The terms ‘disordered eating’ and ‘eating disorders’ serve as broad terms for anyone who is having psychological difficulties with food and therefore have a subsequent difficult relationship with it.
There are a number of recognized eating disorders such as a complete avoidance of food, binge eating and highly restricted or regimented diets.
These disorders are not always based around the person’s need to be fit and healthy (although this is a very common group with eating disorders), and can stem from a number of deeper reasons, with disordered food behaviours being a symptom for these problems.
As a result, there are a number of health professionals and support groups to specifically help those with disordered eating. As nutrition coaches it is important to be able to spot, understanding the science of weight loss, understand and relate to our clients who have disordered eating patterns so we can refer and recommend the best guidance for them.
This article will show you how.
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What Is Disordered Eating?
Disordered eating covers a broad range of serious food problems that are symptomatic of addictive diseases.
The compulsive relationship with food, distorted self-image and self-hatred associated with anorexia, bulimia and general food addiction characterizes the discomfort that drives other addictive behaviors.
This addictive behaviour to food is very similar to the way drug addicts are addicted to drugs.
It involves the same areas in the brain - the same neurotransmitters and many of the symptoms are identical.
This addiction to food, and the recognition and diagnosis of it, is still relatively new in the medical world, and as a result there is very little research or statistics that show how common it is.
Many cases of eating disorders go untreated as those suffering do not seek help. Also, many doctors do not fully understand the problem, so many people do not get referred to the correct specialist.
Types Of Disordered Eating
Disordered eating’ covers all typical eating disorders, including binge eating, bulimia, compulsive overeating, anorexia and any unhealthy relationship with food.
We will look at these with more detail below, but they all tend to originate from two very distinct eating patterns.
DISTINCTIVE EATING DISORDERS
This type of eating disorder usually is a result of having placed a heavy restriction on the diet. This can be due to the over evaluation of eating, body shape and weight control that will lead to a strict diet and/or exercise routine. The result is low body weight producing the effects of starvation, which can result in death.
Anorexia nervosa is the most common restrictive eating disorder that is centered around a heavy restriction of food intake.
Inappropriate eating habits or rituals, an obsession with having a thin figure and an irrational fear of weight gain, as well as a distorted body self-presentation, characterize this disorder.
The result is usually a lot of weight loss and the effects of starvation can commonly be seen. On an extreme level, complete self-starvation occurs, which can bring serious health conditions with a high death rate.
Anorexia is a term used by medical professionals to describe a natural lack of appetite, thus leading to a disorder. Anorexia nervosa is when someone does not lose their appetite but blocks out these hunger levels sometimes by the use of harmful substances or behaviours.
Other problems that are commonly seen with this disorder are constipation, diarrhoea, osteoporosis, tooth loss, hair loss, oedema, heart failure, lung problems and many others.
Patients with anorexia nervosa often experience dizziness, headaches, drowsiness, fever and a general lack of energy.
It is also diagnosed nine times more often in females than in males.
Anorexia athletica or hypergymnasia is another restrictive based eating disorder characterized by excessive and compulsive exercise.
People with this disorder often feel they need to exercise to remain in control of their life, and feel a sense of deep guilt if they cannot.
Signs or symptoms of anorexia athletica include:
Anorexia athletica is not a recognized mental disorder but it has been shown that if left untreated it can result in mental disorders.
Patients will also suffer from anxiety, stress effects and malnourishment that can also lead to further complications in major organs such as the liver, kidney, heart or brain.
BINGE-PURGE EATING DISORDERS
The second type of eating disorders results from those who follow those same restrictive eating patterns but also suffer from a binge eating and purging disorder.
This accounts for a number of common eating disorders and is different to anorexia and its variants because the individuals are not usually underweight.
Purging disorder is characterized by recurrent purging (self induced vomiting or misuse of laxatives/diuretics) to control weight or shape in people with normal or near-normal weight.
The difference between purging disorder and bulimia nervosa is that patients have the ability to control food intake, and those with purging disorder do not consume a large amount of food before they purge.
This disorder is associated with clinically significant levels of distress and involves frequent trips to the bathroom after a meal, use of laxatives, and obsession over appearance and weight.
Bulimia nervosa is a common binge-purge eating disorder that entails frequent (at least twice a week) consumption of large amount of foods in a short amount of time followed by an attempt to rid oneself of the food consumed (purging). Fasting excessively after a binge to offset the calorie intake is often a common sub type.
Bulimia nervosa can be difficult to detect, as those suffering from it tend to be of average weight. Many bulimics are much more likely to have an affective disorder, such as depression or a general anxiety disorder. They can also be overly conscious of body shape, size and weight.
This disorder may result in constipation, gastric reflux, dehydration, infertility, dental erosion, electrolyte imbalance, gastroparesis and many more.
Binge Eating/Food Addiction
Binge eating, or food addiction is a very serious and common problem that results in some people being unable to control themselves around certain foods, no matter how hard they try.
The symptoms associated with food addiction also happen to be typical symptoms of addiction.
This has a well-defined biological basis, because new studies have shown that junk food activates the same areas in the brain as drugs of abuse. Therefore, people who are susceptible to becoming addicted can be addicted to foods, just like drug addicts to drugs.
This is one of, if not the most common eating disorders, and is particularly common in those focused on nutrition and training.
Heavily processed foods, particularly those high in sugar and wheat, have a powerful ‘reward’ system in the brain, involving brain neurotransmitters like dopamine.
As these foods signal and ‘hijack’ dopamine in the brain, this can lead to addiction problems, as the person is always left wanting more.
Although still a relatively unresearched eating disorder, more studies are currently being conducted to learn more about it. To date, some research suggests that females are more likely to suffer from this disorder, including those who are overweight and obese.
Symptoms Of Disordered Eating
Each eating disorder will have a range of various symptoms that are most common to them, but there are a number of typical symptoms that overlap between them all, particularly within the binge-purge eating disorder group.
In is important to understand these so you can potentially spot any eating disorder within your client group.
CRAVINGS DESPITE BEING FULL
Everybody can get cravings from time to time, but if this is regularly after a large meal and balanced meal, it could mean there is a problem.
This is more so the case if the person is full, so is not hungry yet constantly craving something sweet. Also, this person may have difficulty controlling the urge, and it never seems to stop.
EATING MORE THAN INTENDED TO
This symptom can quickly show you if a problem may exist. If the person decides to give in to a craving yet instead of only eating a portion or so, they eat the whole thing.
For example, instead of one slice of cake after a meal, they eat the whole cake.
EATING TO THE POINT OF BEING EXCESSIVELY 'STUFFED'
The person not only gives in to their cravings despite not being hungry, but continues to eat until they become uncomfortable or excessively ‘stuffed’.
GUILTY FEELING AFTER CERTAIN FOODS
The person may feel an extreme sense of guilt after giving into their cravings and overeating.
They assure themselves that it won’t happen again, yet they repeat the whole process over and over again.
CREATING EXCUSES FOR EATING HABITS
The person spends a lot of time thinking about whether to give in to cravings, and looks for an excuse as to why they should give in.
This includes (after binge eating) searching for a reason as to why they can validate the overeating they just did.
BREAKING GOOD HABITS
The person sets daily habits or goals to achieve yet constantly finds themselves breaking them.
UNDER REPORTING OF FOOD
The person dismisses the binge eating and never reports it to others. They may eat alone and hide the packaging, to not only convince others that it is not happening, but to convince themselves too.
UNABLE TO QUIT DESPITE NEGATIVE IMPACTS
As we know, eating disorders can have drastic consequences on our health and well-being.
Despite these issues, the person continues in the long term with these bad dietary habits, even when they know that their relationship with food is negatively affecting their health.
These example symptoms are simply guidelines to help you better understand the processes and thoughts of someone who is potentially suffering from an eating disorder.
Who Is At Risk Of Eating Disorders
Everyone can be at risk of one type or more of eating disorders, but they are typically seen in a number of specific groups:
Many teenagers begin to take an interest in their diet at this age, and in particular how it can affect the way they look. At this age many teenagers can feel the pressure from their parents, peers or media to look a certain way.
This usually results in many undertaking their first ‘diet’ without any supervision or guidance.
Many teenagers will therefore restrict calories, which may interfere with growth, bone development and the onset of puberty. It may also put them at risk for the development of a full blown eating disorder, now, or later in life.
SPORTS PERSONS AND GYM GOERS
This group of people also reports high levels of eating disorders, again mainly based on the pressure they feel to look or perform a certain way for their sport or hobby.
This becomes even more common in groups of athletic people who are overly conscious of their weight and many need to ‘make-weight’ for their sports.
Young athletic females appear to be the most prone to these disorders.
Also, women with menstrual irregularities, as frequently seen in athletes with eating disorders, are more likely to have lower bone mass density (BMD) and bone mineral content (BMC) values.
This link between disordered eating, amenorrhoea and osteoporosis has been termed the female athletic ‘triad’ because all three of these frequently occur together.
How Is Disordered Eating Diagnosed?
Unlike other addictions, there is no blood test to diagnose food addictions. A questionnaire is typically used to examine behavioural problems.
Practicing health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) as their official criteria for diagnosing mental disorders.
Not all eating disorders are yet recognized in the DSM, such as food addiction. This means some people can go untreated until a full blown disorder occurs.
The Yale Food Association Scale has been created to help diagnose those with food addictions. It is a set of 27 questions that relate to the official criteria used by health professionals to diagnose addictions.
Treatment For Diagnosed Eating
As nutrition coaches it is important for us to understand eating disorders, how they may occur and how to refer our clients who may be suffering from a disorder.
If your client has tried to deal with these problems on their own (or perhaps with your help) yet failed, it’s important to recommend that they seek the advice of qualified specialists.
There are then a number of different options available:
12 STEP PROGRAMMES
One of the easiest and quickest methods to find help is a 12 step programme.
These work similarly to the alcoholic anonymous (AA) programmes, focusing around local meetings, support networks and sponsors.
They are also usually free and can be accessed from anywhere in the world. Some of the popular ones include:
PSYCHOLOGIST AND COGNITIVE BEHAVIOURAL THERAPY
The client can be referred to a psychologist, ideally with eating disorder experience, who will use a Cognitive Behavioural Therapy (CBT) approach.
This has been shown to work successfully too.
PSYCHIATRISTS AND DRUG THERAPY
Medication may be used to treat eating disorders, particularly in those showing signs of depression.
This may work temporarily, but does not solve the problem. Steps 1 and 2 should be used alongside any medication.
COMMERCIAL TREATMENT PROGRAMMES
There are a number of dedicated treatment clinics that can be used as an intensive rehabilitation course for those suffering from eating disorders.
These can be found throughout the UK, with a popular one being PROMIS – www.promis.co.uk
Eating disorders are a very real and very serious problem.
If left untreated they will only lead to health problems further down the line.
They can become very difficult to treat alone, so it is always advised that you urge a client to seek trained medical help when dealing with any disorder.
As nutrition coaches, it’s important to understand eating disorders and how we can help clients successfully overcome them in the safest and quickest manner possible.
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References & Further Reading