For ordinary people, eating is a very simple thing, and it is difficult for them to imagine why someone cannot control what they eat.
It's not about being promiscuous or stinking, but about a mental illness— Eating Disorder (ED), a mental illness in which food and eating behaviors are the primary source of anxiety.
In this era of "thin or die" slogans, the problem of eating disorders is also becoming more common. However, little is known about eating disorders, and some people with eating disorders don't even know that their manifestations are a disease or how to turn to them.
We invited 4 professional dietitians to share their experience in the treatment of eating disorders. If you see a friend around you battling an eating disorder, I hope their experience will help you.
Anorexia Nervosa is a very serious psychosocial disease with 3 main features:
1. The calorie intake of patients with anorexia nervosa is very low, and the weight will be much lower than that of normal people.
Due to insufficient intake of energy and nutrients, there will also be various problems, such as hair loss, easy to be afraid of cold, anemia, and it is very common in women to not menstruate.
2. Patients with general anorexia nervosa have a strong sense of fear of weight gain.
3. Some patients will have "body image disturbance", deviations in self-image cognition, obviously the weight is very low, or will feel fat.
From the perspective of behavioral performance, anorexia nervosa can also be divided into two categories:
One group of patients is characterized by constant restriction of their calorie intake and a constant stay in a very low range of body weight. Another group of patients may have regular binge eating, or vomiting, laxative use, but these behaviors occur occasionally; if they occur very frequently, they may be diagnosed with another eating disorder.
The patients I treat with anorexia nervosa are mainly adolescents, and between the ages of 12 and 18, there are more women than men.
One patient, probably in his 20s, was a severe anxiety sufferer. When she found herself gaining some sense of accomplishment by controlling her diet, she continued to reinforce the behavior, which gradually developed into an eating disorder.
Another young patient, who experienced a lot of life stress, became more and more serious about how often she controlled her weight and diet when she found that she could control her weight and diet. The last time she saw me, she said she probably only ate one meal a day. But she also knew that this was not right, so she wanted to slowly increase the number of snacks and add a little calorie.
There is also an interesting case, a 16-year-old boy. He has a history of anxiety and suddenly began to worry about whether he was eating too much during the epidemic. But he felt that he was not afraid of weight gain, he himself felt that he was thinner, he was not afraid of normal weight, he was just afraid that he would become very fat.
He began to control his diet in January this year, and then found that his appetite was getting worse and worse, and he also had some gastrointestinal discomfort.
In fact, this is very common in patients with anorexia nervosa. After restricting the diet, the body's metabolism will decline, the appetite will also decline, and the digestive system will begin to strike a little; and when you start to eat more food again, you will find that the digestive system does not seem to be as good as before, and after eating it, you will have stomach pain.
These discomforts, in turn, will continue to reinforce the act of restricting the diet, and further dietary restriction will lead to weight loss and further strikes of the digestive system, thus entering a vicious circle.
The treatment of eating disorders is very slow. For patients without eating disorders, the dietitian gives him a goal that he may accomplish easily and will not find any difficulty; but for people with anorexia nervosa, eating more food is a great fear for him.
I had a patient who at the beginning set him the goal of eating breakfast on time every day, even if it was not a regular breakfast, a protein bar. But he told him that the suggestion frightened him terribly. We agreed to another goal: to start eating a little in the morning, starting three days a week. He felt a little relieved about this goal and felt that he could do it.
Another difficulty is that many people with eating disorders have a "black and white" mindset, thinking that if I don't achieve this goal, my life will be over, and everything will be over.
Therefore, when setting goals for such a patient, we should also pay great attention to it, we must set a goal for him, but also tell him to be more tolerant of himself, and the treatment will have set back (backward) or improve( which is very normal.
Eating disorder patients often have other psychological diseases, very much need psychotherapist, psychologist intervention, from the psychological aspect to communicate with the patient, so the treatment of eating disorders must require multi-faceted teamwork.
Some of the more serious patients, when his weight drop to a very low and potentially life-threatening situation, we will immediately refer him to the hospital. The hospital's dietitian will develop a treatment plan that prescribes how many calories and how many meals to eat per day. Although these treatment options are more aggressive, they are useful for correcting weight and preventing some life hazards.
People at higher risk of disease are, first of all, people with depression or anxiety disorders, people with very strong perfectionism pursuits, and people who are engaged in some professions that have very high requirements for appearance, such as dancers, actors, and athletes, who have a higher rate of anorexia or binge eating disorder than others.
Overall, the prevalence of anorexia nervosa is low. In developed countries, the incidence is about 1.6 per cent for women and 0.8 per cent for men in a year, but this number changes every year.
First of all, I will carefully read some of his original mental illness assessments to fully understand his background information. See if he has any pressure, whether he has family and friends to support him, whether he will cook his own food, whether he buys his own vegetables, etc.
During the nutritional assessment phase, I wouldn't specifically ask them to achieve a goal, but more importantly, let me understand their motivations and why they control their diet. If the patient mentions that he actually eats a little more, then I may set a feeding goal for him to try; if I have a very serious patient, I will refer him to some hospital and receive hospitalization, because it will be more strict and will help him regain weight faster.
During the conversation, I pay great attention to my wording because their mental state is very sensitive and do not want nutritional counseling to cause them extra harm. I think the first thing to do in treating eating disorders is not to hurt patients more.
For example, when asking a question, you must ask the patient's opinion to see if he wants to talk. If some of the words I use trigger his sensitive words, I'll ask him to bring them up; if he doesn't feel well, I won't talk about it anymore.
I don't usually say the words "calories," "calories," "BMI"; I don't analyze weight numbers, but ask them what they think of their body shape, what they think of their own weight.
I wouldn't say, "This food is good, this food is bad," or "This food is high in calories, this food is low in calories." If the patient brings it up, we can discuss it again, but I won't do it unilaterally, because dietitians say "which food is good and which food is bad" reinforces their black-and-white thinking. For anorexia nervosa, no matter what kind of food, as long as you can start eating, it is very good for the body. I would listen to them with a neutral stance and then make some notes.
Symptoms in patients with bulimia nervosa include binge eating and spontaneous compensatory behaviors. When overeating, the general eating speed is very fast, and it is difficult to control the amount of food.
Bulimia nervosa is distinguished from bulimia by spontaneous and inappropriate compensatory behaviors after each binge eating, such as vomiting behavior, hunger strike, laxatives, diet pills, etc.; some patients will immediately perform a lot of exercise in the hope of consuming these calories consumed by binge eating.
Patients are afraid of weight, and all compensatory actions are the patient's aggressive weight control. These symptoms recur, averaging at least once a week and may persist for at least three months.
He was a 22-year-old college student in the United States, and it was his girlfriend who brought him to consult.
He was very concerned about weight, claiming to be a fat man in junior high school and having lost weight in high school; he was very afraid of becoming fat, thinking that he was fat.
He said that he did not like to eat sweets, but he would eat a lot and drink a lot of wine at parties, and he would induce vomiting after every dinner, and his friends also knew that he induced vomiting, and he did not feel guilty after vomiting. The girlfriend said that after each time he "ate too much", his temper became very bad and irritable.
He also told me that his stomach was very bad, eating a little greasy and spicy things would hurt his stomach; when he went out with friends, he always felt that he had no energy, and her girlfriend said that he would sleep a lot every day and felt that he was often very weak.
In my first consultation, I used the "motivational interview method" to express empathy and let him know that emotional fluctuations and anger are understood; I also told him that it is normal for weight to fluctuate up and down, and some fluctuations are caused by changes in body water; there is no need to weigh multiple times a day, if you insist on weighing, it is recommended to weigh twice a week.
In the first consultation, I found that patients could not recognize their hunger and satiety, and it was difficult to eat according to satiety. My advice to him was:
1. Slow down the speed of eating, chew 10-15 times per bite of food, put down the chopsticks appropriately during the meal, and stop for 3-5 minutes to rest.
2. Schedule 3 meals a day, arrange a snack in the afternoon, and ensure that the fasting time will not be greater than 4 hours.
The diet plan I give my patients is divided into three stages.
The first stage of the meal plan is a small portion of the meal, with additional snacks. While meeting the nutritional needs of patients, avoid large meals that stimulate vomiting behavior.
The second stage is a slow transition process that guides mindful eating according to the patient's situation, helps the patient feel his or her physical needs and feelings of fullness, and cultivates the patient's control over eating.
By the third stage, the patient has greater autonomy and can choose what time to eat and what to eat. And I will recommend foods with high nutrient content for patients and avoid low nutrient calorie intake.
In the first phase, I did not educate the patient about preparing their own meals, because during the communication, it was found that the patient had concerns and fears about the meal. At the same time, in order to avoid the preparation process and the behavior of cleaning up the dishes after the meal to increase the pressure on him, I did not ask him not to eat takeaway, do not participate in the party, and can continue to maintain the past living habits.
I also encourage the patient's girlfriend to accompany him to eat more meals, and encourage him to adhere to the diet plan to prevent the patient from inducing vomiting after meals.
In my interactions with patients, I will first try to understand which factors will stimulate patients to take compensatory behavior after binge eating, and then customize a timed and quantitative diet plan for patients to avoid these stimuli.
In the first few diet plans, minimize the patient's stress, set only 3 small goals at a time, and review the patient's eating behavior until the next correction.
The first consultation will not give the patient much nutrition education, but more time to listen with empathy and build a good relationship of trust with the patient.
In the first consultation, patients can be guided, if there is also emetic behavior in the later stage, it is not recommended to brush your teeth immediately after vomiting, which is not good for your teeth, you can use water or soda to gargle your mouth to balance the pH of the mouth.
In counseling, understand the stage the client is at and pay attention to the wording, avoiding giving too much advice, as this may be resentful to the patient. I will maintain a united front with my patients in a non-judgmental manner and find ways and techniques to help them reach their goals.
Mindful eating and intuitive eating education are taught in the second or third post-visit consultation and, depending on the progress, using dialectical behavioral therapy DBT.
In the treatment of patients with bulimia nervosa, it is often necessary to work with mental health professionals to intervene in the treatment.
● Women are at higher risk than men ● Adolescents ● People with a family history of eating disorders ● People with psychological and emotional problems (depression, anxiety) ● Models or some anchors ● In some cases, trauma and stress can be risk factors ● People who are dieting
If there is overeating or compensatory behavior after the meal, it is recommended that you explain your situation with your family and friends, get help and understanding from the people around you, and seek professional nutritionist consultation in time.
Weight does not need to be weighed every day, if you are very concerned about weight and body, weigh 1-2 times a week. Encourage yourself to develop a positive sense of a healthy body.
The word Orthorexia Nervosa first appeared in the 1990s as a term coined by American physician and author Steven Bratman to mean an obsession with proper or "healthy eating."
Orthorexia consists of two roots, ortho meaning "correct" and orexi meaning "appetite."
While being aware of and paying attention to the nutritional quality of the food they eat is not a problem in itself, some people become very obsessed with what is called a "healthy diet" and thus compromise their own health.
Symptoms of ON may include:
Compulsively check ingredient lists and nutrition labels
● Pay too much attention to the healthy components of food
Reduce the intake of more and more food types, such as all sugars, all carbohydrates, all dairy products, all meat, all animal products, etc
Do not eat anything other than a small portion of foods that are considered "healthy" or "pure."
Have an unusual interest in whether what others eat is healthy
Spend a few hours a day thinking about what food might be available at upcoming events
● Show extreme distress when "safe" or "healthy" foods are not present
● Indulge in blogs on social platforms about "Healthy Food and Healthy Lifestyles."
There may or may not be a body image problem
CURRENTLY ON is not included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Since there are no formal diagnostic criteria, it is difficult to accurately estimate how many people have orthoremia.
It may be an independent eating disorder, a type of existing eating disorder (such as anorexia), or it may be an obsessive-compulsive disorder.
The high risk factors for eating disorders are divided into physiological, psychological and social factors.
Physiological risk factors include someone close to the family who has a dietary disorder, mental health problems, a history of non-good weight loss, type 1 diabetes, excessive dieting, or excessive exercise, resulting in negative total physical energy.
Psychological risk factors include perfectionism, dissatisfaction with body image, and a history of anxiety disorders.
Social risk factors include stigmatization of weight, bullying, internalization of "perfect appearance," and more
I haven't met a patient who has been diagnosed with ON. As stated in the first question, ON is not currently included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
But there are patients who do not have symptoms of vomiting, excessive exercise, weight attachment, or attachment to perfect appearance, but because they are obsessed with the concept of "healthy eating", they limit diet, reduce or do not get energy from food, resulting in stunting, nutrient loss or significant weight loss.
Similar to anorexia nervosa, ON involves limiting the amount and variety of food eaten, which can lead to malnutrition.
As a result, the two diseases have many of the same physical consequences, such as affecting cardiovascular health, intestinal function (constipation and diarrhea, etc.), mental malaise, hormonal confusion, hair loss, dry skin, anemia, menstrual disorders, and other issues.
There is currently no clinical treatment specifically for ON, but many eating disorder specialists see anorexia as a type of anorexia and/or obsessive-compulsive disorder.
Therefore, therapeutic interventions often involve psychotherapy, increasing the variety of foods eaten, encouraging or requiring patients to be exposed to foods they are anxious or fearful of, and restoring weight as needed.
1. Anorexia nervosa: manifested as significant low body weight due to limited energy intake
2. Bulimia nervosa: manifested as uncontrolled eating state, strong emotional experience, repeated compensatory behavior, self-evaluation is affected by weight and application
3. Binge eating disorder: manifested as an out-of-control eating state, strong emotional experience, and uncompensated sexual behavior
4. Avoidant/restrictive feeding disorder: manifested by the inability to consume sufficient amounts or specific types of food to meet their energy and nutritional needs, resulting in significant weight loss.
1. Psychological factors
Certain temperaments and personality traits, including high perfectionism, fear of maturity, impulsiveness and anxiety tendencies, and lower levels of trust in interpersonal interactions, are closely related to the high incidence of ED.
Cognitive, behavioral, and emotional factors resulting from a range of acquired changes also increase the risk of ED. For example, low self-esteem cognition, inflexible cognition, dieting behavior, high negative emotions (especially for depressed people) and so on.
2. Socio-cultural factors
Family factors, particularly in the case of the nuclear family, such as women with higher parental education are at higher risk of developing the disease; parents are overprotective, overly manipulative, or impose personal values on their children; and family relationships are disturbed or childhood abuse (including physical, psychological, sexual, and neglected);
Social factors, such as the sociocultural concept of "beauty as thinness", lack of support or poor interpersonal relationships, and traumatic events such as sexual abuse, weight-related ridicule, discrimination or insults.
3. Biological factors
Genetically inherited, the risk of developing disease in first-degree relatives (such as their children) in young women with eating disorders is about four times the average; neurobiology, abnormal function of the hypothalamic-pituitary-adrenal axis is associated with eating disorders.
In the process of diet improvement, the patient's endless pursuit of thinness and the morbid fear of gaining weight lead to emotional collapse, refusal to be hospitalized, and refusal to see a psychotherapist.
Interventions were ineffective, the duration of the disease was long, and it was repetitive. During this period, patients are advised to go to a specialist hospital for hospitalization and continue to receive treatment from a psychotherapist.
Dietitians often work with other health care teams, such as mental health professionals, to intervene in the treatment of eating disorders. A diverse range of treatments, including psychologists, psychotherapists, dietitians, and family members, is necessary to effectively treat eating disorders.
On the different stages of the disease, the focus of treatment is also different. Weight recovery or stabilization is one of the most important goals in the treatment of eating disorders; the focus of the acute nutritional reconstruction process is to avoid possible refeed syndromes; and in the middle and late stages of eating disorder treatment, the goal of treatment gradually shifts to the re-development of healthy eating habits.
Through professional nutrition consultations, dietitians customize private diet plans for patients, improve nutritional status, understand personal health needs, and teach patients lifelong benefits from eating habits.
Edit | hawthorn
Design | grapefruit