Beyond Food and Weight

Exploring the Complexities of Eating Disorders

(Relentless grip of eating disorders captured by Shiuli Aggarwal)

Disclaimer: This article is a general overview of eating disorders. The resources at the end are provided to dig deeper into these and find more specific information and support on eating disorders.

What is an eating disorder?

We all experience moments or periods of concern for our body shape, weight, or general appearance which might I say, is normal for the most part. Eating disorders are more than about just food, but actually complex mental health conditions that often require intervention. Scientific research has shown that eating disorders are not merely a result of vanity and desire to be thin, but rather a complex interplay of genetic, psychological, and environmental factors. Although it may start as an unhealthy obsession with food, body weight, or body shape, they often evolve into complex mental health conditions that affect individuals’ physical, emotional, and psychological well-being. Very generally, common symptoms include severe restriction of food, food binges, and purging behaviors like vomiting or overexercising.

Why is this important?

In severe cases, eating disorders can cause serious health consequences (serious lack of nutrition) and may even result in death if left untreated. Also, the psychological consequences linked with eating disorders such as depression, anxiety, self-harm, and suicidal thoughts and behaviors are a serious concern for mental health and well-being. In fact, eating disorders are among the deadliest mental illnesses, second to opioid overdose.

The Difference between body weight and body image: 

Body weight refers to the numerical measurement of a person’s mass, while body image encompasses their perception, thoughts, feelings, and attitudes towards their own body. While body weight focuses on the physical aspect, body image involves the psychological and emotional relationship individuals have with their bodies, impacting self-esteem and overall mental well-being.

Risk factors:

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. Many studies show a genetic heritability link (which might suggest that eating disorders run in families). Researchers are continuing to work on identifying DNA variations that are linked to the increased risk of developing eating disorders. More recently, experts have proposed that differences in brain structure and biology may also play a role in the development of eating disorders. In particular, levels of the brain messaging chemicals – serotonin and dopamine may be factors.

Personality traits may be another factor – specifically neuroticism, perfectionism, and impulsivity are often linked to a higher risk of developing an eating disorder. 

Other potential causes include – pressures to be thin, bullying/abuse, cultural preferences for thinness, and exposure to media promoting these ideals. 

This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders. However, more studies are needed before strong conclusions can be made.

Most common types of eating disorders:

Anorexia Nervosa: Self-starvation, distorted body image, and severe weight loss.

Bulimia Nervosa: Binging and purging of food, accompanied by guilt, loss of control, and physical complications.

Binge Eating Disorder: An uncontrolled battle with excessive food consumption, leading to weight gain, obesity, and emotional distress.

Avoidant/Restrictive Food Intake Disorder (ARFID): A complex eating disorder characterized by aversions to certain foods based on sensory properties, causing anxiety, limited food choices, and nutritional deficiencies.

How to know if you have an eating disorder?

Although some symptoms are shared amongst eating disorders, each is unique in the way it is expressed. Below are some “general” symptoms (sourced from Healthline)

General mental and behavioral signs may include: 

• Dramatic weight loss, excuses to avoid mealtime, denying feeling hungry
• Concern about eating in public
• Preoccupation with weight, food, calories, fat grams, or dieting
• Complaints of constipation, cold intolerance, abdominal pain, lethargy, or excess energy
• Intense fear of weight gain or being “fat”
• Dressing in layers to hide weight loss or stay warm
• Severely limiting and restricting the amount and types of food consumed
• Refusing to eat certain foods 
• Expressing a need to “burn off” calories
• Repeatedly weighing oneself
• Patterns of binge eating and purging
• Developing rituals around food
• Excessively exercising
• Missing menstrual periods (in people who would typically menstruate)

General physical signs may include:

• Stomach cramps and other gastrointestinal symptoms
• Difficulty concentrating
• Atypical lab test results (anemia, low thyroid levels, low hormone levels, low potassium, low blood cell counts, slow heart rate)
• Dizziness, fainting
• Feeling cold all the time
• Sleep & menstrual irregularities
• Calluses across the tops of the finger joints (a sign of inducing vomiting)
• Dry skin, thin nails, thinning hair
• Muscle weakness
• Poor wound healing & immune system function

Treatments 

Recovering from an eating disorder is a tough journey that requires comprehensive treatment, including therapy, medical support, and a multidisciplinary approach. Treatment involves therapy, nutritional counseling, and support groups. It aims to address emotional triggers, develop healthy coping mechanisms, normalize eating behaviors, and address distorted thinking patterns.

Evidence-based treatment methods: 

For anorexia nervosa, there is evidence for the use of cognitive-behavioral therapy (CBT) as well as family-based treatment (FBT, or the Maudsley method)

CBT therapy is widely considered the first line treatment for adults with bulimia nervosa, although interpersonal therapy (IPT) has been shown to be useful as well.  

Dialectical behavioral therapy (DBT) is presented as a model that might be useful for patients who have not succeeded with the more traditional approaches such as CBT or IPT.

How does CBT help in the treatment of eating disorders? 

Cognitive Behavioral Therapy (CBT) is an evidence-based therapeutic approach that can be highly effective in the treatment of eating disorders. CBT for eating disorders focuses on identifying and modifying maladaptive thoughts, beliefs, and behaviors related to food, body image, and weight. Through CBT, individuals with eating disorders learn to challenge negative and distorted thoughts about their body, develop healthier coping strategies, and establish a more balanced and positive relationship with food. CBT also addresses underlying emotional and psychological factors contributing to the eating disorder, such as low self-esteem, perfectionism, and body dissatisfaction. It helps individuals develop skills to manage triggers and cravings, establish regular and balanced eating patterns, and improve body image. The collaborative and goal-oriented nature of CBT empowers individuals to make lasting changes and achieve long-term recovery.

Takeaways:

• Eating disorders are complex mental health conditions that go beyond food and body image concerns. 
• It is important to help those suffering from them because they can have serious health consequences and impact mental well-being. 
• Eating disorders are influenced by a combination of genetic, psychological, and environmental factors. 
• There are different types of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (among other lesser known ones), each with its own characteristics and health effects. 
• Seeking professional help and evidence-based treatments such as the ones mentioned above, can support recovery. 
• It is important to challenge myths surrounding eating disorders and promote understanding and support for individuals affected.

NEW ARTICLE (2) 

Breaking some Eating Disorder Myths: 

Myths surrounding eating disorders are often formed and perpetuated due to a lack of accurate information, societal misconceptions, and media influence. Misunderstandings about the causes, nature, and treatment of eating disorders contribute to these myths. Media portrayal, including glamorizing thinness or promoting unrealistic body ideals, can reinforce harmful stereotypes and misconceptions. Stigmatization and judgment also play a role in perpetuating myths, as they prevent open discussions and understanding.

How can we bust these myths? 

• Promote education and awareness about eating disorders
• Providing accurate information about the causes, risk factors, and complexities of these disorders
• Encouraging open conversations and reducing stigma surrounding eating disorders creates a safe space for individuals to share their experiences and seek support.
• Collaboration between healthcare professionals, advocacy groups, and the media can lead to responsible reporting and portrayal of eating disorders, focusing on promoting empathy, understanding, and body positivity.
• Empowering individuals to challenge and question societal beauty standards and promoting diverse body representation to foster a more inclusive and supportive environment.

( make this a new document and also add a description about how myths are formed and perpetuated)

Myth: Eating disorders are a lifestyle choice.

Fact: Eating disorders are not a choice but serious mental illnesses characterized by biased and maladaptive behaviors and attitudes towards food and body image. They are not a lifestyle choice or a phase that individuals can simply “snap out of.”

Myth: Disordered eating is the same as an eating disorder.

Fact: Disordered eating refers to irregular eating habits, while an eating disorder involves persistent and severe disturbances in eating patterns and psychological well-being.

Myth: You can tell if someone has an eating disorder just by their appearance.

Fact: They can affect individuals of all body weights, including those who are underweight, overweight, or within a healthy weight range. Physical appearance alone is not a reliable indicator, as the impact of eating disorders extends beyond outward appearance.

Myth: Eating disorders only affect young, affluent females.

Fact: Eating disorders can affect people of all genders, ages, ethnicities, socioeconomic backgrounds, and body types. They do not discriminate based on these factors.

Myth: Eating disorders are solely about food and weight.

Fact: While food and weight concerns are often present, eating disorders run much deeper than that. They involve a complex interplay of psychological, emotional, and social factors, including low self-esteem, body dissatisfaction, perfectionism, control issues, trauma, and underlying mental health conditions.

Additional reading: 

Body Dysmorphia: 

While eating disorders and body dysmorphia are separate conditions, they often coexist. Body dysmorphia, also known as body dysmorphic disorder (BDD), is a mental health condition characterized by a persistent preoccupation with perceived flaws in one’s appearance. Individuals with body dysmorphia have an excessive and distorted focus on certain aspects of their body, often believing that these perceived flaws are significant and noticeable to others, even when they may be minimal or nonexistent.

Body dysmorphia can be closely related to eating disorders, as both conditions involve a distorted body image. While body dysmorphia focuses on specific perceived flaws, eating disorders, such as anorexia nervosa, bulimia nervosa, or binge eating disorder, involve disordered eating behaviors and attitudes towards food, weight, and body shape. Individuals with body dysmorphia may develop eating disorders as they attempt to control or alter their perceived flaws through restrictive eating, excessive exercising, or other disordered eating behaviors. On the other hand, individuals with eating disorders may also experience body dysmorphia, perceiving themselves as overweight or unattractive, regardless of their actual appearance.

Resources:

Websites:

1. National Eating Disorders Association (NEDA): NEDA is one of the leading organizations dedicated to supporting individuals and families affected by eating disorders. Their website offers plenty of resources – educational articles, treatment options, helpline information, and recovery support.

2. Academy for Eating Disorders (AED): AED is an international professional organization focused on eating disorders research, treatment, and prevention. Their website provides access to scientific articles, clinical guidelines, and information on upcoming events and conferences.

3. National Institute of Mental Health: A federal government website that details information about eating disorders and has links to other information on mental health issues and grant opportunities.

Books:

1. When Your Teen Has an Eating Disorder: Practical Strategies to Support Your Teen With Anorexia, Bulimia, and Binge Eating (2018). This book, by Dr. Muhlheim, provides an overview of how parents can implement Family-Based Therapy (FBT) strategies.

2. 50 Ways to Soothe Yourself Without Food, Susan Albers, Psy.D. (2009). This book draws upon a variety of evidence-based techniques to cope with emotional eating. The techniques are divided into 5 sections: 1) Mindful meditation techniques; 2) Change your thoughts, change your eating; 3) Soothing sensations to calm and relax the body; 4) Soothing yourself with distractions; and 5) Soothing yourself with emotional relationships.

3. Life Without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too, by Jenni Schaefer and Thom Rutledge. In her recovery, which is summarized in the book, Jenni Schaefer personified the eating disorder as “Ed,” an abusive boyfriend and explains how she broke up with him.

4. Evidence Based Treatment for Eating Disorders: Children, Adolescents, and Adults (Eating Disorders in the 21st Century), by Ida Dancyger and Victor Fornari. includes up-to-date research, provides overviews of treatment recommendations, and the authors suggest areas for future research.

5. The Oxford Handbook of Child and Adolescent Eating Disorders: Developmental Perspectives, by James Lock (2012). Provides key information to understanding how to recognize, assess, and treat eating disorders in children and adolescents.

Audio/Videos:

1. Anorexia, malnutrition and your bones Podcast by Jennifer Gaudian, MD, interviewed by Tabitha Farrar. Because the risk to bone health in teens with restrictive eating disorders is so significant and so often misunderstood, I highly recommend listening to this podcast, which is a good description on the issue.

Scientific research papers:

1. “Eating Disorders and Emotional Eating: Exploring the Link” by Stice, Eric et al. (2003)
2. “Sociocultural Influences on Body Image and Eating Disturbance” by Thompson, J. Kevin and Stice, Eric (2001)
3. “Neurobiology of Eating Disorders: Insights from Brain Imaging Studies” by Frank, Guido K. (2015)
4. “Prevalence and Incidence of Eating Disorders: A Systematic Review and Meta-analysis” by Smink, Frédérique R.E. et al. (2012)
5. “Body Image Interventions for Eating Disorders: A Systematic Review of the Literature” by Halliwell, Emma et al. (2009)