Friday, March 10, 2023 Struggling with food: Anorexia, bulimia, binge eating and ARFID – What they are and how to get help
written by Brenna Schmader, Campus Recreation registered dietitian and nutrition education coordinator.
March is National Nutrition Month.
Balanced eating is an eating pattern that incorporates a variety of food groups throughout the day while respecting physical health, mental health, and personal values. Nutrition is not black or white; foods are not good or bad. Focus on recommendations and moderation. Food is integral to all dimensions of wellness. If you are not fueling your body well, it could impact other parts of your life such as work or academic performance. Your diet and your weight do not equal your worth. If considering balancing your diet, aim for small, reasonable steps. Taking small steps will help facilitate sustainable, lifelong positive habits. For information on general nutrition recommendations, visit myplate.gov.
Balanced eating is not...
- Skipping meals and ignoring hunger and fullness cues
- Restricting certain types of foods or food groups
- Experiencing intense feelings of guilt, stress, or lack of control revolving around food, eating, or body
- Using food and/or exercise to compensate for one another
- Fixation on only eating the “right” or “healthy” foods
- Fixation on physical appearance or weight
According to the National Eating Disorder Association (NEDA), “Although our current culture is highly obsessed with food and weight, and disordered patterns of eating are very common, clinical eating disorders are less so. 20 million women and 10 million men will struggle with an eating disorder at some point in their lives. A 2007 study found that 0.9% of women and 0.3% of men had anorexia during their life, 1.5% of women and 0.5% of men had bulimia during their life, and 3.5% of women and 2.0% of men had binge eating disorder during their life. The consequences of eating disorders can be life-threatening, and many individuals find that stigma against mental illness (and eating disorders in particular) can obstruct a timely diagnosis and adequate treatment.” Few statistics have yet to focus on non-binary, genderqueer, and transgender individuals.
Truths about eating disorders
- People with eating disorders can look healthy, yet may be extremely ill
- There are many different types of eating disorders
- Not all eating disorders have to do with restriction and low body weight
- Two people with the same eating disorder can have diverse experiences and symptoms
- Eating disorders can affect anyone regardless of gender, age, race, ethnicity, body shape and weight, sexual orientation, and socioeconomic status
- Eating disorders are bio-psycho-social
- Disordered eating tendencies are commonly normalized or overlooked
- Recovery is possible. Early detection and intervention are key
Eating disorders are a big deal and can be life-threatening. “Eating disorders have the highest mortality rate of any psychiatric illness due to suicide and other health consequences including heart attack, kidney failure, osteoporosis, and electrolyte imbalance. People who struggle with eating disorders also have intense emotional distress and a severely impacted quality of life.”
Like many physical and mental health conditions, relationships with food exist on a spectrum and may not be wholly healthful or unhealthful. Not every one that exhibits negative eating patterns has a clinically diagnosable eating disorder, although both are important to identify and treat. If you are concerned if you or someone you know has disordered eating habits and/or an eating disorder, reach out to your physician or mental health provider. If you see a UNL student with disordered eating habits, report it to a UNL employee. UNL employees can take action to support a student in-need.
For more information, you can take the National Eating Disorder Association’s Screening Tool (not a substitute for clinical evaluation).
There is hope. “Recovery time varies from person to person. Although not everyone with an eating disorder will recover fully, many do improve with treatment. Even with full recovery, many people with eating disorders find that they have to take steps to make sure they stay well. This can include planning meals; regular check-ins with a therapist, dietitian, or doctor; medication; and/or other types of self-care.”
Overview of Eating Disorders
Anorexia
- Restrictive intake, typically inadequate calorie intake
- Difficulties maintaining an appropriate body weight for height and age; weight loss is common
- Distorted body image
Avoidant Restrictive Food Intake Disorder
- Exclusion of a food or food group often due to sensory characteristics (texture, smell, etc.), fear of choking or vomiting, lack of appetite or interest in food
- No distress about body shape or size
- More common amongst people with autism spectrum conditions, ADHD, and intellectual disabilities, and children who don’t outgrow normal picky eating
Binge Eating Disorder
- Most common eating disorder
- Recurrent episodes of eating large quantities of food; a feeling of a loss of control during the binge; experiencing shame, distress, or guilt afterward
- Not regularly using compensatory measures
Bulimia Nervosa
• Cycle of bingeing and compensatory behaviors
- Bingeing: consuming unusually large amounts of food in one sitting and feeling that eating behavior is out of control
- Compensatory behaviors include vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise
Orthorexia
• Obsession with proper or ‘healthful’ eating
- Could present as cutting out foods or food groups, spending hours thinking about food, showing high levels of distress when “safe” or “healthy” foods are unavailable
• Often unrecognized; not yet recognized in the Diagnostic and Statistical Manual
Pica
• Eating substances that are not food and/or do not provide nutritional value
- Common items include ice, coffee grounds, hair, dirt, paper, chalk
• Sometimes occurs post-pregnancy
Common behaviors of someone with disordered eating (DE) habits or an eating disorder (ED)
Note: Everyone experiences DE/ED differently and this list is not comprehensive, nor must someone with DE/ED exhibit any of these behaviors
- Dressing in layers to hide weight
- Secretive eating; having a hidden food or snack space
- Pushing food around their plate without eating much
- Emotional distress before, during, and after eating; emotional distress when not able to plan meals or what to eat
- Trip(s) to the bathroom during and/or after meals
- Exercising for an extended amount of time or multiple times a day; using physical activity to offset meal(s) or snack(s)
- Frequently comparing self/own body to others
- Using food to cope with emotions or stress
Symptoms of someone with DE/ED may experience
Note: Symptoms may not always be easily identifiable and may take an extended amount of time to be present. Changes to the body may cause irreversible damage.
- Significant and/or quick weight loss or gain
- Nutritional deficiency
- Dizziness
- Difficulties concentrating
- Cold sensitivity
- Sleep problems
- Muscle weakness
- Dry skin, brittle nails, fine, dry, brittle hair
- Menstrual irregularities
- Osteoporosis
- Abnormal laboratory findings
- Impaired immune functioning
- Gastrointestinal problems including constipation and abdominal pain
- Heart problems or failure
- Kidney and liver problems or failure
How to treat DE/ED. What you can do.
Every DE/ED is different, and the way someone experiences DE/ED is different. Therefore, it is important for individuals to work with their wellness team, which may include a physician, dietitian, and therapist, to establish a care plan. Their wellness team will work together to improve the individual’s physical and mental well-being.
You can take small steps to help yourself and others have a positive relationship with food by avoiding making comments about someone’s food choices, how they’re eating, their body shape and size, etc. Even positive comments about someone’s healthful choices can potentially be hurtful. If you notice others making comments about someone’s diet or body, you can redirect the conversation, trying to remove any value placed on someone’s food or body.
• For example, you may hear someone say, “I won’t tell anyone you’re eating that cookie”, “I didn’t get my workout in so I should have a salad”, or “I shouldn’t have another slice of pizza”. These kinds of comments place value on food, insinuating that certain foods are (un)safe, act as rewards, or should involve guilt.
- If something like this happens to you or a peer, you can respond by mentioning the food’s appearance, flavor, or functionality, taking away any positive or negative value a food might hold. For example, you may respond with, “I thought this cookie looked tasty”, “I want to enjoy a salad”, or “this pizza is giving my body energy”.
• People may make comments about others’ bodies. You might hear, “that person really let themselves go”, “they look so good now that they’ve lost weight”, or “I wish I was their size”. These kinds of comments place unnecessary value on someone’s weight or body shape.
- If something like this happens to you or a peer, you can respond by saying that someone’s appearance does not determine their health and well-being as well as their worth/desirability as a human being. You never know what is going on in someone’s life. There are so many factors that influence someone’s weight, such as genetics and family history, metabolism, hormone balance, mental health, with diet and physical activity being two pieces of the large puzzle.
If you are concerned that someone’s diet or weight is impacting their health and well-being, it can be difficult to navigate this type of conversation in a compassionate manner. You can follow these steps, outlined by NEDA.
- Set a private time and place to have this discussion.
- Plan what you are going to say and be prepared for a negative reaction. This person may not be ready to open up.
- Use “I” statements to avoid placing blame or targeting the individual.
- Stick to talking about behaviors and changes you have observed and calmly point out why you are concerned.
- If appropriate, encourage the person to seek professional help.
- You are not alone; tell someone you are concerned about your peer. It is not your responsibility to fix this person, but you can still be a part of their support system.
Resources
UNL’s Counseling and Psychological Services offers one-to-one consultations with counselors that specialize in DE/ED, a DE/ED-specific therapy group called Food and Mood, and a workshop called the Body Acceptance Program.
caps.unl.edu | caps.unl.edu/eating-disorders | caps.unl.edu/body-acceptance-programUniversity Health Center and Campus Recreation each have dietitians that offer nutrition consultations.
For more information about eating disorders, visit nationaleatingdisorders.org