What happens within the body during eating disorder recovery?

eating disorder recovery refeeding syndrome

What you need to know as you embark on your recovery journey

 

If you’re in recovery from an eating disorder, we want to start by saying that we truly believe recovery is possible for every person! However, we also know that the early stages of recovery can be particularly scary as you face a tonne of new sensations and experiences. In this article, we’ll walk you through just some of what is going on inside your body during the refeeding phase so that you know what to expect during this period.

 

What will happen to my metabolism during recovery?

In a period of malnutrition like what is typically seen in those with eating disorders, the body slows the metabolism to preserve what little energy it is getting. However, as nutritional rehabilitation begins, the body becomes hypermetabolic.

This means that your body kicks into high gear and begins to utilise the fuel it was previously lacking, initially going towards repairing the vital organs and processes needed for survival.

Metabolism can remain heightened for several months. Until nutritional rehabilitation is complete, a person in eating disorder recovery will need more nutrition than someone of the same weight, height and age who has never had an eating disorder.1

Attempting to maintain one’s weight during recovery through the partial restriction of food can cause the proper functioning of systems like digestion and reproduction to be sacrificed for more life-sustaining processes. This is why it’s SO important to get adequate nutrition, no matter what that looks like for you. 

 

What will happen to my weight during recovery?

Changes in weight are extremely common at the beginning of the refeeding process, but not for the reasons you might think!

The first cause is the body stabilising, moving from a catabolic state to an anabolic state – in other words, the body shifts from a state of decomposition to a state of repair. This can actually cause some initial weight loss in the first week of refeeding, but this will neutralise.

The second cause is the body becoming appropriately hydrated. People with eating disorders can become extremely dehydrated from behaviours such as laxative or diuretic use, purging, excess caffeine consumption or refusal to drink water. They may also be over-hydrated if they are consuming excessive amounts of fluid. As hydration levels balance out, shifts in weight should be expected.

Over time, weight will gradually increase as lean mass and fat mass are formed. Lean mass is usually created first, to rebuild the skeletal muscles (ie. those used for movement) and to repair damaged organ tissue.2 Fat mass typically comes later in recovery, and is often first seen around the abdomen to protect your vital organs.

It’s important to remember that reaching weight restoration is not the end of your journey, and that it is the thoughts, beliefs and behaviours that truly determine recovery.

 

What will happen to my digestion during recovery?

During a prolonged period of starvation, such as that seen in eating disorders, energy that would normally go towards maintaining the structure and function of gut is sacrificed for more imperative survival processes. This causes issues with digestion such as gastroparesis (slowed gastric emptying), reduced gastric capacity, tissue wastage within the gastrointestinal tract and slowed colonic motility.3 This is all just to say that the gut stops working how it should.

Thankfully, this is reversible with good nutrition! However, it takes time during the refeeding phase to repair the gut and restore its function. This means that in the beginning of recovery, it’s unfortunately common to experience discomfort or pain, nausea, constipation, bloating or distention, and premature fullness.

As you give your gut (and the other systems in your body!) the nutrition it needs to repair, you can expect it to return to its fully-functioning self.

Remember that eating disorder recovery is a long game, and it can take up to 12 months to fully restore from a state of malnutrition. It’s incredibly important to have a great support team around you to guide you through it – and that’s where we come in!

Reach out to us at [email protected] to find out how we can help you on your journey towards recovery.

 

Karli Battaglia, APD

EHL Team x

 

References

  1. Marzola E, Nasser J, Hashim S, Shih P, Kaye W. Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. BMC Psychiatry. 2013;13(1).
  2. Golden N, Meyer W. Nutritional rehabilitation of anorexia nervosa. Goals and dangers. International Journal of Adolescent Medicine and Health. 2004;16(2).
  3. Georg S. Gut Function in Anorexia Nervosa and Bulimia Nervosa. Scandinavian Journal of Gastroenterology. 2003;38(6):573-587.

Why your body weight does not determine your health

healthy lifestyle weight

Four reasons why your body weight is overrated

 

Weight has been considered to be a key indicator of health for as long as we have known. It continues to be a fundamental factor that is looked at in research surrounding health and lifestyle. But how accurate is it actually at determining our health at an individual and population level?  

You may have read our previous blog post where we picked apart the reliability of BMI. In this article, we will dig deeper into the literature surrounding weight science and what the implications really are when it comes to our health. 

 

What is weight science?

Weight science refers to the research on body weight, which includes and is not limited to:

  • The regulation of body weight (weight loss or gain)
  •  Internal and external factors influencing weight change or maintenance
  •  Intentional or non-intentional weight loss or gain
  • The relationship between weight and health

A lot of weight science research takes into account health outcomes concerning weight or BMI. This might be because the assumption that BMI is a useful indicator of health is still held by many scientists and health researchers. The general consensus is that:

  • Achieving a BMI in the normal range of 18.5-25 will improve health.
  • Dieting and exercise should be encouraged in those lying outside this range to ensure they work towards achieving a ‘healthier’ BMI and are no longer considered ‘obese’ or ‘overweight.’

Read on to explore four reasons why we believe weight can sometimes be overestimated as an indicator of health.

 

ONE: Weight is more often than not, an inaccurate predictor of health.

When we dig deeper into the research, we realise that and social determinants of health play a much greater view than we think. Social determinants of health (SDoH) are the conditions in which we are born, live, work and age. 

SDoH can be thought of as the ’causes of the causes’ as they often shape how we may receive or learn about health and the conditions that may promote good health or disease risk and are the biggest single cause of health inequality. (1)

We also know that being in a larger body may actually be protective, particularly in old age and may have more favourable outcomes. 

A 2011 review showed that those with particular health conditions such as cardiovascular disease survive longer and have a lower mortality rate than those considered a ‘normal’ weight. (2)

Research also found that any effects related to obesity were counteracted when fitness was incorporated, suggesting that low fitness and activity levels may be more damaging to health than being at a higher BMI or weight. (2)

 

TWO: Weight loss is not associated with improved health.

A 2013 review by Tomiyama et al. (3) looked at the changes in cholesterol, triglycerides, systolic/diastolic blood pressure, and fasting blood glucose and weight loss. 

The findings showed minimal improvements in these biochemical markers after weight loss interventions. However, there was no correlation between the actual amount of weight change and the improvement of these factors. 

The review also showed that some confounding variables in the interventions, such as diet and exercise change, might have had an impact. These and engaging actively with your healthcare system are perhaps more beneficial than weight loss. (3)

Other studies have shown that weight cycling (repeated periods of losing and regaining weight) can actually be detrimental to health, increasing mortality risk. (4)

Park et al. showed that weight cycling increased risks of developing type 2 diabetes and can be considered an independent risk factor for the condition. (5) In addition, Welti et al. found that some cancer incidences increased (including a 38% increased risk of endometrial cancer) with weight cycling. (6)

Byun et al. similarly discovered that weight cycling led to poorer heart health, particularly in premenopausal women and women with no history of pregnancy – so we can see a trend here with the negative consequences weight cycling may have on our bodies. (7)

 

THREE: Dieting can lead to poorer mental and physical health.

For those of us who have tried dieting, we know that it quickly loses the fun and excitement that it may have initially started with. Research shows that diets are a cause of stress, creating hypervigilance around food and weight.

This increased thinking and anxiety around food can make us more restrictive when it comes to our diet and may potentially develop into disordered eating or even an eating disorder. 

In a study by Bombak et al., it was shown that dieting is also associated with a loss of bone and lean mass and poorer immunity and skeletal integrity. (8)

This is significant, as we believe our bones reach their peak mass around the ages of 25-30, and any bone mass loss after this age can be irreversible. This increases our chances of developing osteopenia or osteoporosis and being more prone to fractures and serious injury. (8)

 

FOUR: Weight loss is not often achieved and maintained in the long term.

Countless studies have shown that weight loss is uncommon initially, but lasting weight loss is even more rare to accomplish. In fact, some research even shows that more weight is sometimes gained than what was lost in the first place. (9)

A further review by Ayyad and Anderson found that the median success rate of a diet program is around 15%. We believe that this is due to the physiological and psychological effects of dieting, as mentioned in the previous point. (10)

Improvements to health can be obtained without a focus on weight, and non-diet approaches have sparked interest in recent years to improve body image, self-esteem, depressive and disordered eating behaviours. (11)

Non-diet interventions also have displayed improvements in diet quality and diversity of foods, including a higher fruit and vegetable intake and less restriction and stress around food. (12, 13) They have also shown to improve physical activity participation, blood lipid and glucose levels, and total cholesterol and blood pressure. (12, 14)

By reading this, remind yourself that you are already embarking upon an incredible healing journey and have come so far to begin to break away from what may be a period of disordered eating.

We hope this article helped to outline some of the research surrounding why weight loss may not always be as great as diet culture often makes it seem. Until next time, keep your head up and rise above restriction!

 

Priya Chotai, BSc ANutr

EHL Team x

 

References:

1. Irwin A, Valentine N, Brown C, Loewenson R, Solar O, Brown H, Koller T, Vega J. The commission on social determinants of health: tackling the social roots of health inequities. PLoS Med. 2006 May;3(6):e106. doi: 10.1371/journal.pmed.0030106. PMID: 16681414; PMCID: PMC1459479.

2. McAuley PA, Blair SN. Obesity paradoxes. J Sports Sci. 2011 May;29(8):773-82. doi: 10.1080/02640414.2011.553965. PMID: 21416445.

3. Tomiyama AJ, Ahlstrom B, Mann T. Long-term effects of dieting: Is weight loss related to health? Social and Personality Psychology Compass 2013; 7(12): 861-877.

4. Tae Jung Oh, Jae Hoon Moon, Sung Hee Choi, Soo Lim, Kyong Soo Park, Nam H Cho, Hak Chul Jang, Body-Weight Fluctuation and Incident Diabetes Mellitus, Cardiovascular Disease, and Mortality: A 16-Year Prospective Cohort Study, The Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 3, March 2019, Pages 639–646, https://doi.org/10.1210/jc.2018-01239

5. Park KY, Hwang HS, Cho KH, Han K, Nam GE, Kim YH, Kwon Y, Park YG. Body Weight Fluctuation as a Risk Factor for Type 2 Diabetes: Results from a Nationwide Cohort Study. J Clin Med. 2019 Jun 30;8(7):950. doi: 10.3390/jcm8070950. PMID: 31261984; PMCID: PMC6678837.

6. Welti LM, Beavers DP, Caan BJ, Sangi-Haghpeykar H, Vitolins MZ, Beavers KM. Weight Fluctuation and Cancer Risk in Postmenopausal Women: The Women’s Health Initiative. Cancer Epidemiol Biomarkers Prev. 2017 May;26(5):779-786. doi: 10.1158/1055-9965.EPI-16-0611. Epub 2017 Jan 9. PMID: 28069684; PMCID: PMC5413381.

7. Byun SS, Bello NA, Liao M, Makarem N, Aggarwal B. Associations of weight cycling with cardiovascular health using American Heart Association’s Life’s Simple 7 in a diverse sample of women. Prev Med Rep. 2019 Nov 2;16:100991. doi: 10.1016/j.pmedr.2019.100991. Erratum in: Prev Med Rep. 2020 Oct 29;20:101236. PMID: 31750075; PMCID: PMC6849443.

8. Bombak A, Monaghan LF, Rich E. Dietary approaches to weight-loss, Health At Every Size® and beyond: rethinking the war on obesity. Social Theory and Health. 2019 Mar 1;17(1):89-108. https://doi.org/10.1057/s41285-018-0070-9

9. Bravata DM, Sanders L, Huang J, et al. Efficacy and safety of low-carbohydrate diets: a systematic review. 2003. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK69697/

10. Ayyad C, Andersen T. Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999. Obes Rev. 2000 Oct;1(2):113-9. doi: 10.1046/j.1467-789x.2000.00019.x. PMID: 12119984.

11. Clifford D, Ozier A, Bundros J, Moore J, Kreiser A, Morris MN. Impact of non-diet approaches on attitudes, behaviors, and health outcomes: a systematic review. J Nutr Educ Behav. 2015 Mar-Apr;47(2):143-55.e1. doi: 10.1016/j.jneb.2014.12.002. PMID: 25754299.

12. Carroll S, Borkoles E, Polman R. Short-term effects of a non-dieting lifestyle intervention program on weight management, fitness, metabolic risk, and psychological well-being in obese premenopausal females with the metabolic syndrome. Appl Physiol Nutr Metab. 2007 Feb;32(1):125-42. doi: 10.1139/h06-093. PMID: 17332789.

13. Greene GW, White AA, Hoerr SL, Lohse B, Schembre SM, Riebe D, Patterson J, Kattelmann KK, Shoff S, Horacek T, Blissmer B, Phillips BW. Impact of an online healthful eating and physical activity program for college students. Am J Health Promot. 2012 Nov-Dec;27(2):e47-58. doi: 10.4278/ajhp.110606-QUAN-239. PMID: 23113786.

14. Ciliska D. Evaluation of two non-dieting interventions for obese women. West J Nurs Res. 1998 Feb;20(1):119-35. doi: 10.1177/019394599802000108. PMID: 9473971.

 

Hormones and seed cycling: does it really work?

seed cycling hormone balance

The science behind seed cycling and regulating your hormones

 

Seed cycling has sparked interest online over recent years as a way to potentially optimise our hormone levels. 

Many have claimed its value in helping them to balance the symptoms that we face over our monthly cycles. Others have reported it to have boosted their fertility or reduced the severity of menopausal symptoms.

But how effective can the consumption of specific seeds be for our reproductive health, and what is the research behind it? Read our article to find out more. 

 

What is seed cycling?

Seed cycling comes under the branch of naturopathic or alternative medicine and is a practice thought to help regulate hormone levels in people who have periods. (1)

During seed cycling, the diet is supplemented with four different seeds: flax, pumpkin, sesame and sunflower, grounded to aid nutrient absorption and eaten raw each day. (1)

In the first phase of the cycle, known as the follicular phase, a mixture of pumpkin and flax seeds are consumed at the amount of 1 tablespoon (tbsp) per day. (2) This is usually from around day one (the start of your period) to about day fourteen or ovulation. This phase is when eggs are ripening and is thought to balance oestrogen levels. (3)

Following this, a 1 tbsp blend of ground sesame and sunflower seeds is consumed daily from approximately 14-28 of the cycle during the luteal phase. These seeds are believed to boost progesterone levels. The seeds are believed to contain optimal amounts of nutrients, fats, and vitamins that help to best support hormonal function in the body. (2)

For those who are going through or have gone through menopause, it is recommended to follow the moon’s cycles for guidance, which similarly last 27-29 days. (2)

 

What are the supposed benefits of seed cycling?

As well as aiding in hormone levels and regulating period cycles, seed cycling has been said to improve acne, ease fatigue and mood swings, and improve thyroid hormone levels.

Furthermore, many have claimed it to better menopausal symptoms such as hot flushes, night sweats and aided with hair health and cellulite. (2)

 

What does the research say?

As diet and nutrition professionals, it is vital for us to look at the literature on any topic before making recommendations to clients or patients. Evidence-based research holds far greater strength in being valid and reliable as opposed to word-of-mouth or anecdotal claims.

There remains to be no evidence or studies undertaken on the seed cycling method, so we cannot claim its effectiveness from a scientific viewpoint. Most of the perspectives we hear about are simply anecdotal, which we know is not always a reliable form of evidence as it merely lacks data and numbers.

There is a discrepancy between the claims made on the benefits of seed cycling. Remember that some changes to your menstrual cycle are expected, and it is normal to experience different changes and symptoms to your friends or family members. (2)

Although there is no consistent data around the benefits of seed cycling, there also probably may not be any dangerous or detrimental effects of incorporating more seeds in your diet. 

Some small studies undertaken on women have shown that flaxseed intake may regulate cycles and reduce breast pain. (4) However, other research surrounding the oestrogen promoting and inhibiting effects remain unclear. (5)

 

Should I try seed cycling?

Whilst we don’t recommend this specific method due to the lack of research and its uncertain benefits, seeds remain to be a fantastic source of mono and polyunsaturated fatty acids and protein.

Furthermore, consuming a range of seeds provides essential vitamins such as E and B6 and minerals such as calcium, magnesium, and zinc, which play fundamental roles in reproductive health. (6, 7, 8, 9) However, studies show neither zinc nor vitamin E has shown to impact hormone levels or improve menopausal symptoms. (10, 11)

Remember – not one food will have all of the nutrition, and no food has zero nutrition. Seeds can absolutely be enjoyed as a part of a varied and balanced diet, and consuming a tablespoon a day is not considered excessive.

Still, like all other foods, they are NOT a ‘superfood’ (it’s just a marketing term!), and other food groups such as whole grains, fruits, vegetables, dairy (or dairy alternatives) and protein sources should also form the basis of your diet. 

As always, we are passionate about eating intuitively and embracing all of the foods we love as a part of our meals and snacks too – some foods bring us emotional and cultural values that a green juice or salad may not always offer, and that is perfectly normal and even worthy of celebrating!

We know that reproductive health can be a difficult area to navigate, so feel free to get in touch with us to explore this further via a consultation. You can also check out our other articles on optimising your nutrition for fertility, and steps to get your period back.

Be mindful of your body, and if you are facing any symptoms that may be aligned with polycystic ovarian syndrome (PCOS), endometriosis, irregular bleeding, infertility, or amenorrhoea (the absence of periods), then it may be best to speak to your GP as soon as possible to help to diagnose and/or work with these conditions. 

If you already have a diagnosis or suspected PCOS, why not read about how to manage symptoms without restricting your diet?

Finally, take short a moment to remind yourself of all of the amazing recovery you are making with each day. Just by reading this, you are a person who is full of courage, curiosity, and kindness.

If you enjoyed this article and want to read more, please get in touch with us and let us know other topics you would like us to cover in the future!

 

Priya Chotai, BSc ANutr

EHL Team x 

 

References

  1. Toler, S. Seed Cycling: I tried it. (And dug into the research on whether it works.) Clue 2020 Jan 28. Available at: https://helloclue.com/articles/culture/seed-cycling-i-tried-it-and-dug-into-the-research-on-whether-it-works

  2. Healthline., Can Seed Cycling Balance Hormones and Ease Menopause Symptoms?Available at: https://www.healthline.com/nutrition/seed-cycling#effectiveness

  1. Jabbour HN, Kelly RW, Fraser HM, Critchley HO. Endocrine regulation of menstruation. Endocr Rev. 2006 Feb;27(1):17-46. doi: 10.1210/er.2004-0021. Epub 2005 Sep 13. PMID: 16160098.

  2. Phipps WR, Martini MC, Lampe JW, Slavin JL, Kurzer MS. Effect of flax seed ingestion on the menstrual cycle. J Clin Endocrinol Metab. 1993 Nov;77(5):1215-9. doi: 10.1210/jcem.77.5.8077314. PMID: 8077314.

  3. Rodríguez-García C, Sánchez-Quesada C, Toledo E, Delgado-Rodríguez M, Gaforio JJ. Naturally Lignan-Rich Foods: A Dietary Tool for Health Promotion? Molecules. 2019 Mar 6;24(5):917. doi: 10.3390/molecules24050917. PMID: 30845651; PMCID: PMC6429205.

  4. Kontic-Vucinic O, Sulovic N, Radunovic N. Micronutrients in women’s reproductive health: I. Vitamins. Int J Fertil Womens Med. 2006 May-Jun;51(3):106-15. PMID: 17039854.

  5. Kontic-Vucinic O, Sulovic N, Radunovic N. Micronutrients in women’s reproductive health: II. Minerals and trace elements. Int J Fertil Womens Med. 2006 May-Jun;51(3):116-24. PMID: 17039855.

  6. Traber MG. Vitamin E inadequacy in humans: causes and consequences. Adv Nutr. 2014 Sep;5(5):503-14. doi: 10.3945/an.114.006254. PMID: 25469382; PMCID: PMC4188222.

  7. Favier AE. The role of zinc in reproduction. Hormonal mechanisms. Biol Trace Elem Res. 1992 Jan-Mar;32:363-82. doi: 10.1007/BF02784623. PMID: 1375078.

  8. Sunar F, Gormus ZI, Baltaci AK, Mogulkoc R. The effect of low dose zinc supplementation to serum estrogen and progesterone levels in post-menopausal women. Biol Trace Elem Res. 2008 Dec;126 Suppl 1:S11-4. doi: 10.1007/s12011-008-8211-y. Epub 2008 Aug 31. PMID: 18759067.

  9. Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomised, controlled trials. Ann Intern Med. 2002 Nov 19;137(10):805-13. doi: 10.7326/0003-4819-137-10-200211190-00009. PMID: 12435217.

 

How to distinguish your healthy self from your eating disorder self

two minds eating disorder recovery

Recognising and challenging your eating disorder thoughts

 

At the beginning of the recovery process, many of our clients worry about who they’ll be without their eating disorder. Oftentimes, the eating disorder has ruled over their thoughts, emotions and behaviours for so long that they fear it has permanently taken over their identity.

However, through the privilege of seeing many people recover, we know that this is not the case. Instead, as the person progresses through their recovery journey, what we actually see is their true identity becoming stronger as the eating disorder retreats.

This is where the idea of having a healthy self and an eating disorder self comes from. In this article, we’ll talk you through how to tell them apart and how doing so can help you in your recovery.

 

What is the concept of the healthy self and the eating disorder self all about?

The concept of the healthy self and the eating disorder self is based on the work of Carolyn Costin, a renowned eating disorder clinician, founder of the first eating disorder residential treatment program, and author of ‘8 Keys to Recovery from an Eating Disorder’. You can learn more about Carolyn’s incredible work here.

When we explain the idea of the two selves, many people resonate with it right away, clearly seeing it reflected in their own thoughts and behaviours.

The healthy self is the part of you that was in control before your thoughts and behaviours became warped by diet culture, trauma, fear and so on.

It is the rational, kind and non-critical part of you that, over time, has been hijacked by your eating disorder self. This is the part of you that is harsh, fearful and has a distorted view of the world and yourself.

To make sense of this concept, you might like to think of an angel on one shoulder and a devil on the other, battling to be the dominant voice. This is similar to how your healthy self and your eating disorder self interact.

Ambivalence is incredibly common in eating disorder recovery. It would be very unusual to have a client whose commitment to recovery is steadfast throughout the entire process! This phenomenon a representation of the conflict between the healthy self and the eating disorder self.

When part of you wants to recover and part of you is terrified to get better, that is the two selves at work. When part of you knows that the eating disorder behaviours are irrational and part of you feels compelled to engage in them, that too is the two selves.  As you become more aware of the two voices, they will become more distinct.

The ultimate goal isn’t to eradicate your eating disorder self – this is the part of you that alerts you when something is wrong, when you’re struggling to cope or when you’re feeling afraid.

Instead, the goal is to strengthen your healthy self and reintegrate the eating disorder self to form one single embodiment, where the latter continues to do its job of alerting you to problems. When prior you may have used eating disorder behaviours to silence these alarm bells, once the two selves are integrated, you will be able to use more constructive strategies to address the issues you are being alerted to.

 

How can I strengthen my healthy self?

There are several ways you can get more in touch with your health self, in order to strengthen this part of you over your eating disorder self.

One of the simplest ways is to consider what you would say to friend or a small child in a similar situation. For example, while your eating disorder self might tell you to engage in restriction to compensate for a large meal, we’re sure that’s not what you would recommend to your little sister! Your healthy self tends to emerge more strongly in your compassion for others.

Once you have identified the voice of your healthy self, you can use it to dialogue with your eating disorder self. In other words, you can come up with “healthy” responses to your eating disorder thoughts, either in your head or on paper. You might like to utilities this worksheet from EDIT™

As an example, if your eating disorder self says “If I gain more than x amount of weight, I’ll be miserable”, you may come up with a response like “The number on the scale does not define me and it won’t change the way I feel unless I allow it to”.

This can assist you in your recovery by helping you to turn up the volume of your health self and strengthen it over your eating disorder self.

Saying all this, be sure not demonise your eating disorder self. As we mentioned above, it has been acting as a coping strategy during a difficult time in your life. However, through the process of recovery, we can support you to find new, healthier behaviours to replace your eating disorder.

Remember that your eating disorder cannot be stronger than you are, because you give it all of its power.

The idea of the healthy self and the eating disorder self is, of course, just one way to look at and understand eating disorders. It may resonate with you and it may not!

If you take only one thing away from this article, let it be this: you are not your eating disorder and recovery is possible.

Reach out to us at [email protected] to find out how we can support you on your recovery journey.

 

Karli Battaglia MDiet, APD

EHL Team x

Can I practice body neutrality and still care about my appearance?

body image positive neutral

Still care about what you look like?

You will probably not be surprised to hear that “body neutrality” is a huge buzzword in anti-diet spaces at the moment.

Body neutrality first gained popularity in 2015 as an alternative to the often-toxic “body positivity” movement.  It pushes back against beauty ideals and the promotion of appearance as the ultimate success or failure; instead, the key ideology of body neutrality is that how you look is not what makes you an amazing human being.

However, this begs the question – can you practice body neutrality and also put time and effort into how you look?

In short: absolutely!

Adopting a neutral perspective of your body doesn’t mean that you are suddenly blinded to your own appearance and aren’t allowed to put any thought towards it – instead, it means that your goals shift from aiming to conform to beauty standards to aiming to achieve contentment within yourself.

To learn more about the fundamentals of body neutrality, you can check out our blog “Four Ways to Practice Body Neutrality” here. As noted in that article, this concept is relatively new and as such, scientific research in this area is limited. However, you can learn more about body neutrality from people such as Anuschka Rees (find her on Instagram @anuschkarees and check out her book, Beyond Beautiful) and Jameela Jamil (follow @iweigh on Instagram and take her free course on FutureLearn, Exploring Body Neutrality and Body Image).

In this article, we’ll unpack three ways you can care about your appearance AND live a life of body neutrality.

 

ONE: Remember that self-worth is not reliant on appearance

Although your self-esteem may change from day to day, your self-worth is unalterable. Just like the value of a £5 note can’t be changed by the perceptions of others, neither can yours!

To practice body neutrality, you must disconnect your identity and worth from the way you perceive your appearance. The way you look does not define who you are.

Remove the pressure to feel positively about your body! There will always be aspects of your appearance that you like less than others – that’s okay! Body neutrality isn’t about feeling neutral about your appearance; instead, it’s about neutralising the impact of how you feel about your appearance on your mood, self-worth, identity and actions. In other words, focus on not allowing negative thoughts about your body stop you from living your life to its fullest.

 

TWO: Take care of your body

Another component of body neutrality is the idea that regardless of how you feel about your body on any given day, it’s important to show it care and respect.

Some days, this might take the form of brushing your hair, applying skincare or putting on clean clothes in the morning. On other days, taking it easy and staying in your PJs all day might be how you take care of yourself. Your appearance doesn’t need to change in order to care for your body!

This moves the focus from how you look at your body to how you feel within your body.

 

THREE: Utilise your appearance as a source of self-expression

The way we choose to show ourselves to the world is an incredible opportunity for self-expression. Through our clothes, makeup, hair and jewellery, we get to experiment and experience joy.

When you get ready in the morning, choose to present yourself in a way that makes you feel powerful, without an emphasis on how you look or how other people might perceive you.

In her book, The Curate Closet, Anuschka Rees writes ‘If something is your style and you love it, I believe you should wear it, regardless of whether it supposedly “flatters” your body or doesn’t. Plus, if we are being honest, to flatter almost always means “make you look thinner”, and that definitely shouldn’t be your prime objective when it comes to getting dressed’.

When you practice body neutrality, you can still feel a sense of peace in your body on days when you don’t get dressed up.

There is such a stark difference between using our appearance to conform to societal pressures and using it to show our uniqueness! This shifts the balance from your body having the power over you to you having the power over your body.

The take home message from all of this is that you can absolutely still take pride in your appearance while practicing body neutrality! Your body is simply a tool for you to use as you desire.

If you’re experiencing body image concerns, we’re here to help! Reach out to us at [email protected] to find out how we can support you towards introducing body neutrality in your own life.

 

Karli Battaglia MDiet, APD

EHL Team x   

Journalling for beginners

Inspiration and tips to get you started with a ‘food and mood’ journal

Starting a food and mood journal can be a critical initial step to eating more mindfully and trusting your body. It can help us understand how we respond to food and other lifestyle factors. We can then use our discoveries from the journalling process to optimise our habits and live happier lives.

We’re so thrilled you are reading this article on your journey to becoming a more intuitive eater, so without further ado – let’s get started!

 

What is a food and mood journal?

A food and mood journal is a tool used to document what you have eaten measured against your general mood changes and feelings throughout the day. Tracking your food habits this way may help you notice general patterns of behaviour around food, why you may be craving particular foods or perhaps notice common themes in what increases the likelihood of eating particular foods over others. It can also be a significant starting step towards achieving more balance in your food choices.

You are welcome to adapt food and mood journalling any way you want in a way that works best for you. The key is to make the process an enjoyable and freeing one to let in curiosity and awareness around food, let go of restrictions or guilt, and simply seek to acknowledge and understand the body.

 

Is a food journal the same as a food diary?

In short, no. Traditionally used food diaries, such as 24-hour recalls or food frequency questionnaires (FFQ), are used to calculate what foods and quantities we consume over a given period. Whilst they are a popular approach in the clinic, they have been shown to increase anxiety and stress around food and may lack validity. (1,2,3)

On the other hand, a food and mood journal aims to create compassion for your body by being honest and non-judgemental about your diet and lifestyle. It is simply a strategy we can use to connect with what we are eating and reflect on how foods make us feel. 

 

When may a food and mood journal not be appropriate?

Some of the following situations may not be the best in which to introduce a food and mood journal:

  • Current or past experience of an eating disorder
  • Undergoing extreme food restriction and fasting
  • Experiencing rapid weight loss
  • Purging and self-induced vomiting behaviours
  • Misuse of diuretics or laxatives
  • Partaking in extreme exercise

 If you show severe signs of disordered eating, a food and mood journal may not be advised for you as it can potentially complexify your relationship with food.

Journalling can be time-consuming, and it can lead to us scrupulously checking calories and nutritional information, thus affecting what and how much we eat. This may drive someone further into their eating disorder and could even be more triggering than helpful.

Whilst some people in the stage of recovery find them a valuable tool to improve their awareness of their body, this may not be the case for everyone, so it is essential to approach this step from a place of consciousness and care.

In this case, it is best to consult a healthcare professional who will be able to assess and advise what is best for you in your journey.

If it is not deemed suitable for you, remember there are still plenty of other excellent tools you can use to heighten bodily awareness, and food journaling may even be one you come back to in the future.

 

How long should I keep a food and mood journal for?

This is entirely up to you and whether you find it to be helpful. Journalling can be quite a task in itself, so it’s important to make it manageable and sustainable.

Start small – we recommend trying this activity consistently for a week or so and see if you notice any changes or patterns. You can always add or take away what you choose to record and streamline this with your goals and outcomes. No day is the same, and understandably, you may not always want to record every meal due to time restraints, mood changes or lifestyle. For example, journalling your meal may be the last thing on your mind when you are out for dinner with friends at the end of a long week, and that’s okay! In fact, we urge you to savour the moment!

 

What should I include in my food and mood journal?

This is the fun part! You can absolutely tailor your food and mood journal to yourself and what you would like to explore within yourself. You could opt for a more written style or a table layout and keep it as detailed or as minimal as possible. You could handwrite it in your favourite notebook, use a tablet or computer, or even voice record your answers. Some ideas for the headings or columns you could include are:

  • A brief outline of the meal or snack in front of you
  • The time of day of the meal or snack
  • Your environment – are you eating alone or with others? Outdoors or at home?
  • Your stress and mood levels
  • Have you moved, stretched or exercised today?
  • Context to the day – are you working, or is it a day off? Have you witnessed anything socially, in the news or on media that may have affected you?
  • How long has it been since you had last eaten? 
  • How you feel before eating it
  • Your ‘number’ on the hunger wheel/hunger scale before eating (click here to read more about the types of hunger and how to use a scale system)
  • How much of the meal you ate
  • Your ‘number’ on the hunger wheel after eating
  • How you feel after eating it – Satisfied or miserable? Content or peckish?
  • Any further reflections (4) 

Whilst the above are more food-specific, some further journal questions you could also ask yourself at the end of the day or week for an overview could include:

  • How do I feel today?
  • What has had a positive impact on my life recently?
  • What are three things I am grateful for today?
  • What may I need more help or support with going forward?
  • What are some things that occupy my thoughts a lot, maybe more than they should?
  • What can I do for my self-care today?
  • If a close friend was experiencing what I am currently experiencing, what advice or reassurance might I offer them? (4)

 

EHL’s top tips:

  1. Remember, no emotion or feeling is the right or wrong one to have, so it’s key to be as honest with yourself as possible. There’s no judgement from this exercise, and it is a stepping stone to eating more intuitively. 
  2. Listen to your body. Some people may find any kind of food journaling to be triggering and stress-inducing. If this sounds like something you may struggle with, there are plenty of other steps you can take. Why not start with writing a letter of gratitude to your body (you can read more about body neutrality in this post) or by making a gentle self-care schedule?
  3. When in doubt, seek advice from a registered nutrition professional, if possible, who would be happy to guide you through this process and other tools to help you on your journey. To enquire about our nutrition counselling services, please email [email protected].
  4. Lastly, don’t forget to take a moment to remember your worth. Acknowledge the incredible efforts you are taking right now by reading this article and being motivated to improve your relationship with food. You are doing amazingly!

 

Priya Chotai, BSc ANutr

EHL Team x 

 

References 

  1. Cade J., Thompson R., Burley V., Warm D. Development, validation and utilisation of food-frequency questionnaires—A review. Public Health Nutr. 2002;5:567–587. doi: 10.1079/PHN2001318.
  2. Briefel RR, Sempos CT, McDowell MA, Chien S, Alaimo K. Dietary methods research in the third National Health and Nutrition Examination Survey: underreporting of energy intake. Am J Clin Nutr. 1997;65(4 Suppl):1203S–1209S.
  3. Hebert JR, Ebbeling CB, Matthews CE, Hurley TG, Ma Y, Druker S, et al. Systematic errors in middle-aged women’s estimates of energy intake: comparing three self-report measures to total energy expenditure from doubly labeled water. Ann Epidemiol. 2002;12(8):577–86.
  4. Thomas L. How to Just Eat It: A step-by-step guide to escaping diets and finding food freedom. London: Bluebird; 2021: 314-316.

Can you be in a larger body and also have an eating disorder?

The truth about body diversity in eating disorders

 

When you imagine someone with an eating disorder, you might visualise an emaciated young white woman. This is a common stereotype but it’s completely inaccurate! Eating disorders affect people of all ages, genders, ethnicities, and body sizes. For the purposes of this article, we’ll be focussing our myth-busting on the latter.

A disclaimer to start with: In this article, we’ll be describing different body shapes and sizes, and have endeavoured to do this as inclusively as possible. However, there are times when we use the terms “obese” and “overweight” in a biomedical context. We have kept these in quotations to acknowledge how stigmatising these labels are and to indicate that BMI categories are arbitrary. To learn more about this, check out our recent article about the reliability (or lack thereof) of BMI: We also use the term “fat” as a neutral descriptor, as many people with lived experience have expressed their preference for this terminology.

 

Do you need to be underweight to be diagnosed with an eating disorder?

“Obesity” is NOT an eating disorder and it is NOT the opposite of anorexia nervosa.

Eating disorders occur across the weight spectrum. In fact, less than 6% of people with an eating disorder are underweight.1

Unfortunately, the diagnostic criteria for anorexia nervosa (AN) has not yet caught up to 2021, with the DSM-5 (the current diagnostic manual for mental illnesses) still requiring a BMI of less than 18.5 in order to diagnose it. People who meet all of the criteria for AN but are at a higher body weight are instead diagnosed with “atypical anorexia nervosa”.

Not only is this separation of diagnoses unnecessary (and we’ll get into why later on!) but it’s a huge problem in terms of treatment. For example, in order to access NHS-funded treatment for anorexia in the UK, individuals require an “underweight” BMI.2

We’re as frustrated by this as you are, and we are advocating for the diagnostic criteria of eating disorders to be inclusive of all body sizes!

 

Do all people in larger bodies have binge eating disorder?

One of the major myths we need to dispel is the idea that the only eating disorder that a fat individual can have is binge eating disorder (BED). Branching off from that, there is even the myth that all people in larger bodies have BED. These are both simply untrue!

BED can occur at any body size. Additionally, there are many reasons why a person might be in a bigger body, which may or may not be related to their eating behaviours. Body diversity is a natural phenomenon – just as some people are naturally thin, others are naturally fat. Both are okay!

 

Why do eating disorder diagnoses need to be weight inclusive?

Eating disorder diagnoses are often missed or dismissed in larger-bodied people.

As a society, we encourage fat people to engage in the same behaviours that result in an eating disorder diagnosis in thin people. This is thanks to diet culture, which promotes that it is better to be thin and have a toxic relationship with food than it is to be fat and have a positive relationship with food.

Many people in larger bodies with eating disorders report traumatic experiences when they attempt to seek treatment. This is a result of not only the untrue stereotypes around eating disorders, but also anti-fat bias. As part of this, many struggle with feeling like they’re not “sick enough” to deserve help. This is compounded by their experiences in treatment, such as being provided low-calorie meals, being encouraged to skip dessert or even receiving praise from health professionals for their disordered behaviours.

This is despite their eating disorders being just as severe in terms of medical complications as those who present at a lower BMI.3 These complications can include amenorrhea (loss of menstruation), decreased bone density, loss of lean tissue, gastroparesis (delayed stomach emptying) and irregular heart rhythm.

All people with eating disorders, despite their body size, are in a state of starvation.

If you have an eating disorder and are in a larger body, please know that your experience is valid. There is nothing wrong with your body. You are sick enough to get help. You are worthy of treatment.

Our expert dietitians can support you on your journey to recovery. Get in touch with us at [email protected] to chat with us about how we can help you.

 

Karli Battaglia MDiet, APD

EHL Team x

 

References

  1. Arcelus J, Mitchell A, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders. Archives of General Psychiatry. 2011;68(7):724.
  2. National Health Service. First Step: Information Pack for GP Referrers. Bristol: Mental Health Partnership NHS Trust; 2017.
  3. Neumark-Sztainer D. Higher Weight Status and Restrictive Eating Disorders: An Overlooked Concern. Journal of Adolescent Health. 2015;56(1):1-2.