Please note that this is an Archived article and may contain content that is out of date. The use of she/her/hers pronouns in some articles is not intended to be exclusionary. Eating disorders can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights.
Author: Alice Covey, RD, CD and Kim Passmore, RD, CD
While dieting may not cause eating disorders, it is often a precursor. The National Eating Disorders Association reports that 35% of “normal dieters” progress to pathological dieting and that 20-25% of those individuals develop eating disorders. It is far too common that eating disorders start off as dieting. Dieting can be a way for individuals to exercise control – counting calories and fat grams, limiting types and amounts of food, and watching the numbers drop on the scale. Focusing on dieting and weight loss can become an escape from life stressors and difficult emotions.
Dieting as a Cultural Norm
Dieting has become common and normalized in our society. This is evident since children ages nine to eleven are dieting at alarming rates. A study published in the Journal of American Dietetic Association in 1992 found that 46% of nine to eleven year olds are “sometimes” or “very often” on diets and that 82% of their families are “sometimes” or “very often” on diets. It is not surprising that the rates have increased over the years, especially since that has been the trend of the dieting industry. In 1980 the dieting industry was a $10 billion dollar industry. In 2013 it was reported to be a $61 billion dollar industry in the US, and it just keeps growing. Sixty billion dollars is more than the Gross National Product (GNP) of over half of all the nations in the world.
This trend for dieting and the pursuit of thinness is a relatively new phenomenon in the course of history. Less than one hundred years ago Americans strived for “excess” body fat. They viewed fatness as a sign of success, health, and beauty. There were even articles in magazines like Harper’s Bazaar with advice on how to put on extra pounds. At this time physicians were even encouraging Americans to gain weight, and they believed that a “balanced personality” was obtained by having a large number of fat cells.
Our culture has blatantly sold the false idea that being ultra-thin is equated with beauty. To obtain this image, Americans place an alarming amount of time, energy, and money into diets, and in the end the diets rarely work. The dieting failure rate helps to explain the industry’s rapid growth. When a diet fails, the search is on for a new one that “really works.” Ninety-five percent of dieters regain their lost weight. Plus, many of those who have “failed” put on additional weight within one to five years. The 5% of “successful dieters” are usually successful because they have actually adopted a new lifestyle, not because they have stuck to their rigid new way of eating.
Most people blame themselves and their “lack of willpower” for their diet failures. In reality, diet failure can be attributed to the body responding to hunger and the body’s state of semi-starvation or starvation. The body and mind react to a diet in the same way they would to starvation. In starvation, the body’s metabolism decreases, and cravings increase. This is the set up for diet failure. Metabolism naturally slowing down during starvation is the body’s attempt to conserve energy. A decrease in metabolism means the body is burning calories at a slower rate. Also while on a diet, the mind becomes preoccupied with thoughts of food and cravings intensify, especially for foods that will provide quick energy, like sweets. Eventually, it is too difficult to fight nature. People can’t remain on diets forever and when dieters terminate their diet efforts, it is common for overeating to ensue. Overeating and even “normal eating” with a suppressed metabolism will cause the weight that was lost to come back. The failure rate of dieting (95%) is so high, not because people aren’t good enough or strong enough but because our bodies were designed to fight weight loss.
The Downside of Rigid or Tightly Counted Meal Plans to Treat Eating Disorders
Many treatment facilities and dietitians use meal plans that count calories, carbohydrates, or that utilize measuring or weighing portions as a way to treat eating disorders. This approach has some pluses, but also has disadvantages. Meal plans such as these are similar to a diet. People following meal plans are allotted a certain amount of carbohydrate, protein, and fat servings, or they are allowed to choose from pre-planned food items. Just like a diet, there are strict rules and boundaries. Some individuals with eating disorders may really need and like this structure, however, for many the new set of rules and boundaries that the meal plan provides are just replacing the old set of rules the eating disorder provided. Sometimes dietitians will even encourage their clients with eating disorders to weigh and measure their food to get the “correct” amount. The act of weighing and measuring food allows for no flexibility. And on top of that, it gives the message that food must be controlled, regulated, and monitored, which is exactly how someone with an eating disorder already feels about food. If a meal plan is not followed precisely, often strong feelings of guilt and failure emerge. Meal planning which is done in a rigid manner, may give an individual with an eating disorder the impression that they need these guidelines because they have proven themselves untrustworthy with food. They can become very dependent on this external method of controlling food intake, instead of relearning to rely on themselves for the answers.
Intuitive eating (also known as “Mindful Eating”) teaches individuals how to rely on themselves and listen to internal cues. It also provides guidance on how to form a healthy relationship with food. It is an anti-diet approach to eating. There are no rules to break and no temptations to resist. Intuitive eating is possible for most clients once they have allowed structure to help them re-nourish their bodies.
To get back to a healthy and natural experience with food, it is important to remember that infants and toddlers innately possess this ability. Infants easily know when they are hungry and full. Doctors guide new mothers to respect their infant’s inner wisdom. It is amazing that infants intuitively know that they need more food right before a growth spurt and will naturally crave increased feedings. Toddlers are the same. A study done by Leann Birch, Ph.D., showed that children ages two to five were eating, on average, the same amount of calories daily for a week, even though the calories from their individual meals varied greatly. This study shows that toddlers don’t need to count calories to get the appropriate amount of energy; they naturally know what they need.
The ability to use these internal cues (hunger and satiety sensations and cravings) to regulate food intake is present in everyone. This is true no matter how long the individual has been ignoring them. The challenge in becoming an intuitive eater is to reconnect with the already present internal cues and to learn to ignore the external ones. After years of poor eating habits and eating disorder behaviors, it may take months for normal hunger/fullness cues to return.
Dieting is a purely external way to regulate food intake. Other things that control food intake, which are external, are:
- Only choosing “good” or “healthy” foods,
- Automatically finishing everything on the plate, and
- Taking the portion that is listed on the food label.
Using external factors to determine what, how much, and when to eat is a starting place, with an eventual goal of learning to honor internal cues.
In the case of patients who are suffering with severe anorexia, external control and assistance will be necessary, at least in the initial stages of treatment, because they are not yet physically or emotionally capable of eating intuitively.
Fears Regarding Listening to Our Bodies
Most people initially believe that by using internal cues to guide food amounts and food choices, they will inevitably be “unhealthy,” make the wrong choices, and eat too much. This is a sign of a lack of self-trust, which is natural when external factors have been used for so long to make these choices for us. Regaining trust is a process. It takes time and practice, but it is well worth it. By using internal cues it is possible to never diet again! Trusting internal cues can work when clients learn to listen to their internal cues rather than the negative voice of the “eating disorder” mind, or emotion driven cues to over or under eat.
When people start eliminating all the old external rules and controls, it is normal to crave foods that were once restricted. For example, when individuals go on low-carbohydrate diets, usually that is the nutrient they start to think about and crave. After stopping the diet it is quite common to “over-indulge” in foods high in carbohydrates. This is because the body is craving them so intensely. It is the same with any food. The more and longer a food is restricted, the more intense the cravings will be. This can be especially scary for individuals with eating disorders. At first, it may make them feel out of control and like they cannot be trusted with food. But eventually the extreme cravings subside and return to “normal.” It is important for them to keep this in mind as they are going through the process of becoming an intuitive eater.
Just as the body and mind intensely crave foods that have been restricted, the reverse also holds true. An example of this is going on a road trip and only having limited options of fast food available. At first it may be fun, exciting and pleasurable to eat these foods, especially if they aren’t foods normally consumed. However, after a while, fast food will get old and boring, and cravings for other foods will arise. This is because your body and mind get tired of the same thing over and over. We crave variety, as typified in the old adage “variety is the spice of life.”
Listening to the Body and Weight
By listening to hunger and fullness cues and to what the body is craving, our body will naturally find a weight where it feels comfortable. This is known as the body’s set-point weight. An easy way to understand this concept is with an analogy. A thermostat is set at 70 degrees. When the room drops below that temperature, heat will blow out of the vent and warm the room. If the temperature in the room goes above 70 degrees the air conditioner will blow cool air. Metabolism and hunger operate in a very similar way.
Hunger and fullness cues and metabolism play a role in the regulation of our body’s weight, just as the heating and cooling of the room helps control the temperature where the thermostat is set. When weight drops below our set-point, hunger will increase and metabolism will lower to conserve energy. When our weight goes above our set-point, hunger decreases and metabolism increases to burn energy more easily.
It is true that the regulatory mechanisms do work harder to keep the body from going below the set-point than above it. This is most likely due to the fact that during the majority of human history food sources have been scarce, and it has been vital for the body to preserve energy as a means of survival. However, the more we are able to tune into the regulatory mechanisms, the more likely weight will remain stable.
A study was done to exhibit the phenomenon of set-point weight. Volunteers were made to either gain or lose weight. After the artificial control was removed from the experiment, their weight automatically returned to normal. Possibly, the individuals in this experiment were able to reconnect to their bodies by listening to their hunger and fullness cues, after the artificial, external controls were removed.
Being Mindful While Eating
In order to get back in touch with hunger/satiety cues and to figure out what the body is craving, it is important to be mindful while eating. Using our senses while eating is a great way to get back in touch with our bodies. In our modern-day lives, many of us are rushing around and eating food on the run. Eating in this manner, most individuals do not pay attention to hunger and fullness cues, let alone the taste, texture, sight, and smell of their food. Staying fully aware of these aspects of food will enhance the experience of eating, and more enjoyment and satisfaction will be derived.
Checking in during various times throughout the meal can also help us to be mindful while eating. We can ask questions like:
- Where is my hunger/satiety level?
- Am I enjoying this food?
- What would make my eating experience more pleasurable in this moment?
- Would I rather be eating something else?
- Am I staying present while I am eating, or is my mind wandering around?
- What external things influenced my food choices today?
- How can I reconnect to the internal signals my body is giving me?
Asking questions and being curious and mindful during mealtimes will be beneficial to someone working on becoming a more intuitive eater. Awareness is such an important component of change. Without this subtle awareness we may find it impossible to become an intuitive eater and difficult to move out of the diet mentality.
A loved one with anorexia or restrictive traits will initially need structure to help them eat enough food to be re-nourished. Those who are purging or otherwise “getting rid of” ingested calories are also at high risk for malnourishment – no matter what their body weight or size might be. Re-nourishment is the most critical immediate concern for someone suffering with an eating disorder. Meal planning, mealtime structure and supervision are important especially in initial stages of recovery and if weight restoration is imperative due to compromised medical health. The structure provided by a therapist specializing in Family Based Treatment (FBT) approaches can be helpful in many circumstances, and a well trained dietitian can aid in a consulting role to parents. It is important, however, to wisely manage that structure and supervision, especially for adult clients, to best reduce the resistance many clients have when parents take on a food management role. As clients begin to progress and stabilize medically, emotionally and mentally, they can work towards intuitive eating where structure comes from the inside-out and clients are listening again to their bodies.
Tips for Families
Get rid of scales
This doesn’t mean just hide them. Actually, throw them away. To someone with an eating disorder the number on the scale can become a way to determine how much to eat or how to feel (“good” or “bad” about themselves). Weighing can become an unhealthy obsession. The number on the scale is another way for individuals with eating disorders to look outside themselves (externally) for answers. Clients can weigh-in “back to scale” with professionals who monitor their weight to assure progression is being made.
Don’t comment on appearances
This is true even if you think it’s a compliment. Something like, “you look healthy,” or even “you’re so thin,” can be twisted around and distorted in the mind of someone with an eating disorder. Try to avoid these comments. It may be more helpful in relationships to talk to loved ones about those things “internal” rather than “external” and those things of greater importance.
Keep a wide variety of foods around the house
Being an intuitive eater means figuring out what is being craved during times of hunger. The more variety that is available, the better chance the craving can be identified and satisfied. Keep various grains like breads, pastas, rice, and cereals on hand. Also, try to keep fresh and frozen fruits and vegetables in the house. Meats, like deli cuts and ground beef and other protein sources like peanut butter and cheese are important for specific cravings. Snack foods are a necessity, as well. Try to keep chips, cookies, and nuts around. These are just some suggestions. It is important to consider taste preferences and meal options while shopping at the grocery store.
Don’t buy “diet foods”
These are very triggering and tempting to individuals with eating disorders. They feed into eating disorder thoughts and behaviors. Plus, they are generally unsatisfying.
Challenge traditional beliefs about food
Avoid labeling foods as “good” or “bad.” Food is food. It has no moral value. All foods have nutritional value because every food is made up of carbohydrates, protein, and/or fat. These are the main nutrients needed for bodies to function properly, a.k.a. macronutrients. By listening to and tuning into the body’s needs, these macronutrients will be consumed in an appropriate way.
Thank you to Alice Covey, RD, CD, Kim Passmore, RD, CD, and Michael E. Berrett, PhD who contributed to the writing of this article.
REFERENCES AND SUGGESTED READINGS:
Facts and Figures on Body Image and Eating Disorders. Available at: http://www.cswd.org/facts.html. Accessed October 10, 2005.
Know Dieting: Risks and Reasons to Stop. Available at: www. NationalEatingDisorders.org. Accessed October 10, 2005.
Reiff DW, Reiff KKL. Eating Disorders: Nutrition therapy in the recovery process. Set-Point. 1998.
Robison, JI. Weight, Health, and Culture: Shifting the paradigm for alternative health care. Alternative Health Practitioner. Spring 1999; v 5; n 1.
Taylor, Mary. Tasting Mindfulness. Yoga Journal. Available at: http://www.yogajournal.com/health/10_1.cfm. Accessed August 10, 2005.
Tribole E, Resch E. Intuitive Eating: A Revolutionary Program That Works. 2nd ed. New York, NY: St. Martin’s Griffin; 2003.
© Copyright Center for Change, October 2006, November 2009 Revised: September 2014