By: Jenelle West, RD, CD

Article based on Jessica Setnick RD/LD’s seminar: “What’s Eating Your Clients? Solving Eating Disorders from the Inside Out”; Center for Change; August 22, 2004

Many patients lose the battle with their eating disorder because they fail to recognize their enemy. Factors contributing to an eating disorder may include genetics, the environment and/or other triggers. When this is the case, what are the steps to recognizing these factors and what is the battle plan?

Taking a Shot at Genetics

Because the study of genetics is new there is still much research to be done to understand connections between an eating disorder and genetics. Jessica Setnick proposes that genetic components of eating disorders may be linked with other illnesses; therefore, a patient genetically prone to another illness may be more prone to develop an eating disorder. Illnesses, she suggests, that may be linked to eating disorders are compulsive disorders, impulsive disorders, addictions, personality disorders, and sleep disorders.

Eating Disorders in the Sight of Society

Our environment is steadily getting worse about the messages being sent about food and weight. Common themes we hear and see everyday in the environment are:

Food makes you fat

Food is gross

Food is unnecessary

Food takes too much time to prepare and eat

Eating is fun when I’m bored

Eating comes last

Food is a reward for when you are good

It is important to be on a diet

All of these environmental messages-sent everyday-are influencing the population to look at food non-intuitively.

Pulling the Trigger. Is Your Safety On?

Triggers are the third group of contributing factors that Setnick mentioned. Triggers for eating disorders may be dieting, death or divorce, and trauma or perceived trauma. Moving to a new city, disappointment, comments about weight/rejection/teasing, and mandated weight loss/gain for a sport are also considered triggers. Simply put, any trigger that exceeds the ability to cope can contribute to an eating disorder.

All of these factors lead to stress in a person’s life, which may lead to disordered eating.

Bull’s Eye of an Eating Disorder
Why is disordered eating a response to stress?
If the patient is feeling bad on the inside, or feeling out of control, our culture can lead her to believe that it is because of the way she looks. However, changing the way she looks doesn’t fix the real problems, the changes she makes are never enough, and problems are never solved.

Meanwhile stress causes changes in brain chemistry and the behaviors that seemed helpful at first become both a habit and an addiction for some people. Further stress means increased degenerative behaviors.

To professionals, disordered eating is a problem, but to the person involved it seems like a solution. To combat disordered eating the patient needs to find healthy alternatives to cope with stress so that the disordered eating does not become an eating disorder.

Enter the Combat Zone: Legalize. Separate. Manage.

If the disordered eating does become an eating disorder there are three ways Setnick suggests to deal with the stress and combat the eating disorder:

  1. The patient must be ready to recover by reaching a turning point with the eating disorder and deciding she wants to recover.
  2. Have a reason to live, i.e. wanting to pursue a career or wanting to become a mother.
  3. Develop an identity without the eating disorder

The main role of the professional in this situation is to help the patient develop an identity separate from the eating disorder. Three ways Setnick suggests to do this are: Legalize food, separate food from feelings, and manage the feelings in other ways.

Legalizing food involves being able to look at food as a source of nutrition instead of a source of fear. This step is as important for someone who binges as it is for someone who restricts. “A healthy relationship with food is more important than any one food you do or do not eat,” says Setnick.

In addition to legalizing food, separating food from feelings involves knowing what food can and cannot do and dispelling the myths associated with food and weight. The road to recovery involves discovering what is behind the fat thoughts. For example, instead of the patient saying “I feel fat”, the patient should be able to say what they are truly feeling… “I feel like a failure” or “I’m afraid to feel emotions.”

Managing feelings in other ways involves finding healthy coping skills and learning how to problem solve. This process helps them overcome their thoughts and emotions and focus their efforts on additional discovery and recovery.

Execute a Plan, Win the Battle

Whatever the cause of the patient’s eating disorder, their objective must be to win the battle. Considering genetics, the environment, and/or other triggers will help them identify their enemy. Once they know and recognize what they’re up against, they can develop a combat plan. They must start by legalizing food, separating their food from feelings, and managing their feelings in other ways. Executing this plan will help the patient take appropriate steps in conquering their enemy, the eating disorder.