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Eating Disorder 101: A Mental Health Therapist Answers Your Most-Asked Questions Part II

Part II – Effects & Finding a Dietitian

Note: There are two parts to this article. For “Part I – Stress and Society,” click here.

I’m Limor Weinstein, founder of LW Wellness Network, and I am going to answer some of your most-asked questions about eating disorders. My background, experience, and education as a licensed mental health therapist are centered on personal and family well-being. As a mother, wife, and psychotherapist, my goal has always been to provide emotional support and knowledge that may be absent due to a variety of variables. I myself am an ED survivor. I am also an Eating Disorder Specialist who works with clients to help them find their way to better health.

What health risks are related to ED?

There are many health risks related to eating disorders. Each eating disorder has its own health consequences due to the nature of the disorders. As anorexia nervosa is characterized by self-starvation, the body is forced to live without the essential nutrients it needs for normal functioning. Anorexia can lead to abnormally slow heart rate and low blood pressure, which increases the risk for heart failure, reduction of bone density, muscle loss and weakness, severe dehydration, which can result in kidney failure, fainting, fatigue, overall weakness, dry hair and skin (hair loss is common). It is also possible that there is a growth of a “downy layer of hair called lanugo” all over the body to keep the body warm (NEDA).

With the binge-and-purge cycle of bulimia, the entire digestive system becomes affected, which leads to electrolyte and chemical imbalances of the body. These electrolyte imbalances “can lead to irregular heartbeats and possibly heart failure and death” (NEDA). This is because electrolyte imbalance is caused by “dehydration and loss of potassium, sodium and chloride” from the body each time the individual purges (NEDA). Gastric rupture can occur during binging. Frequent vomiting can lead to inflammation and possible rupture of the esophagus, tooth decay, and staining from stomach acids. Abuse of laxatives can lead to “chronic irregular bowel movements and constipation” (NEDA).

The consequences of binge eating disorder are similar to the health risks associated with clinical obesity. These include high blood pressure, high cholesterol levels, heart disease due to elevated triglyceride levels, type II diabetes mellitus, and gallbladder disease (NEDA).

Are there any ED withdrawal symptoms? What are they?

Withdrawal from an eating disorder is similar to withdrawal from other addictions. According to a study done by Indiana University, symptoms of withdrawal typically include irritability, cravings, and general restlessness.

Why do people fear overcoming ED?

Fear comes with this decision to recover from an eating disorder because until this point, the eating disorder has helped the individual to feel safe and secure. The eating disorder has given this individual a sense of control and identity. This is why it becomes difficult to stop an eating disorder. But, it is possible. The person affected by the eating disorder must overcome their feelings of helplessness, guilt, shame, and self-disgust to seek help. Once they do this, they will still fear letting go of their eating disorder and going through a change. These fears should be acknowledged and discussed to help in the road to recovery.

There is, of course, always the fear of relapse. The final stage of recovery, maintenance, is about new experiences and adjusting to new developments. With this there is the chance of relapse. But this cannot be the focus of recovery. This is why recovery is an ongoing process, involving asking for help and communicating through thoughts and feelings.

You’ve said that, “While it might not be easy to stop ED, it can be enjoyable.” Can you elaborate?

Although it is not easy to stop an eating disorder, it can be enjoyable. Depending on the type of treatment that one goes through, he or she will likely be surrounded by other people in treatment (which can be both good and bad as discussed earlier). By being surrounded by like-minded individuals, one can see that they are not alone, that there are people out there going through the same thing as them who are also looking to get help.

As August McLaughlin discusses in “The Silver Lining: 5 Happy Truths About Eating Disorder Recovery,” there are positive aspects in the road to recovery. Recovery leaves people “feeling lovelier, inside and out.” Individuals with eating disorders have distorted views of themselves both physically and mentally. They want to lose weight to fix their physical appearance, and they take these drastic measures to make them feel better internally. Treatment, however, teaches people how to appreciate themselves for who they are and to love each and every part of themselves. Treatment leads to greater energy. Eating disorders take an extreme amount of physical and emotional energy to sustain. By letting go of an eating disorder people will gain back this energy to do things they love physically and to think about something other than the eating disorder.

Treatment also brings enjoyment back to food. Food is no longer as scary as it once may have seemed. By mending one’s relationship with food, he or she can enjoy their favorite foods without feeling the extreme guilt before, during, and after. Treatment leads to freedom. Eating disorders have such control over people’s lives. By not letting the eating disorder dictate every life decision, individuals are surprised to see how much they can freely live their life, by their own rules. Lastly, treatment leads to gratitude. Living with an eating disorder can be extremely challenging and detrimental. People in recovery, living without an eating disorder, will learn to be thankful for their bodies and minds. It may be scary to think about what one’s life would be like giving up this eating disorder that has had so much control, but there is nothing to lose by giving up an eating disorder, just a beautiful life to gain.

I’m sick of people focusing on why I shouldn’t maintain my ED (health risks, etc.)! Can you tell me why people do continue their ED?

It is easy to list all of the reasons why clients should try and get rid of their eating disorders. There are health risks involved, the eating disorders take over the individual’s life, there’s dramatic weight loss as well as damage to the digestive system and potential organ damage. Sometimes it is not enough to express to the client the negative effects that an eating disorder can have. Rather, we should focus on why people maintain their eating disorders. People with eating disorders become comfortable with their eating disorders. They begin living a lie and don’t know how to get out of it, or if they even want to. As stated earlier, the eating disorder that has such control over their life becomes a sense of security and control. The eating disorder begins making life decisions that the individual does not have to make. Further, the eating disorder becomes his or her release. The willpower not to eat, the binging, purging, or excessive exercise gives the individual a way to relieve stress.

By teaching clients alternative ways to have control in their daily lives or new ways to cope and calm themselves, clients can hopefully give up the detrimental ways in which they achieve this through their eating disorders. If a client can begin to enjoy these alternatives they may be more likely to give up the harmful techniques they were using and transition into recovery.

Is it a myth that the ED person “sacrifices” something or deprives themself when they stop their ED?

Many people believe that when they quit something they are addicted to they will be sacrificing something. In the case of eating disorders a client may feel that they are missing out on something by giving up their eating disorder. To help with recovery we must show how positive it can be to live a life without an eating disorder. There should be “nothing to fear, nothing to ‘give up’ and absolutely everything to gain” (Carr, 2011).

Why do eating disorders provide people with a feeling of safety and security?

Life with an eating disorder provides people with a feeling of safety and security. This is because eating disorders are started out of instability, with the hope that the eating disorder will create stability or some kind of control. Eating disorders hold great control over individuals lives that they grow accustomed to over time. It can be scary to let go of this sense of control and comfort that they have been living with.

Is there a link between boredom and ED?

Yes, many people eat out of sheer boredom. It is important to differentiate between biological hunger and boredom. When we develop negative eating habits, we become unaware of why we are eating. An individual may try to fill themselves up with food when they do not feel like their lives are full. Eating becomes a mindless activity, similar to when one emotionally eats.

What is going on the brain of an eating disorder client?

In addition to the other emotional, physical, and social effects that eating disorders have on an individual, eating disorders can lead to neurological damage (Emilyprogram.com). A client’s nervous system is negatively impacted when they engage in restrictive behavior. This leads to disruptions in neurotransmitter behavior, structural changes, and abnormal activity during anorexic states, a weakened response in the reward regions of the brain, and potential shrinking of the brain. Nerve related conditions such as seizures, disordered thinking, and numbness or odd nerve sensations in the hands or feet are also possible effects. Eating disorder clients may become depressed, irritable, or isolated due to the adverse effects on the emotional centers of the brain. An individual also could have difficulty thinking, switching tasks, and setting priorities due to the disruption in the brain’s normal functioning.

Is it an illusion that I can overcome my eating disorder?

In some cases body dissatisfaction does not change once an individual has “recovered” from an eating disorder. Even when the physiological and behavioral aspects return to status quo, mentally a client may still feel negatively about their body. This is why recovery from an eating disorder is an ongoing process that involves overcoming daily triggers that an individual may encounter. However, it is not an illusion. There can be a light at the end of the tunnel.

How do I stop?

Unfortunately, this is not as simple as reading a response. However, I’ve put a list of things I have my clients ask themselves:

  1. What does the ED really do for me?
  2. What purpose does it serve?
  3. Do I really enjoy it?
  4. Do I really need to go through life playing with my health just to maintain my eating disorder?
  5. What am I getting out of maintaining this eating disorder?
  6. Would my life be incomplete without it?
  7. How could I make my life more complete so I can get rid of my eating disorder? How can I use the resources and people around me to help?

Where can I find a dietitian?

If you are trying to figure out where to find a dietitian, chances are, there is someone not far from you. There are fabulous nutritionists, dietitians, and eating disorder therapists all around the country who are qualified and ready to help you. Your doctor may have some good recommendations if you want to find a local dietitian. Do you want someone who is uniquely matched with you? Give us a call. We will learn about you — from your personality, your history, your health past, your struggles, and your goals — and we will find someone in your area who fits you best. We have many fantastic providers whom we trust and adore to help guide our clients on their path to recovery.

If you or someone you know is struggling with an ED, it’s time to take the necessary steps to change life for the better. You can grow into the best version of yourself, starting right now.

If you would like me to connect you with one of our expert therapists or dietitians, contact me or book an appointment with me. I look forward to hearing from you!

10 Tips From A Dietitian Nutritionist for Picky Eaters

 

“I know! She eats anything! I can’t believe it!” your friend exclaims, referring to her 5-year-old daughter as she chomps away on a Salmon Avocado Roll, while your child eats “orange mac and cheese only, Mom, not the white kind!”

Is your friend’s daughter more advanced? More gifted? More mature? Not at all! Your friend’s child is simply different from yours, and that’s OK. 

Feeding troubles affect up to 25% of normally developing children and up to 35% of children with neurodevelopmental disabilities. That’s a lot, right? It’s a common issue to have, but it’s not a problem — it’s something you can work with and overcome together as a family. It’s important for everyone in the family to understand what the “picky eater” is going through, so you can all help out. Many families work with a child dietitian nutritionist to help them along this tricky path, and you may want to, as well. It’s always good to seek help if something isn’t working for you or your family.

Here are 10 tips for families with picky eaters so you can understand where your child is coming from, and help them eat well in the process.

1. Establish A Routine

It’s important to have a routine. As adults, we should also look into this, because it’s been proven that our bodies are happiest when we have a specific schedule to stick to. Studies have shown that children and adults who eat at the same time every day are less likely to be obese and have lower BMIs and blood pressure than people who eat at random points throughout the day. According to Gerda Pot, a professor at King’s College London who was interviewed by the Times, appetite, digestion, and how our body processes food are actually linked to circadian rhythms. This means that our bodies follow a 24-hour pattern in relation to food, just like how our bodies need sleep. It’s so interesting! But it can be so hard to stick to a schedule…

Here are ways to feed your child in a way to encourage their appetite by establishing a routine.

  • Consistency — Serve small meals and snacks at consistent times of the day, with 2–3 hours between each meal and snack time, allowing the child to become hungry before the next meal. Young children feel most comfortable with scheduled mealtimes.
  • Beverages After — Offer milk, nutritional beverages, juice, soup, or water at the end of the meal or snack, and not before, in order to prevent filling their stomachs.
  • Duration
    • Eating should begin within 15 mins of the start of the meal.
    • Meals should last no longer than 20–30 mins.
    • When the meal is over, all food should be removed and only be offered again at the next planned meal. You should not become a short order cook!

2. Respect Your Child’s Appetite

Your kid may not be hungry! And even if they are, it’s important to never force or bribe your child into eating. Forcing or bribing creates pressure, which can lead to children eating even less in the long run. Positive tactics like praise or a gift can also create pressure, though. It’s hard to remember this when you’re trying to get your child to eat, but, believe it or not, pressure in any way makes kids like food less.

What are examples of pressuring messages or tactics?

  • Praise (“Oh my gosh, you are such a good boy for eating that! Good job!”)
  • Shame or guilt (“If you loved me then you would eat this…”)
  • Bribes (“If you eat this, I’ll give you a toy after dinner!”)
  • Distraction (“Just watch your favorite TV show while you eat this…”)
  • Threat or force (“You have to eat this or I won’t let you go to that birthday party this weekend.”)
  • Pressuring therapy (“We’re going to have to bring your nutritionist back for therapy if you don’t eat this…”)
  • Nutrition admonitions (“You need more spinach to grow stronger…”)

So what should you do?

  • Start to learn and notice your child’s hunger signals.
  • Allow your child to choose how much or how little of the offered food to eat. Don’t make them clean their plate!
  • Respect your child’s natural inner signals of hunger and fullness. They will change from day to day, so be open for differences!

3. Make Food Fun

Let your child have fun with food! Food is a glorious thing, and we should treat it as such, as long as we aren’t negatively affecting others in the process. Why not enjoy it? Cut pieces of toasts into silly shapes! Make funny faces with fruit on the plate! Make everything on the plate the same color in different shades! When we understand that food is meant to be enjoyed, we’re more apt to be curious for more options. Discover your playful side, too!

Here are some ways to make meals fun for you and your child:

  • Make Faces On Plates — Paint plates at a paint studio or buy plates with faces on them, so you can move the food around to become different parts of a person’s head. Spaghetti can be the hair, broccoli can be the nose, corn can be the teeth, and so on.
  • Be A Monster — Allow kids to act like monsters destroying and devouring their food, as long as they don’t make a mess around the house, or as long as they take responsibility for cleaning up afterwards. The spinach can be the grass in the yard, the chicken can be the house, the pasta can be the fence… and THEY ARE THE MONSTERS EATING THE NEIGHBORHOOD!
  • Grow Your Own Food — This gives kids a chance to see where it came from, and have a hand in the process. When a child plants something and watches it grow from seemingly nothing over a long period of time, it makes it rewarding to try a bite of what they saw growing on the windowsill or in the garden!
  • Watch Cooking Shows Together — Shows like “Master Chef Jr.” are a great way to get kids excited about food. When they see other children their age making food and becoming masters at cooking, it makes it more exciting. Try some of the recipes that you see on the cooking shows together! Notice what excites your kid, and incorporate that meal into your next plan.
  • Use Dips And Spreads — Get kids to eat their fruits and veggies by offering fun things to dip the food into. It’s fun to try different tastes, and the physical movement of dipping gets them connected to their food in a different way.
  • Eat A Rainbow A Day — Focusing on color is a great way to get kids to try different food groups. Encourage them to try to eat something of each color of the rainbow every day, and keep track of what they ate already!
  • Make Up Your Own Food Names — Teach children the proper names of foods, but come up with your own silly words for them, too. A green smoothie can be “monster juice” and pineapple can be a “ferris wheel.” Ask your kids to help you come up with their own funny names!
  • Make Food Into Fun Shapes — Does your kid have an obsession with the solar system? Cut things into stars and circles for the planets! Are they learning to spell? Make the food spell out their name on a plate. Make the meals look fun and enticing, and your child may be more keen to try a bite or two… or more!

4. Be Creative

Systematically introduce new food! Provide some of your child’s favorite foods together with a small amount of new food. If the child refuses a new food, offer just one bite of the new food without tricking, hiding, bribing or forcing. (If the child continues to refuse after three attempts, do not force the child.) Attempt to reintroduce the new food after a few days or weeks. A child’s preference often changes, even if it takes a few tries!

5. Minimize Distractions

Avoid allowing television, tablets, toys, electronics or books at mealtimes, as this takes away the experience of eating. Instead, engage children using food or by allowing children to self-feed.

6. Establish Rules

Don’t make a second meal if your child refuses the first one. Having a second option always available, like a salad or a bowl of cereal, takes the pressure off both parent and child, because everyone knows the child will still be able to eat something. (If your kid wants to have a sugary bowl of cereal every night, obviously this option doesn’t work for you!) Your child should know that you will not drop what you’re doing to make them what they want, even if they don’t like what’s offered.

Everyone should wait at the table until they are excused from the table. This means that if your child doesn’t want the meal, they still have to sit at the table until everyone else is finished, whether they eat or not.

Whatever your rules are, stick to them as much as you can.

7. Be Patient

Encourage independent feeding – allow for food spillage and age-appropriate mess during mealtimes; cover the floor if it makes cleaning up after meals easier.

Maintain a neutral attitude during feeding time and never become or even appear angry. Your child shouldn’t associate anger with food!

Be patient with your kid, but also be patient with yourself! This may be a trying experience for both of you, but if you give in to what your child always wants to eat, they won’t grow.

8. No Sweets As A Reward

Dessert is not a reward for eating well. This teaches your child that the dessert is the best part, and they should save room for it. It only increases your child’s desire for sweets! Think of making your family’s typical dessert fruit or yogurt, or only offering dessert once or twice a week.

9. Have Your Child Help

Ask your kid what they want! What vegetables and fruits are they craving? Have them help you pick out healthy food at the grocery store. They can help you prep the meal, too! Many kids love to help wash veggies, set the table, or stir a sauce.

10. Set A Good Example

  • Eat Together As A Family — Families should eat together as often as possible. Three-four times a week is what you should aim for, and if you can get more than that in, great! Keep in mind that this doesn’t have to be dinner. It can be breakfast or lunch. It also doesn’t have to be a home cooked meal! Eating together can include ordering your favorite takeout every once in a while.
  • Try Things You Don’t Like — If there is a particular food that you yourself don’t like, tell your child you are going to try it prepared in a different fashion to see if you like it in a new way. Show your child that people can change, and it’s ok to try things again.
  • You Have To Eat Your Fruits And Veggies, Too! — Don’t tell your child to eat a nutritious meal and then only serve yourself the pasta and tomato sauce. Do what you’re asking your kid to do.

 

Should I seek the help of a CDN Certified Dietitian Nutritionist?

It’s OK to ask for help. There is a certified dietitian nutritionist in your area who has trained for this, and who may know the ups and downs better than you do. Why not seek the help of a professional?

If you want to find a dietitian nutritionist, ask your pediatrician about where to start. They can lead you in the right direction on where to look in your area.

Or, ask us! We’re always happy to help you find a dietitian or nutritionist who’s right for your family. We’ll match you with a professional specialist, and their expertise, knowledge, and planning tools will help you solve your picky eater concerns. Whether you want to seek the advice of a licensed dietitian nutritionist, a therapist, a fitness guru, or a tutor, we’re your one-stop-shop to help you and your entire family — adult or child. Contact us for more information!