Eating disorders are complex illnesses with both psychological and physical aspects that require treatment.
For this reason, over the past few decades, it has become more common for the treatment of people with eating disorders to be managed by multi-disciplinary teams which can deliver the necessary medical, psychological and nutritional help.
As society’s foremost expert on nutrition, the dietitian has an important role on the treatment team for a person suffering from an eating disorder, and more opportunities are opening up for dietitians to develop as experts in this role.
Julie Deane-Williams, a registered dietitian and ADSA (Association for Dietetics in South Africa) spokesperson who has a special interest in treating people with eating disorders, points out that in some cases, the dietitian may also be the first port of call for help.
“Even though there are high levels of denial associated with disorders such as anorexia nervosa or bulimia nervosa, the dietitian is often the healthcare professional on call, especially when it comes to a person struggling with emotional/comfort eating or binge eating disorder. Typically, in the first session, a sufferer, usually female, confides that she is desperate to lose weight; reveals disgust at her body, even if she is within a healthy BMI (Body Mass Index) and feels shame that she has been unable to stick to a diet. The dietitian soon discovers that the emotional eater has tried many different diets.
Patients commonly are keenly aware of the energy content of different foods but that doesn’t mean that they know much about nutrition. Often the patient hopes that the dietitian can provide a ‘miracle’ diet that is finally going to help her lose weight and keep it off.”
The dietitian who works with people with eating disorders plays an important role in the assessment, treatment, monitoring, support and education of the patient. As advocates of evidence-based science, they serve as important resources of nutrition knowledge for the patient, the patient’s family and the other healthcare professionals on the treatment team. They need to be skilled at determining a patient’s nutritional status, eating patterns and behaviour, food rules and beliefs.
It is the dietitian who takes into account the patient’s meal planning, food shopping and cooking skills. The dietitian works closely with other team members to understand how the patient’s underlying psychological and emotional issues impacts on their eating behaviours, as well as their motivation and capacity for behaviour change. The dietitian will work collaboratively with the patient to develop the nutrition aspect of the treatment plan, and to support the patient and the rest of the team throughout its implementation.
In the light of recent research in the UK that has attributed more deaths to eating disorders than any other psychiatric disease, Deane-Williams urges people with unhealthy relationships with food to seek help sooner rather than later. “Using food, or the lack of it, to cope with distressing emotions and situations is a maladaptive way of managing life,” she says. “All eating disorders are addictions, and it is the nature of an addiction to further and further alienate a person from their own inner truth. Addictions also usually drastically stunt emotional growth.
Once a person accepts that they have an eating disorder, and they seek good medical help, the healing journey is one that is difficult yet immensely rewarding. Not only can they recover, but they find out who they really are – bright and exceptionally intuitive people who had developed a coping mechanism to keep their ‘heads above water’ during extremely challenging times in their lives. Once they develop healthy ways of managing difficult emotions, they can go on to thrive, and create healthy and very happy lives. “
If you think you or a loved one might be struggling with an eating disorder, consider visiting a registered dietitian for expert guidance and advice. If you are looking for a dietitian in your area, please visit www.adsa.org.za
[Adapted from ADSA press release.]
How I’m raising my kids to have a healthy relationship with food, despite my eating disorder
by Sarika Chawla
I was making waffles for my kids when sadness and frustration kicked in. I looked at the thick pool of butter melting into each square of my 6-year-old son’s waffle, extra pats given with love and determination to fill out his thin frame. My daughter, a little dumpling of a toddler, had a much lighter smear spread thinly across her waffle.
This is how it starts.
When I look back on my own years of obsessive dieting and binge eating, it’s always with a laugh and an eye roll: “Every teenage girl had an eating disorder then. It was a rite of passage.” I was never frighteningly skinny or forced into treatment. It was simply always there, quietly controlling my moods, my wardrobe, my metabolism and my sense of worth.
In adulthood, my relationship with my eating disorder has softened into more of an easygoing partnership than toxic abuse. But it often makes its presence known through internal dialogues and little games: Daily weigh-ins that determine whether I’m wearing pants with buttons that day; parsing out cookies two at a time because odd numbers are uncomfortable.
The gravity of my responsibility as a parent is not lost on me: I’m partly in charge of two little people’s nutrition, helping to establish habits that could shape their relationship with food. And I desperately want them both to remain free from my burdens.
My fears aren’t entirely unfounded. Some research has pinpointed a genetic link to anorexia nervosa, suggesting the disease can be inherited. But more broadly, a whole confluence of factors can lead to disordered eating, and much of that begins in childhood.
“Eating disorders are very complex illnesses . . .” says Claire Mysko, CEO of the National Eating Disorders Association. “Factors like biological predisposition, co-occurring psychological conditions and cultural messages all play into it.”
Though I could never pinpoint the origins of my disorder, memories related to my weight and body shape flow from every direction. My paediatrician lecturing me about adding more roughage to my diet. Watching my mother fret about her own body, even though to me she was just mom and I didn’t understand why it mattered. Eating my way through a box of cereal – no milk added – because my body craved endless amounts of sugar. Always being the slowest, the clumsiest, the last one picked and wondering why other girls could be thin without even trying.
But back then, no one ever thought there was a problem with a young girl obsessing over calories and fat grams, as long as the net result was weight loss. Because I never hit any physical danger – either hospitalization thin or obesity-level heavy – it wasn’t a “real” disorder.
Even though I was never diagnosed with a disorder, I reasoned that I had learned enough in my lifetime to empower my kids. I would never force my children to eat if they’re not hungry. I don’t talk about my body issues with them. If going out to dinner means they only eat french fries for one meal, that’s okay.
But I couldn’t control my reactions of glee and high praise when my kids made the “right” choices. That rose to the surface when I offered my son a bite of my food.
“No, thanks,” he said.
“I’m only offering it because I think you’ll actually like it,” I wheedled. (See how laid-back and supportive I can be?)
He sighed heavily. “But then I might like it. And then you’ll be really proud of me. And I can’t deal with that right now.”
“Kids are so smart,” says Lauren Anton, a Los Angeles-based registered dietitian nutritionist who specializes in treating disordered eating. “If you have an agenda with food, kids will sniff it out.”
How can we model healthy eating without making it a big deal?
“First, we have to move away from the term ‘healthy’ even though it’s well-intentioned,” she said. “There is no good food, bad food.”
To illustrate that, Anton points to various scenarios that seem innocuous but can add up: A little girl at a birthday party who, after being chastised by her mother for eating M&Ms, secretly stuffed her mouth with the candy, grabbed two handfuls and ran away. Parents who say, “You’ve had enough bread, now eat your vegetables,” and the kids who look for praise when they do eat those vegetables. Even “clean eating,” paleo diets and other modern food trends can evolve into disordered eating because they’re based on the idea of restricting food.
I reached out to other parents who had battled eating disorders. One of them, Kimberly Bernstein, is a college friend and I remembered how deeply anorexia affected her daily life. She told me her struggles started when she was 10 – not far from her three kids’ ages now.
“In my desire to feed them real, whole foods, I noticed that one of my daughters was becoming sugar obsessed,” she said. “All of her imaginary play had to do with cupcakes and candy stores, and I realized I was creating what I didn’t want.”
Bernstein, an Austin-based yoga teacher and licensed clinical social worker, had to give up some control over her children’s diets. “I still shudder every time my husband feeds them the organic version of Nutri-Grain bars,” she says. But she has reframed her focus – and theirs.
“I ask them to pay attention to how their bodies feel after they eat because giving them the tools to trust themselves is going to work out better than controlling their choices,” Bernstein says. “That’s the gift I can offer them because of my past.”
Another mother, Katie Norris, shared similar insight.
“I knew that if I didn’t ever comment on his food or force him to eat, that would be better for him. But at the same time, I was starving myself. You think you’re hiding it from them but you’re not,” says the Ohio mother of a teenager.
Norris worked toward her own recovery using the “intuitive eating” philosophy, which allows you to eat unconditionally – without assigning “good” or “bad” labels to specific foods – and teaches you to listen to your body for hunger cues while using methods other than eating to honour your feelings.
That’s easier said than done, of course. Between sensitivities to certain ingredients and the health habits she developed within her CrossFit community, Norris struggled with the idea that setting any food restrictions is a sign of disordered eating. Through time, she reached a balanced mindset that has worked for her, and that she can pass along to her son.
“The message we try to give is that we eat food that fuels our body and brain to work as best they can,” Norris says. Because her son also struggles with food sensitivities, she’s had to be careful about letting him experiment but keeps the focus on how foods make him feel.
She also suggests taking a step back. “If you’re really upset that they won’t eat their broccoli, sit with it and ask what is making you panic.”
As for other steps, everyone I spoke with offered similar suggestions:
– Avoid talking about weight, body mass index or numbers on a scale. That can be a trigger that leads to an unhealthy fixation.
– Let your kids take the lead. Using the Ellyn Satter Institute’s Division of Responsibility, it’s your job as a caretaker to decide what, where and when they will eat. It’s their job to decide whether they’ll eat it and how much.
– Don’t label food “good vs. bad,” “healthy vs. unhealthy.” “When there are deprivation and restriction, it becomes a ‘Last Supper’ mentality,” Anton says. “Serve your kids food family-style, in abundance, and all foods become equal. When you have variety – maybe some nights there’s fruit for dessert and others its ice cream – you no longer feel like you have to have it.”
– Dine together as much as possible. According to the American Academy of Pediatrics, eating at least three meals together a week has a protective factor against eating disorders. It makes eating as much about the experience of being with loved ones as it is about the food itself.
– Pay attention to your kids’ digital use. While social media doesn’t cause disordered eating, it can amplify behaviours that are characteristic of people with eating disorders: The need for approval, comparing yourself to others and a sense of competition.
– Ease up on yourself. As Mysko says, “People with eating disorders tend to be really hard on themselves, and you’ve got to give yourself a break. If you’re making an intentional statement that you don’t want to pass on disordered eating to your kids, that’s a positive step.”