Eating Disorder Recovery Methodology: What Needs to Change
As someone who spent over two years cycling in and out of eating disorder recovery treatment centers and working with other individuals embarking on their own recovery journeys, I have learned first hand about the gaps in sustainable treatment protocosl. When I was in recovery, I was often informed that much of the phenomena in which I had experienced was not “normal,” or was told that full recovery was not possible. Upon conducting years worth of research and recovering on my own, I can stand here today, nearly eight years later, and say that full recovery is attainable to all who seek it. My goal in writing this is to propose a change in approach to the ways in which eating disorders are treated, in a much less generalized fashion.
Nutrition is a relatively new and unexplored area of study. The field itself is around ninety-six years old, its roots in the mid 1920s (Mozaffarian, 2018). Comparatively, biology has been studied for roughly five thousand years, and paleoanthropology around one-hundred-ninety. This is reflected in the world of eating disorder recovery, and much of the common phenomena experienced by an individual recovering from an eating disorder are not common knowledge, or even acknowledged as a whole. The refusal to acknowledge and spread awareness of common recovery phenomena keeps the nutrition industry in bed with diet culture, preventing those who suffer from truly finding freedom. To emphasize the seriousness and severity of this issue, statistics show that anorexia has the highest mortality rate of any mental illness–particularly, death by suicide. Eating disorder recovery coach Tabitha Farrar explains why this occurs, in the context of her own experiences with recovery. Farrar details the thoughts and feelings that plagued her whilst coming out of malnutrition, the intensity of the incessant hunger pangs nearly too much to bear. She was relentlessly hungry. Her body compelled her to eat, thousands upon thousands of calories per day. It seemed as if it would never end, but eventually it did (Farrar, 2019).
Many healthcare facilities claim that this is an emerging binge eating disorder; but this notion is harmful to both individuals with anorexia and individuals with binge eating disorder. Binge eating disorder is the most common eating disorder, yet credible information is scarce, and exceptionally hard to find. It is far more complex than one may think; and it is important to note that it is separate from anorexia nervosa. Both disorders have elements rooted in restriction, but binge eating disorder is not characterized by behaviors such as purging or other compensatory coping mechanisms (de Zwaan, 2001). This false narrative is harmful to both parties, as it prevents each from attaining full recovery, and from getting back in touch with their bodies signals.
Many facilities demonize normal phenomena in recovery such as post-starvation hyperphagia and overshoot weight, placing too much emphasis on weight and BMI in their relation to health. Post-starvation hyperphagia is an extremely common yet underreported phenomena, essentially known as extreme hunger post restriction. Believe it or not, it is common for individuals in eating disorder recovery to eat around ten-thousand calories per day, until the body returns to a state of energy balance! The human body’s only agenda is to optimize health, and once it establishes that food is in abundance, it will ask for food in greater amounts in order to return to energy balance faster! Upon doing so, and leptin and ghrelin hormones rebalance, hunger cues will normalize.
Another common phenomena that often accompanies post-starvation hyperphagia is known as overshoot. This essentially entails the individual “overshooting” the body’s genetically predetermined set weight range while repairs are being done, and until the body can trust that famine is no longer present. As Tabitha Farrar would say, “resource accumulation precedes growth” (Farrar, 2019). The body cannot conduct repairs unless it has the resources to do so, whilst offering the insurance that it won’t be starved again. These phenomena, as well as a multitude of others are underrepresented, and those experiencing said phenomena report feeling crazy or “broken.” Farrar discusses the importance of paying attention to first hand experiences and qualitative data; in other words, recounting and documenting the experiences of individuals who survive anorexia nervosa, rather than taking articles that barely graze the surface as to just how severe eating disorders truly are as a textbook for nutritional practices.
As Tabitha Farrar puts it, “we knew more [about proper nutrition] when we knew less” (Farrar, 2019). Farrar, like many modern recovery coaches and advocates, promotes HAES, or Health At Every Size. This philosophy, as will be explained further throughout this memo, promotes the notion that health does not have a ‘look.’ Health will look different from person to person, as each individual has an entirely unique set of genetics. Diet culture’s false promise that one can look a certain way if they follow a certain exercise regime and cut calories is, quite honestly, a very prominent reason why relapses are so common. This begs the mention of the ways in which society places thinner bodies on a pedestal and grants them moral value.
The Health At Every Size philosophy comprises five principles; weight inclusivity, health enhancement, eating for well-being, respectful care, and life-enhancing movement. Each principle promotes happiness and quality of life, rather than restriction, target weights, and unattainable beauty standards. To offer a statistic, around seventy-five percent of women claim to struggle with disordered eating, while men are wildly underreported due to lack of representation (Harrelson, 2015). Diet culture depends on society believing that if everyone works out and eats a certain way, they can look like the models they see on TV. It promotes the idea that weight loss is the secret to happiness, when it is in fact the opposite. Human bodies were never the problem; society is. Even if we all exercised and ate the exact same way, we would still look entirely different; and being thin does not necessarily equate to health or happiness.
There are very few dietitians who specialize in eating disorder recovery with the Health At Every Size designation. This designation is particularly important, as many conventional eating disorder recovery practices have proven to be riddled with unaddressed diet culture myths and biases. Diet culture has pegged health as a particular look, tying closely to the beauty standard. Proclaiming skinnier is automatically “healthier,” which it is not. The Health At Every Size (HAES) philosophy outlines health as more than just a look; it takes into account physical, mental, and emotional wellbeing. It acknowledges that real health comes in many different sizes.
How do I propose we drive change in this field? By increasing healthcare professionals with the Health At Every Size designation and making resources addressing eating disorder recovery phenomena more widely accessible. In doing so, recovery rates should rise, and relapse rates should diminish. Those who struggle should feel like they are seen, not as if they are a unicorn; different from everyone else who undergoes recovery. Not only would the increase in accessibility to resources help those who are struggling, but they would also help those looking to support loved ones in recovery (ASDAH, 2022).
Diet culture is a behemoth of an industry; racking up around seventy one million in net worth. Everything from literature to media is riddled with fad diets and nutrition myths, washing out many credible sources and facts. Yet despite the size of the industry, ninety-five percent of diets fail. These fad diets perpetuate a cycle of binging and restricting, all while normalizing disordered eating patterns (Harrelson, 2015). Another factor that makes this argument particularly tricky to navigate is the diversity in which medical issues of this nature manifest. While certain medical issues may present similarly, or even co-occur, they can be entirely separate issues, not to be confused or lumped together. Speaking as an individual who has themselves recovered from an eating disorder and spent copious hours searching the internet for support and resources, I wish that there was a means in which information could be properly filtered and censored by a licensed professional; because the internet will tell us whatever our eating disorders want to hear.
The big issue at play is that, especially with the prevalence of social media, many nutritionists (who are not certified to be giving medical advice) promote nutrition in a way that is riddled with bias and in bed with the diet culture industry. This distribution of unsolicited medical advice can be detrimental to the health of those seeking to manage a clinical illness, or recover from a deadly disorder. The waters have been increasingly muddied because of the lack of knowledge between the distinction of a nutritionist, versus that of a dietician. Dieticians are certified to work with individuals struggling with eating disorders and other clinical conditions, whereas nutritionists specialize in an entirely different area. Despite the job title, nutritionists are not always certified to give nutrition advice; at least not medically. The title “nutritionist” is essentially a broader understanding of “wellness,” whereas a dietician can diagnose and treat medical conditions. The Academy of Nutrition and Dietetics says it best; “all registered dietitians are nutritionists but not all nutritionists are registered dietitians” (Academy of Nutrition Dietetics).
Far too many people of all ages fall into the ever-exhausting, diet culture perpetuating cycle that is under-fueling and over exercising. Diet culture promises, ‘if you eat x amount of calories and train x amount of hours, you’ll be unstoppable.’ The idea that ‘thinner is better’ is etched in stone in the minds of young people, skyrocketing them towards a career plagued by chronic injury, health complications and mental health struggles. However, this (short term) feeling of achievement is fleeting and comes at much too high a cost. Teenagers are especially impressionable throughout these truly formative years. The rate at which information is posted on social media is alarming. Health looks different on everyone, and is not one size fits all. Nutrition should be revised and studied in greater depth, particularly in its emphasis in schools and athletics. As well as promoting the Health at Every Size philosophy, the increased education and accessibility of resources and health care specialists can ensure that athletes and young people do not make the same mistakes that diet culture has been promoting for years. It is never too late to create change, and this is the generation to do it.
References
Academy of Nutrition and Dietetics. (n.d.). Every registered dietitian is a nutritionist, but not every nutritionist is a registered dietitian. EatRightPro. Retrieved September 15, 2022, from https://www.eatrightpro.org/about-us/what-is-an-rdn-and-dtr/what-is-a-registered-dietitian-nutritionist/every-registered-dietitian-is-a-nutritionist-but-not-every-nutritionist-is-a-registered-dietitian
ASDAH. (2022, April 22). The health at every size® (HAES®) principles. ASDAH. Retrieved September 15, 2022, from https://asdah.org/health-at-every-size-haes-approach/
de Zwaan, M. (2001, May 1). Binge eating disorder and obesity. Nature News. Retrieved October 1, 2022, from https://www.nature.com/articles/0801699
Farrar, T. (2019). Rehabilitate, rewire, recover!: Anorexia recovery for the determined adult. CreateSpace Independent Publishing Platform.
Harrelson, L. (2015, February 11). Survey finds disordered eating behaviors among three out of four American women (fall, 2008). UNC Gillings School of Global Public Health. Retrieved September 15, 2022, from https://sph.unc.edu/cphm/carolina-public-health-magazine-accelerate-fall-2008/survey-finds-disordered-eating-behaviors-among-three-out-of-four-american-women-fall-2008/
Mozaffarian, D., Rosenberg, I., & Uauy, R. (2018, June 13). History of modern nutrition science-implications for current research, dietary guidelines, and food policy. The BMJ. Retrieved September 15, 2022, from https://www.bmj.com/content/361/bmj.k2392