This coming week (26 Feb - 4 Mar) is Eating Disorders Awareness Week, and it also happens to coincide with my completing training in Nutrition Interventions for Eating Disorders and Eating Distress.
Eating disorders are complex disorders of abnormal eating attitudes and behaviours that have important consequences for the physical and mental health of affected individuals. Eating disorders require a multidisciplinary approach. Consistent support and counselling are essential for long-term recovery. All members of the team should be skilled in treating eating disorders (doctors, dietitian/nutritionists, psychotherapists and nurses).
Once a patient’s weight is back within a certain range, then nutrition counselling can be helpful in helping them on the path to physical recovery.
There are many types of eating disorders:
Anorexia nervosa is where restriction of energy intake is leading to a significantly low body weight. The patient has an intense fear of gaining weight or becoming fat. There is a disturbance in the way the patient perceives their own weight and shape.
Bulimia nervosa is characterised as recurrent episodes of bingeing (uncontrolled excessive consumption of food) and purging (compensatory behaviour to prevent weight gain – self-induced vomiting, misuse of laxatives or excessive exercise)
Binge eating disorder is characterised by recurring uncontrolled episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances. The patient may eat more rapidly than normal, until feeling uncomfortably full, when not hungry, eating alone because of shame or feeling disgusted with oneself.
Feeding or eating disorders not elsewhere classified (FED-NEC) are disturbances in eating behaviours that do not necessarily fall into a specific category, but is the most common eating disorder diagnosis.
Other eating disorders include night eating syndrome (excessive food consumption at night), nocturnal sleep-related eating disorder (the patient is somewhere between wakefulness and sleep) and orthorexia (an unhealthy obsession with healthy eating).
No single factor can account for the development of an eating disorder in an individual. They are multi-factorial conditions and predisposing factors include (but are not limited to) history of childhood obesity, low self-esteem, personality traits, history of traumatic experiences, high-achieving families and genetic factors.
Recovery from an eating disorder can take many years. It is not just a matter of getting the person to eat, but addressing the underlying psychological issues. The individual may need to develop other coping mechanisms to replace the eating disorder.
Long-term, eating disorders may make an individual more susceptible to osteoporosis and fertility problems. There may be physical effects from long-term vomiting and laxative abuse. Nutritional deficiencies should be addressed and nutritional interventions put in place to restore the patient to their optimal health.
Nutritional therapy for patients with eating disorders is very different to nutritional therapy for the rest of the population. The patient needs to be educated about the nutritional benefits of different foods, appropriate food behaviours and food choice and variety. In this instance, nutritional counselling is about creating options rather than making any restrictions. Small achievable goals need to be set weekly and progress followed closely. Macro and micronutrients need to be built up gradually, and foods that contribute positively to good health introduced.
Nutritional counselling needs to be done flexibly, sensitively and patiently in a non-judgmental and caring way, working at a pace to suit the patient. It is important to remain optimistic and hopeful as people can, and do recover.
Dalle Grave, R. (2011). Eating disorders: Progress and challenges. European Journal of Internal Medicine, 22(2), 153–160. https://doi.org/10.1016/j.ejim.2010.12.010
Fairburn, C.G. & Harrison, P.J. (2003). Eating disorders. The Lancet, 361(2003), 407-416
Treasure, J., Claudino, A. M., & Zucker, N. (2010). Eating disorders. The Lancet, 375(9714), 583–593. https://doi.org/10.1016/S0140-6736(09)61748-7