National Eating Disorders Awareness Week

Important Facts, Dangerous Fiction

Every 62 minutes, at least one person dies from an eating disorder. Over 30 million people in the United States suffer from an eating disorder and 10 million of these are men. While most people have heard of some celebrities with eating disorder like anorexia and bulimia, few appreciate just how widespread and dangerous eating disorders actually are. At Simplicity Nutrition we see the spectrum of eating disorders, from anorexia, bulimia, orthorexia and many others that don’t fit into a “category” of eating disorder types. We feel that it’s incredibly important to let you, our community, know, that we are safe and trusted practitioners if you or someone you know is struggling with an eating disorder.

Our collective misunderstanding of eating disorders, along with a culture deeply rooted in diet mentality and body negativity, inhibits the individual from seeking treatment or help. It’s important to realize that even if we (or someone we know) don’t personally experience an eating disorder, how we speak in front of young people, our children, our partners, our peers, our colleagues and about our own body can impact a person’s openness and willingness to acknowledge they need help and get the help they need.

As mothers, fathers, siblings, family and friends, it’s crucial to appreciate our amazing bodies and to model (or restore) healthy relationships with food and our body. When we comment, compare, constantly talk about the next diet we are going to do, belittle our body and all the little details, speak critically about ourselves, feel and express shame when we eat chocolate, carbs, fat, candy, ice cream, bread, etc, we normalize this disordered pattern and it will continue to be pervasive in our society. Food does not have a value. I mean if you eat healthier are you really a better person, morally? Definitely some food for thought.

What are eating disorders?

Eating disorders are serious, but treatable mental illnesses that negatively impact a person’s ability to NOURISH themselves appropriately. They can be recognized by a persistent pattern of eating or dieting behavior that interrupts a individual’s ability to live a balanced and vital life, and can cause a myriad of physical problems and/or emotional and social distress. Oftentimes, the food is the symptom to the underlying cause. However, while food is only the symptom, it’s critical that a nutritionist who specializes in eating disorders is able to address the potential serious health consequences that result.

WARNING Signs and Symptoms:

The earlier an eating disorder is detected, likelihood of recovery increases. Therefore, it is important to be aware of some of the warning signs of an eating disorder.

Eating disorders don’t always fit into neat categories and vary in their warning signs. Someone struggling with an eating disorder may show only some signs and symptoms at any given time. These lists are intended as a general overview of the types of behaviors that may indicate a problem. If you or they are unsure about whether or not they might need help, consider this anonymous online screening test: https://www.nationaleatingdisorders.org/screening-tool

Emotional and Behavioral

Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting
Refusal to eat certain foods, restrictions against whole categories of food (e.g., no carbohydrates, no fat, no animal protein, no pizza, etc.)
Appears uncomfortable eating around others
Food rituals, such as eating only a particular food or food group (e.g. condiments), excessive chewing, not allowing foods to touch, moving food around on plate
Skipping meals or eating small portions of food at regular meals
Hiding food in room or from family or others
Frequent dieting, or any new practices with food or fad diets (no sugar, no carbs, no dairy, vegetarianism/veganism)
Withdrawal from friends, family and social activities
Extreme concern with body size and shape
Frequent checking in the mirror for perceived flaws in appearance
Intense mood swings
Short-tempered
Anxiety

Physical

Heart palpitations
Getting sick all the time
Low energy/fatigue
Noticeable fluctuations in weight, both up and down
Stomach cramps, other non-specific gastrointestinal complaints (constipation, diarrhea, acid reflux, bloating/gas, gut flora imbalance)
Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
Difficulty concentrating
Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
Dizziness, especially upon standing
Fainting/syncope
Feeling cold all the time
Sleep problems
Cuts and calluses across the top of finger joints (a result of inducing vomiting)
Dental problems, such as enamel erosion, cavities, discoloration of teeth due to vomiting and tooth sensitivity
Dry skin and hair, and brittle nails
Swelling around salivary glands
Fine hair on body (lanugo)
Hair falling out
Muscle weakness
Yellow skin (in context of eating large amounts of carrots)
Cold, mottled hands and feet, or swelling of feet
Poor wound healing

Different Types of Eating Disorders:

Anorexia Nervosa – the persistent restriction of energy intake, intense fear of gaining weight and disturbance in self-perceived weight or shape
Bulimia Nervosa – potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating
Binge Eating Disorder – life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating
Otherwise Specified Feeding or Eating Disorder (OSFED) – serious, life-threatening, and treatable eating disorder, encompassing those individuals who did not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder
Avoidant Restrictive Food Intake Disorder (ARFID) – similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness
Pica – involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips
Rumination Disorder – the regular regurgitation of food that occurs for at least one month; regurgitated food may be re-chewed, re-swallowed, or spit out
Orthoexia – an obsession with proper or ‘healthful’ eating where affected individuals become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being
Compulsive Exercise – not a recognized clinical diagnosis in the DSM-5, but many people struggle with symptoms associated with this term
Laxative Abuse – serious and dangerous, often resulting in a variety of health complications and sometimes causing life-threatening conditions; occurs when a person attempts to eliminate unwanted calories, lose weight, “feel thin,” or “feel empty” through the repeated, frequent use of laxatives
Diabulimia – an eating disorder in a person with diabetes, typically type I diabetes, wherein the person purposefully restricts insulin in order to lose weight

Aren’t eating disorders rare and don’t they only impact certain groups?

Eating disorders affect people from all races and ethnic groups all over the world. While some groups are disproportionately impacted, it is estimated 30 million Americans of all ages and gender identities suffer from an eating disorder. This is conservative, as eating disorders a vastly under-reported due to intense stigmatization of the conditions.
Males represent ~25% of individuals with anorexia nervosa. Since many people falsely assume males can’t have eating disorders, they are often diagnosed later, leading to a higher risk of death.
Some eating disordered behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among males as they are among females.
One study found that 35% of female and 10% of male college athletes were at risk for anorexia nervosa and 58% of female and 38% of male college athletes were at risk for bulimia nervosa. Among female college athletes surveyed, 25.5% had subclinical eating disorder symptoms.
At least 3.5% of women and 2.0% of men report having symptoms that meet the requirements for binge eating disorder some time during their life.

People can just decide start or stop eating, so eating disorders are not a big deal, right?

An eating disorder is NOT a choice, passing fad, or phase. Eating disorders can be extremely deadly mental health conditions and collectively have the highest death rates among all mental illnesses!
It is exceedingly damaging to discuss and treat eating disorders as “not a big deal”, since the people suffering with eating disorders often don’t realize they have a problem or believe it’s as serious as it is.
It’s been shown that beginning treatment for an eating disorder as early as possible significantly improves recovery and survival rates. If you or a loved one of has (or is suspected to have) an eating disorder, it is absolutely critical that the individual feels surrounded by compassionate and trusting people who believe and support them in their recovery as possible.

What can cause a person to develop an eating disorder?

Although the root causes and triggers are highly individual, some common contributing factors to the development of eating disorders include:

Traumas (physical, mental, emotional) and significant loss
Dieting and a dieting culture and microculture
Social pressure and expectations
Lack of social acceptance
Significant emotional or physical stress
Stigmatization (especially around body size, sexuality, and identity)
Role modeling of body negative language and behaviors, or eating disordered behaviors by peers, family members, or those in a person’s community (or desired community)
Epigenetics (genetic predisposition)
Gut flora imbalances/dysbiosis
Chronic illness and other mental health conditions
Participation in athletics that encourage certain body shapes or sizes

How can you help?

Consult with a professional to understand what to do: family doctor, therapist, nutritionist, school counselor.

Tips from the National Eating Disorder Association

Learn as much as you can about eating disorders. Read books, articles, and brochures. Know the difference between facts and myths about weight, nutrition, and exercise. Knowing the facts will help you reason with your friend about any inaccurate ideas that may be fueling their disordered eating patterns.
Rehearse what you want to say. This may help reduce your anxiety and clarify exactly what you want to say. Other people have found writing out their main points helpful.
Set a private time and place to talk. No one wants to have personal issues dissected in front of a crowd, so make sure you find a time and place where you will have time to discuss your concerns without being rushed or in front of a crowd.
Be honest. Talk openly and honestly about your concerns with the person who is struggling with eating or body image problems. Avoiding it or ignoring it won’t help!
Use “I” statements. Focus on behaviors that you have personally observed, such as “I have noticed that you aren’t eating dinner with us anymore,” or “I am worried about how frequently you are going to the gym.” It’s easy to sound accusatory (“You’re not eating! You’re exercising too much!”), which can cause a person to feel defensive. Instead, stick to pointing out what you’ve observed. If you can, also point out behaviors not related to eating and weight, which may be easier for the person to see and accept.
Stick to the facts. Raising concerns about a potential eating disorder can bring up lots of emotions, and it’s important not to let those run the show. Instead, talk about behaviors and changes you have observed and calmly point out why you are concerned (“I have seen you run to the bathroom after meals and feel worried you might be making yourself throw up.”).
Be caring, but be firm. Caring about your friend does not mean being manipulated by them. Your friend must be responsible for their actions and the consequences of those actions. Avoid making rules, promises, or expectations that you cannot or will not uphold. For example, “I promise not to tell anyone.” Or, “If you do this one more time, I’ll never talk to you again.”
Remove potential stigma. Remind your loved one that there’s no shame in admitting you struggle with an eating disorder or other mental health issue. Many people will be diagnosed with these issues during their lifetimes, and many will recover.
Avoid overly simplistic solutions. Being told “Just stop” or “Just eat” isn’t helpful. It can leave the sufferer feeling frustrated, defensive, and misunderstood.
Be prepared for negative reactions. Some eating disorder sufferers are glad that someone has noticed they are struggling. Others respond differently. Some may become angry and hostile, insisting that you are the one with the problem. Others may brush off your concerns or minimize potential dangers. Both of these responses are normal. Reiterate your concerns, let them know you care, and leave the conversation open.
Encourage them to seek professional help. Many eating disorder sufferers require professional help in order to get better. Offer to help the sufferer find a physician or therapist if they don’t have one, or attend an appointment where the eating disorder is discussed. Getting timely, effective treatment dramatically increases a person’s chances for recovery. If your loved one is ready to seek treatment or you want to explore options, the NEDA Helpline is a great place to start. Contact the Helpline >
Tell someone. It may seem difficult to know when, if at all, to tell someone else about your concerns. Addressing body image or eating problems in their beginning stages offers your friend the best chance for working through these issues and becoming healthy again. Don’t wait until the situation is so severe that your friend’s life is in danger. Your friend needs a great deal of support and understanding.
Many times well-intentioned attempts to help someone with an eating disorder can actually make the issue worse and damage relationships. Some counter-productive discussions, actions, and behaviors to AVOID include:
- Focusing on a person’s body shape or weight
- Playing ‘food police’ or attempting to manipulate their food choices
- Assuming you understand their experience with an eating disorder because you have a relationship and that you know how to best help them
- Making or appearing to make your care, support, and love for the individual contingent upon their recovery progress
- Assuming that recovery is a linear process and that their effort will be directly proportional to your assessment of their progress
- Disregarding how difficult eating disorder recovery can be — Imagine how you would feel confronting your most difficult challenge multiple times per day, every single day!

What else can I do that would likely be helpful?

In addition to focusing on being a safe and supportive person whom that individual can confide in about their struggle, also consider:

If and when the person asks for help or seems open, gently offer to set up a meeting with a trained therapist, nutritionist or other healthcare professionals trained in eating disorder treatment. It’s best for the individual to be engaged in selecting their own care team, since finding providers who they trust and connect with is a critical part of therapy.
Role model and encourage others around the person to practice body positive language, avoid discussing or describing anyone’s body shape, size and weight.
Avoid discussions about dieting and/or calories
Eat regular meals and snacks and avoid comments that assess your food choices (e.g. “clean”, “healthy” or “good” vs. “bad”) or which could be interpreted to equate your self-worth relative with food choices (e.g. “I was so bad/good, I ate….”)

How can Simplicity Nutrition help support eating disorder recovery?

We provide clients with compassionate, individualized medical nutrition therapy services that include:

1-on-1 nutrition therapy and counseling sessions, both in-person
Individualized nutrition guidance based on your own unique body, labs, genetics, lifestyle and goals
Accountability and nutrition/lifestyle coaching
Experiential nutrition:
- Grocery store tours (teaching clients how to shop and read labels)
- Cooking lessons
- Eating Coaching
Restoring relationship with food and body
Intuitive eating or meal planning
Tracking recovery based on labs and body composition
Coordination of care with other members of a comprehensive eating disorder recovery support team including: transition care team from inpatient facility, therapists, primary care doctors, etc. as well as support in building a recovery team

Reach out to us at 425-445-3816 or erin@simplicitynutrition.com to see if we are the right fit for you or a loved one’s eating disorder recovery journey.

Statistics source: https://www.nationaleatingdisorders.org/statistics-research-eating-disorders