Healing from Within: How Nutrition Counseling Supports Eating Disorder Treatment

In a culture where the pressure to be thin can be all-consuming, the prevalence of eating disorders has become a critical concern affecting individuals of all ages, genders, and backgrounds. Nearly 9% of the US population will experience an eating disorder in their lifetime. The alarming rise in the incidence of eating disorders underscores the urgent need for awareness and understanding surrounding these complex mental health conditions. Treatment involves teams of medical and mental health professionals, including registered dietitians, working together to provide the best care.

Types of Eating Disorders

Anorexia Nervosa

Anorexia nervosa is characterized by extreme dieting, weight loss, body image distortion, and an intense fear of being fat or gaining weight. Someone with anorexia will often restrict their food intake to only “safe foods”, and will avoid “fear foods,” or foods they perceive to be fattening. 

Those struggling with anorexia can experience a host of physical complications including weight loss, muscle wasting, bone loss and fractures, heart weakening, dehydration, dizziness and fainting, hair loss, and amenorrhea. Mentally and emotionally, someone with anorexia may become moody, irritable, unable to focus, and socially withdrawn.

Although it is termed “atypical anorexia” when someone in a larger body struggles with anorexia, this diagnosis is anything but “atypical.” Many people who struggle with anorexia but do not meet the traditional low body weight criteria are overlooked for treatment. We are working to change this.

Bulimia Nervosa

Bulimia nervosa is characterized by frequent episodes of binge eating and purging. Vomiting is typically associated with bulimia, however those struggling with this disorder also tend to routinely restrict their intake in an attempt to lose weight.

Someone with bulimia will often have erratic eating patterns, like restricting all day followed by binge eating and purging at night in secret. Although some individuals may have low body weight, not everyone with bulimia is in a smaller body.

Bulimia can result in dental erosion, digestive difficulties, constipation, diarrhea, erosion of the esophagus, irregular heartbeat, muscle weakness and cramps, dehydration and dangerous electrolyte imbalances.

Binge eating disorder

Binge eating disorder is characterized by frequent episodes of binge eating. A binge is classified as eating faster than usual, eating a large amount of food in a short period of time, eating until uncomfortably full, eating alone or in secret, and feeling out of control around food.

Binge eating disorder can result in weight gain, digestive difficulties, guilt, shame, depression, and social isolation. Those with binge eating disorder, especially in people in larger bodies, are often dismissed as lacking discipline or willpower and are prescribed weight loss as a result of weight stigma in health care. This is wrong; people in all body sizes suffering from binge eating disorder deserve compassionate and effective treatment for their condition that does not focus on weight loss.

ARFID

Avoidant restrictive food intake disorder (ARFID) is often called a selective eating disorder and results in someone eating less than they should because they only have a few foods that feel safe to eat. ARFID is different from other eating disorders in that those with ARFID do not fear weight gain and do not struggle with body image.

Someone with ARFID may have extreme aversions to foods of a particular taste, texture, temperature, or smell. They may fear that these foods will cause them to become sick, vomit, or choke.

ARFID is more than just picky eating. It is not something that sufferers will just “grow out of.” Without treatment, ARFID can result in weight loss, nutrient deficiencies, or malnutrition.

What causes an eating disorder?

Eating disorders are caused by a combination of genetic and environmental factors. We know that eating disorders are hereditary and tend to run in families. Children and adults who experience trauma, neglect, or abuse are also more likely to develop eating disorders.

Pressure from parents, doctors, or peers to be thin or engage in dieting will also alter a child’s relationship with food and can have lasting effects about how they perceive their food choices and their body into adulthood.

Who is most at risk of developing an eating disorder?

People most at risk of developing an eating disorder are those who…

• Struggle with perfectionism, anxiety, depression or OCD
• Have poor body image, low self esteem, or low self worth
• Have been teased or bullied about their size
• Engage in sports that emphasize body size (like track, gymnastics, ballet, or wrestling)
• Engage in dieting or intentional weight loss
• Grew up in homes where parents engaged in dieting or had an eating disorder

Over 70% of people with eating disorders also have other mental health conditions, like anxiety and mood disorders. If you are struggling with anxiety, depression, or addiction you may be at higher risk of an eating disorder.

Warning signs and symptoms of eating disorders

Changes in physical appearance or health, like:

• Weight loss or gain
• Dry skin, nails, and hair
• Always feeling cold
• Fine, down-like hair (lanugo) all over body
• Amenorrhea
• Fatigue
• Insomnia
• Constipation or digestive discomfort
• Heart palpitations
• Dizziness or fainting
• Bad breath or tooth decay
• Stress fractures
• Scrapes on the back of hands and knuckles

Changes in food thoughts and behaviors, like:

• Cutting out foods or food groups
• Fearing or feeling guilty about eating foods with fat, carbs, or sugar
• Reducing variety of foods to those that feel “safe”
• Skipping meals or fasting for long periods
• Suddenly following a vegetarian or vegan diet
• Pushing food around the plate or hiding food
• Having new strict rules about what, when, and how to eat
• Being extra aware of nutrition labels or calorie counts
• Cooking or baking for others, but not eating it
• Eating in secret or lying about what you ate
• Spending a lot of time in the bathroom after meals
• Becoming irritable if someone questions your food choices

Changes in body image thoughts and behaviors, like:

• Feeling preoccupied by your reflection in mirrors
• Body checking or pinching/pulling on different parts of your body
• Weighing yourself multiple times a day or week
• Obsessively checking for changes on your body
• Thinking of yourself as fat when others tell you you’re too thin

Changes in exercise thoughts and behaviors, like:

• Feeling compelled to exercise to make up for eating
• Adopting a new, highly regimented routine
• Exercising despite being injured
• Feeling extremely guilty for skipping a workout

Eating disorder treatment

Once you have a diagnosis, your provider can help you determine next steps and assemble a support team. Your support team typically consists of a medical doctor, a mental health therapist, and a registered dietitian.

Depending on the severity of your eating disorder, you may be referred to a higher level of care. At higher levels of care, like hospitalization or residential, you will have a medical and mental health care team assisting you in your recovery daily. A dietitian will provide you with a meal plan designed to nourish and replenish your body based on your unique needs.

At lower levels of care, like partial hospitalization (PHP) or intensive outpatient (IOP), you will still have access to your support team most days of the week while also learning how to transition back to your everyday life with the skills you have learned in recovery.

For children living with their parents, family-based treatment (FBT) is often recommended. This style of treatment centers the parent as the primary support provider. Parents are coached on how to prepare adequate meals and navigate difficult mealtimes with their child. Parents are also responsible for monitoring their child’s weight and any problematic behaviors.

Outpatient support can help you navigate daily struggles with your eating disorder and maintain your recovery. Your dietitian may still recommend a meal plan and can help hold you accountable to your eating goals. As you progress in your recovery, you may transition to a more intuitive eating style with your dietitian’s support.

Eating Disorder Nutrition Counseling

Being properly nourished is a critical part of recovering both physically and mentally from an eating disorder. Restricting, purging, and bingeing can all result in extreme weight fluctuations, hormone dysfunction, amenorrhea, gastrointestinal distress, bone loss, muscle wasting, organ failure, and cognitive impairment. You can consider your meal plan your medicine while you’re in recovery.

At every level of care, your dietitian will help you determine what and how much you need to eat to rehabilitate your body and brain. The primary objective of your meal plan is to ensure that you are eating enough to meet your body’s energy needs and/or restore your weight. After you’ve established nutritional adequacy, your dietitian will help you accomplish consistency, balance, and variety in your meal choices.

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What to expect when starting your recovery

Fear

The eating disorder can make you feel fearful or distrusting of food or weight gain, making it difficult to buy into the recovery process. Starvation can also put your body into permanent fight-or-flight mode. When your brain is properly nourished, the fear often subsides and the process becomes easier.

Hypermetabolism and refeeding syndrome

Eating after enduring long periods of starvation can result in dangerous electrolyte imbalances as your body rushes to draw nutrients from the food into its cells. This is called refeeding syndrome. Your dietitian and doctor will closely monitor your labs to ensure that your body is safe during the re-nourishment process.

You may also experience a period of hypermetabolism, or a time when your body burns more energy than usual in an attempt to replenish and repair damaged tissues and organs. You may need to eat much more than you expect during this time. Your dietitian will repeatedly assess your progress and determine the correct amount of food to eat on your meal plan to adequately fuel your body.

GI discomfort

Irregular eating like restricting, purging, or bingeing can impair gut function causing constipation, diarrhea, gas, bloating, and other stomach upset when food is reintroduced to your digestive tract. It is normal and expected to experience some discomfort during the renourishment process. 

Your dietitian can help you determine what foods feel best to eat and recommend supplements or other interventions to make you more comfortable during this time. 

Menstrual cycle

Amenorrhea, or the loss of your period, can result from long periods of under-eating. A reassuring sign of nutritional recovery is the return of your menstrual cycle. This indicates that your body has enough energy to support normal hormone function once again.

Thoughts and behaviors

The eating disorder can distort your thoughts on food, body image, and weight. There will be times in your recovery when these thoughts feel more intense than others. Your dietitian and your therapist will help you challenge disordered thinking and behaviors so that you can return to eating normally and living your life to its fullest.

Ups and downs

Recovery is not linear. It’s messy and unpredictable and sometimes feels like it’s going nowhere fast. Rest assured that this is normal and expected. Throughout the recovery process your support team will be on your side helping you to reflect on and celebrate your wins as well as navigate slips back into disordered behaviors.

You can recover, we can help

Recovering from an eating disorder is no easy feat. Having the right people on your support team can make recovery feel less complicated. Here at Rebecca Bitzer and Associates, we have dietitians specialized in the treatment of eating disorders, including anorexia, bulimia, binge eating, and ARFID.

Meeting one-on-one with a dietitian can help reduce stress around eating and weight fluctuations while you focus on recovery. We treat eating disorders in people of all ages, races, and backgrounds. We are sensitive to the fact that everyone’s recovery looks different, and you deserve tailored recommendations, not a cookie-cutter approach.

You may also find it helpful to engage in recovery-focused work outside of your sessions with your dietitians. Resources like books, social media, blogs, and podcasts can all help keep you grounded in your recovery even when you are not talking directly with your provider.