When does normal eating become disordered?

 

When does normal eating become disordered?

There is a lot of focus on the two extremes of the eating continuum; overeating leading to obesity and undereating to the point of anorexia nervosa, but where does everyone else fit in? Are we all ‘normal’?

Normal eating is considered to be flexible and balanced. You eat when hungry and stop when full. You can eat healthy (nutrient rich) and unhealthy (nutrient poor) foods. There are some constraints so that you do not over indulge all the time but you are not too overly strict either. If this sounds like you then you have it sorted…..

However, what I’ve noticed is, that when it comes down to it many people suffer from disordered eating or at least crossed into disordered eating at some point in their life. Maybe you were a ‘normal eater’ but you noticed that you gained weight over a year or more. You may have felt uncomfortable in your clothes and your confidence was affected. You then decide to make a conscious effort to lose the weight that has crept on. You start to monitor what you eat and lose some weight. But then you start to feel guilty for eating that burger or ice-cream at the weekend. But it’s ok you will barely eat anything on Monday to make up for it… and so it goes, with a constant focus on weight with regular and severe restrictions.

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Disordered eating is difficult to define but it involves a deviation away from normal eating behaviours but not to the point of an eating disorder such as anorexia nervosa or bulimia nervosa.

Signs of disordered eating

  • Constantly focusing on weight
  • Food intake strictly monitored and/or restricted
  • Not eating when hungry or waiting until a time you set
  • Unable to stop eating when full
  • Eating because you are bored, anxious or lonely

On the other hand you could have an obsession with healthy food to the point that it is no longer healthy “orthorexia nervosa”. You may be so fixated on healthy and pure food that it consumes your life. Your self-esteem becomes linked to whether or not you had a “good food day”. You may create severe food restrictions in order to show discipline and sometimes even superiority over others. It gets to the point that it affects relationships and your own mental and physical health. The prevalence rate of orthorexia nervosa is estimated to be about 7% in the general population and can range from 35-58% for high risk groups such as healthcare professional including dietitians/nutritionists.2

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I would be lying if I said that I’ve just always had a healthy and positive attitude towards food! I was obsessed with my weight from a very young age. I only realised how bad it was when a few years ago I read a diary that I had when I was nine, in which I wrote “I wish I wasn’t so fat”. I was not fat but I had already started to link weight and body size to self-worth and confidence.

This theme continued in my teens but I also had the realisation that food could affect my mood in both a positive and negative way. I started to notice that when I had meals with lots of fresh fruit and veg I felt better in myself, more positive and more energetic but when I ate processed, especially sugary foods I often felt more negative about things and I had lower energy levels overall. I also linked exercise to feeling good and confident, and I later learned that was because of all the endorphins being released!

In my first year of university I moved in with girls who were members of a commercial slimming programme. They followed a strict point system and used the points left over for alcohol. I never joined but I did start to make dinners like theirs, which were often plates of low point vegetables. I certainly upped my intake of vegetables but I was left feeling unsatisfied and often hungry within an hour or two.  I even actively avoided eating avocados because of the calorie density! I often craved snacks and when I didn’t give in to these cravings and went to bed with the start of hunger pains I felt good and knew it wouldn’t be long until weight started to come off. Then there were the days when I ‘wasn’t strong’ and ate and sometimes over ate. I felt guilty and needless to say my self-talk was very negative!

I became less social and had the mentality that I’d be happy when I was a certain weight. I avoided having a 21st as I didn’t want to see my friends until I had reached my weight loss goal and felt better in myself. The university I went to was over 4 hours from home so I usually only went home every 6 to 8 weeks. When I did go home my family and friends would either say to me “you look great and you’ve lost weight” or if I didn’t look that great then nothing would be said. These comments where all said with good intentions but it affected my self-esteem when I hadn’t lost weight and I didn’t look as good as I could have. Each time I headed back to college I made a goal that I’d be “X” weight before I went home again and if I hadn’t reached that goal I’d make up excuses like I had to work or I didn’t have money to do whatever was planned. I was also determined to get a first class honours degree and I was often stressed as I did not know if I was doing enough to achieve my goal. There were also a lot of family issues and food took the edge off this, albeit momentarily.

It was only after I finished my degree and went travelling that things started to change. I went travelling with two friends and we first went to China for a month. We joined a tour group of nine backpackers. We often had our meals organised for us and we ate together all the time. My whole attachment/controlling behaviour with food dwindled.  After that month we went to Australia. I had an amazing time and didn’t give too much thought to food until I arrived in Melbourne after a month travelling down the east coast. I realised at that point that I’d gained weight and by the time I was leaving Australia I was determined to lose this extra weight. I spent three months travelling solo in South East Asia. I started reading books about detoxes and fasts. I started to do a few day fasts and after reading a book on why a seven day fast would be good for me, I decided to do it! The only thing I allowed myself was a slice of lemon and water for seven days…! I don’t know whether I was delirious or not but I felt amazing after it. I’ve never tried it since and would not recommend it because of the potential serious adverse effects but it is just what happened at that stage in my life.

When I came home I became more and more interested in nutrition. I decided to apply for a Masters in Human Nutrition. I loved the course and I also wanted to learn more about holistic nutrition so I did another nutrition course at weekends. I also worked part-time in a health food store and overall I just loved what I was doing. At this stage I was much more of a ‘normal eater’.

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Although I loved the masters in nutrition I realised I was heading towards a research career but I wanted to help people change their diets. I decided to move to England to do a two year post-graduate diploma in dietetics. I lived with other student dietitians and I became more relaxed and viewed food more in terms of nutrient/health value rather than on kilocalorie content. I got back to basics and realised the simple things work. There were no more drastic diets but I still knew that I had to have discipline and strategies in place to prevent myself from gaining weight. I am not someone who can eat what I want and remain the same weight. I love food, and although I eat healthy the majority of time I do have some processed foods occasionally. Some people may disagree but even too much healthy food can lead to weight gain. I’m now quite relaxed with what I eat and the portions sizes because I know my body and I’ve so many good habits ingrained that I don’t need to think about my diet on a daily basis. But if I start to gain weight and I begin to feel uncomfortable then I’ll start monitoring my food intake more closely. When I speak about weight it’s not about the number on the scales; for me it’s about feeling good and comfortable with my body shape and size.

I am not someone who will ever just see food as an energy source, nor would I want to. Our food choices affect our physical and mental health, with these effects being more pronounced in some people more than others. Likewise our mood and emotions can also affect what we chose to eat. The type of food we eat even has positive or negative effects on the strains of bacteria which colonise our gut. These bacteria may then affect our overall health and even our brain and cognitive function (gut-brain axis)! The exact mechanism is still unknown but it may be via regulating immunity or hormonal and neural messages.3

I feel my own experience has helped me to be become an intuitive practitioner. I love weight management and I really empathise with clients. I understand that it is not as simple as just being in energy balance or to only eat a square of chocolate and save the rest for another time. What we eat on a daily basis is intrinsically linked to our emotions and our environment. What works for one person may not work for another.

As a nutrition tutor I try to be real with my students and let them know that it is not always about how much knowledge you can share but it’s about your ability to listen and build rapport with clients that will determine if they and their client are successful!

Written by Sharon O’Brien

sharon-o-brien

Wellpark College Nutrition Tutor and Nutrition Blogger.

Please follow Sharon on Facebook Our Food Karma

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References:

  1. Dunford, M. & Doyle, J.A. (2015) Nutrition for sport and exercise. (3rd edition) Stamford, CT: Cengage.
  2. Varga, M., Dukay-Szabo, S., Tury, F., van Furth, E.F. (2013) Evidence and gaps in the literature on orthorexia nervosa. Eating and weight Disorders. Jun;18(2):103-11. doi: 10.1007/s40519-013-0026-y.
  3. Holzer, P., Farz, A. Neuropeptides and the Microbiota-gut-brain-axis. Adv Exp Med Biol. 2014; 817:195-219