Written By: Dianna Yanchis, BScFN
Reviewed by Andrea Miller MHSc, RD
As a dietetic intern I recently had the opportunity to work with, counsel, and provide dietary advice to individuals in an eating disorders outpatient program. In light of Eating Disorders Awareness Week, February 1st – 7th, I would like to share some of my experience working with this population.
In a society where Lady Gaga is criticized for having a “flabby” belly after her Super Bowl half time performance and continuous focus on diet and appearance, it is not uncommon for many to suffer from low self-esteem and body dissatisfaction. Along with social media, a combination of biological, psychological and environmental components all contribute to an individual’s mental health. Eating disorders are serious mental illnesses with life-threatening physical and psychological complications. The Diagnostic and Statistical Manual of Mental Disorders: 5th Edition (DSM-5), identifies four main diagnoses: anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID). Each diagnosis has specific criteria related to diagnostic criteria, physical and psychological complications, and treatments.
The motivation for diet changes can vary amongst individuals. It can include life events, cultural and societal pressures, genetics, stress, emotions, psychological health difficulties and many more. Some of the general signs and symptoms include marked weight loss, gain or fluctuations, failure to gain expected weight associated with growth and development, weakness, fatigue, dizziness, and compensatory behaviours (dieting, fasting, excessive exercise, etc.) The physiological consequences of an eating disorders effects the entire body from the brain, heart, and bones.
Something that stood out to me when working with this population was the severe anxiety that food brings to these individuals. Eating is something that we do every single day to give us energy, meet vitamin and nutrient requirements, socialize, and most importantly survive. Someone with an eating disorder exhibits high levels of fear and stress associated with certain foods and eating. An eating disorder is not a choice but a serious illness. These individuals require support and treatment to rebuild a health relationship with food and normalize eating patterns and behaviours.
I also had the opportunity to do some research on orthorexia nervosa. (ON). The National Eating Disorders Association (NEDA) identifies ON as an unhealthy obsession with eating foods that one considers healthy in order to obtain optimal health. ON is not currently recognized as a clinical diagnosis in the DSM-5. However, the NEDA believes this eating style can be considered as a psychological disorder due to its physical, psychological and social consequences. Orthorexics are concerned about where their food is produced, how it might be processed, and how it is packaged, all of which may affect the food “purity”. This leads to restrictive diets including only foods that are deemed healthful to the individual in hope of preventing these illnesses and diseases. Orthorexic behaviours may eventually become so restrictive that one eliminates entire food groups and consequently becomes malnourished as critical nutrients are eliminated from the diet.
So when does “healthy” eating become a concern? Healthy eating becomes a concern when enthusiasm transforms into obsession. This is apparent when the focus on healthy eating is consuming an inordinate amount of time and attention in an individual’s life. Also, deviation from the diet is often associated with guilt and self-loathing. As an individual begins to eliminate more foods from the diet and the list of foods deemed acceptable decreases, the risk of nutritional deficiencies, social isolation and psychological disturbance increases. Ultimately, one of the main warnings signs begins when the desire to eat healthily interferes with daily living, social activities, and relationships.
It is evident that eating disorders are multi-factorial diseases. Recovery form an eating disorder involves overcoming physical, mental and emotional barriers in order to restore normal eating habits, thoughts and behaviours. From my experience I have learned that eating disorders are not a quick fix. They require extensive support, time, effort, determination and rehabilitation; however, it is without a doubt worth the weight.
For more information on eating disorders, we recommend the following websites: