Understanding Eating Disorders Educational Series (Part 4)

Why I Believe Eating Disorders are Such an Unpopular Topic

Why would a naturopathic doctor and functional medicine practitioner who specializes in women’s health, digestive health, and mood support dedicate so much time posting on a subject that is not nearly as trendy and popular as say, anxiety or thyroid disorder? (To be fair, I covered the later here, here, and here.)

The reason is exactly that, it doesn’t get attention.

Eating disorders (ED) are not a topic many people seek out unless it’s how to stop “food addiction.” Importantly, you can’t tell if someone has an eating disorder based on their body size. Many people struggle with disordered eating and look “normal” or are even larger bodied. Believing that one must be “skinny” to have an eating disorder, many may not stop to consider if their eating could be disordered. Therefore, people often only skim the surface of potential symptoms of ED until they feel desperate and recognize that they need to help themselves or someone else.

This makes sense.

Facing an ED can be scary. Furthermore, it’s tempting to brush behaviors under the rug that intuitively feel not nourishing in order to achieve the acceptance of diet and wellness culture. In other words, although one may have an inkling that perhaps what they are doing, or not doing, to fuel their body is not optimal, there is something that one is “getting” from these dietary regulations that they don’t want to lose.

This peer pressure is real and evasive. It seems that these days, in order to “fit in” the wellness space, one must be subscribing to some type of dietary diatribe or food rules.

The Contentious Food Debates

Whether it’s social pressure to look a certain way, or fear for one’s health, how and what one should eat is certainly a topic of contention in health and wellness. After over fifteen years in practice, I have yet to find more than a handful of my clients who start out with me feeling their relationship with their food choices and body is balanced and peaceful. (Thankfully, most eventually do as we continue to work together.)

Rather than allowing space and freedom for different ways to nurture ourselves based on our own preferences, needs, culture, and of course, health, many nutritional influencers are preaching that their way is the way for us.

Similar to religious fever, wellness experts are throwing out fear bombs on the negative health consequence if their dietary rules aren’t followed and giving promises of healing all bodily symptoms if they are. In fairness, many are doing this out of their own belief and good intentions.

The problem is that there’s too many “ways.”

How’d we get here?

To Eat or Not to Eat? … This is the Question

We don’t question any other natural urge, just hunger.

• If we have to pee, we pee.
• If we have to breath, we breath.
• If we are thirsty, we search for hydration.
• If we have to go number 2, well, we go.

However, ask someone seeped in diet and wellness culture if they’re hungry and want to eat, and be prepared for a mental gymnastics’ tournament or a ping-pong game with no rackets!

The scene usually goes something like this:

Either someone asks the person if they want to go out to eat or they themselves notice that they may be feeling a nudge of hunger. (Gasp!)

Then, there’s a long pause with a deep contemplation on if one “should” be hungry. Rationally reviewing their schedule and time frame of their last meal, they quickly calculate if it’s correct to follow their body’s pleading for fuel.

Next, there’s the tortuous brain scan on if it’s socially or ethically okay to eat at this particular time. After all, isn’t the office team all participating in that new fast?

If the proper allotted time has been achieved, well, then there’s the torment of deciding what to eat so one doesn’t live in shame and regret afterwards!

Yikes!

Isn’t food supposed to be medicine, not a source of stress?

This Is Why I’ll Keep Bringing Up ED

What I’m most concerned about is that health marketers and influencers have used our insecurities, body image issues, and society’s body size prejudices to reinforce the restrictive food practices popularized by books and medical experts.

This means that rather than people receiving intervention at the start of a disordered dietary pattern, the wellness space may be contributing to and promoting some of this behavior as “healthy.”

As stated previously, my concern is that our current approach to nutrition, health, and fitness, if not carefully scrutinized, could be perpetuating and fueling health anxiety, false anxiety, and eating disorders.

I am on a mission to combat this!

In my first post on eating disorders, I provided an overview and some statistics of them. Next, I examined specific risk factors and characteristics of eating disorders. I left off with reviewing some general signs and symptoms of ED and two of the most recognized types, anorexia nervosa (including atypical anorexia) and bulimia nervosa.

Now, let’s continue to educate ourselves on this subject so we have a fighting chance up against diet culture.  I will now discuss two other categories of eating disorders, Binge Eating Disorder and Other Specified Feeding and Eating Disorders. This information is based on the several references I mentioned here.

Two Other Categories of Eating Disorders: Binge Eating Disorder and Other Specified Feeding and Eating Disorders

Binge Eating Disorder (BED)

According to the Anxiety and Depression Association of America:

Binge eating disorder (BED) is a severe, 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. It is the most common eating disorder in the United States.

BED is one of the newest eating disorders formally recognized in the DSM-5. Before the most recent revision in 2013, BED was listed as a subtype of EDNOS (now referred to as OSFED). The change is important because some insurance companies will not cover eating disorder treatment without a DSM diagnosis. 

Binge Eating Disorder Diagnostic Criteria

NEDA lists the criteria for BED as follows:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 
  • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
  • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
• The binge eating episodes are associated with three (or more) of the following: 
  • Eating much more rapidly than normal.
  • Eating until feeling uncomfortably full.
  • Eating large amounts of food when not feeling physically hungry.
  • Eating alone because of feeling embarrassed by how much one is eating.
  • Feeling disgusted with oneself, depressed, or very guilty afterward.
• Marked distress regarding binge eating is present.
• The binge eating occurs, on average, at least once a week for 3 months.
• The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

More Signs and Symptoms of Binge Eating Disorder

Click here for a full list of symptoms and warning signs.

Other Specified Feeding or Eating Disorders (OSFED)

OSFED was previously classified as Eating Disorder Not Otherwise Specified (EDNOS).

This category includes those with a significant eating disorder but who do not meet any of the current diagnostic criteria. It has been mistakingly perceived to be a “catch-all” classification and less serious than other eating disorders. This is not true. In fact, OSFED is just as life-threatening as other ED.

Read this list carefully, as these ED behaviors can easily be missed in our diet culture world.

Categories in OSFED

Examples of ED in this section, as laid out by NEDA, include:

• Atypical Anorexia Nervosa: All criteria are met for anorexia, except despite significant weight loss, the individual’s weight is within or above the normal range. (See more here.)
• Binge Eating Disorder (of low frequency and/or limited duration): All of the criteria for BED are met, except at a lower frequency and/or for less than three months.
• Bulimia Nervosa (of low frequency and/or limited duration): All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behavior occurs at a lower frequency and/or for less than three months.
• Purging Disorder: Recurrent purging behavior to influence weight or shape in the absence of binge eating.
• Night Eating Syndrome: Recurrent episodes of night eating. Eating after awakening from sleep, or by excessive food consumption after the evening meal. The behavior is not better explained by environmental influences or social norms. The behavior causes significant distress/impairment. The behavior is not better explained by another mental health disorder (e.g. BED).

More information on these disorders can be found here.

Summary So Far on Eating Disorders

Our culture’s relationship with food is dysfunctional and I want to call it out, even though I know it’s controversial to do so.

We don’t get enough education on what a healthy relationship with food and our bodies looks like, because so many are trapped in what it isn’t.

Although often unnoticed, many may be suffering with eating disordered behavior because it is socially accepted, misunderstood, and/or normalized.

Many people live a life of constant stress, guilt, or worry around everything that goes in their mouth and what exercise they did or did not do that day.

Yet, we all deserve so much more.

I am in a field that promotes food as medicine, and I do still believe it is, but it’s also more than that. Food is not just a hodgepodge of nutrients that are epigenetic modulators to enhance or hinder body and brain health. Food is also a source of pleasure and reward, cultural identity, and it promotes bonding and relationships. I think these latter things need to be embraced, not blotted out or belittled. After all the mind-body connection is just as powerful in modulating our wellness as macronutrients.

I’ve seen many of my clients have major turnarounds when we stopped focusing on the dietary rights and wrongs and placed attention on what is truly nourishing to them on the body-mind-spirit level. Not only did they get healthier, their lives and moods improved.

It is my hope that this series will help people to pause and start to disentangle from their dysfunctional relationship to diet and wellness culture and move into a peaceful relationship with their bodies and themselves.

Eating disorders of all types can be fatal and are insidious and unless they result in extreme changes in appearance or behavior, they are too often underrecognized, and even dangerously reinforced.

It’s time to stop this.

Please help me get the message out by sharing this information widely.

Eating Disorder Resources:

• National Association of Eating Disorders (NAED): Resources
• ANAD (National Association of Anorexia Nervosa and Associated Disorders)
• Eating Disorders Anonymous
• Resources on How to Be Healthy Without Obsessing About Weight

*Important Note:

If you struggle with mental health or an eating disorder, please reach out for professional support.

You may also wish to consider implementing holistic resources and partnering with a naturopathic doctor.

For example, I offer mind-body support for general mood issues using a functional medicine and wellness-oriented approach. I also practice using a non-diet, HAES approach to nutrition.

Click here to learn more about my approach to whole-person, mind-body care.

Free resources and more education are also available to you here.

Please stay tuned for an upcoming opportunity that can support you in holistic mind-body-heart-soul healing. (Join my newsletter below to learn more.)

Many blessings.