Kristen Chulada, RDN, LD

“If I eat, I’ll gain weight.”

“I should avoid that food because it will make me look fat.”

“I cannot stand to look at my body in the mirror.”

“I need to exercise today to burn off the dessert I ate last night.” 

“If I lose weight, I will be healthy.”

“If I lose weight, I will be enough.”

The number of people who experience these types of negative thoughts and feelings each day is staggering. Indeed, The National Eating Disorders Association estimates that as many as 30 million Americans will suffer from an eating disorder—and go through these emotions—at some point in their life. Yet, many still consider eating disorders a “food problem,” when in reality they are complex diseases that extend far beyond what a person eats. 

So, what can you do to be informed and keep from developing an eating disorder? Let us start by gaining a deeper understanding of the different types of disorders, risk factors and warning signs. 

Eating Disorders Defined

Eating disorders are classified as mental illnesses, based on strict diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). Eating disorders do not discriminate based on age, gender, race, ethnicity, or socioeconomic status. And while their exact cause is unknown, most experts agree they are the result of many different biological, psychological, and social/environmental factors. Here is a look at some of the most common disorders.

Binge Eating Disorder (BED) is the most prevalent eating disorder in the United States. BED sufferers frequently eat large quantities of food while feeling the loss of control, guilt, and shame.

Anorexia Nervosa is characterized by extreme food restriction due an intense fear of gaining weight or becoming fat. Weight loss is a component, however AN affects people in all body sizes. This is usually seen in people who have a negative or distorted body image.

Bulimia Nervosa is an emotional disorder like Anorexia Nervosa, where someone has a distorted view of their body. However, this eating disorder involves episodes of binging, or eating extreme amounts of food, followed by purging through self-induced vomiting, laxative abuse, or extreme exercise. 

Avoidant Restrictive Food Intake Disorder (ARFID) is often referred to as “extreme picky eating.” ARFID is characterized by severe food restrictions related to a lack of interest in food, avoidance based on the sensory characteristics of food, or concern about aversive consequences of eating. 

Orthorexia is another eating disorder that is sadly gaining popularity. But, unfortunately, the DSM-V has not yet classified it as a diagnosable disorder. Orthorexia is an obsession with healthy eating leading to extreme food rigidity and restriction which often causes weight loss and malnutrition. 

Risk Factors For Eating Disorders

Believe it or not, dieting is one of the biggest risk factors in developing an eating disorder, or what some in the medical field call disordered eating. Every day, Americans are flooded with dieting-related messages—many of which are contradictory and, at a minimum, confusing for most people. Christy Harrison, MPH, RD, CEDRD, defines this “diet culture” as a system of beliefs that: 

  • Worships thinness and equates it to health and moral virtue. This means you can spend your whole life thinking you are irreparably broken just because you do not look like the impossibly thin “ideal.”
  • Promotes weight loss as a means of attaining higher status. This means you feel compelled to spend a massive amount of time, energy, and money trying to shrink your body, even though research is clear that almost no one can sustain intentional weight loss for more than a few years.
  • Demonizes certain ways of eating, while elevating others. This means you are forced to be hyper-vigilant about your eating, ashamed of making certain food choices, and distracted from your pleasure, purpose, and power.
  • Oppresses people who do not match up with the supposed picture of “health,” which disproportionately harms certain populations, including women, people of color, and people with disabilities. This can be damaging to both your mental and physical health.
     

Despite some success stories, research has repeatedly shown that dieting to lose weight simply does not work. It is estimated that up to 97 percent of dieters will regain all the weight they lost within five years—and nearly two-thirds of them will end up weighing more than when they started dieting. Sounds crazy, right? Yet, it is true. Although it may seem like a good idea, dieting can actually lead to higher weight gain, lower self-esteem, and unhealthy relationships with food and your body. Not to mention it has the potential to ignite an eating disorder. 

Other risk factors involve a range of biological, psychological, and social circumstances that can contribute to an unhealthy relationship with food. These include having a close friend or family member with an eating disorder, other mental health conditions, Type 1 diabetes, a strong desire to be “perfect,” a negative body image, or even being teased or bullied about weight.

Warning Signs of Eating Disorders

Some major warning signs of eating disorders and disordered eating include:

  • Cutting out food groups or having strict rules/restrictions around eating
  • Eating in private
  • Immense feelings of guilt or shame after eating certain foods
  • Sneaking off to the restroom frequently after meals
  • Excessive exercise
  • Frequent dieting
  • Rapid weight changes
  • Preoccupation with weight and body size
  • Extreme mood changes
  • Loss of menstrual cycle
  • Always feeling cold
  • Dental problems
  • Thinning hair, skin, or nails 
     

Recovery Is Possible

Now that you have a better understanding of what eating disorders are and what can trigger them, it is important to know that recovery from an eating disorder is possible. 

Indeed, recovering from an eating disorder is often challenging and intermittent. But it can be done. Depending on the severity, treatment can occur in multiple places, including a hospital, residential center or in the outpatient setting. Eating disorder treatment meal plans often start with an exchange system during the refeeding process and then shift into more intuitive eating over time.

Think of it in terms of this analogy: Recovering from an eating disorder is like recovering from a broken arm. When you first break your arm, you need a cast. Your arm needs extra support and time to heal without your brain having to do much work. Once the cast is removed, you may need physical therapy to regain strength, flexibility, and range of motion. And, at the same time, you have to unlearn movement patterns or habits that might have caused the injury in the first place.

Therapy to overcome an eating disorder is similar. As a Registered Dietitian Nutritionist in the collegiate setting, I practice as a non-diet dietitian using an Intuitive Eating framework and as a Health at Every Size®-aligned practitioner. In eating disorder recovery, I use a meal plan to provide support when someone needs structure (i.e., the cast) to start healing. Following the meal plan, we shift to Intuitive Eating, where I teach people how to watch for body signals and cues and adjust feelings and beliefs related to food. Through this process, you can discover how food makes you feel, what you like and do not like, and work through old belief systems that may be inaccurate or even harmful. 

Using the broken arm analogy, after completing physical therapy can confidently use your healed arm. You do not think much about it—it is just part of your normal life, doing what it is meant to do. The same is true for normal eating. It is a place where food is just food. It is both nourishing and satisfying, and simply one aspect of daily life instead of a subject of too much focus and attention. Food is much more than energy and calories. It is love, culture, celebration, and connection. Food is an essential part of all our lives, so let us make it a place of peace. 

Avoid An Eating Disorder By Celebrating Body Diversity

Society’s pressure to be thin is, unfortunately, very intense. The best way to avoid an eating disorder is to celebrate body diversity. In many other parts of the world, and in U.S. history, diverse body sizes and shapes have been celebrated and seen as beautiful. It is important to remember that body weight does not equate to good health. If we look at the social determinants of health, individual behavior like what we eat and how we exercise is responsible for only 36 percent of our total health. Other determinants include genetics and biology, social circumstances, medical care, and our physical environment. The bottom line is that you cannot tell if someone is healthy just by looking at them. Instead, I encourage you to keep an open mind and embrace a wide range of body shapes and sizes!

Resources

March 22, 2021