in a number of distinguished venues across New York City.
WHEN WE HAVE SUFFICIENTLY TORTURED EACH OTHER, LONDON, UK
When We Have Sufficiently Tortured Each Other is a new play by Martin Crimp that breaks through the surface of contemporary debate to explore the messy, often violent nature of desire and the fluid, complicated roles that men and women play. Cate Blanchett and Stephen Dillane make up the cast for the National Theatre.
ABQ SOLO, ALBUQUERQUE, USA
The 5th Annual ABQ Solo Festival of Solo Performers takes place this January at the Aux Dog Theatre, Nob Hill. This year features six emotionally powerful solo productions.
UNDER THE RADAR FESTIVAL, NEW YORK, USA
Over the last 15 years, New York institution The Public Theatre's Under The Radar Festival has presented over 229 companies from 42 countries. It has grown into a landmark of the New York City theater season and is a vital part of The Public's mission, providing a high-visibility platform to support artists from diverse backgrounds who are redefining the act of making theatre.
Would you like us to include your world premiere, festival, concert, or company news in a future edition of Around The Globe? Submit your news and events to socialmedia@TheatreArtLife.com
Claire Hammond is an accomplished young performer with international credits in Music Theatre, Cabaret, Film and Television. Born and raised in Melbourne, Australia, Claire completed her studies at the University of Ballarat Arts Academy, gaining a Bachelor of Arts in Music Theatre.
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redpajama_set_name: RedPajamaCommonCrawl


text:
Retail 398 Pharmaceutical 236 Customer Service 173 Other 149 Sales 128 Transportation 86
Management 76 Information Technology (IT) 40 Logistics 39 Engineering 33 Accounting 31 Supply Chain 31 Manufacturing 27 Administration 22 Warehouse 21 Health Care 19 Nurse 19 Professional Services 17 Nonprofit - Social Services 15 Food Services 15
Part-Time 6 Full-Time 3 Full/Part-Time 1
Business Development General Labor Tennessee
VARIOUS WAREHOUSE POSITIONS ACROSS THE USA - TN, MT, MO, TX, MI, WV, NC, ID, AZ, SD, CA, OH, WI Featured
AVAILABLE POSITIONS INCLUDE: ORDER PICKERS STOCKERS WAREHOUSE RECEIVING CLERKS WAREHOUSE FACILITY MANAGERS CLICK ON LINK BELOW TO BE DIRECTED TO OUR WEBSITE TO SEARCH LOCATIONS AND JOB REQUIReMENTS & APPLICATION PROCESS : https://www.concordancehealthcare.com/careers
Concordance Healthcare Solutions TN, MT, MO, TX, MI, WV, NC, ID, AZ, SD, CA, OH, WI Full/Part-Time
Full Time Nabisco Sales Service Representative/Merchandiser Order Writer- Morristown, TN - 1907830
Mondelēz International, Inc. empowers people to snack right in over 160 countries around the world. We're leading the future of snacking with iconic brands such as Oreo, belVita and LU biscuits; Cadbury Dairy Milk, Milka and Toblerone chocolate; Sour Patch Kids candy and Trident gum. Our 90,000 colleagues around the world are key to the success of our business. Great people and great brands . That's who we are. Join us on our mission to continue leading the future of snacking around the world by offering the right snack , for the right moment , made the right way . As a part of Sales , you'll put our customers at the heart of our business. By building strong relationships with every customer, big or small, you'll help Mondelēz International become the supplier of choice and ensure we deliver world-class execution of our business plans in every store. Primary Role: The role of the Mondelēz International Sales Service Representative Order Writer (SSROW) is to build a world-class Direct Store Delivery (DSD) business at the retail level. Sales Service Representative Order Writers (SSROW) fulfill the merchandising needs of our grocery-related customers through stocking the shelves and building and maintaining displays. We service nationally recognized customers such as Walmart, Kroger and Target, as well as regional customers. As a Sales Service Representative Order Writer (SSROW) for our company, you are primarily, though not exclusively, merchandising Nabisco specific brands. This includes physically moving products from the backrooms of our customer stores and then stocking the product on the shelf. Areas of focus will include stocking to ensure full-shelf conditions, neatly-merchandising displays and shelves, building display point-of-sale in all areas of the store, properly-rotating product on the shelf, and creating and hanging accurate price tags / point-of-sale in all departments. A major objective of this role is to establish and maintain clear and effective communication with key store individuals and fellow Mondelēz team members, while providing outstanding customer service. This role will be responsible for maintaining an efficient and accurate merchandising service schedule, which includes driving to multiple customer stores throughout the shift. The SSROW will also be responsible for identifying selling opportunities at store level and communicating those opportunities, and individual store problems to the appropriate Mondelēz International personnel. Mondelēz International is an employer of inclusion who partners with diversity groups that cater to people of all races, colors, religions, national origins, ethnicities, ages, genders, sexual orientations, gender identities, and gender expressions. Our company also works with military veterans to help hire our heroes who have served our nation, as well as partnering with disability networks to include people of all abilities to help the company succeed for years to come. Benefits and Compensation: The FULL-TIME Sales Service Representative position offers a comprehensive medical, dental and vision benefit package, Employee Assistance Program, paid vacation and holidays. Along with a competitive hourly compensation rate, the role also offers work related mileage reimbursement and eligibility to participate in an incentive program. Hourly compensation starting range: $13 - $15, subject to relevant experience. Key Competencies: Planning and organizing skills Effective communication skills Creativity Flexibility Detail-oriented Problem solving skills Self-starter Selling and Inventory Management: Fully using sales, order management systems and technologies that ensure exceptional customer service Promotions/Merchandising: Identifying opportunities to use promotional and merchandising techniques to develop and support customer relations Computer literate (Microsoft Office, Internet and Cellular/Wireless devices) Requirements: Ability to perform hard work in a fast-paced work environment and to meet the defined physical activities, which include: Repetitive lifting (from floor to waist, chest high and above), bending, and carrying up to 25 lbs., occasionally over 50 lbs., pushing & pulling over 100 lbs., etc., occasional ladder use, while adhering to established safety expectations and processes Ability to stand and stock shelves, using repetitive hand/arm motions throughout the entire shift Unpacking Nabisco product consisting of 100 cases or more Experience utilizing hand pallet jack and pushing/pulling U-Boat carts is preferred. Previous retail / grocery experience is a plus, as well as work that has included physical activities (lifting, bending, reaching, carrying, pushing and pulling). Ability to drive your personal vehicle to a variety of store locations (mileage will be reimbursed). A flexible work schedule is required, including being available to work weekends and holidays. Additional responsibilities as assigned. High School Diploma or GED required. You must be at least 18 years of age, have a valid driver's license, reliable transportation and proof of auto insurance. Successful completion of drug test, MVR check, and general background check. Mondelēz Global LLC is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected Veteran status, sexual orientation, gender identity, gender expression, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact 847-943-5460 for assistance.
Mondelez International Morristown, TN, USA Full-Time
Part-Time Nabisco Retail Merchandise Stocker - Franklin, TN - 1907818
Mondelēz International, Inc. empowers people to snack right in over 160 countries around the world. We're leading the future of snacking with iconic brands such as Oreo, belVita and LU biscuits; Cadbury Dairy Milk, Milka and Toblerone chocolate; Sour Patch Kids candy and Trident gum. Our 90,000 colleagues around the world are key to the success of our business. Great people and great brands . That's who we are. Join us on our mission to continue leading the future of snacking around the world by offering the right snack , for the right moment , made the right way . As a part of Sales, you'll put our customers at the heart of our business. By building strong relationships with every customer, big or small, you'll help Mondelēz International become the supplier of choice and ensure we deliver world-class execution of our business plans in every store. Primary Role: The role of the Mondelēz International Sales Service Representative (Stocker) is to build a world-class Direct Store Delivery (DSD) business at the retail level. Sales Service Representatives (Stockers) fulfill the merchandising needs of our grocery-related customers through stocking the shelves and building and maintaining displays. We service nationally recognized customers such as Walmart, Kroger and Target, as well as regional customers. As a Sales Service Representative (Stocker) for our company, you are primarily, though not exclusively, merchandising Nabisco specific brands. This includes physically moving products from the backrooms of our customer stores and then stocking the product on the shelf. Areas of focus will include stocking to ensure full-shelf conditions, neatly-merchandising displays and shelves, building display point-of-sale in all areas of the store, properly-rotating product on the shelf, and creating and hanging accurate price tags / point-of-sale in all departments. A major objective of this role is to establish and maintain clear and effective communication with key store individuals and fellow Mondelēz team members, while providing outstanding customer service. This role will be responsible for maintaining an efficient and accurate merchandising service schedule, which includes driving to multiple customer stores throughout the shift. This role is also be responsible for identifying and communicating individual store opportunities to the appropriate Mondelēz International personnel. Mondelēz International is an employer of inclusion who partners with diversity groups that cater to people of all races, colors, religions, national origins, ethnicities, ages, genders, sexual orientations, gender identities, and gender expressions. Our company also works with military veterans to help hire our heroes who have served our nation, as well as partnering with disability networks to include people of all abilities to help the company succeed for years to come. Benefits and Compensation: The PART-TIME Sales Service Representative position offers a competitive hourly compensation rate, work related mileage reimbursement and an Employee Assistance Program. Hourly compensation fixed rate: $13, subject to relevant experience. Key Competencies: Ability to perform hard work in a fast-paced work environment and to meet the defined physical activities, which include: Repetitive lifting (from floor to waist, chest high and above), bending, and carrying up to 25 lbs., occasionally over 50 lbs., pushing & pulling over 100 lbs., etc., occasional ladder use, while adhering to established safety expectations and processes Ability to stand and stock shelves, using repetitive hand/arm motions throughout the entire shift Unpacking Nabisco product consisting of 100 cases or more Experience utilizing hand pallet jack and pushing/pulling U-Boat carts is preferred Previous retail / grocery experience is a plus, as well as work that has included repetitive physical activities (lifting, bending, reaching, carrying, pushing and pulling) Ability to drive your personal vehicle to a variety of store locations (mileage will be reimbursed) A flexible work schedule is required, including being available to work weekends and holidays Additional responsibilities as assigned You must be at least 18 years of age, have a valid driver's license, reliable transportation and proof of auto insurance Have a personal email account and access to the internet (business internet/data expenses will be reimbursed up to $10/per month, unless documentation of higher expenses incurred is provided) Successful completion of a drug test, MVR check, and general background check Requirements: You must be at least 18 years of age, have a valid driver's license, reliable transportation, proof of auto insurance and have access to the internet with a personal email account. A flexible work schedule is required, including being available to work weekends and holidays. Previous retail / grocery experience a plus. Successful completion of drug test, MVR check, and general background check. Mondelēz Global LLC is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, gender, national origin, disability, protected Veteran status, uniform service, sexual orientation, gender identity, gender expression, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact 847-943-5460 for assistance. Applicants must complete all required steps in the application process, including providing education and work history, in order to be considered for this position. All applicants will receive an email after submitting the first stage of the application. This email will include a link to return to the second stage of the application process. If you had previously submitted a resume, you will need to confirm/verify education and work history. For those that did not submit a resume, you will need to manually enter education and work history.
Mondelez International Franklin, TN, USA Part-Time
Part-time Nabisco Retail Merchandise Stocker- Brentwood, TN - 1907900
Mondelēz International, Inc. empowers people to snack right in over 160 countries around the world. We're leading the future of snacking with iconic brands such as Oreo, belVita and LU biscuits; Cadbury Dairy Milk, Milka and Toblerone chocolate; Sour Patch Kids candy and Trident gum. Our 90,000 colleagues around the world are key to the success of our business. Great people and great brands . That's who we are. Join us on our mission to continue leading the future of snacking around the world by offering the right snack , for the right moment , made the right way . As a part of Sales, you'll put our customers at the heart of our business. By building strong relationships with every customer, big or small, you'll help Mondelēz International become the supplier of choice and ensure we deliver world-class execution of our business plans in every store. Primary Role: The role of the Mondelēz International Sales Service Representative (Stocker) is to build a world-class Direct Store Delivery (DSD) business at the retail level. Sales Service Representatives (Stockers) fulfill the merchandising needs of our grocery-related customers through stocking the shelves and building and maintaining displays. We service nationally recognized customers such as Walmart, Kroger and Target, as well as regional customers. As a Sales Service Representative (Stocker) for our company, you are primarily, though not exclusively, merchandising Nabisco specific brands. This includes physically moving products from the backrooms of our customer stores and then stocking the product on the shelf. Areas of focus will include stocking to ensure full-shelf conditions, neatly-merchandising displays and shelves, building display point-of-sale in all areas of the store, properly-rotating product on the shelf, and creating and hanging accurate price tags / point-of-sale in all departments. A major objective of this role is to establish and maintain clear and effective communication with key store individuals and fellow Mondelēz team members, while providing outstanding customer service. This role will be responsible for maintaining an efficient and accurate merchandising service schedule, which includes driving to multiple customer stores throughout the shift. This role is also be responsible for identifying and communicating individual store opportunities to the appropriate Mondelēz International personnel. Mondelēz International is an employer of inclusion who partners with diversity groups that cater to people of all races, colors, religions, national origins, ethnicities, ages, genders, sexual orientations, gender identities, and gender expressions. Our company also works with military veterans to help hire our heroes who have served our nation, as well as partnering with disability networks to include people of all abilities to help the company succeed for years to come. Benefits and Compensation: The PART-TIME Sales Service Representative position offers a competitive hourly compensation rate, work related mileage reimbursement and an Employee Assistance Program. Key Competencies: Ability to perform hard work in a fast-paced work environment and to meet the defined physical activities, which include: Repetitive lifting (from floor to waist, chest high and above), bending, and carrying up to 25 lbs., occasionally over 50 lbs., pushing & pulling over 100 lbs., etc., occasional ladder use, while adhering to established safety expectations and processes Ability to stand and stock shelves, using repetitive hand/arm motions throughout the entire shift Unpacking Nabisco product consisting of 100 cases or more Experience utilizing hand pallet jack and pushing/pulling U-Boat carts is preferred Previous retail / grocery experience is a plus, as well as work that has included repetitive physical activities (lifting, bending, reaching, carrying, pushing and pulling) Ability to drive your personal vehicle to a variety of store locations (mileage will be reimbursed) A flexible work schedule is required, including being available to work weekends and holidays Additional responsibilities as assigned You must be at least 18 years of age, have a valid driver's license, reliable transportation and proof of auto insurance Have a personal email account and access to the internet (business internet/data expenses will be reimbursed up to $10/per month, unless documentation of higher expenses incurred is provided) Successful completion of a drug test, MVR check, and general background check Requirements: You must be at least 18 years of age, have a valid driver's license, reliable transportation, proof of auto insurance and have access to the internet with a personal email account. A flexible work schedule is required, including being available to work weekends and holidays. Previous retail / grocery experience a plus. Successful completion of drug test, MVR check, and general background check. Mondelēz Global LLC is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, gender, national origin, disability, protected Veteran status, uniform service, sexual orientation, gender identity, gender expression, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact 847-943-5460 for assistance. Applicants must complete all required steps in the application process, including providing education and work history, in order to be considered for this position. All applicants will receive an email after submitting the first stage of the application. This email will include a link to return to the second stage of the application process. If you had previously submitted a resume, you will need to confirm/verify education and work history. For those that did not submit a resume, you will need to manually enter education and work history.
Mondelez International Brentwood, TN, USA Part-Time
PART-TIME Nabisco Sales Service Representative/Stocker - McMinnville, TN. Hourly compensation starting range: $11 - $13, subject to relevant experience - 1906356
Mondelez International Murfreesboro, TN, USA Part-Time
Full Time Nabisco Sales Service Representative/Merchandiser Order Writer - Knoxville/Clinton, TN. Hourly compensation starting range: $13 - $15, subject to relevant experience. - 1906362
Mondelēz International, Inc. empowers people to snack right in over 160 countries around the world. We're leading the future of snacking with iconic brands such as Oreo, belVita and LU biscuits; Cadbury Dairy Milk, Milka and Toblerone chocolate; Sour Patch Kids candy and Trident gum. Our 90,000 colleagues around the world are key to the success of our business. Great people and great brands . That's who we are. Join us on our mission to continue leading the future of snacking around the world by offering the right snack , for the right moment , made the right way . As a part of Sales , you'll put our customers at the heart of our business. By building strong relationships with every customer, big or small, you'll help Mondelēz International become the supplier of choice and ensure we deliver world-class execution of our business plans in every store. Primary Role: The role of the Mondelēz International Sales Service Representative Order Writer (SSROW) is to build a world-class Direct Store Delivery (DSD) business at the retail level. Sales Service Representative Order Writers (SSROW) fulfill the merchandising needs of our grocery-related customers through stocking the shelves and building and maintaining displays. We service nationally recognized customers such as Walmart, Kroger and Target, as well as regional customers. As a Sales Service Representative Order Writer (SSROW) for our company, you are primarily, though not exclusively, merchandising Nabisco specific brands. This includes physically moving products from the backrooms of our customer stores and then stocking the product on the shelf. Areas of focus will include stocking to ensure full-shelf conditions, neatly-merchandising displays and shelves, building display point-of-sale in all areas of the store, properly-rotating product on the shelf, and creating and hanging accurate price tags / point-of-sale in all departments. A major objective of this role is to establish and maintain clear and effective communication with key store individuals and fellow Mondelēz team members, while providing outstanding customer service. This role will be responsible for maintaining an efficient and accurate merchandising service schedule, which includes driving to multiple customer stores throughout the shift. The SSROW will also be responsible for identifying selling opportunities at store level and communicating those opportunities, and individual store problems to the appropriate Mondelēz International personnel. Mondelēz International is an employer of inclusion who partners with diversity groups that cater to people of all races, colors, religions, national origins, ethnicities, ages, genders, sexual orientations, gender identities, and gender expressions. Our company also works with military veterans to help hire our heroes who have served our nation, as well as partnering with disability networks to include people of all abilities to help the company succeed for years to come. Benefits and Compensation: The FULL-TIME Sales Service Representative position offers a comprehensive medical, dental and vision benefit package, Employee Assistance Program, paid vacation and holidays. Along with a competitive hourly compensation rate, the role also offers work related mileage reimbursement and eligibility to participate in an incentive program. Key Competencies: Planning and organizing skills Effective communication skills Creativity Flexibility Detail-oriented Problem solving skills Self-starter Selling and Inventory Management: Fully using sales, order management systems and technologies that ensure exceptional customer service Promotions/Merchandising: Identifying opportunities to use promotional and merchandising techniques to develop and support customer relations Computer literate (Microsoft Office, Internet and Cellular/Wireless devices) Requirements: Ability to perform hard work in a fast-paced work environment and to meet the defined physical activities, which include: Repetitive lifting (from floor to waist, chest high and above), bending, and carrying up to 25 lbs., occasionally over 50 lbs., pushing & pulling over 100 lbs., etc., occasional ladder use, while adhering to established safety expectations and processes Ability to stand and stock shelves, using repetitive hand/arm motions throughout the entire shift Unpacking Nabisco product consisting of 100 cases or more Experience utilizing hand pallet jack and pushing/pulling U-Boat carts is preferred. Previous retail / grocery experience is a plus, as well as work that has included physical activities (lifting, bending, reaching, carrying, pushing and pulling). Ability to drive your personal vehicle to a variety of store locations (mileage will be reimbursed). A flexible work schedule is required, including being available to work weekends and holidays. Additional responsibilities as assigned. High School Diploma or GED required. You must be at least 18 years of age, have a valid driver's license, reliable transportation and proof of auto insurance. Successful completion of drug test, MVR check, and general background check. Mondelēz Global LLC is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected Veteran status, sexual orientation, gender identity, gender expression, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact 847-943-5460 for assistance.
Mondelez International Knoxville, TN, USA Full-Time
Part-Time Nabisco Retail Merchandise Stocker - Knoxville, TN - 1907263
Mondelēz International, Inc. empowers people to snack right in over 160 countries around the world. We're leading the future of snacking with iconic brands such as Oreo, belVita and LU biscuits; Cadbury Dairy Milk, Milka and Toblerone chocolate; Sour Patch Kids candy and Trident gum. Our 90,000 colleagues around the world are key to the success of our business. Great people and great brands . That's who we are. Join us on our mission to continue leading the future of snacking around the world by offering the right snack , for the right moment , made the right way . As a part of Sales, you'll put our customers at the heart of our business. By building strong relationships with every customer, big or small, you'll help Mondelēz International become the supplier of choice and ensure we deliver world-class execution of our business plans in every store. Primary Role: The role of the Mondelēz International Sales Service Representative (Stocker) is to build a world-class Direct Store Delivery (DSD) business at the retail level. Sales Service Representatives (Stockers) fulfill the merchandising needs of our grocery-related customers through stocking the shelves and building and maintaining displays. We service nationally recognized customers such as Walmart, Kroger and Target, as well as regional customers. As a Sales Service Representative (Stocker) for our company, you are primarily, though not exclusively, merchandising Nabisco specific brands. This includes physically moving products from the backrooms of our customer stores and then stocking the product on the shelf. Areas of focus will include stocking to ensure full-shelf conditions, neatly-merchandising displays and shelves, building display point-of-sale in all areas of the store, properly-rotating product on the shelf, and creating and hanging accurate price tags / point-of-sale in all departments. A major objective of this role is to establish and maintain clear and effective communication with key store individuals and fellow Mondelēz team members, while providing outstanding customer service. This role will be responsible for maintaining an efficient and accurate merchandising service schedule, which includes driving to multiple customer stores throughout the shift. This role is also be responsible for identifying and communicating individual store opportunities to the appropriate Mondelēz International personnel. Mondelēz International is an employer of inclusion who partners with diversity groups that cater to people of all races, colors, religions, national origins, ethnicities, ages, genders, sexual orientations, gender identities, and gender expressions. Our company also works with military veterans to help hire our heroes who have served our nation, as well as partnering with disability networks to include people of all abilities to help the company succeed for years to come. Benefits and Compensation: The PART-TIME Sales Service Representative position offers a competitive hourly compensation rate, work related mileage reimbursement and an Employee Assistance Program. Hourly compensation starting range: $11 - $13, subject to relevant experience. Key Competencies: Ability to perform hard work in a fast-paced work environment and to meet the defined physical activities, which include: Repetitive lifting (from floor to waist, chest high and above), bending, and carrying up to 25 lbs., occasionally over 50 lbs., pushing & pulling over 100 lbs., etc., occasional ladder use, while adhering to established safety expectations and processes Ability to stand and stock shelves, using repetitive hand/arm motions throughout the entire shift Unpacking Nabisco product consisting of 100 cases or more Experience utilizing hand pallet jack and pushing/pulling U-Boat carts is preferred Previous retail / grocery experience is a plus, as well as work that has included repetitive physical activities (lifting, bending, reaching, carrying, pushing and pulling) Ability to drive your personal vehicle to a variety of store locations (mileage will be reimbursed) A flexible work schedule is required, including being available to work weekends and holidays Additional responsibilities as assigned You must be at least 18 years of age, have a valid driver's license, reliable transportation and proof of auto insurance Have a personal email account and access to the internet (business internet/data expenses will be reimbursed up to $10/per month, unless documentation of higher expenses incurred is provided) Successful completion of a drug test, MVR check, and general background check Requirements: You must be at least 18 years of age, have a valid driver's license, reliable transportation, proof of auto insurance and have access to the internet with a personal email account. A flexible work schedule is required, including being available to work weekends and holidays. Previous retail / grocery experience a plus. Successful completion of drug test, MVR check, and general background check. Mondelēz Global LLC is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, gender, national origin, disability, protected Veteran status, uniform service, sexual orientation, gender identity, gender expression, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact 847-943-5460 for assistance. Applicants must complete all required steps in the application process, including providing education and work history, in order to be considered for this position. All applicants will receive an email after submitting the first stage of the application. This email will include a link to return to the second stage of the application process. If you had previously submitted a resume, you will need to confirm/verify education and work history. For those that did not submit a resume, you will need to manually enter education and work history.
Mondelez International Knoxville, TN, USA Part-Time
Part Time Nabisco Retail Merchandise Stocker - Kodak, TN - 1906947
Mondelez International Kodak, TN 37764, USA Part-Time
PART-TIME Nabisco Sales Service Representative/Stocker- Athens, TN. Hourly compensation starting range: $12 - $13, subject to relevant experience - 1906849
Mondelez International Athens, TN 37303, USA Part-Time
Part Time Nabisco Merchandiser - Knoxville, TN - 1814330
With our portfolio of global Power Brands such as Oreo and belVita biscuits, Cadbury Dairy Milk and Milka chocolate and Trident gum, we're the world's #1 in biscuits and candy, and #2 in chocolate and gum. We're Mondelēz International , a snacking powerhouse with operations in more than 80 countries, with approximately 90,000 employees globally and our brands are marketed in around 165 countries. Our purpose and vision is to create more MOMENTS OF JOY by building the BEST SNACKING COMPANY IN THE WORLD . As a part of Sales , you'll put our customers at the heart of our business. By building strong relationships with every customer, big or small, you'll help Mondelēz International become the supplier of choice and ensure we deliver world-class execution of our business plans in every store. Primary Role: The role of the Mondelēz International Sales Service Representative (Merchandiser) is to build a world-class Direct Store Delivery (DSD) business at the retail level by fulfilling the merchandising needs of our grocery-related customers. As a Merchandiser for our company you are primarily, though not exclusively, merchandising Nabisco specific brands. Areas of focus will include full-shelf conditions, neatly-merchandised displays and shelves, building display point-of-sale in all areas of the store, properly-rotated product on the shelf, and accurate price tags / point-of-sale in all departments. A major objective of this role is to establish and maintain rapport with key store individuals, while providing outstanding customer service. This role will be responsible for maintaining a timely and accurate merchandising call schedule. This role will also be responsible for identifying and communicating individual store opportunities to the appropriate Mondelēz International personnel. Mondelēz International is an employer of inclusion who partners with diversity groups which cater to people of all ethnicities, genders, ages and sexual orientations. Mondelēz International also works with military veterans to help hire our heroes who have served our nation, as well as partner with disability networks to include people of all abilities to help the company succeed for years to come. Benefits and Compensation: The PART-TIME Sales Service Representative position offers a competitive hourly compensation rate, work related mileage reimbursement and an Employee Assistance Program. Key Competencies: Ability to perform hard work in a fast-pace work environment and meet the defined physical activities (frequent lifting, bending, and carrying up to 25 lbs., occasionally over 50 lbs., pushing, pulling, etc.) while adhering to the safety expectations and processes Planning and organizing skills Effective communication skills Creativity Flexibility Detail-oriented Problem solving skills Computer literate (Microsoft Office, Internet and Cellular/Wireless devices) Requirements: You must be at least 18 years of age, have a valid driver's license, reliable transportation, proof of auto insurance and have access to the internet with a personal email account. A flexible work schedule is required, including being available to work weekends and holidays. Previous retail / grocery experience a plus. Successful completion of drug test, MVR check, and general background check. Mondelēz Global LLC is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, gender, national origin, disability, protected Veteran status, uniform service, sexual orientation, gender identity, gender expression, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact 847-943-5460 for assistance. Applicants must complete all required steps in the application process, including providing education and work history, in order to be considered for this position. All applicants will receive an email after submitting the first stage of the application. This email will include a link to return to the second stage of the application process. If you had previously submitted a resume, you will need to confirm/verify education and work history. For those that did not submit a resume, you will need to manually enter education and work history.


One of my most popular posts ever is one that lists various webcams where it's possible to see orcas. Most of them aren't really designed for wildlife viewing, so aren't really set up for watching live whales. There's a new video webcam that is just awesome to watch whether the whales are around or not - but in my first week of checking in on it, I did in fact see orcas!
OrcaLab is a land-based research station off northern Vancouver Island, set up right in the heart of the summer territory of the Northern Resident killer whales. Founded by whale researcher Dr. Paul Spong, OrcaLab conducts research on wild whales, advocates against killer whales in captivity, and shares the beauty of the Inside Passage with people around the world. The audio part of OrcaLab is known as OrcaLive, where you can tune into live streaming hydrophones much like you can at OrcaSound for listening in to the Southern Resident orca's core range. At OrcaLive there is also a community page where you can connect with other listeners. (Note: I haven't been able to get very clear audio from OrcaLive myself - I'm wondering if it has something to do with being a Mac user? It has a lot of electronic distortion noise with it. I'd love to hear if other Mac users have more success tuning in!
Eileen, another viewer, has posted some of her fantastic screen shots to a Flickr album here, showing a little bit better idea of what it can look like. She got some shots of both orcas and dolphins, and even some shots where it's possible to ID the whales.
Every time I've tuned in when the camera was on, there is something cool to look at, whether the whales are there or not. I encourage you to check it out! Here's the link again.


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Laser scanners, sensors to protect key Trans-Anatolian gas pipeline
May 30 2014 00:01:00
TANAP aims to start carrying 16 billion cubic metres (bcm) of gas per year by 2018 or 2019 from Azerbaijan's Shah Deniz II field in the Caspian Sea.
he Trans Anatolian Natural Gas Pipeline (TANAP), a $12 billion investment that is projected to carry Azerbaijani gas to western Turkey, will be constantly monitored and protected via high-tech methods, according to a draft environmental impact assessment report.
The monitoring system for the 1,085-kilometer pipeline will be accessible from its stations and planned control chambers, the report said.
The staff and vehicle identification system will be decorated with digital equipment, which will ease detecting any attacks on the pipeline and its stations, Anadolu Agency reported May 29.
Turkey's oil pipelines in the southeastern provinces have suffered from both terrorist attacks and theft.
Vital for Turkey, Europe
The planned security system merges optical sensors, motion perception cables and laser scanners to eye compressors, gas valves and pigging and measuring stations. Surveillance cameras will also contribute to security.
An illumination system will also ease reactions against any problems, the report said. Security staff will be trained on action plans and procedures, it said.
The observing system is designed to provide accurate data and visual material in the case of an emergency, it also said.
Energy-hungry Turkey is raising high hopes on the pipeline, which is projected to bring in annually 16 billion cubic meters (bmc) of gas to Turkey initially, as the country is trying to break its Russian dependency for its largest product of imports.
The gas will be shipped across Turkey and eventually into Italy through TANAP, which will link to the Trans-Adriatic Pipeline (TAP), whose partners include BP and Statoil.
Azerbaijan's giant Shah Deniz II is expected to supply 10 billion bcm per year to Europe, in addition to the 6 bcm that Turkey will keep for its own needs.
Europe is also hopeful of the project in terms of reducing the share of Russian gas it consumes.
"This is a major milestone for the diversification of our energy supplies, to the benefit of European consumers and businesses," Reuters had quoted European Commission President Jose Manuel Barroso as saying at the end of last year.
The state of Azerbaijan will pay $7 billion for the project, while Turkey's state-run pipeline company will contribute between $3 billion to $5 billion and the rest will be financed by BP, another partner, daily Hurriyet has reported. The project executives have said the pipeline will be operative as of 2018.


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Companies recognize that maintaining a safe work environment is just as important as increasing productivity. Its maximizing the safety and efficiency of a facility that matters most, and SDVs are a tool both manufacturers and warehouses can use to makes this possible
Contributed by | OTTO Motors
05/17/18, 08:54 AM | Other Topics | Clearpath Robotics | self driving
Technology has made a significant impact on operational efficiency in factories, distribution centers, and warehouses. Automation through the use of self-driving vehicles has specifically made a difference in material handling. But there is another important benefit to self-driving technology - safety. Self-driving vehicles can create an ideal mix of process improvements and a safer workplace for employees.
"We think there's a lot of areas where robots can lend additional safety to factories. They don't get tired or cut corners, and it's always been a general condition of ours to maintain that benefit, so that we are not only helping with productivity, but also building a safer solution." - Ryan Gariepy
A primary goal of any industrial environment is to provide safe working conditions. Aside from being the right thing to do, it's a prudent business decision. Unfortunately, accidents with forklifts, racking, and other material handling equipment are common in factories and warehouses.
Plus, ergonomic issues such as strain, overexertion, and heavy lifting, can lead to employee time off and overall higher costs for the employer. Understanding this, many manufacturers continually look for ways to reduce physical stress on workers with the intent of preventing work-related injuries and other problems.
Another deterrent can be the direct financial cost of an unsafe working environment. OSHA penalties for workplace hazards can range from $7,000 for smaller violations up to $70,000 for repeat offenders.
An engaged and happy employee contributes to a safer and more productive workforce as well. A study conducted by Gallup found that the top 25% of the teams they studied (those identified as "most engaged") had 50% fewer workplace incidents. These employees were also less likely to call out sick or leave the job. When a safe workplace is maintained, the business enjoys the added benefit of satisfied employees - and a stable workforce.
A warehouse or distribution center can be full of hazards. According to OSHA, the fatal injury rate for the warehouse industry is higher than the national average for all industries. Causes of accidental injuries can come about from the unsafe use of forklifts, incorrect materials stacking, and failure to use personal protective equipment. Each is a specific function improved or avoided through automation.
There are 96,785 accidents per year related to forklifts. Compared to the estimated number of forklifts in the United States (855,900), that means that each year, more than 1 in 10 forklifts are involved in an accident.
The dock is one area in particular in a warehouse where employees are at risk for sustaining serious injuries. The American Supply Association states that 25% of all industrial accidents happen in this location of the facility, many of which are due to forklifts. OSHA's dock-related accident report cited common accidents as being fractured legs from being hit by dock plates or falling/ driving off the dock. The control and predictability of SDVs in this specific work location has obvious benefits for individuals and the company.
Self-driving vehicles and other material handling automation can also have applications for preventing other types of injuries that may happen over time, such as from repeatedly reaching into hard-to-get-to storage shelves, lifting heavy boxes onto pallets, or other repetitive use problems.
"Our self-driving vehicles could go even faster. OTTO software and hardware allows for significantly faster speeds but for safety reasons, constraints have been put on them. OTTO is designed to work alongside humans, not to race them." - Ryan Gariepy
Making matters worse for manufacturers and distribution center operators with regards to safety is the general market trend towards greater supply chain velocity. Everything needs to get done faster today - from sourcing to production to shipping - but doing so can create all types of safety risks for employees.
As throughput increases, it can become harder for human workers to physically keep up with certain tasks. Most material handling and production operations require machine to worker handoffs at various points so this is unavoidable. An example could be when a pallet of finished product is complete and must be moved to shipping. An employee with a hand truck or forklift can perform the task, but a properly used SDV can do so more safely and reliably. Forced to move, say, twice the pallets because of faster production creates even greater pressure that can lead to poor decision making by employees when it comes to safety. Higher expectations, and unrealistic quotas, will inevitably have negative consequences and when there is pressure to perform. It's often safety that gets pushed aside first.
Safe Self-Driving Vehicles
"When an accident happens in an industrial environment with a forklift, there isn't an immediate thought to remove all forklifts from use. With self-driving vehicles, we want to do even better than that. We want to ensure there are no accidents that ever call into question the safety of our vehicles." - Ryan Gariepy
Self-driving vehicles can play a key role for companies looking to safely bridge these types of gaps in workflows and other unsafe situations in their operations. It's a technology perfectly designed for many of the tasks in production and warehouse that put employees most at risk, but the vehicles themselves can integrate seamlessly, and safely, with employees everywhere in the work environment too.
This is possible because self-driving vehicles used as part of the material handling function or anywhere else are fully aware of what's going on around them. They can see, react, and avoid the people and circumstances around them - creating a safer environment even as the speed of production continues to increase.
Companies recognize that maintaining a safe work environment is just as important as increasing productivity. Ultimately, it's maximizing the safety and efficiency of a facility that matters most, and SDVs are a tool both manufacturers and warehouses can use to makes this possible.
Published with permission from the OTTO MOTORS blog.
The content & opinions in this article are the author's and do not necessarily represent the views of RoboticsTomorrow
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Zaber LC40 Non Motorized Linear Stage Gantry Systems
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5. Any refunds will take this discount into account.


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So it's 2007. Wow. I still remember the back to the millennium celebration, and yet that seems far in the distant past.
Well, this New Years was certainly interesting. One of my close friend's baby was born just before midnight! How crazy is that? But I didn't find out about that until this morning.
Last night, I went to Times Square to watch the ball drop. It was really awesome. I threw a party with over 30 people and we all got hammered and (almost all of us) had a great time. That said, there was certainly no shortage of drama.
There was a late twenties gay couple who came to the party. They have been together for many years, but still had relationship issues because one guy was a total flirt. He would approach you and stand a little too close and lay his hand on the small of your back or in your hair while talking. Suffice it to say, his boyfriend saw the other "flirting" and was not amused, so he started to do the same thing. Well, after the ball dropped, they left the building and apparently got into a fist fight on the street and then one of them got arrested. Talk about drama! Fortunately, the police let him go after being detained for a while, but still... it was unreal.
So there it is. I hope you all have a healthy and happy new year.


The Ion Neo Jackets can be worm both on and off the water. They give a nice wind breaking layer and the harness can still be worn while you're using it. A great choice to keep warm while hanging on the beach trying to keep warm for your next session.


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Barbara Bush Houston Literacy Foundation:
24th Annual A Celebration of Reading
2018 A Celebration of Reading; Photo by Dave Rossman
Alexander Andrews, Robbie Derrick, Lizzie Andrews, Pace Andrews, Pierce Bush, Sarahbeth Bush, Ashley
Victoria White, Marquist Taylor; Photo by Dave Rossman
Cal, Hannah, Janice and Bob McNair; Photo by Dave Rossman
Charles and Betty Fox with Julie Baker Finck and Ron Finck; Photo by Dave Rossman
Christina _CK_ Kerley, Governor John Kasich, Jim Gaffigan, Candice Millard, Clive Cussler, Photo by
Greg Garland, Sonya Reed and Enrique San Miguel; Photo by Dave Rossman
John and Cindy Gremp with Liz and Chad Deaton; Photo by Dave Rossman
Julie Baker Finck, Ashley Bush, Neil and Maria Bush on stage at A Celebration of Reading; Photo by D
Mary Sarah; Photo by Dave Rossman
Neil and Maria Bush, Terri and John Havens, Photo by Jenny Antill
Betty and John Hrncir; Photo by Dave Rossman
Bill and Iris Griffiths, Photo by Jenny Antill
Cathy and Joe Cleary, Photo by Jenny Antill
Clemmie Pierce, Sarahbeth Bush, Photo by Jenny Antill
John Verity and Katherine Clegg; Photo by Dave Rossman
Kristen Stubbs and Ernest Johnson; Photo by Dave Rossman
Linda McReynolds and Rose Cullen; Photo by Dave Rossman
Mike and Laurel D'Antoni; Photo by Dave Rossman
Stuart Smith, Trish Morille, Photo by Jenny Antill
The 24th annual A Celebration of Reading was held at the Hobby Center for the Performing Arts on Thursday, April 19, 2018. The uplifting evening, hosted by Neil and Maria Bush, chairs of the Barbara Bush Houston Literacy Foundation, raised over $2.4 million to benefit the local Barbara Bush Houston Literacy Foundation as well as the national Barbara Bush Foundation for Family Literacy.
Nearly 1900 guests gathered at the Hobby Center to celebrate the power of reading and former First Lady Barbara Bush's indelible legacy. Mrs. Bush championed the advancement of literacy for the better part of 30 years. This year's lineup of bestselling authors included Clive Cussler, Jim Gaffigan, Governor John Kasich, Christina "CK" Kerley, and Candice Millard.
The tribute to Barbara Bush began with remarks from James Baker, U.S. Secretary of State and White House Chief of Staff under President George H. W. Bush, who said of the former First Lady, "She was a true heroine who has helped build a better world – one person at a time . . . and we love her for that." Following Mr. Baker's remarks, a lighthearted video of the Curiosity Cruiser mobile library mascots, Northtale and Owlbotron, at a boot camp hosted by the mascots of the Houston Astros, the Houston Rockets, and the Houston Texans, was presented. To the delight of everyone in attendance, Barbara Bush and Neil Bush appeared at the end cheekily suggesting they had played the roles of the mobile library mascots.
Following the video, Neil and Maria Bush; Foundation President, Dr. Julie Baker Finck; and Ashley Bush, granddaughter of George H. W. Bush and Barbara Bush, spoke of their admiration for Mrs. Bush and her dedication to the cause of literacy. They also expressed their gratitude for the overwhelming outpouring of support, prayers, and messages following the former First Lady's passing.
When it came time to make the author presentations, each was introduced by a member of the Bush family. From the stage, the authors shared entertaining and unique stories depicting their personal experiences and expounding on their award-winning works.
The Reverend Dr. Russell Levenson of St. Martin's Episcopal Church followed the author presentations with his own poignant insights into Barbara Bush's last days. Reverend Levenson ended with a prayer followed by a moment of silence.
After the moment of silence, Houston's own Mary Sarah, a 2016 contestant on The Voice, performed Miley Cyrus's The Climb. Joining Victoria White, Marquist Taylor, and the 35-member Houston Gospel Choir, she then led the audience in singing Amazing Grace, concluding the emotional tribute to Barbara Bush.
Dinner, catered by Jackson and Company, followed. Guests enjoyed the delicious meal while sharing stories and sentiments from the memorable evening.
Guests: Clive Cussler, Jim Gaffigan, Governor John Kasich, Christina "CK" Kerley, Candice Millard, Neil and Maria Bush, Ron Finck and Julie Baker Finck, Jim Pierce, Clemmie Pierce, Janet Cussler, Annette Strake, Betty and John Hrncir, Rose Cullen, Anne and Dr. John Mendelsohn, Iris and Bill Griffiths, Cal and Hannah McNair, Lizzie Andrews, Alexander Andrews, Pace Andrews, Cathy and Joe Cleary, Sonya Reed and Enrique San Miguel, and Gail and Greg Garland.
Prior to the evening's festivities, a private authors' luncheon, hosted by Neil and Maria Bush, was held at the stately residence of Terri and John Havens to kick off the 2018 "A Celebration of Reading." Surrounded by the expansive grounds, the nearly 40 guests enjoyed a refreshing lunch courtesy of Jackson and Company. Neil Bush expressed his heartfelt gratitude to attendees for their kind words about his mother as well as their continued generosity and support of the foundation over the past five years.
Guests: Clive Cussler, Jim Gaffigan, Governor John Kasich, Christina "CK" Kerley, Candice Millard, Neil and Maria Bush, Julie Baker Finck, Janet Cussler, Gail and Greg Garland, Sonya Reed and Enrique San Miguel, Cathy and Joe Cleary, Sarah Beth Bush, Clemmie Pierce, Ty and Lee Tillman, and Trish Morille.
About Barbara Bush Houston Literacy Foundation
The Barbara Bush Houston Literacy Foundation is a charitable organization formed by Neil and Maria Bush to carry forth First Lady Barbara Bush's legacy in the literacy cause and to focus deeply on breaking the intergenerational cycle of low literacy in the Bush family's hometown. Founded on Mrs. Bush's belief, "If you help a person to read, then their opportunities in life will be endless," the Barbara Bush Foundation's mission is to improve lives through the power of literacy: the ability to read, write, speak clearly, and think critically.
For more information, please visit www.bushhoustonliteracy.org or follow us on Facebook at
www.facebook.com/bushhoustonliteracy, on Twitter @bushhoustonlit, and on Instagram.
@bushhoustonlit.


The first year of changes in U.S. Healthcare have impacted advertising and created new and expanded revenue categories. We'll quickly review the impact to radio advertising from the past year then turn our attention to the best prospects for the second year of the ACA. We'll look at healthcare categories and each of their marketing objectives so you can prepare the most compelling proposals. Join us to learn the best prospects and how to sell to them.
This webinar is only available to IBA dues paying member stations. It is free of charge.
Click Here to View the Archived Video of this Webinar.