Disordered Eating and Eating Disorders: Risk Factors and Recovery

Disordered Eating and Eating Disorders: Risk Factors and Recovery

By: Kinga Balogh, Registered Dietitian, CDE, Reviewed and Edited by JM Nutrition Team

 

In this post:

• Eating disorders in Canada

• Eating disorders and disordered eating background

• Diagnosis and complication risks associated with eating disorders

• Recovery from eating disorders

• Key players in disordered eating and eating disorder recovery

 

At JM Nutrition, we strive to provide a multitude of dietary services with an evolving emphasis on disordered eating and eating disorders. In our practice we find families often feel overwhelmed and appear in need of guidance to understand eating dynamics, ways to support their loved one’s recovery and strategies to navigate both publicly- and privately-funded specialized eating disorder services. 

This post was created with the intention to raise awareness about best practices to manage eating disorders. Reason being, much uncertainty exists both about what constitutes eating disorders and how to optimally facilitate recovery for affected individuals and their families.

 

An Introduction to Eating Disorders in Canada

It may surprise most readers that an estimated 2.7 million people in Canada are impacted by eating disorders. Approximately 1.4 million of these are youth. These are staggering statistics.

A number of eating disorders exists. These include Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED),  Avoidance Restrictive Food Intake Disorder (ARFID) and Otherwise Specified Feeding and Eating Disorder (OSFED).

Of note is that the majority of people struggling with their eating never get diagnosed. What’s more, only about 10% of sufferers receive appropriate treatment. An even smaller percentage receive timely and appropriate interventions that can offer symptom reversal, as described by the National Initiative for Eating Disorders (1).

The dietitians at JM Nutrition are dedicated to closing this gap. As such, we offer timely, evidence-based and accessible services to those in need.

Eating disorders are no doubt a serious mental illness. But, they are also treatable.

They can affect anyone regardless of age, racial and ethnic identity, sexual orientation or socioeconomic background. In recent years the number of new cases and unprecedented spikes in hospital admissions has skyrocketed. This has also shed light on the disjointed nature of eating disorder services in Canada.

 

Disordered Eating and Eating Disorders: A Background 

Disordered eating encompasses a distorted relationship with food, body and/or exercise routines for most people. While eating struggles have been observed for centuries, what follows is a brief overview of the relentless pressure people face to look and feel “thin”. 

As we live in a society that places excessive emphasis on appearances, delivers health care services often infused with some degree of weight bias. As such, it draws heightened attention to personal responsibility over managing one’s health and wellbeing. No wonder people are prone to disordered eating.

We often minimize or ignore the impact of non-controllable factors. These include genetics, socio-economical status and stress on body weight and overall health.

Given the circumstances, many clients often avoid routine medical checkups due to fear of weight-based discrimination. For those that attend regular appointments, they frequently report adverse experiences of being reprimanded for not taking good care of their body. This is despite the fact they tend to showcase size diversity. In other words, with a weight-biased lens, health practitioners often fail to normalize the fact that healthy bodies come in different sizes and shapes. This is an important fact that we cannot overlook.

The beauty and fashion industry also place relentless pressure on people. This much is clear. This pressure is particularly exerted on vulnerable individuals to achieve a certain look or fit within a weight range that is often non-realistic, non-achievable and non-maintainable.

Furthermore, the fitness industry also tends to project the message that one’s physique and body composition is substantially amenable to change. This is given the right eating and exercise routine is established and maintained by the individual.

Unfortunately, the above mentioned narrative around full personal control over one’s size, shape and health is not scientifically based or substantiated by evidence.

According to Obesity Canada, 70-80% of one’s Body Mass Index, (BMI), is determined by genes and mandating weight loss often is suggestive of weight bias, particularly in the absence of medical complications secondary to living in a larger body (2).

In the presence of the dynamics described above, no wonder disordered eating behaviours have an opportunity to flourish across the lifespan.

 

Disordered Eating Characteristics

Here is a sample of disordered eating characteristics, according to Change Creates Change, an online eating disorder care organization based on the East Coast (3):

• Excessive preoccupation about food choices. This includes portion size, calorie and nutrient content, “clean eating” tendency and overall inflexibility about including a variety of foods or maintaining eating flexibility.
• Disordered eating patterns, skipped meals, narrow food choice repertoire, inability to enjoy foods during special occasions with spontaneity.
• Strict eating and exercising rules. This includes under-eating and possibly overeating cycles, abuse of laxatives, overexercising contributing to repetitive bodily injuries.
• Feelings of guilt, shame and loss of control over eating patterns or exercise routines.
• Distorted body image. An emphasis on appearance as key measure of self-worth.
• Weight preoccupation and fluctuation with unrelenting effort to control body weight.
• Impaired quality of life, decreased social engagement driven predominantly by food, body image and movement routine prioritization over other facets of life.

 

Eating Disorder Diagnosis

While in Canada only medical doctors, psychologists or nurse practitioners can diagnose eating disorders, in general clients affected by eating disorders or disordered eating may show similar symptoms.

What may be different, however, is the degree of severity and/or frequency of symptoms.

A diagnosis requires that very specific symptoms are met. That said, however, clients may not meet all diagnostic criteria for eating disorders, yet would manifest disordered eating symptoms, possibly being at lower risk of medical complications.

What’s important to note is that often disordered eating symptoms progress into full-blown eating disorder manifestation. Therefore, one can look at disordered eating as a serious red flag that requires attention with a preventive focus. By the time an eating disorder is diagnosed, usually more extensive and multidisciplinary care is needed. As a result, treatment duration often stretches out for years to decades.

It’s also important to note that disordered eating or an eating disorder can affect people at any stage throughout the lifespan. It typically emerges in the teenage years. At times, it persists or resurfaces even in midlife or senior years.

Children and teens are particularly vulnerable to the dynamics of eating disorders, as their bodies are undergoing tremendous change. As such, growth trajectory can be negatively impacted.

 

Untreated Eating Disorder Complication Risks

As disordered eating progresses into eating disorders, affected individuals can experience a variety of medical risk factors. Symptoms will be unique for each individual. That said, there are some general trends specific to each eating disorder.

Let’s take a closer look:

Anorexia Nervosa

With anorexia nervosa, given significant and ongoing reduction in dietary intake, people can become malnourished.

Characteristics of malnutrition include significant weight loss, change in heart function (including pulse and heart rate) and possible cessation of menstrual periods for females.

Other characteristics are hair loss, suppressed immune function and suboptimal body temperature regulation (leading to clients feeling cold despite wearing multiple layers of clothing). sleep and mood disturbances are also common. Bone loss in addition to stunted growth patterns can be present as well.

Bulimia Nervosa

Bulimia nervosa typically presents with uncontrollable binge eating followed by purging. This is done an attempt to cancel out the guilt-inducing effect of the food binge. Binging may happen through the use of forced vomiting, overuse of laxative, diuretics, diet pills or over-exercising. 

Due to the compensatory purging mechanisms in place, typical complications may include electrolyte imbalances secondary to vomiting or heavy laxative use. As electrolytes control heart function, heart troubles may result requiring intravenous rebalancing.

Furthermore, repeated and unrelenting stomach acid exposure in the esophagus and dentition can cause further complications and at times medical emergencies.

Bing Eating Disorder

With binge eating disorder, the body struggles with a surplus of calorically dense foods. This often impacts hormonal health, digestive health and joint integrity as an upward trend in body weight is observed.

Other important considerations

To add more complexity to the care delivery of specialized eating disorder services, it is important to raise awareness about co-morbidities associated with eating disorders. As described in the Canadian Eating Disorders Strategy (2019- 2029) document, 93% of those with ED will also experience a co-existing mood disorder, 56% will experience an anxiety disorder and 22% will have a substance use disorder (4).

While complication risk varies, clients with eating struggles should seek medical help for prompt diagnosis and further medical investigation. This will help establish baseline scores and trigger on-going monitoring for safety and overall well-being.

In addition, we encourage families to book consultations for nutritional assessment and mental health services. Advisably, we recommend to seek out the help of professionals specializing in eating disorders.

Clients often don’t feel “sick enough” and usually take desperate measures to deflect all the attention the eating disorder requires. They can also downplay the impact of the illness. This is part of a self-defence mechanism and the eating disorder’s control over one’s psyche primarily.

Resistance to treatment, particularly in the earlier stages of the disorder, is a hallmark of the illness. This should not be a barrier to seek timely and appropriate help. Self-judgment and critical thinking skills can be impaired about the serious nature of the illness. This is particularly true when one’s brain is malnourished with chronic food restrictions and other adverse dynamics in place.

We encourage family members to follow through their suspicions about their loved one’s eating struggles and advocate for the necessary services.

 

Risk Factors For Developing Disordered Eating or Eating Disorders

There is no single cause of developing eating disorders. That saidm according to the Canadian Mental Health Association, along with genetic predisposition, certain personal risk factors increase the likelihood of developing eating struggles.

These include and are not limited to low self-esteem or self- worth. A general lack of control over one’s life or circumstances is also cited. As is the need for perfection or possibly impulsive character traits. Difficult family relationships and a history of abuse or trauma are risk factors as well.

Observing family members engage in dieting behaviours at home, focus on appearances, and the use of food in the context of reward or punishment constitute additional triggers for the onset or progression of eating struggles.

 

Eating Disorder Recovery

In Canada, treatment is typically offered in a variety of settings, depending on the severity of the eating disorder.

Typically, upon the completion of a referral by a physician to a treatment facility, triaging will take place.

This is usually followed by an extensive intake appointment, where the medical, psychological and social needs of the family are assessed and a care plan is devised.

At times, families have no other choice than to access emergency departments in the event of serious complications from eating disorder. Typically though, they face extensive wait times prior to admission to specialized eating disorder services. This situation leaves many families scrambling to devise their own care teams.

Recovery from eating disorders is a complex process. There is no doubt about it. 

When you receive treatment for a broken bone that predominantly affects physical health, the healing journey is relatively predictable. Eating struggles, on the other hand, affect individuals on a physical, psychological, functional and social level. What’s more, they require multidisciplinary care over prolonged periods of time.

In addition, recovery is rarely linear or predictable in nature. Families often face relapses. Looking at these as opportunities to take a deeper dive into recovery serves as a refreshing reframe to the established narrative labeling the slip as a personal failure.

 

Key Players in Disordered Eating and Eating Disorder Recovery

We propose a model of recovery where the client plays the central role.

Medical professionals, dietitians, mental health professionals, family members, support and peer groups constitute additional critical players on the healing journey.

Working collaboratively, in an environment infused with trust, respect and deeply-rooted empathy, creates a synergistic effect offering optimal outcomes.

Ideally, clients and affected families would benefit from case management or recovery coaching, along with service navigation.

What we find though, is that often clients lack the support, financial resources or face additional barriers to access to the services they truly need.

At times, they come with significant guilt and shame around the relentless nature of their struggles and describe a deep sense of failure in not being able to overcome their disorder.

They often keep their disorder private even in the most intimate family relationships, as they do not want to burden their loved ones. Needless to say, there’s a great deal to unpack.

Recovery with the help of a registered dietitian

From a nutritional perspective, a registered dietitian specializing in eating disorders can help clients in a number of ways. This includes weight restoration or stabilization, reclaim normalized eating habits, respond to the body’s hunger and fullness cues more accurately, develop flexibility with eating habits and tap back into the joy of eating a wide variety of food options.

Dietitians also work with families to help implement meal planning to ensure provision of nutritionally and calorically optimal food choices. In addition, they can instruct families on meal support in hopes of guiding affected individuals to consistently meet their body’s daily nutritional requirements.

What’s more, dietitians help clients critically reassess dieting behaviours, body image struggles and body weight management. This contributes to a healed relationship with food and body.

Recovery with the help of medical professionals

The involvement of medical professionals is also critical for a number of reasons. These include: diagnose an eating disorder, assess medical stability, monitor the optimal functioning of vital organs and provide corrective measures in case of medical emergencies.

Doctors or nurse practitioners typically observe the client’s heart rate, blood pressure, gastrointestinal function, hormonal function and growth patterns for pediatric clients.

Recovery with the help of mental health professionals

Mental health professionals constitute another fundamental player on a client’s healing path.

Not only can they help with psychological stabilization, they also help clients understand how the eating disorder often serves as a coping mechanism for underlying social and psychological stress.

Therapists can offer tremendous help to clients in beginning to explore their emotional triggers, self-esteem, interpersonal difficulties, and body image concerns, amongst other things.

Recovery with the help of family members

Family members, friends and/or loved ones often take a lion’s share in the recovery journey. This is very important to understand. 

They are the ones who tend to raise red flags about certain behaviours that their loved ones display.

They also take the first brave steps to gently confront eating struggles and work hard to get clients’ buy-in to seek treatment.

In addition, they advocate for higher levels of care, in case they observe deteriorating physical and/or psychological wellbeing of their loved ones.

Given that Canada’s specialized, publicly funded eating disorder clinics and treatment services are disjointed and often inaccessible due to long wait times, families are left to assemble their privately-funded care team and implement “home hospitalization” for their affected folks.

What this means, is to deliver intensive home-based care with the help of health care professionals (medical doctor, therapist and dietitian). For some affected individuals, this care is optimal and brings about the necessary healing they will eventually achieve. For others, eating disorders may become chronic, necessitating multiple hospital readmissions, coupled with extensive need for privately-funded care.

While most families embark in securing treatment and maintain unwavering hope to see their loved ones recover from an eating disorder, it is insightful to know that some folks are affected by treatment resistant eating disorders.

In other words, some individuals may never fully recover. While they may be able to stabilize their nutritional status and/or body weight, they continue to rely on characteristics of an eating disorder for emotional regulation as a coping mechanism. For example, someone with anorexia nervosa character traits such as perfectionism, inflexibility and low mood may provide a perfect backdrop to maintain the disorder.

Public support

Publicly funded services in Canada, range from residential care to inpatient unit services. They also include day treatment programs, intensive outpatient programs, outpatient programs and step-down or transitional care. While this list presents a robust selection of choices, when it comes to securing a spot, things are challenging. Clients are often declined based on geographic location, age, co-morbid symptoms or lack of open spots necessitating longer wait times.

Disordered Eating and Eating Disorders: Final Thoughts

It is important to end with a message of hope.

Recovery is possible. It is a walkable road with the necessary support and expertise in place for most affected individuals and families. Disordered eating or eating disorders are “life thieves” that can be stopped in their tracks. When this occurs, it will allow people to regain physical, psychological and social functioning and to thrive in life.

At JM Nutrition, our goal is to provide accessible, timely and evidence-based nutritional interventions that clients can count on in their healing journey.

We also strive to advocate on clients’ behalf to their medical doctors. We create linkages with mental health professionals as well. Additionally, we offer eating disorder service navigation as their health needs change during various stages of recovery.

 

Conclusion

Should you feel you require personalized nutritional care for disordered eating and eating disorder recovery with dietitian Kinga Balogh, or another practitioner, book a free consultation or contact us for an appointment. As always if you have comments or questions, we encourage to let us know. 

 

Helpful Resources

National Eating Disorder Information Centre

National Initiative for Eating Disorders

CAMH – please search for a list of hospitals offering publicly-funded ED services in Ontario

Kelty Mental Health Resource Centre

Eating Disorder Association of Canada

Eating Disorder Foundation of Canada

Sheena’s Place

Body Brave

BANA Buimia Anorexia Nervosa Association

 

References

1. https://www.nied.ca/eating-disorders-in-canada
2. Obesity Canada
3. Change Creates Change 
4. https://nedic.ca/media/uploaded/Canadian_Eating_Disorders_Strategy_2019-2029_-_dps_-_ENG.pdf

 

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Kinga Balogh is a registered dietitian who specializes in disordered eating and eating disorder recovery. She is a weight-neutral HAES™ dietitian and health and nutrition coach, combining dietetics and coaching strategies to enable clients achieve fulfilling lives. She also works with clients to help them make peace with food and their bodies. In addition, she works towards achieving self-liberation from unrealistic body ideals and develop body acceptance. Kinga has appeared in a number of publications including The Toronto Star, Bored Panda, Canadian Living and more. Kinga is available for virtual nutritional counselling. 

 

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JM Nutrition is a nutritional counselling service by registered dietitians and nutritionists in Canada. Main offices: Toronto, Ottawa, Halifax, Vancouver