Introduction
Diet trends like keto, intermittent fasting, and paleo are common in our society. We also as a society tend to have preoccupations with food, calories, and weight/appearance. But at what point do these diets and preoccupations become problematic?
Definition
Disordered eating is located on a continuum between “normal” healthy eating and an eating disorder. It may include symptoms and behaviours of eating disorders, but at a reduced frequency or lower level of severity. It may include restrictive eating, compulsive eating, or irregular/inflexible patterns of eating. It is important to note that any diet or certain pattern of eating without medical reason would verge towards disordered eating.
Signs and Symptoms
Signs and symptoms of disordered eating may include, but are not limited to:
- Binge eating
- Restricting or avoiding certain foods without a medical reason
- Skipping meals or fasting
- Chronic weight fluctuations
- Strict rituals or routines around food and/or exercise
- Cutting food into smaller pieces, slowing pace of eating, or engaging in any other behaviours that “trick” yourself into feeling fuller from less food
- Feelings of guilt/shame or a sense of loss of control around your eating behaviours
- Anxiety or preoccupation associated with specific foods, weight, and/or body image
- Self-induced vomiting
- Laxative, diuretic, or enema misuse
- Using diet pills
Risk Factors
History of weight bullying, stress, food insecurity, minority status, higher weight, family history, and pre-existing mental health symptoms are common risk factors for increasing one’s likelihood of developing disordered eating and an eating disorder. Chronic dieting is another strong risk factor as it leads to weight cycling: a pattern of dieting to lose weight, then regaining the weight after the diet stops, and attempting to diet again. Anyone can develop disordered eating patterns; it is due to a combination of genetic, psychosocial, cultural, and environmental factors. While it is more often seen in youth and gender/cultural minorities, it can also affect any gender, age, culture, or socioeconomic status.
Prevalence
According to the National Eating Disorder Centre, between 840,000 and 1,750,000 Canadians engage in disordered eating behaviours and other symptoms of eating disorders. While the prevalence of various eating disorders can change depending on the type of disorder and individual characteristics, generally speaking it is estimated between 2-4%.
Of note, the prevalence of disordered eating and eating disorders dramatically increased during the COVID-19 pandemic; several possible explanations for this may include isolation, increased time on social media, decreased access to medical treatment, and increased anxiety.
Consequences
There can be a number of negative consequences associated with not only eating disorders, but also those who engage in disordered eating. For instance, there can be issues related to obesity, diabetes, bone loss, anemia, gastrointestinal issues, electrolyte/fluid imbalance, heart rate/blood pressure issues, reduced sleep quality, decreased dental health, poor mental health (e.g., anxiety, depression, suicidality, low self-esteem) and social isolation. Those who engage in disordered eating are at higher risk of developing an eating disorder.
Disordered eating can sometimes be difficult to detect since the individual may not display overt signs or “classic” symptoms of an eating disorder. For instance, they may not engage in self-induced vomiting or appear very thin. Regardless, disordered eating behaviours may still result in significant physical and emotional distress.
Eating Disorders
Eating Disorders are diagnosable mental health disorders characterized by maladaptive behaviours, thoughts, and emotions related to weight, image, food and/or eating behaviours; they contribute to significant impairment to one’s daily functioning and quality of life.
There is a high degree of stigma associated with eating disorders; common myths from society pertain to ideas that eating disorders are a lifestyle choice or phase. Society also tends to assume that they only affect Caucasian middle-to-upper class females, which is incorrect. Anyone can be susceptible to developing an eating disorder. Eating disorders have the highest mortality rate compared to other mental health disorders (Canadian Eating Disorders Alliance, 2019).
Types of Eating Disorders
There are numerous categories of eating disorders that can be diagnosed by a professional. Several common ones are listed here:
Persistent behaviours that interfere with one’s ability to maintain a healthy weight (e.g., restricting food, purging, over-exercising, misusing diuretics, etc.). This also includes a significant fear of gaining weight, obsessive checking of weight, overestimation of body size, and negative self-evaluation.
Persistent episodes of restriction of food followed by binge eating (eating a large amount of food in a short amount of time). This also includes feeling loss of control over one’s eating behaviours, negative self-image, and recurring compensatory behaviours after a binge to prevent weight gain (e.g., excessive exercise, vomiting, misuse of laxatives, etc.). The cycle of restriction of food, binging, and purging occurs weekly for at least 3 months.
Recurring episodes of binge eating/overeating that contribute to significant distress, including guilt, shame, and/or anxiety over such eating behaviours. Individuals may also hide these behaviours. Binge eating includes a sense of loss of control over one’s eating and consuming a significant amount of food over a short period of time.
Persistent consumption of non-food items over a least a month in individuals where it is not developmentally appropriate.
There are also several unofficial or informal eating disorders that are more newly researched.
A pattern of disordered eating that involves eating only foods regarded as “healthy” by the individual. The individual gains enjoyment from eating “correctly” rather than enjoying the tastes/textures of food. They tend to have significant distress when they gain weight or when they do not eat healthy foods. It can lead to an obsessive focus on food and eventually develop into an eating disorder such as anorexia.
Reflects a pattern of disordered eating including binge eating or eating atypically in the period between sleep and wakefulness (i.e., when the person is unconscious). When the person is awake, they usually have no recollection of this behaviour. Atypical eating may include eating strange combinations of food, uncooked food, or even non-food items.
A type of maladaptive pattern of behaviour that includes compulsive exercising. The person’s exercise goals take up the majority of their life and it can contribute to health consequences. Such behaviours may include being unwilling to miss a workout; prioritizing exercise over work or relationships; believing your self-worth is connected to your athletic performance; and rarely being satisfied with your athletic gains/achievements.
Treatment
Choose a healthy diet of whole foods and avoid extreme diets or “quick fixes” like diet pills; consult with a registered dietician and/or physician. Engage in healthy coping strategies for managing stress and any mental health issues (e.g., hobbies, appropriate amounts of exercise, spending time with friends/family, attend therapy, meditate, etc.).
Family therapy and cognitive behavioural therapy (CBT) are evidence-based psychotherapeutic interventions that can help to manage disordered eating in youth and adults. With CBT, you and a therapist work together to work towards your goals; you typically learn how to challenge negative thoughts surrounding your image, improve eating habits, develop problem solving skills, and learn healthy ways of coping with stress, anxiety, trauma and/or depression. You also learn to avoid triggers associated with your disordered eating (e.g., weighing yourself frequently). For individuals with more severe symptoms, a residential treatment program or day program may be recommended.
Prevention
Ultimately, preventative strategies are the most beneficial in order to minimize one’s chance of developing disordered eating. For instance, learn about the signs of disordered eating and how to prevent eating disorders. Recognize that health and well-being come in all shapes and sizes and monitor yourself for negative self-talk about your weight or appearance. Avoid strict diets if there is no medical cause and instead focus on eating whole foods in moderation. Avoid constant checking of the scale and learn healthy coping strategies for stress. If you question if your eating behaviours are healthy, reach out and talk to a professional (physician, psychologist, dietician, etc.).
Conclusion
In conclusion, disordered eating is a common occurrence that sometimes can be challenging to detect. Having a negative body image is one of many risk factors for developing disordered eating patterns. What do you appreciate about your body and how it helps you throughout the day?