Reclaiming Your Body After Abuse and Assault

Trigger Warning: Impact of abuse and assault on physical, mental, and emotional health. Reader discretion advised.

au·ton·o·my
/ôˈtänəmē/
noun

You may ask: Where does the voice of a registered dietitian treating eating disorders/disordered eating belong in a conversation about the impacts of abuse and assault?

Our answer: Front and center.

Experiencing a loss of body autonomy through traumatic events such as abuse and assault is a topic that is becoming more openly discussed in media and research. Finally! – a realm of experiences that many (most) of us can relate to on some level is no longer “hush-hush”. With the growing amount and variety of community support for survivors, where does the non-diet, body neutral dietitian fit in?

Trauma affects everything. Survivors often experience changes in their physical, mental, and emotional health (sometimes gradually, sometimes suddenly).* Many of these changes are intricately weaved with digestive health and eating behaviors. Cue the non-diet, body neutral dietitian!

It is our hope to help survivors of trauma move forward in their healing journeys by encouraging a reclamation of body autonomy and educating on the specific ways traumatic events can alter the how we feed ourselves. This. Takes. Time. All the time one may need. Some ways in which a dietitian at Nutritious Thoughts** may support you in reclaiming your body autonomy include the following:

  • Restoration of balanced and adequate nourishment
  • Rehabilitation from eating disorder/disordered eating behaviors
  • Attunement to bodily cues (hunger, fullness, other digestive and emotional cues related to eating)
  • Creating a self-care plan
  • Cultivating a space where your voice and experience is heard and respected

If you or someone you know needs support around the topics of abuse and/or assault, please consider reaching out to or providing them with the following resources:

  • National Domestic Violence Hotline – 1-800-799-7233
  • National Sexual Assault Hotline (RAINN) – 1-800-656-4673
  • Our Voice (local Western NC support!) – 828-255-7576
  • For crises, medical emergencies, etc. – Dial 911

*Details on these changes can be found via Dialogues of Clinical Neuroscience here: Traumatic stress: effects on the brain

**A registered dietitian is an important part of a treatment team for survivors with dis-regulated eating behaviors but they cannot be the entire team. Survivors deserve a team that involves multiple clinicians and at minimum, the addition of a therapist and physician.

‘Clean’ Eating: Magic or Mayhem?

This month, we feature an article published by Outside Magazine that discusses the clean eating trend in depth.

Bonus: the article includes perspective from one of our own here at Nutritious Thoughts – Margaret Ruch, MS, RD, LDN!

Is ‘Clean Eating’ Good for You? Not Really.

Trying to eat perfectly all the time is a losing battle

The clean-eating trend isn’t new, but it is ever present. It’s a hashtag on Instagram, a hot topic on Twitter and Reddit, and a whole category of food blogs, cookbooks, and magazines. While this approach to eating looks a little different for everyone, it always promotes whole foods and warns against processed options and added sugars. Some clean-eating plans even eschew whole-food staples like dairy, grains, and naturally occurring sugars. Despite the trend’s prevalence—and the fact that “eating clean” as a term sounds benign enough—health experts are wary of the approach for a handful of reasons. Here’s an overview of why athletes should steer clear of the trend.

“Clean Eating” Is an Ambiguous Term

There’s no agreed-upon definition of clean eating. “Generally, it’s about eating foods that are less or not at all processed. It’s always a form of restrictive eating, and for some people, it leads to avoiding whole food groups,” says Margaret Ruch, a registered dietitian who specializes in sports nutrition and disordered eating. The paleo version of clean eating, for example, emphasizes protein, vegetables, nuts, seeds, and some fruit, but it cuts out dairy, grains, legumes, added sugars, and processed foods.

The flexibility of what constitutes clean eating can lead adherents down a path of increasing restriction. The diet promises to be the cure for all kinds of ailments: fatigue, bloating, acne, weight gain, and even some chronic illnesses. If someone adopts of a couple of rules (like cutting out sugar and processed carbs) and doesn’t see benefits, it’s likely they’ll keep adding rules and cutting out foods until they do. “It’s a slippery slope—you want to eat healthier, but there’s really no end goal for clean eating, no way to know you’re doing a good job with it,” says Heather Caplan, a registered dietitian, distance runner, and former running coach.

Plus, while diet certainly impacts health, it’s unrealistic to give it so much power. Factors that are totally out of our control (genetics, for one) play a huge part in our health outcomes, as do things like our relationships, location, and socioeconomic status. “I say that to comfort people, but it’s often jarring. Just because you eat ‘perfectly’ doesn’t mean you’re definitely going to be healthy,” says Caplan.

You Need More Calories Than Veggies Can Provide

“Proper nutrition can play a big role in sports performance, but proper fueling has more to do with getting enough—enough energy, enough carbs, enough protein, enough fat, and enough fluid,” Ruch says. In other words: prioritizing nutrient-dense food is good, but the most important thing is to make sure you’re giving your body the calories it needs to perform and recover properly.

“No matter how you define clean eating, it’s about cutting out certain foods, which makes it much harder to get enough food overall,” Ruch says. “If you’re not consuming as much energy as you need, that really can damage your body in the short and the long term.”

It’s Tough to Get Enough Carbs from Whole Foods 

Exactly how many carbs a person needs depends on several factors—age, gender, weight, activity level, genetics—but “for endurance athletes, carbs should generally be about 50 to 60 percent of your total food intake,” Caplan says.

“If you define clean eating as no processed carbs, it’s going to be really tough to reach your carb needs because of all the fiber that comes with unprocessed carbs,” she says. Fiber increases a food’s volume without increasing its energy, so it makes you feel full more quickly. If you’re also cutting out whole grains and legumes, it’ll be even tougher to fulfill your carbohydrate needs.

Processed Carbs and Sugar Are Great Workout Fuel

Complex carbohydrates from whole foods are great choices most of the time. They’re more nutrient dense than processed carbs, and they digest slowly for steady energy. They’re not a good source of quick energy, though. “I wouldn’t recommend that someone eat a sweet potato or a slice of Ezekiel bread right before working out—they will be slow to enter your bloodstream,” Ruch says.

“So many athletes aren’t getting adequate carbs, usually because they’re afraid of sugar,” she says. “Processed carbs and sugars are great when you need blood sugar quickly, like when you’re about to go on a run or do any kind of intense or long workout.”

Plus, whole carbs preworkout can cause an upset stomach. Fiber is resistant to digestion, which means you’ll likely deal with some bloating and a sensitive stomach while your body breaks down fiber-rich foods—inconvenient during, say, a long training run. “Some people need a low-fiber preworkout snack, like white bread or cereal,” Caplan says. “Other people, like me, can tolerate more fiber and be fine.” If your gut isn’t having it, don’t hesitate to switch to a processed-carb snack or sugar (like a honey stick) that’s easier for your body to break down.

Restrictive Eating Creates Nutrient Deficiencies

Nobody wants to get sidelined by a stress fracture, and diet plays a big role in bone health. Eliminating dairy affects your calcium and vitamin D intake. “If you’re not replacing that dairy with something else, you’re likely going to be deficient,” says Ruch. And relying on supplements won’t cut it; studies have consistently shown that these supplements don’t reduce the risk of osteopenia, osteoporosis, or fractures, and that your best bet for good bone health is getting adequate calcium through your diet. (If you have a dairy allergy, you can get calcium and vitamin D from fortified products, like nondairy milks.)

Whole grains also provide important micronutrients, including vitamin E and various B vitamins such as riboflavin, thiamine, niacin, and folate, that offer critical support to digestion, the nervous system, and more, Caplan says. “Most whole grains are fortified with folate or folic acid, and sometimes iron.” All of these nutrients are essential for good health, and while it’s possible to get them elsewhere, grains are an easy and inexpensive source.

Diet Can Cause Mental and Emotional Stress, Too

“When we talk about health, we have to take into account not only the nutritional value of what we’re eating but also emotionally how we feel when we’re eating a certain way,” says Breese Annable, a psychologist who specializes in disordered eating, chronic dieting, and body image. Although a less rigid style of clean eating might be fine for some people, too many food rules can have a big negative impact on overall health, Annable says. For example, if you avoid social gatherings for fear of not being able to eat “clean,” you’re isolating yourself, which can have its own negative consequences. Plus, chronic stress has been shown to impair sports recovery.

Stressors of rigid clean eating might include spending more money on food (whole foods are generally more expensive) and constantly denying yourself the foods you’re craving. “There’s a trade-off between any potential benefits of following a certain diet and the stress you put on yourself when you’re so rigid and inflexible,” Ruch says. “This is true even if you do manage to get enough energy and nutrition from a diet.”

The Bottom Line

Clean eating essentially paints foods as being good or bad. “It creates this sense of morality around food,” Annable says. But health isn’t black and white, and thinking of food that way won’t do you any favors. If anything, it sets you up for feelings of guilt and failure when you inevitably break whatever diet rules you’ve set for yourself.

“It’s harmful to put labels on your diet and yourself, instead of just saying you eat a flexible diet and you’re mindful about your food intake,” Ruch says. There’s nothing wrong with wanting to eat healthfully, but the best approach is to focus on eating mostly nutritious foods while thinking of the occasional less nutritious treats as just part of an overall healthy balance. In other words: ditch the idea of clean eating, and embrace the fact that no one meal or food choice will make or break your health.

Direct article link here: https://www.outsideonline.com/2391283/is-clean-eating-good

Is ‘National Nutrition Month’ a Recovery-Positive Campaign?

As registered dietitians dedicated to the prevention and evidence-based treatment of eating disorders and disordered eating, we found ourselves asking the following questions leading into National Nutrition Month®:

  • Does National Nutrition Month® (NNM) align with Eating Disorder/Disordered Eating (ED/DE) recovery?
  • As Health At Every Size® (HAES) informed professionals, to what extent might we ethically support participation in this month-long campaign focusing on nutrition and physical activity to our clients, our peers, friends, loved ones…ourselves?

The quick answers?

  • A little bit, kind of, sorta…
  • Proceed with caution

Here’s a more in-depth look at our perspective:

Let’s begin by explaining a little bit more about NNM!  NNM was created by the Academy of Nutrition and Dietetics (AND), the largest organization of food and nutrition professionals in the United States. AND defines NNM as follows:

What is National Nutrition Month®?

National Nutrition Month® is an annual nutrition education and information campaign created by the Academy of Nutrition and Dietetics. The campaign, celebrated each year during the month of March, focuses on the importance of making informed food choices and developing sound eating and physical activity habits.

– Academy of Nutrition and Dietetics (AND)

We’ve done a thorough review of the National Nutrition Month website for 2019 and wanted to share some thoughts with you.

What we appreciated about this year’s theme:

  1. The 2019 NNM theme is self-titled (“National Nutrition Month®”) which makes it more inclusive of many different topics of discussion – including eating disorders and disordered eating! Win!
  2. Many of the educational materials encouraged making sustainable changes towards achieving balanced food and movement routines that are individualized. We love this approach!
  3. Mental health and motivation for change (which are totally intertwined with eating and moving our bodies) were not excluded from the conversation!

What we could have done without:

  1. The language! Reviewing the NNM website brought up a much larger conundrum – the way we speak about nourishment in our society. The language we use to address nutrition and movement is morally charged. The “good/bad” or “right/wrong” polarization is not recovery-positive and continues to drive us farther away from seeing food as just food and moving our bodies as joyful and drives the shame wagon. Shame does not motivate people to adopt health-promoting behaviors.
  2. Weight management. Encouraging weight management through portion control and calorie tracking is not an approach that is respectful and accepting of all body shapes and sizes and promotes the message that larger bodies are inherently in need of “fixing” or must be controlled in some manner. Nah, nah, nah. Not buying it. Weight management is not weight neutral. It’s not HAES-informed. It’s not recovery-positive. It’s oppressive and unethical to prescribe disordered eating behaviors to people living in larger bodies. Also, there is a body of evidence against it.

*Caveat: National Nutrition Month was not created specifically for those in recovery from ED/DE, but for the general United States public.  However, even so, language equating terms such as “weight management” and “portion control” as being “right” can be harmful for at-risk populations and creates unnecessary vulnerability to developing ED/DE behaviors.

Suggestions for observing NNM in ED/DE recovery:

  1. Celebrate how far you’ve come! Take this opportunity to reflect on how eating and movement patterns have become more sustainable and balanced.
  2. Set goals. How might you propel your recovery forward this month? What would it look like to take steps to strengthen our relationships with ourselves and with food, movement, and recovery?
  3. Increase your food variety – try some new foods this month!
  4. Take up space and use your voice. Be in a larger body. Be fat. Exist as you are.

We love our field, our colleagues, and the wealth of valuable knowledge provided by AND, and we hope to continue to shift the way nutrition and wellness are presented to the general public to be more inclusive and less stigmatizing!

Check out what other ED/DE clinicians have said about NNM over the years:

https://marcird.com/my-take-on-national-nutrition-month/

https://veritascollaborative.com/blog/blog-national-nutrition-month/

https://www.sovcal.com/recovery/having-an-eating-disorder-during-national-nutrition-month/

 

 

 

What is “Health At Every Size”?

THE HEALTH AT EVERY SIZE® APPROACH:

Weight does NOT define Health.

The framing for a Health At Every Size (HAES®) approach comes out of discussions among healthcare workers, consumers, and activists who reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice. The HAES® model is an approach to both policy and individual decision-making. It addresses broad forces that support health, such as safe and affordable access. It also helps people find sustainable practices that support individual and community well-being. The HAES® approach honors the healing power of social connections, evolves in response to the experiences and needs of a diverse community, and grounds itself in a social justice framework.

The Health At Every Size® Principles are:

Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.

Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.

Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.

Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.

Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

OSFED & Additional Eating or Feeding Disorders: The Signs, Symptoms, & Impact

Other Specified Feeding or Eating Disorder

According to the National Eating Disorder Association

Formerly described at Eating Disorders Not Otherwise Specified (EDNOS) in the DSM-IV, Other Specified Feeding or Eating Disorder (OSFED), is a feeding or eating disorder that causes significant distress or impairment, but does not meet the criteria for another feeding or eating disorder.

Examples of OSFED Include:

  • Atypical anorexia nervosa (weight is not below normal)
  • Bulimia nervosa (with less frequent behaviors)
  • Binge-eating disorder (with less frequent occurrences)
  • Purging disorder (purging without binge eating)
  • Night eating syndrome (excessive nighttime food consumption)

The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious problems in areas of work, school or relationships. If something does not seem right, but your experience does not fall into a clear category, you still deserve attention. If you are concerned about your eating and exercise habits and your thoughts and emotions concerning food, activity and body image, we urge you to consult an ED expert.

Symptoms associated with anorexia nervosa include:

  • Inadequate food intake leading to a weight that is clearly too low.
  • Intense fear of weight gain, obsession with weight and persistent behavior to prevent weight gain.
    • Self-esteem overly related to body image.
    • Inability to appreciate the severity of the situation.
    • Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months.

Restricting Type does not involve binge eating or purging.

Symptoms associated with bulimia nervosa include:

  • Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.
  • A feeling of being out of control during the binge-eatingepisodes.
  • Self-esteem overly related to body image.

Symptoms associated with binge eating disorder include:

  • Frequent episodes of consuming very large amount of food but without behaviors to prevent weight gain, such as self-induced vomiting.
  • A feeling of being out of control during the binge eating episodes.
  • Feelings of strong shame or guilt regarding the binge eating.
  • Indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame about the behavior.

 

Additional Eating or Feeding Disorders

Avoidant/Restrictive Food Intake Disorder

  • Failure to consume adequate amounts of food, with serious nutritional consequences, but without the psychological features of Anorexia Nervosa.
  • Reasons for the avoidance of food include fear of vomiting or dislike of the textures of the food.

Pica

  • The persistent eating of non-food items when it is not a part of cultural or social norms.

Rumination Disorder

  • Regurgitation of food that has already been swallowed. The regurgitated food is often re-swallowed or spit out.

Unspecified Feeding or Eating Disorder

  • When behaviors do not meet full criteria for any of the other feeding and eating disorders, but still cause clinically significant problems.
  • Alternatively, when clinician is unable to assess whether an individual meets criterion for another disorder, for example, when there is a lack of information in an emergency situation.

Binge Eating Disorder: The Signs, Symptoms, & Impact

Binge Eating Disorder

According to the National Eating Disorder Association...

Binge eating disorder (BED) is an eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. Binge eating disorder is a severe, life-threatening and treatable eating disorder. Common aspects of BED include functional impairment, suicide risk and a high frequency of co-occurring psychiatric disorders.

Binge eating disorder is the most common eating disorder in the United States, affecting 3.5% of women, 2% of men,1 and up to 1.6% of adolescents.2

The DSM-5, released in May 2013, lists binge eating disorder as a diagnosable eating disorder. Binge eating disorder had previously been listed as a subcategory of Eating Disorder Not Otherwise Specified (EDNOS) in the DSM-IV, released in 1994. Full recognition of BED as an eating disorder diagnosis is significant, as some insurance companies will not cover an individual’s eating disorder treatment without a DSM diagnosis.

BED Symptoms and Diagnostic Criteria
The DSM-5, published in 2013, lists the diagnostic criteria for binge eating disorder:

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
    • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
  2. The binge eating episodes are associated with three (or more) of the following:
    • Eating much more rapidly than normal.
    • Eating until feeling uncomfortably full.
    • Eating large amounts of food when not feeling physically hungry.
    • Eating alone because of feeling embarrassed by how much one is eating.
    • Feeling disgusted with oneself, depressed, or very guilty afterward.
  3. Marked distress regarding binge eating is present.
  4. The binge eating occurs, on average, at least once a week for 3 months.
  5. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Characteristics of BED
In addition to the diagnostic criteria for binge eating disorder, individuals with BED may display some of the behavioral, emotional and physical characteristics below. Not every person suffering from BED will display all of the associated characteristics, and not every person displaying these characteristics is suffering from BED, but these can be used as a reference point to understand BED predispositions and behaviors.

Behavioral Characteristics

  • Evidence of binge eating, including the disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
  • Secretive food behaviors, including eating secretly (e.g., eating alone or in the car, hiding wrappers) and stealing, hiding, or hoarding food.
  • Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting; and developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, not allowing foods to touch).
  • Can involve extreme restriction and rigidity with food and periodic dieting and/or fasting.
  • Has periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling uncomfortably full, but does not purge.
  • Creating lifestyle schedules or rituals to make time for binge sessions.

Emotional and Mental Characteristics

  • Experiencing feelings of anger, anxiety, worthlessness, or shame preceding binges. Initiating the binge is a means of relieving tension or numbing negative feelings.
  • Co-occurring conditions such as depression may be present. Those with BED may also experience social isolation, moodiness, and irritability.
  • Feeling disgust about one’s body size. Those with BED may have been teased about their body while growing up.
  • Avoiding conflict; trying to “keep the peace.”
  • Certain thought patterns and personality types are associated with binge eating disorder. These include:
    • Rigid and inflexible “all or nothing” thinking
    • A strong need to be in control
    • Difficulty expressing feelings and needs
    • Perfectionistic tendencies
    • Working hard to please others

Physical Characteristics

  • Body weight varies from normal to mild, moderate, or severe obesity.
  • Weight gain may or may not be associated with BED. It is important to note that while there is a correlation between BED and weight gain, not everyone who is overweight binges or has BED.

BED Population and Demographics
Binge eating disorder is the most common eating disorder in the United States; it is estimated to affect 1-5% of the general population.1 BED affects 3.5% of women, 2% of men,1 and up to 1.6% of adolescents.2

Demographic Information

  • Binge eating disorder affects women slightly more often than men—estimates indicate that about 60% of people struggling with binge eating disorder are female and 40% are male.
  • In women, binge eating disorder is most common in early adulthood. In men, binge eating disorder is more common in midlife.
  • Binge eating disorder affects people of all demographics across cultures.

Physical and Psychological Effects of BED
Binge eating disorder has strong associations with depression, anxiety, guilt and shame. Those suffering from BED may also experience comorbid conditions, either due to the effects of the disorder or due to another root cause. Comorbid conditions can be both physical and/or psychological.

Physical Effects

  • Most obese people do not have binge eating disorder. However, of individuals with BED, up to two-thirds are obese; people who struggle with binge eating disorder tend to be of normal or heavier-than-average weight.
  • The health risks of BED are most commonly those associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:
    • High blood pressure
    • High cholesterol levels
    • Heart disease
    • Type II diabetes
    • Gallbladder disease
    • Fatigue
    • Joint pain
    • Sleep apnea

Psychological Effects

  • People struggling with binge eating disorder often express distress, shame and guilt over their eating behaviors.
  • People with binge eating disorder report a lower quality of life than those without binge eating disorder.
  • Binge eating disorder is often associated with symptoms of depression.
  • Compared with normal weight or obese control groups, people with BED have higher levels of anxiety and both current and lifetime major depression.

BED Treatment
Effective evidence-based treatments are available for binge eating disorder, including specific forms of cognitive behavioral therapy (CBT), interpersonal therapy (IPT), dialectical behavioral therapy (DBT), and pharmacotherapy.

All treatments should be evaluated in the matrix of risks, benefits, and alternatives. Decisions regarding treatments should be made after consulting with a trained medical professional and eating disorder specialist.

To find a treatment provider who specializes in binge eating disorder, please visit NEDA’s Treatment Referral database.

Social Stigma of BED
Many people suffering from binge eating disorder report that it is a stigmatized and frequently misunderstood disease. Greater public awareness that BED is a real diagnosis—and should not be conflated with occasional overeating—is needed in order to ensure that every person suffering from BED has the opportunity to access resources, treatment, and support for recovery.

NEDA’s shareable binge eating disorder infographic offers an easy way to spread the word about BED. It is important to underscore that BED is not a choice; it’s an illness that requires recognition and treatment.

Sources
1. Hudson, J.I., Hiripi, E., Pope, H.G. et al. (2007)The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol.Psychiatry, 61, 348–358.
2. Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry. 2011;68(7):714–723

Bulimia Nervosa: The Signs, Symptoms, & Impact

Bulimia Nervosa

According to the National Eating Disorder Association…

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Symptoms

  • Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.
  • A feeling of being out of control during the binge-eating episodes.
  • Self-esteem overly related to body image.

The chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.

Warning Signs of Bulimia Nervosa

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
  • Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.
  • Unusual swelling of the cheeks or jaw area.
  • Calluses on the back of the hands and knuckles from self-induced vomiting.
  • Discoloration or staining of the teeth.
  • Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.
  • Withdrawal from usual friends and activities.
  • In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
  • Continued exercise despite injury; overuse injuries.

Health Consequences of Bulimia Nervosa

Bulimia nervosa can be extremely harmful to the body.  The recurrent binge-and-purge cycles can damage the entire digestive system and purging behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.  Some of the health consequences of bulimia nervosa include:

  • Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death.  Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
  • Inflammation and possible rupture of the esophagus from frequent vomiting.
  • Tooth decay and staining from stomach acids released during frequent vomiting.
  • Chronic irregular bowel movements and constipation as a result of laxative abuse.
  • Gastric rupture is an uncommon but possible side effect of binge eating.

About Bulimia Nervosa

  • Bulimia nervosa affects 1-2% of adolescent and young adult women.
  • Approximately 80% of bulimia nervosa patients are female.
  • People struggling with bulimia nervosa usually appear to be of average body weight.
  • Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health.
  • Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.
  • Risk of death from suicide or medical complications is markedly increased for eating disorders

Anorexia Nervosa: The Signs, Symptoms, & Impact

Anorexia Nervosa

According to the National Eating Disorder Association

Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.

Symptoms

  • Inadequate food intake leading to a weight that is clearly too low.
  • Intense fear of weight gain, obsession with weight and persistent behavior to prevent weight gain.
  • Self-esteem overly related to body image.
  • Inability to appreciate the severity of the situation.
  • Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months.
  • Restricting Type does not involve binge eating or purging.

Eating disorders experts have found that prompt intensive treatment significantly improves the chances of recovery.  Therefore, it is important to be aware of some of the warning signs of anorexia nervosa.

Warning Signs

  • Dramatic weight loss.
  • Preoccupation with weight, food, calories, fat grams, and dieting.
  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.).
  • Frequent comments about feeling “fat” or overweight despite weight loss.
  • Anxiety about gaining weight or being “fat.”
  • Denial of hunger.
  • Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).
  • Consistent excuses to avoid mealtimes or situations involving food.
  • Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.
  • Withdrawal from usual friends and activities.
  • In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Health Consequences of Anorexia Nervosa

Anorexia nervosa involves self-starvation.; The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all its processes to conserve energy. This “slowing down” can have serious medical consequences:

  • Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing.  The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower.
  • Reduction of bone density (osteoporosis), which results in dry, brittle bones.
  • Muscle loss and weakness.
  • Severe dehydration, which can result in kidney failure.
  • Fainting, fatigue, and overall weakness.
  • Dry hair and skin, hair loss is common.
  • Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

About Anorexia Nervosa

  • Approximately 90-95% of anorexia nervosa sufferers are girls and women.
  • Between 0.5–1% of American women suffer from anorexia nervosa.
  • Anorexia nervosa is one of the most common psychiatric diagnoses in young women.
  • Between 5-20% of individuals struggling with anorexia nervosa will die.  The probabilities of death increases within that range depending on the length of the condition.
  • Anorexia nervosa has one of the highest death rates of any mental health condition.
  • Anorexia nervosa typically appears in early to mid-adolescence.

Registered Dietitians and Nutritionists: Similarities and Differences

Registered Dietitians (RDs) and Nutritionists have a similar professional passion – to help guide others in living their best lives through individualized and balanced eating patterns, movement routines, and overall self-care. However, there are stark differences in the education, training, and legal certification processes between Registered Dietitians and Nutritionists that are important to recognize when choosing the nutrition professional that is best suited to meet your needs.

Education and Training
All RDs must complete a formal education program resulting in a minimum of a 4-year baccalaureate degree from an accredited university. These degree programs include extensive coursework in the following areas:

  • Biology and Microbiology
  • Organic chemistry and Biochemistry
  • Human Anatomy and Physiology
  • Foodservice systems management
  • Food and nutrition sciences
  • Computer science and Business
  • Sociology and Psychology
  • Economics

Dietitians have also participated in a rigorous practical internship (minimum of 1,200 hours of hands-on experience) and are qualified to provide medical nutrition therapy (MNT) for chronic illnesses such as diabetes, kidney disease, cancer, metabolic disorders, and many other disease states. Nutritionists may have certificates and/or degrees in nutrition-related fields but are not required to complete the same formal education programs as RDs and cannot legally or ethically provide medical nutrition therapy.

Legal Certification
To become a registered dietitian, one must pass a comprehensive national exam and will likely need to acquire a license to practice in their individual locations. These certifications are upheld through renewal processes and by completing ongoing continuing education requirements. Non-licensed Nutritionists do not have to uphold national or state credentials and do not have to complete continuing education activities. “Nutritionist” is not a regulated title, so anyone can call themselves one regardless of their educational background, work experience, or services offered.

When embarking on your journey to balanced nutrition, ensure that you are choosing the nutrition professional that has the qualifications, experience, and ability to meet your individual needs and to help guide you in reaching your health and wellness goals!

Locations

31 College Place, Suite 200
Asheville, NC 28801

1612 Asheville Hwy, Suite 1 & 3
Hendersonville, NC 28791

140 Appalachian Street, Suites EE & FF
Boone, NC 28607

 

Contact Us

Phone: (828) 333-0096
Fax: (828) 505-8772
Email: info@nutritious-thoughts.com

Nutritious Thoughts' locations have accessible office spaces.

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Who We Are

We provide support around Eating Concerns, Embodiment, Nutrition for Substance Use Recovery, Nutrition for Mental Health, Nutrition for Competitive & Recreational Athletes, Chronic Health Concerns, and Gestational, & Hormonal & Reproductive Nutrition.