Eating Disorders: Let’s strive for fewer labels, better understanding
National Eating Disorders Awareness Week is Feb. 22-28, 2021. According to the National Eating Disorders Association (NEDA), the goal of National Eating Disorders Awareness Week (#NEDAwareness) is to shine the spotlight on eating disorders by educating the public, spreading a message of hope, and putting lifesaving resources into the hands of those in need. As an eating disorder specialist dietitian, I want to share information and raise awareness on this important topic.
Every day, we receive messages from society or from our families of origin that affect our relationship with food, weight, body image and movement. These messages can contribute to eating disorders, which are not a choice. Eating disorders are a condition of the brain that manifests in a dysfunctional relationship with food, weight, body image and movement.
How many of these messages have you heard, without knowing they could be contributing to eating disorders?
“It’s okay if I eat this and am uncomfortably full, as long as I exercise it off.”
“If you are controlling your weight, making your weight go down, you are doing something right.”
Or, as a child, “You had a great day. Here’s some food as a reward.”
When I think of an eating disorder, I think of it as a maladaptive way that the brain tries to protect you. When our brain assesses for danger, it typically pulls information into the back of the brain, and this “fight or flight” response makes us anxious. For some, this anxiousness can kill all their appetite, make them not want to eat at all. It can make food taste bitter or have an off-taste. For others, it can actually make their digestive tract and hunger feel hyperactive and ravenous. For yet others, it can make them feel like they are fogging out; almost like a panic attack with food.
It is vitally important to address the harm that our oversimplification around eating disorders causes, specifically with weight stigma. Eating disorders impact all sizes, genders, ethnicities and socioeconomic statuses. Meaning, each of these simplified definitions below can impact anyone at any time. It is common for one’s brain to morph between the varying presentations of an eating disorder.
As I tell my clients, I don’t treat a disorder. I treat an individual. Everyone is unique in why their brain has latched on to this dysfunctional relationship for protection.
In general, eating disorders can be defined by categories.
1. Anorexia nervosa is an eating disorder generally causing a loss of appetite or an obsession around losing weight. According to NEDA, anorexia nervosa is defined as “an eating disorder characterized by weight loss; difficulties maintaining an appropriate body weight for height, age and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives and/or binge eat.”I see anorexia nervosa as a lack of drive or desire to eat. It can be centered around weight, but it’s actually not directly about the weight. It’s more about of the act of being in control. So, when you step on a scale, it probably wouldn’t matter what the number is, because in our society, that’s viewed as “safety.” We are told that if you’re controlling your weight, you’re doing something right. Think about it – I could go to social media and find a post in five seconds that’s geared toward weight loss. It’s much harder to find information that says “appreciate your body, appreciate your health.”
2. Bulimia nervosa means ravenous hunger. One has a tendency to eat in secret and feels much shame when doing so. There is also a compensatory relationship with getting rid of the consumption by either purging, laxative use or excessive exercise. NEDA defines bulimia nervosa this way: “Bulimia nervosa is a serious, 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.”
I equate bulimia nervosa with the brain being on fire. It wants to get rid of the food and can’t relax. It gets euphoric when it finally gets rid of the food. Again, this is an area where societal messages play into the brain’s feeling of “safety,” by conveying that it’s okay to feel uncomfortably full as long as we “exercise it off.” The “Exercise Dependence Scale” was developed in 2002 by Heather A. Hausenblas and Danielle Symons Downs as a way to specify whether individuals have evidence of physiological dependence on exercise.
3. Binge eating disorder is the most common, yet most overlooked, eating disorder due to stigma (primarily weight stigma). NEDA defines binge eating disorder as “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.”
With binge eating disorder, we know there’s a hole one is trying to fill. So again, looking at the messages we received as a child, we may have been told to go get some food if no adult was available to be attentive to our needs, or we may have been given food as a reward for achievement or behavior.
4. ARFID, or “Avoidant, Restrictive, Food Intake Disorder” is mislabeled by many as a “picky” eater. It is very similar to anorexia; however, it is distinguished by a lack of preoccupation around weight or body image.
NEDA describes ARFID as “previously referred to as ‘Selective Eating Disorder.’ ARFID is 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.”
I challenge you, as we talk about eating disorder awareness, to take off the labels and just think about the relationship you, or someone you love, has with food, weight, movement and body image. From day one, we are inundated with messages around these topics. So, naturally, it would make sense that our brains might have dysfunction. Because, if we are told these things will give us security, they will give us success, you will be liked, you are honoring your health, then why wouldn’t our brain connect to these habits when we are scanning for danger and say “Bingo. There’s my safe spot.”
If you are suspecting you may have an undiagnosed eating disorder, check out this screening tool provided by the National Eating Disorder Awareness organization.
1. National Eating Disorders Association (NEDA), https://www.nationaleatingdisorders.org/, accessed Feb. 15, 2021.
2. HA Hausenblas, D Symons Downs. “Exercise Dependance Scale – 21 Manual.” Copyright 2002. https://www.personal.psu.edu/dsd11/EDS/EDS21Manual.pdf#:~:text=Introduction%20The%20Exercise%20Dependence%20Scale-21%20operationalizes%20exercise%20dependence,%281%29%20Mean%20overall%20score%20of%20exercise%20dependence%20symptoms, accessed Feb. 15, 2021.
3. National Eating Disorders Association (NEDA), “Eating Disorders Screening Tool.” https://www.nationaleatingdisorders.org/screening-tool, accessed Feb. 15, 2021.