Many of us experience difficulties with food, weight and body image. These difficulties may negatively affect our lives and our self-esteem. If food and weight issues are causing distress in your life, seek support. You do not have to wait until you meet the criteria for a clinical eating disorder in order to get help. You deserve help at every stage of your struggles.
Food and weight preoccupations occur on a continuum that encompasses behaviours such as constantly worrying about our body shape and what we eat, as well as medically serious clinical eating disorders, like anorexia or bulimia nervosa. The development of a clinical eating disorder such as anorexia or bulimia can be the result of a combination of genetic, environmental, and psychological causes. This is referred to as the biopsychosocial model. Some people may not meet the criteria for a clinically diagnosed eating disorder, but may engage in unhealthy behaviours such as bingeing or restricting. You still need and deserve help.
Any kind of disordered eating pattern can affect an individual’s self-esteem, relationships, and daily life. The issue is not whether the pattern can be labelled with a particular diagnosis, but the degree to which it causes distress in a person's life or the lives of those around them.
Find help by looking at the local options available to you. A professional counsellor who is knowledgeable about food and weight issues will work with you to overcome food and weight preoccupation. Some counsellors may also offer telephone or online services. There are also a number of online support groups. You can learn more about available resources in the service provider directory.
You can also discuss your concerns with your family doctor. This guide may help you in discussing your concerns with your family doctor.
Given the complex nature of eating disorders and the many factors that play a role in their development and perpetuation, treatment must address a variety of issues. It is accepted that a two-track approach is necessary for the treatment of eating disorders. The two tracks are:
Treatment will focus more on the physiological issues in the early phases of therapy, with the view to establishing some degree of normalcy with eating and weight. This enables the individual to benefit from the therapy to address psychological issues. The therapist must not lose perspective on either track, and achieving a balance between the two is essential. Focusing on only one track to the total exclusion of the other is never in the best interest of the individual and may prevent full and lasting recovery. In order to be effective, the professional treating the person with an eating disorder in either phase of treatment must have a thorough understanding of eating disorders.
The process of normalizing eating is often referred to as “eating with training wheels.” The individual has to learn what normal eating is and that dieting (which would include behaviour like avoiding foods and counting fat, grams, or calories) is not consistent with the goals of achieving health and well-being.
Some individuals with eating disorders have never had normal eating patterns in their lives. It may be helpful for an individual to be in contact with a dietitian or nutritionist who has expertise in the treatment of eating disorders. In other words, contact with a dietitian who won't prescribe a weight-reducing or restrictive diet. This contact is helpful in guiding the individual into normal eating in an understanding, respectful manner.
It is also important that individuals with eating disorders learn about weight regulation and the effects of starvation on thinking, feeling, and behaviour, and the effects of purging on the body. As the person begins to normalize their eating, they will begin to recognize how normal eating has helped them concentrate, increased their energy levels, and improved their thinking patterns, moods, and sleep.
Weight gain may initially cause extreme distress to the individual. It is best that individuals with eating disorders weigh themselves in the therapist's or doctor's rooms rather than at home. In that way, the person can be helped to understand the relationship between weight gain and the other emotional, social and physical changes they are experiencing, and helped to accept or at least tolerate the weight gain and understand that it will level off.
Individuals with eating disorders can expect to gain weight at the outset of normalizing their eating, but the gaining will level off as their bodies make a metabolic adjustment to the higher intake of calories. Many individuals hold the faulty belief that if they eat, they will become morbidly obese. This is an example of the dichotomous thinking patterns characteristic of individuals struggling with an eating disorder; they find it difficult to accept that there is the middle ground of a healthy weight for them.
As the underweight individual approaches a healthy weight, sex hormones will return to normal levels and menstruation should resume for individuals who menstruate. At this point the individual will be going through something akin to adolescence once more, with changes in hormonal levels. It is important to help them understand the effects of changing hormone levels on mood so that they aren’t frightened or discouraged.
Once the individual begins to normalize their eating, the predisposing and precipitating issues can be addressed.
Dealing with the individual’s poor sense of identity and self-esteem is of great importance. Some other common psychological themes which need to be addressed include:
Many individuals will benefit from treatment of these issues therapy beyond the point of their initial recovery from the specific weight and eating problems. This will diminish the potential for relapse.
For those who feel isolated and would like to connect with others who have had similar experiences, group assistance is often a good choice. Group therapy, support groups and self-help groups are all ways in which people can come together and, through sharing their experiences, begin to normalize their feelings and help each other deal with their difficulties.
Individual counselling or therapy may be appropriate for individuals who feel overwhelmed in groups or who feel that they would benefit more from individual attention. There are different types of support available. Therapy or counselling may be provided by a therapist, a psychologist, a social worker, or a counsellor. Dietitians and psychiatrists also offer specialized services which may benefit individuals experiencing eating disorders.
For people whose eating problems have reached a stage of medical and/or psychological crisis, a more intensive individual approach may also be required. This approach might include hospitalization or other specialized treatment programs accessed through a family doctor, hospital, community agency or individual therapist.