Nutrition Therapy for Eating Disorders & Disordered Eating

According to the National Institute of Mental Health:

“Eating disorders are serious, biologically influenced medical illnesses marked by severe disturbances to one’s eating behaviors. Although many people think about their health, weight, or appearance from time to time, some people become fixated/obsessed with weight loss, body weight or shape, and controlling their food intake. These may be signs of an eating disorder.”

There is a common misconception that eating disorders are a choice and that only thin, white teenagers develop eating disorders. Unfortunately, the media often perpetuates this stereotype, but nothing could be farther from the truth!

Eating disorders are not a choice, and do not have “one” look.

Eating Disorders are capable of affecting any person at any age, racial/ethnic background, body weight, and gender.

Although eating disorders often appear during the teen years or young adulthood, they may also develop during childhood or later in life (40 years and older).

It’s important to keep in mind that people with eating disorders can appear healthy but be very ill; in fact, eating disorders can be life-threatening. Individuals with eating disorders will require ongoing support and, in most cases, a multi-disciplinary treatment team consisting of a medical doctor, mental health provider and a dietitian to recover.

Common types of eating disorders include: anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder (OSFED), avoidant/restrictive food intake disorder (ARFID), and pica.

Disordered eating sits on a spectrum between “normal eating” and an eating disorder and may include symptoms and behaviors of eating disorders, but to a lesser degree of severity.

Disordered eating may include restrictive eating and skipping meals, compulsive or binge eating, avoiding a particular type of food (i.e., like carbohydrates,) labeling foods as good or bad, using diet pills or other forms of purging, and/or inflexible eating patterns.

Dieting is one of the most common forms of disordered eating.

Unfortunately, disordered eating is very common because dieting and the pursuit of thinness is normalized in Western culture. I don’t know anyone who has not worried about their weight or body image! Do you?

In a nutshell, the difference between disordered eating and an eating disorder boils down to a few factors:

• the degree to which a person’s life is impaired emotionally by obsessive thoughts
• behaviors around food and body image
• the potential physical damage caused by some of the eating behaviors.

Disordered eating and diagnosable eating disorder behaviors exist along a continuum, and there can often be a fine line separating one from the other.

Both will usually develop as an ineffective way of managing uncomfortable feelings.

Both can cause distress and may require outside help in the form of therapy, nutrition therapy and/or medical monitoring for a person to fully heal.

Both deserve attention and treatment!

Common signs of an eating disorder, whether for yourself or your child or loved one include a preoccupation with weight loss (and the scale), food and body image.

Sometimes “wanting to get healthy” can be a catalyst.

Common eating behaviors are eating too little or too much, exercising excessively, following a strict diet plan with measuring, weighing and counting food, eliminating specific food groups (i.e., carbs), lying about hiding food or disordered food behaviors, disappearance of large amounts of food in a short period.

According to the Alliance for Eating disorders, certain characteristics can be tell-tale signs of an eating disorder. Here are characteristics they describe:

• Having ritualistic eating habits, rigid rules around food that interfere with daily functioning
• Refusing to eat with others
• Exercising excessively (to burn calories) or using other methods to burn calories such as vomiting, laxatives, diet pills
• Obsessing over physical characteristics and having unrealistic body weight/size goals
• Hoarding food, hiding food or food wrappers
• Ignoring physical signs of hunger and fullness
• Poor self-esteem and insecurities about physical characteristics
• Physical symptoms related to food restriction or binge eating such as GI problems, fatigue and weakness, dizziness, dehydration, high or low blood pressure, dramatic weight fluctuations, joint pain, irregular periods, swelling of cheeks, constipation
• Extreme picky eating/food refusal that is not tied to body image concern

If you recognize any of these common signs in yourself or a loved one, reach out for help. If you are unsure if you could have an eating disorder, consider taking this short Eating Disorder Screening from the National Eating Disorder Association (NEDA).

The telltale signs of an eating disorder can often be hidden in plain sight with our kids!  That’s because we see our kids on a daily basis so small changes in their food and activity patterns can be easily missed. Here are some important red flags that are unique to our kids and teens.

• Abnormal weight changes. Because childhood is an important time of growth and development, any changes to their weight can be a red flag. Kids AND teens should be gaining weight. If your child is not gaining weight or if they are actively losing weight (EVEN IF YOU THINK YOUR CHILD COULD  “AFFORD TO LOSE WEIGHT”) this is a sign of changes in eating patterns that should be explored with your child (and possibly their doctor.) Children and teens in all size bodies can develop eating disorders.
• Avoiding family meals. If your child refuses to eat with the rest of the family and starts to shun their favorite foods it can indicate some anxiety around eating.
• Sudden interest in “healthy eating,” (and looking at recipes, cooking) as well as body image concerns. Dieting behavior in a child can be a precursor to disordered eating or eating disorders.
• Change in mood/demeanor. A child who is suffering with an eating disorder can become anxious or withdrawn and self-isolate.

These are some possible signs that your child is struggling with their food and/or body image but it does not include every possible scenario. Do not be afraid to talk to your child and seek help from a medical professional, such as your pediatrician.  Early diagnosis and treatment are essential in helping your child to fully recover.

Overeating: Enjoying a delicious meal is one of life’s simple pleasures. Sometimes that restaurant or holiday meal tastes so good, it’s hard to stop eating, even if you’re feeling full. This is “overeating” and it doesn’t usually trigger feelings of guilt or shame. Overeating exists along a continuum of what we consider “normal” eating.

Emotional Eating: Emotional eating is eating for reasons beyond physical hunger. For example, drowning our sorrows in ice cream after a tough break-up, or eating popcorn mindlessly on the sofa because we are bored.

Binge Eating Disorder (BED): Binge Eating Disorder is much more than simply overeating or emotional eating. Read this blog to learn more.

While this list is not exhaustive of all the questions that people have about eating disorders, it covers the most often asked questions we get as dietitians who specialize working with clients who have eating disorders, disordered eating and are in recovery as well. The most important thing to remember is that people can recover and learn to make peace with food and their body image.

If you need help or have more questions, please reach out.

Start by booking a call with Erica, our practice owner, and she will talk with your to determine the best dietitian on our team to work with you. And remember, you are not alone. Eating disorders can affect anyone, the best step is to get help as you heal.