Eating Disorders... The Health Condition That Hides In Plain Sight

The other day I was chatting with a client and we both felt angry at the lack of eating disorder awareness. Eating disorders are a highly stigmatized mental health condition and from my client's perspective, and mine, there are too many people living with eating disorders who aren't aware of the serious harm they cause. Even kids can be prone to eating disorders, mostly teens.

Of course, a person feels uncomfortable and unwell. There are physical health side effects, like headaches, nausea, fatigue, and blurred vision. In addition, challenges with muscle aches, pain, and difficulty sleeping are also common. These symptoms can present in various physical health conditions and can be different with each individual.

A person may also complain of anxiety, depression, difficulty concentrating, or low motivation. Again these symptoms can present as general stress and overwhelm, feeling like a “normal” part of everyday life. But they are far from normal.

Often times a person with an eating disorder, or disordered eating, is not fully aware they have a problem.

An eating disorder causes intense fear around food and body issues. Therefore dieting, exercise, and other “health” practices are used to help reduce that fear. This may seem harmless, but when we are too focused on dieting and healthy eating as acceptable health practices, then too often people are able to go on living with obsessive, anxious, and harmful thoughts and behaviors around their body and health.  

Here's an example...

I lived with orthorexia for a really long time; basically that is an unhealthy obsession with eating healthy. No one ever questioned my behaviors because I was “healthy.” Labs would be “normal," my weight was in a “healthy” range, I ate healthy and I worked out. All acceptable behaviors. However, I also lost my period and I had a slow heart rate (known as bradycardia) and a heart palpitation.

When I visited my doctors my low heart rate was questioned and then easily dismissed with “but I work out a lot." Losing my period was not questioned because I was being praised for my dedication to working out and dieting. Now that I am recovered I am still living the physical consequences of orthorexia.

But what if someone would have questioned me about what was going in my life or mind at the time? What if someone would have asked me some questions to learn what was really going on?

They would have learned that I hated my body and I felt intense anxiety for missing a workout, or not being able to meet the workout goals I had for myself each day. They would have learned that I was hungry, and I thought this was normal.

Newsflash - it is not normal to be hungry.

They would have learned that I struggled with self-acceptance and I was not able to be fully present and happy because I was too worried about what I looked like or what I was going to eat. They would have learned that I skipped events and social plans because I was “punishing” myself for what I ate or what I thought I looked like that day.

They would have learned that if I ate the wedding cake I would have spent hours the next day trying to compensate. They would have learned that the more “healthy” I tried to be, the more foods I eliminated from my diet and the fewer foods I ate, the more I felt I needed to work out harder because my body still did not make me happy. I was never asked if I had a problem and I never admitted to having one. Sure I was really unhappy but I thought my body was the problem, so I never said anything.

This! This is why eating disorders hide in plain sight.

They hide behind socially normalized behaviors. Eating disorders are often portrayed inaccurately in the media. They are not just about “emaciated” young women or young college girls purging. Eating disorders are a spectrum of behaviors and symptoms and can vacillate between binging, purging, and restriction. Often many individuals with an eating disorder have a body shape and size that does not suggest there is an eating disorder present. So when I went to the doctor to be weighed my weight did not signal a problem because according to the BMI I was “healthy.”

Self Acceptance - it’s not that easy.

There are so many people struggling with accepting themselves and their body. They are constantly in a state of dieting to try to change their body. There is this idea that if I can just change my body then I can be happy and start living my life.

The problem with this is that a person with an eating disorder will keep trying diets and programs, and the more they diet and try programs - the more their eating disorder will develop. I often speak to health providers and health coaches who understand that recommending diets is not healthy for someone with an eating disorder because of the potential harm and damage to the body.

Here is the problem - the person presenting to a doctor for health advice is not going to tell that doctor that they have an eating disorder. Often the individual may not know they have an eating disorder. They just know they are miserable, unhappy, and uncomfortable, and they think that changing their body will fix it. So, of course, my fellow health colleagues are not intentionally doing harm in giving dieting advice, but there is unintentional harm because dieting only makes the problem worse; and because the right questions are not being asked.

Here is another problem: We live in a health-obsessed society where “dieting” and exercise are praised. So when a person has unbalanced health practices it can go unseen. As health professionals we have a duty to do “no harm,” but not asking questions and not assessing for eating disorders is causing a great amount of harm.

Every 62 minutes a person dies as a direct result of an eating disorder.

I hear clients say things to me like “well my labs are good. It may not be that bad.” First of all, a person is not likely to go to a doctor or health professional because of an eating disorder. They will present because of other health effects and the health professional will draw labs and the labs will be normal. Why? - because the body is really great at surviving. It is good at adapting, and when lab results are abnormal and a real problem is detected it is too late. Many clients are admitted to the ER for dehydration or fainting. It doesn’t have to result in life-threatening health conditions for a person to get help.

We can better support a person with an eating disorder by asking questions.

A person with an eating disorder is so fearful of weight gain and food that their shame keeps their eating behaviors secret. We can do no harm by asking questions when a person presents to us with a desire to diet and lose weight and when they present with illness complaints.

A quick screening tool is called the SCOFF (Morgan, Reid, & Lacy, 2000) and it asks the following questions:

• Do you make yourself sick because you feel uncomfortably full?
• Do you worry that you have lost control over how much you eat?
• Have you recently lost more than 14 pounds in a 3-month period?
• Do you believe yourself to be fat when others say you are too thin?
• Would you say that food dominates your life?

Any “yes” answer suggests a problem. This screening tool can help you identify someone at risk for an eating disorder, suggesting you do not need to prescribe any type of dieting or workout program. It can help you identify why a person may be complaining of health issues, because they have disordered eating and most likely are not eating in a way that is beneficial to their body.

If you are health professional, a fitness professional or a health or wellness coach - please consider assessing individuals for an eating disorder using the SCOFF tool. These short questions can save a life and can help you identify a person at risk for a life-threatening illness. The sooner disordered eating behaviors are identified the sooner a person can get help to learn how to find a balance with “health” behaviors that may have gone too far.

Important Resources:

http://edrcsv.org/

https://www.nationaleatingdisorders.org/ 

https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml