Eating Disorders Education: How do they Happen?
Most people fall into their eating disorder
Eating disorders start small and insidiously grow bigger and bigger while hiding in the shadow of our cultural obsession with dieting, exercise, and having a thin/fit/muscular body.
Maybe it starts with:
your own reaction to your body, like emotional responses to body types
body changes (think puberty, quarantine, postpartum, college, aging, normal fluctuations)
someone commenting about your body
a new diet
a new exercise plan
soothing emotions or disconnecting with food
feeling so overwhelmed or emotional that your appetite changes
there are honestly like 300 more examples, so for space reasons - etc.
Here is a list of several things I saw from my own social media network this morning in about 10 minutes:
“discipline > excuses” workout picture
4 pictures of apple watch workout summaries and 1 group fitness class summary
3 posts about “cheating” or eating too much leftover Halloween candy
2 “healthy dinner” stories
2 at home fitness ads
3 Keto posts
These posts are well meaning - AND - they demonstrate our cultural focus on food, bodies, and movement. This is the content we absorb in our brains and bodies all day, every day. Diet, diet, diet. Exercise, exercise, exercise.
While some people are completely unscathed by diet culture, the truth is:
Most people develop some sort of body image awareness/distress or food anxiety
Many people develop disordered eating or disordered exercise
Some people develop the full blown, life destroying, eating disorder
People can’t choose to have an eating disorder.
Eating disorders are complex diagnoses that develop from genetic, biological, personality, and sociocultural factors. As mentioned in a previous post, eating disorders are like a tornado. You can have all the conditions for an eating disorder to develop and it doesn’t happen. You can also have just a few of the conditions for an eating disorder to develop and it does. There is no singular cause.
Challenge Question: Let’s be honest. If eating disorders were “pickable,” think about how many people would try to pick anorexia as a weight loss or food control strategy. Really - I want you to think about this. A few things to consider while you mull this over:
According to the CDC, in 2013-2016 about 50% of Americans were trying to lose weight REGARDLESS of their current health status.
How many conversations do you have per month with your friends or family about changes in someone’s body, weight, or shape?
How many conversations do you have per month with your friends or family about changes in someone’s eating or dieting?
How frequently do you or do you hear other people praise weight loss?
Last bit of evidence: I cannot count how many people have said to me, “I wish I had anorexia; I have the opposite problem” when they find out my profession. [If you have ever said this, no judgement, but please take note].
The typical person has absolutely no idea that eating disorders, quite literally, destroy lives. I highly encourage everyone reading this to consider how they talk about eating disorders. We would never say, “I wish I had an addiction to alcohol,” so please - let’s commit to shifting our language here.
Eating disorders cannot be picked. They just can’t. Once we can accept this fact, it does a few really useful things:
It allows for the person suffering from an eating disorder to reduce the self-blame and shame. It also makes room for more self-compassion and patience.
It allows for the person suffering to take ownership of managing eating disorder symptoms rather than judging or reacting to the symptoms.
For example; being able to think about eating disorder management in the same way we think about cancer treatment - no one asks for cancer, it is something that happens to people. We wouldn’t blame someone or ourselves if their body developed cancer.
It allows for family and friends to increase their capacity to support rather than blame the sufferer or blame themselves for their loved one’s eating disorder.
Eating disorders hide in plain sight
Very few people even realize that they have an eating disorder at first because:
they might be getting a lot of positive feedback from others about their exercise, food, and/or weight
eating disorders help people cope with painful things
eating disorders can soothe in the anxiety and emotions, so the sufferer might be unaware of the dangers ahead if the eating disorder is left untreated
there might be so much shame related to food behaviors and fear of judgment from others that they don’t want to ask for help
many people around them are using the exact same behaviors (like dieting and exercising) and it doesn’t spiral into an eating disorder
they might be feeling very accomplished in their eating disorder goals which can lead to a temporary improvement in mood
Remember: eating disorder goals are moving targets, they continue to up the ante until the goals are unreachable. For example, an exercise target goal will get harder, longer, and more intense until the sufferer is exercising several hours a day and feels incredible distress if they can’t finish their workout or reach a certain metric (time, calories burned, “closing a ring”). They might choose working out over sleep or over spending time with loved ones.
they might initially experience an improvement in functioning in different domains of life (school, work, productivity) before the eating disorder behaviors up the ante, get out of control, and interfere with the ability to function
Validating the reality of an eating disorder is tough business - mainly because a hallmark of eating disorders is not recognizing that there is a problem. The eating disorder mind constantly minimizes the severity of the illness.
Common phrases to look out for:
“I’m not that sick”
“I’m not as sick as people who have to go to the hospital”
“I don’t look like I have an eating disorder”
“my labs and vitals are fine so I am okay”
“I’m not underweight so I don’t need help”
“everything is fine, I have this under control”
Common behaviors to look out for:
working out when sick or injured
not being able to miss a workout
inflexible eating habits
only eating alone or eating before social meals
inflexible use of tracking devices for food/activity
inflexible weighing or measuring of food
self weighing or measurements of the body impacting the mood
chronic “body checking” - meaning checking how the body looks in a mirror or checking body size, shape, feeling with hands
making work out goals based on the amount of food that was consumed previously or is planned to be consumed later
refusal to eat certain foods because they feel like they “can’t control themselves” around those food items
trips to the bathroom in the 30 minutes after a meal
social isolation - picking eating disorder goals over spending time with loved ones or participating in previously enjoyed hobbies
How do I help a loved one or help myself?
reach out to a qualified professional for emotional support, access to resources, family education, and eating disorder treatment
look for someone who has specialized training and experience with eating disorders
ask your provider if they are specialized in working with eating disorders
read their website, business profile, business social media, ask trusted people in the community for recommendations
look for CEDS/CEDS-S/CEDRD/CEDRN/CAT designation - this is an eating disorder certification program from the international association of eating disorder professionals. It signifies that the provider passed exams about eating disorder development and treatment, they have specialized supervision from an eating disorder professional, and they complete regular eating disorder continuing educations
try to set up a multidisciplinary treatment team including:
an eating disorder informed physician
an eating disorder informed psychiatrist
an eating disorder informed individual therapist
an eating disorder informed therapist for family/couples therapy as needed
an eating disorder informed dietitian
resist the urge to blame yourself or others. Shift your focus to managing symptoms
Of course we want to understand the WHY of the eating disorder. But the most important first step is getting any use of eating disorder behaviors under control
log onto the National Eating Disorder Association’s website to get support and resources: https://www.nationaleatingdisorders.org/
go to the emergency department or call 911 in a medical emergency
quit the diet talk - full stop - with friends, family, and acquaintances
You don’t have to do this alone. No one picks this.
Thanks for tuning into this Tackett Tip!
Dr. Tackett