Let’s talk about eating disorders today. There are common misconceptions that surround the terms ‘eating disorders’. This article will focus on breaking down a lot of the stigma associated with eating disorders, serve as a guide for the general population and providing practical advice on how to achieve one’s health and fitness goals with an eating disorder.
Let’s start from the top with a few questions:
- What are eating disorders?
- What is considered unhealthy eating behaviour?
- descriptions of common eating disorders backed up by criteria from DSM-5
- What constitutes to being an eating disorder
- Signs to look for in determining if an eating disorder is present
- What is the correct approach in tackling one’s health and fitness goals?
Common eating disorders:
Anorexia nervosa:
Obsession with weight and taking unhealthy measures to be thinner such as severely restricting food intake (McQuillan, 2021)
Criteria: (Mitchell et al., 2005)
- does not meet energy intake requirements: leads to low body weight for sex, age etc. (Sometimes one doesn’t recognize how low their bodyweight already is. One can use BMI, bone mass, frailty level, dietary habits to evaluate)
- intense fear of gaining weight
- two subtypes occurring over three months: restriction or using compensatory behaviour (binge eating/purging)
Common traits and affects (McQuillan, 2021)
- noticeable obsessive compulsive traits
- The list is extensive but this is what one can see with significantly decreased nutrient intake due to anorexia as well as compensatory mechanisms/ behaviours: slow heart rate, low blood pressure, abnormal blood count, risk of heart failure, risk of bone loss (osteopenia or osteoporosis), decreased muscle tone, dehydration (may less to kidney failure), missed periods, low testosterone, weakness, fatigue, dizziness, fainting, dry skin (may be yellow in color), blue color of fingers, hair loss and dry hair
Binge eating disorder:
Defined by episodes of consuming large amounts of food impulsively in a short period of time (Schag et al., 2013)
Criteria: (Wilfley et al., 2016)
- impulsive consumption happens at least once a week
- loss of control during episodes
- distress or feelings of guilt associated with behaviour leading to a recycled process
- no inappropriate compensatory behaviour (unlike bulimia and anorexia)
Common traits and affects (Wilfley et al., 2016)
- over evaluating shape & weight, report higher rates of depressive disorders, posttraumatic stress disorder, generalized anxiety disorder, OCD, impulse control disorder, panic attacks and substance abuse problems
- risk to developing obesity
Bulimia nervosa:
Defined by recurrent episodes of binge eating, followed by 1 or more compensatory behaviors to eliminate the calories (e.g. vomiting, laxatives, fasting, etc.) (avg. a minimum of twice weekly for 3+ months) (DSM-IV)
- Behavioral – individual experiences recurrent episodes of eating abnormally large amounts of food + engaging in behaviors to inhibit weight gain (e.g. vomiting, exercise) (DSM, 2000)
- Cognitive – self-evaluation and the importance of body weight or shape (Cooper & Fairburn, 1993)
Common traits and affects:
- depression, borderline personality disorder, substance abuse, self-injury
- subconjunctival haemorrhage or recurrent epistaxis, dental erosion, dental cavities (due to self-induced vomiting)
Orthorexia Nervosa (OrNe):
Defined by an excessive obsession to a perfect healthy diet, that in turn, might be causing one to harm themselves (Bratman, 1997)
- a condition characterized by disordered eating behavior generated by a pathologic obsession for biologically pure and healthy nutrition (Brytek-Matera, 2012)
Different from anorexia/bulimia nervosa, who primarily obsess about the quantity of food intake as well as physical appearance, patients with orthorexia are preoccupied with the quality of food intake (Mathieu, 2005)
Criteria: Proposed by (Moroze et al., 2014)
- Obsessional preoccupation (OP) with eating “healthy foods”, concerned with the quality and composition of meals
- OP becomes impairing by 1) nutritional imbalances and/or 2) social, academic, or vocational functioning
- Not merely an exacerbation of the symptoms of another disorder (e.g. obsessive-compulsive disorder)
Common traits and affects
- Perfectionism, narcissism, rigidity, need for control, self-discipline (Roncero et al., 2021)
- Aesthetic anxieties, the feeling of not being liked, damages in the body image (Akturk et al., 2019))
- Stay awaying from foods containing artificial colorants, sweeteners, preservatives, pesticide residues or genetically modified components, etc.) (Akturk et al., 2019)
What you can do if you/ your client suffers from an eating disorder or know someone who does:
- Understand what their relationship to exercise was prior to the eating disorder
- Don’t overwhelm them with exercises like HITT workouts, Cardio as these can exacerbate symptoms (significant loss in energy & weight; cardiovascular damage etc.) and obsessive tendencies
- Alternative: Introduce less intensive workout like light strength training or just with body weight
- Mind over matter – balance routines with mindfulness training to look beyond the behaviours and explore one’s true feelings or goals associated with lifestyle
- Improving their bone density is really important:
- Not eating enough=bone density decreases. Once caloric or nutrient intake returns, bone mass tends to catch up with the inclusion of basic activity. Food intake should be properly assessed.
- Focus on the intrinsic motivation instead of extrinsic i.e. stop focusing on the scale, numbers; refocus on how they feel after working out “ it helps with anxiety, I feel more focused etc.” Sometimes it helps to be with like-minded individuals and avoid people who perpetuate negative feelings. Goals would need to be redefined and this does not happen overnight. It is important to have support here (therapy, sponsor, peer etc.).
And there you have it. Identifying eating disorders or the onset of one can be difficult thus it is important to work with the appropriate practitioners. In some cases, it can be caught early but playing the blame game will only lead to additional guilt. With our clients, we approach with a supportive attitude and provide education around the individual’s needs. It does not help that social media, family, friends, coaches etc. are pushing unrealistic expectations to vulnerable individuals. Building a system of trust and education will go a long way.
Article written by:
-Ryuya Tanida (4th year Kinesiology student at the University of Toronto)
-Sophia Navas (3rd year Kinesiology Student at the University of Ontario Institute of Technology)
-Shaneh-Abbas Jaffer (Registered Kinesiologist)
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