I Had No Idea! Secrets About Eating Disorders

We can't always tell just by looking at someone 
that something isn't right.

There are no excuses for perpetuating misinformation about eating disorders. No justification exists for minimizing eating disorders based on BMI, for generalizing them by age or gender, or for continuing to blame parents for causing them. While the news media may sensationalize and sometimes distort research, social media can fight back to correct misinformation. So read on, and please share!

Today starts a week devoted to spreading the word about eating disorders with the theme “I had no idea!” Thank you NEDA, the National Eating Disorder Association and promoter of Eating Disorder Awareness Week, for inspiring this post.

Random thoughts come to mind when I consider what this theme means to me—and what it might mean to you.  My beliefs and knowledge about eating disorders have evolved over many years, to which I credit the Academy for Eating Disorder listserve, the FBT researchers and Laura Collins and FEAST, blogs like Carrie Arnold’s  and my many, many awesome patients and colleagues. 

What I’ve learned over the decades

Got your period? This doesn’t minimize your diagnosis of anorexia, if you meet the other criteria. And resuming menses after being without a period does not mean you have fully recovered. No, the work is not yet done.

Obese and anorexic? How can that be? You do not need to be below the BMI chart to meet criteria for anorexia. Really. Unfortunately, you are the ones who most often fall through the cracks. And you are continually subjected to messages that your weight is the issue. I am truly sorry for this. Health care professionals need to be educated! 

Eating disorders are quite common in males, straight and gay. Males get anorexia, and struggle with bulimia and binge eating. Their focus on bulking up their muscle mass may seem like a cultural norm, but may be the sign of an underlying disorder. Check out Roberto Olivardia’s work on men and eating disorders.

Time to look at eating disorders a bit differently.

Over 30 or 40 and struggling with an eating disorder? You are not alone! Eating disorders are not just a teen thing. You can be living with an eating disorder at any age—an eating disorder that never resolved, one that reared it’s head again after previously recovering, or one that developed later in adulthood. Check out Dr. Cynthia Bulik’s work on this population. 

Parents don’t cause eating disorders. And parents shouldn’t be sidelined in the treatment of kids with eating disorders. They play an integral part in recovery, particularly when your poorly nourished brain fights you on eating. Learn more about how families can help from FEAST, from scholarly articles and other from resources.

Barbie didn’t cause your eating disorder. Sure, the media may impact how we see ourselves but eating disorders are much more complicated, involving genetic predisposition, environmental triggers and support for maintaining the disorder. We don’t know exactly what causes eating disorders, but it won’t be long before we understand the genetics. See what research is underway and how you can help the study of eating disorders and genetics.  

People don’t plan to have an eating disorder. It’s not a decision sufferers made. Individuals with anorexia, bulimia and Binge Eating Disorder aren’t simply refusing to change when they maintain their behaviors. Change is complicated—by fear, anxiety, and hard wiring of behaviors. My patient shares some wisdom we can all learn from here. 

It’s not so easy to just do it as this post describes. In spite of my many years of working with clients with eating disorders, I don’t think I fully grasped how many obstacles to change there can be—that is until Cate. Writing Food to Eat and feeling I was living her struggle with her was beyond enlightening; it heightened my sensitivity to things I had taken for granted—the planning to eat, shopping, cooking, and ultimately eating. 

Let's work to not live by diet rules and restriction, 
but to trust what our bodies both need and enjoy.

Recovery is possible, even for those who have lived with an eating disorder for many decades. But it has to start with the belief that change is possible. Connect with a treatment team-a therapist, an eating disorder dietitian and an MD, and reach out to friends and family for support. I now know that it is not too late to.

Want to help others recover? Share this post to increase awareness of eating disorders, and check out this awesome new eating disorder support by Cate. 

Oh, and please tell me what you think! Thanks for reading.

Intuitive Eating is not for you—maybe not just yet, and maybe not ever.

“Have you lost your mind? You, the anti-calorie-counting dietitian, the believer in legalizing all things chocolate and trusting that everything will be okay? Are you suggesting I should start dieting now, or head to the nearest Weight Watchers meeting and start counting points? Or doing the Paleo thing?”

Nothing of the sort! I’m prompted to write this following two experiences I had at the MEDA conference, that wonderful eating disorder conference held in the Boston area this past weekend. And this pertains to those of you with anorexia as well as those struggling with overeating—compulsive or otherwise.

So I was casually walking in the hall after the keynote presentation by Dr. Roberto Olivardia just killing time until the next break when I’d be selling my book. And I overhear two women, representatives from two respectable eating disorder programs chatting up their programs. “We use an intuitive eating approach with our patients”, she stated. “We don’t use meal plans, but instead have them listen to their body…” Ok, anorexic readers and eating disorder professionals, anything strike you as a bit problematic here? Let’s start with a handy, wiki definition:

“Intuitive eating is a nutrition philosophy based on the premise that becoming more attuned to the body's natural hunger signals is a more effective way to attain a healthy weight, rather than keeping track of the amounts of energy and fats in foods. It's a process that is intended to create a healthy relationship with food, mind and body, making it a popular treatment for disordered eating and eating disorders…”

For starters, to learn to be more attuned to your hunger, to begin to trust it, you need to be able to sense it. Most individuals, by the time they make it to see me, no longer really notice their hunger—not if they’re restricting and not if they are frequently binge eating. With the metabolic slowdown characteristic of food restrictors, hunger gets suppressed, and so that handy cue to get you to eat, that signal you’re supposed to be trusting—it’s largely disappeared! And that “healthy relationship with food” which we all aspire to is just not going to happen with all those unhealthy and distorted thoughts about food and eating and your appearance. Further, if you’ve never had a healthy relationship with food—never trusted your hunger because you went from overeating to undereating, it’s mighty challenging to just start trusting yourself. And for good reason, given your past experience with food and self-regulating.

When I shared my opinions (you didn’t expect I’d just casually stroll past, did you?) the program rep agreed, acknowledging that intuitive eating is an approach they address much later in recovery. We both agreed that normalizing eating under someone else’s direction (a dietitian with eating disorder expertise, for instance), needs to happen first, much before an intuitive eating approach. You can’t expect to be an intuitive eater when you can’t discern hunger and fullness, or when the disordered or diet thoughts are so loud that you can’t trust your physical sensations.

But wait, there’s more.

There were two experiences I wanted to share, remember? The second involves the presentation by Dr. Olivardia, mentioned above, who spoke about ADHD and eating disorders. He highlighted that a very high percentage of obese individuals have undiagnosed ADHD, and identified characteristics of this condition that make it oh-so-challenging to just do it, to follow seemingly reasonable nutrition and behavior recommendations.

For instance, impulsivity. Perhaps if you don’t have ADHD it’s challenging, but manageable, to take a break and have an internal discussion about whether or not you really want to be eating the whole package of cookies, to not respond to your impulse to eat. But in those with impulse control, that discussion comes a bit late. If you struggle with this, you may find yourself eating mindlessly before you’ve even gotten to check in with your signals. And if you eat rather fast, as is typical, you’ll take in a lot of extra calories before the signal of fullness has hit.

Then there’s boredom. Are you still with me? Those with ADHD have a much harder time tolerating boredom. If you struggle with sitting with feeling bored, it may be more difficult to simply acknowledge that you’re not hungry and redirect. Eating to manage this boredom might be the action of choice. Not a very intuitive eating supportive choice!

And while we often think those with attention issues as struggling to stay focused, Dr. Olivardia points out that these very individuals also get hyper-focused on the things they are interested in. This can explain the failure to listen to their hunger, perhaps when they are over-focused on other things. By the time they do respond to their physical hunger they may be ravenous, contributing to overeating. Or maybe there’s an OCD component, with a focus on calories and calorie counting, which may stand in the way of responding to physical cues. Again, making intuitive eating quite a challenge.

To be a successful intuitive eater, you need to be mindful of what you are consuming. Not so easy of you have ADHD and your norm is to multitask! My typical recommendations to separate eating from distractions may not be realistic for those living with ADHD, those for whom multitasking is simply the norm.

What now?

For the record, I am a big advocate of intuitive eating and for years have recommended a fabulous book on the subject by RDs Evelyn Tribole and Elyse Resch. Do take a look for more guidance on learning to be an intuitive eater.

Surely it’s not hopeless if you fit the descriptions above. To become a more intuitive eater requires more organization to your eating, including preplanning eating times and even meals. Organizational skills may not come so easy, so use tools like alarm reminders, such as on your phone or computer, and make shopping lists. Arrange eating times with friends or family for greater accountability, too. Utilize simple, easy-to-follow cookbooks, where close-to-immediate gratification occurs (with recipes taking 20 minutes or less, for instance.) Yes, Food to Eat fits the bill! And seek the guidance of an ADHD expert like Olivardia, along with an RD with a behavioral focus.

And please be realistic—and less harsh—if you’re prone to berate yourself for being lazy. There may be good reasons why you’re falling short with your follow-through with intuitive eating.

Thoughts? Comments? I’d love to hear what you’re thinking.