Happy Wednesday! I hope you are having a nice week so far. I have been enjoying the fall colors lately and getting outside when I can, especially when it is sunny! I just finished my five-week-long food service management rotation at one of the dining halls at U of M. I enjoy food service and learning more about managing food operations – it was especially interesting/crazy with all of the supply chain and staffing issues going on with COVID! Not fun for the staff when they are trying to feed and forecast menus for 2000 people multiple times every day… This week I am doing a one week clinical rotation with the maternal and infant health unit at Michigan Medicine. The one constant of this internship is that it is always changing and quickly on to something new!

Today I’m going to be covering a few concepts…

• • • What is an eating disorder?
    • What is disordered eating?
    • What does it look like to be a healthy eater?,

I often talk about both eating disorders and disordered eating, so I think it’s important to take some time to explain what each means. It’s necessary to make this distinction because one can have a disordered relationship with food without having a full-blown eating disorder, and both are important to address for optimal health and well-being.

What is an eating disorder? 

An eating disorder is a formally diagnosed condition, based on meeting strict diagnostic criteria set in the DSM-5. Eating disorders have a strong biological and genetic component, and are often also rooted in emotional, social, and cultural factors. The most commonly referred to eating disorders are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). However, there are also other, lesser known eating disorders, such as avoidant restrictive food intake disorder (ARFID), rumination disorder, pica, other specified feeding and eating disorder (OSFED), and more. This post will focus on AN, BN, and BED.

Generally, AN is characterized by a persistent reduction in food intake leading to an extremely low weight, a fear of gaining weight, and a distorted view of one’s body. AN is the most deadly mental illness, given the physical effects of starvation. BN is characterized by repeated episodes of binge eating followed by some sort of compensatory behavior (such as vomiting, using laxatives, fasting, or obsessively exercising). Unlike those with AN, those with BN can often be at “normal” weight. BED is characterized by repeated episodes of binge eating (eating uncomfortably large quantities of food in a set time period and feeling out of control with one’s eating). However, in BED, the binge eating is not followed by some sort of purging/compensatory response.

Eating disorders are relatively rare. According to the National Eating Disorders Association, at any given time 0.3-0.4% of women are suffering from AN, 1.0% of women are suffering from BN, and (according to a 2007 study) 3.5% of women in the study sample had BED in their lifetime. While there are of course different prevalence statistics from different studies, it is generally accepted that BED is the most common, followed by BN and then AN. Eating disorders have drastic physical, emotional, and mental health ramifications, impacting all areas of one’s life.

What is disordered eating? 

In contrast to eating disorders, disordered eating is quite common. I would argue that most people experience at least some degree of disordered eating, and that the main reason more people don’t end up with full-blown eating disorders is because of the strong genetic component often needed to develop an eating disorder. Disordered eating is a spectrum of behaviors that range in severity. Disordered eating may lead to a full-blown eating disorder, or it may not. Disordered eating behaviors can look similar to an eating disorder, or aspects of eating disorder, but the key distinction is that the person does not meet formal eating disorder diagnostic criteria.

Examples of disordered eating behaviors may include:

• Fearing and/or unnecessarily removing certain foods or food groups
• Moralizing food or shaming yourself surrounding food (e.g., I’m “good” when I eat a salad and “bad” when I eat a hamburger, certain foods are “good” or “bad”)
• Denying hunger signals out of a fear of gaining weight
• Restricting foods out of a fear of gaining weight
• Compensating after eating “too much” or something “bad” (such as by fasting, restricting food, or obsessively exercising

And the list goes on!

Even though one may not get medical treatment for disordered eating, it can be just as devastating as an eating disorder. While experiencing an eating disorder and walking through recovery was one of the worst/hardest things I have gone through in life, in some ways I am glad that I had an eating disorder because it forced me to get to a place where I now have a healthy relationship with food (the only alternative was to continue starving to death – 10/10 not recommended). I think since many people never hit that much of a rock-bottom with food, they can stay lingering in the disordered eating space for decades… Making matters worse, many of the behaviors above are socially acceptable and even encouraged at times! Thus, food can play an unhealthy role in many people’s lives for so long, without them getting help, and this can have tremendous affects on their social, emotional, mental, physical, and spiritual health.

This causes me great sadness as food is something that is to be enjoyed and cherished with others!

Remember also from a couple weeks ago that experiencing a joy-based approach to food (i.e., a healthy relationship with food) is key to both good nutrition and overall health and well-being. Our nutrition and health will suffer with a disordered and fear-based approach to food.

What does it look like to be a healthy eater?

A healthy eater is one who:

• Eats a variety of foods and from all food groups (unless there is a medically warranted reason to restrict a certain food or food group, such as with an allergy or certain medical condition)
• Is able to be flexible with their eating
• Is able to comfortably attend social gatherings where food is involved
• Is able to comfortably eat what are often deemed “less healthy” foods
• Does not shame herself after eating or compensate (especially after overeating or when eating something that may be deemed “less healthy”)
• Does not moralize food
• Does not obsessively think about food (i.e., her relationship with food does not impact her life in an unhealthy way)
• Sees food as both necessary fuel and a joyful pleasure
• Respects her body and its current size (regardless of how she feels about it)

A healthy eater is one who enjoys food as the gift that it is, and is not mentally weighed down with anxiety and fear surrounding food – she is freed up to live life to the fullest, utilizing her God-given talents for the good of others and exploring all the wonder that the world has to offer!