By Michelle Russell, RD, LD, CEDS
for The Beacon
February 21-27 is National Eating Disorders Awareness Week. Stereotypes about eating disorders unfortunately persist, though understanding is improving that eating disorders impact individuals of all ages, races, body sizes, and genders. Eating disorders are a mental illness and often develop as a way to cope, so it needn’t come as a surprise that we’ve seen a stark increase in eating disorders since the pandemic.
When the world and daily life were out of control, many found comfort in controlling food or exercise. Others felt they lost control over food. Eating disorders present many different ways, though the most common eating disorder, Binge Eating Disorder, is perhaps the most misunderstood of all.
To those unfamiliar with Binge Eating Disorder, the typical assumption is that those struggling with this eating disorder do not restrict their food intake but instead eat large quantities of food.
Yes, the diagnosis of Binge Eating Disorder (BED) requires one to experience recurrent episodes of eating large quantities of food, while simultaneously feeling a lack of control over their eating. There are also feelings of guilt and shame about one's behavior. What these criteria don’t tell you is that people who struggle with binge eating almost always profoundly restrict their diet. To further complicate matters, many people have no idea they're restricting! Oy.
Typically, BED looks like cycles of food restriction followed by binge eating; and these cycles often start out as a diet or weight loss pursuit. One can only maintain external control over what/how much to eat for so long. Eventually, the biological hunger drive kicks in, and the dieter eats larger quantities of food, usually of foods that were cut out of the plan.
For someone who goes on to develop an eating disorder, these cycles become chaotic and may look like eating relatively small amounts during the day, followed by feeling out of control and eating large quantities in the evening. By morning, the cycle starts all over again.
Others may try to eat “normally" (which is, unfortunately, often too little food) and then a time or two throughout the week, be overcome by a desire to eat a large quantity of food. Eating may continue until they are uncomfortably full and overcome with distress about their eating.
How does one recover from BED or any eating disorder for that matter? The gold standard is to work with a dietitian and a therapist specially trained in eating disorders and to intermittently follow up with a primary care provider. It is absolutely essential that at least one professional on this team specifically completes ongoing training in the treatment of eating disorders.
Nutrition is at the heart of eating disorder recovery, and renourishing the body with consistent, enjoyable food is paramount. In BED treatment in particular, evidence is clear that permission to eat, and to enjoy eating, is key to stopping the cycle that drives restriction because restriction, in turn, drives binge eating. Nutrition must be approached in a neutral way, where there are no “good” or “bad” foods, and the clinicians providing support are aware of weight stigma and biases regarding weight. Recovery from an eating disorder must support each individual at a weight that is stable for them, and not necessarily within the confines of the archaic Body Mass Index (BMI) table. Concerns about weight should be addressed from a weight-inclusive framework that honors the body size diversity inherent in humankind.
The unfortunate reality of pursuing eating disorder recovery is that it often takes years of difficult, uncomfortable, and vulnerable work. The silver lining is that recovery is an opportunity to deepen relationships with oneself, their true values in life, and their bond with others. Recovery allows us to live meaningful lives, free to enjoy food, and to respect and care for our bodies—no matter their size.
If you are struggling with an eating disorder, you may call or text the National Eating Disorders Association Helpline at 800-931-2237.
Michelle Russell, RD, LD, CEDS, is a dietitian and Certified Eating Disorder Specialist practicing in downtown Burlington. She provides nutrition therapy for individuals and families struggling with eating disorders and is one of less than ten certified specialists in the state of Iowa. Michelle’s definition of healthy eating includes eating for enjoyment and acknowledges that there are many ways our bodies are nourished.