Eating Disorder Awareness Q&A
This week is National Eating Disorder Awareness Week. As a Nutrition and Fitness Specialist, I strive to offer my clients a balanced and realistic approach to nutrition and fitness with focus on nourishing our bodies as opposed to restricting or depriving ourselves. I do my best to ensure that I am a positive member of this industry and that I am not encouraging the culture that contributes to or triggers disordered eating.
As I am always trying to be the best I can be for my clients, I took this week to reach out to a specialist with experience in counseling those with eating disorders. While this general information was covered in my curriculum for my nutrition coaching certification, it is outside the scope of practice of a nutrition coach to diagnose or counsel an eating disorder. Rather, it is imperative for someone in my position to be aware of the symptoms and indicators of a disorder, refer the individual to a professional for help, and work in tandem with them to support their goals.
Below is my Q&A with Emily, a therapist that has experience working with individuals with eating disorders.
Q: “Can you describe the difference between a true Eating Disorder vs disordered eating?
A: “Think of it like the flu - you could have the symptoms and be coughing, sneezing, etc but not test positive on a flu test. The symptoms are still important and should be addressed but may not meet a full diagnosis standard. Disordered eating is a symptom and an eating disorder is a diagnosis.”
Q: “What are some of the most likely indicators of an Eating Disorder?”
A: “I think there are a lot but I will list a few.
1) A fixation on food: always thinking about the next meal or how to avoid the next meal
2) Concerns about body image or weight
3)People who tend to base their happiness or sense of self worth on their appearance
4)Things going on in life that are completely out of control (for example, during covid, eating disorders drastically increased during covid because people were grappling to find control in their lives)”
Q: “What are some of the most likely causes of an Eating Disorder?”
A: “I think the most discussed are genetics, the way food and body image was discussed in your household, and societal standards. Lesser discussed but really important are traumatic or stressful events in the lifetime. Trauma and eating disorders tend to go hand to hand because they can be an individual's way of gaining control back.”
Q: “What are some different types of Eating Disorders?”
A: “ 1. Anorexia nervosa. I think this is the one that people are most familiar with. This is restriction of food due to intense fear of weight gain and distorted view of body image.
2.Bulimia Nervosa. This is recurrent binge eating paired with compensatory behaviors to "cancel" the binge like vomiting or laxatives due to worries about body image or weight.
3.Binge-eating disorder. This is recurrent excessive eating that is not associated with compensatory behavior. The individual will feel a sense of being out of control while eating.
4 .Avoidant/Restrictive Rood Intake Disorder. This is lesser known. This is avoidance or restriction of food due to texture or other sensory issues, not due to body image issues or weight concern. This disorder causes significant nutritional deficiencies and weight loss.
5. Other Specified Feeding or Eating Disorder - I left this for last because it is the most commonly diagnosed. This is like a catch all diagnosis for people who have significant disordered eating symptoms but do not fit into the diagnostic criteria for the other eating disorders.
Q: “I often think it is important for people to understand what is going into their body from a macronutrient and calorie point of view before making changes depending on their goals. This often means counting calories/macros or portions sizes for a while. Would you agree or disagree that calorie/macro counting can be done in a healthy manner and not lead to disordered eating?”
A: “I think it really depends on the person! I definitely have heard of some people having success with counting calories without becoming obsessive. Some people find it to be very empowering to have a sense of what is going into their body. From an ED perspective, as part of eating disorder treatment, individuals will be paired with a nutritionist and given a meal plan based on counting calories and macros. However, to avoid an unhealthy focus on that for the individual, usually the nutritionist is the one keeping track of that data and it is not disclosed to the individual. We would make sure people were eating x amounts of calories a day, but the nutrition labels were removed from all food before it was given to them. Something to be cautious of is that people in the past three or so generations really have a negative relationship with calories where there is a lot of ingrained negative diet culture that needs to be tackled for someone to have a healthy relationship with calories.”
Q: “When I studied for my CNC, eating disorders were covered in the curriculum. However, there are many on line nutrition coaches and specialists who have not actually had any formal education or certifications in nutrition at all, but just offer nutritional coaching in addition to their personal training. What would you suggest to these coaches to look out for and how to adjust their coaching so as to not lead a client into disordered eating habits?”
A: “I definitely think there should be a focus on becoming more "eating-disorder" informed. I would look into concepts like Health at Every Size and Body Neutrality! And then just knowing some warning signs and being aware of when it is time to refer to a mental health professional.”
Q:”Piggy backing off of the same question above, what would you suggest someone who has a history of eating disorder or disordered eating look for or ask of a nutrition coach prior to hiring?”
A: “I always tell clients who have eating disorder backgrounds to look specifically for individuals who state they are eating disorder informed or have experience working with eating disorders. There are a good amount of professionals in this area who specialize in that! I also always recommend advocating for themselves and being upfront about their ED experience so that professionals are able to alter their approach.”
Q: “Do you notice a strong correlation between eating disorders/disordered eating and over exercising/exercise addiction?”
A: “Yes! There is a lot of discussion right now about the possible addition of an eating disorder called orthorexia. This is basically when someone is unhealthily obsessed with healthy eating and exercise. Interestingly, there is a strong link between any sort of restrictive diet and eating disorders.
Q: “How have those of us in the nutrition and fitness industry contributed to the causes and triggers of eating disorders?”
A: “Traditional fitness and nutrition focused on elimination, body image, rigidity and restriction. I think that fed into an overall societal issue of pushing diet culture.
I have seen a major shift in the past 5 or so years towards nutrition and fitness being more wellness oriented, which is wonderful!”
Q: “What can those of us in the nutrition and fitness industry do better to help people truly achieve their health and fitness goals without contributing to a culture that encourages disordered eating habits or triggers eating disorders?”
A: “Removing rigidity! Getting rid of the labels of "good" and "bad" food. Reframing nutrition, food, and exercise as what you can gain, not what you can lose. I think when looking at meals like okay sure, you want to have fries so lets have fries! But what can we add to make this more nutritious? Rather than let's take away the fries and replace with something nutritious. And then also focusing on the wide array of benefits that come with fitness and nutrition that have nothing to do with weight loss.”
Q: “Please add any additional information that you feel would be helpful to those in the nutrition and fitness industry to understand about this topic.”
A: “Eating disorders are REALLY dangerous. Someone dies every 56 minutes due to an eating disorder. I think I mentioned this above but I think having a full referral list of individuals who specialize in eating disorders or who have worked with them before is really important.
Q: “Please add any additional information that you feel would be helpful to someone who may be struggling with disordered eating but is not fully aware of it.”
A: “It is SO normal and they are not alone! I don't think there is anyone in the past several generations that hasn't experienced disordered eating symptoms. There is a huge freedom that comes with removing obsession with body image and food.”
Thanks so much to Emily for taking the time to answer these questions. There are a few follow up discussions that are already swirling in my brain, so keep an eye out for more on this topic in the near future.
Emily Zubriski is a master’s level counselor that has experience working with trauma and individuals with eating disorders. You can follow her on instagram @therapywithemilyz