Wednesday 10/07/2024
PHOTO: Katarina Wolnik Vera
TEXT: María Sabaté and Lina Camacho
Patients that struggle with an ED tend to avoid foods in general, especially those with high calorie content. In addition, the variety of their foods is usually very limited, mainly restricting the intake of fats, and consuming excessively low-calorie foods and drinks, such as diet products, water and coffee. This restrictive behavior not only complicates nutritional recovery, but also perpetuates the symptoms of the disorder.
In the world of mental health, eating disorders represent one of the most complex and multifaceted challenges for professionals in this field. Although these disorders, which include anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), require dietary intervention, few professionals have agreed on the best way to address this aspect.
How to help a person with an ED?
Due to the lack of information many strategies focus on increasing knowledge and awareness about the need to increase energy intake and food variety, but what is really important is for therapists, clinicians and dietitians to model a different relationship with the body and food and adequately address behavioral aspects with the aim of introducing greater flexibility, pleasure and trust in one’s own body.
What are the most common obstacles in ED treatment and patient recovery?
The recent study carried out by Langlet et al. (2023) explores the most common diet-related obstacles in the treatment of EDs from the perspective of clinicians, identifying five main themes:
Ideas about healthy and unhealthy foods:
It was observed that the main reason for patients to reject foods and drinks is based on what they perceive as “unhealthy”, which is usually related to a high calorie content, the sweetness of said foods or its fat content.
Counting calories… Is counting calories an ED?:
ED patients are constantly counting calories in terms of the ingredients included in a meal, the amount of food present on the plate, and the total size of the plate. Clinicians agreed that patients often base their meal selection on the total number of calories on the plate (too many components or difficult-to-estimate volumes), rather than on the specific foods present in the meal.
Food refusal: Taste, texture and temperature:
Patients often blame taste, texture and temperature and use it as an excuse to reject certain foods, when the real criticism concerns the calorie content.
Restriction of foods with hidden ingredients:
Patients prefer foods where all the ingredients are clearly visible and separated on the plate. When ingredients are not clearly visible, patients often worry that there are high-calorie “hidden ingredients” in the food, such as cooking oil, butter, or sauces, which may prevent the patients identify all the components of the food and reduce their feeling of control.
Challenges with “extra foods”:
Another factor that often causes rejection is whether the food is considered “extra,” which in this context means foods that are not part of the patient’s meal plan, even if they are very low in calories. This problem is more common in more severe cases of ED, however, in moderate cases, some patients use “extra” low-calorie vegetables to increase satiety. That is why nutritionists are often careful with changes in meal plans, as they can cause significant problems in treatment.
Helping with understanding: effective treatment to overcome an eating disorder
All topics are interconnected and overlapping, such as the difficulties of calculating calories with hidden ingredients. These themes together reduce food variety and limit food selection for ED patients, emphasizing their need for control and perception of food as a threat. Understanding food refusal, rather than selection, is crucial to understanding the behavior of ED patients.
Exploring individual beliefs about what is healthy and what is not, making those beliefs more flexible, introducing greater pleasure into eating, reducing the need to calculate calories and instead learning to trust more the body’s appetite and internal cues such as hunger and satiety, are all skills that develop during the recovery process both with the help of psychotherapy and nutritional sessions.
References:
- Langlet, B., Nyberg, M., Wendin, K., & Zandian, M. (2023). The clinicians’ view of food-related obstacles for treating eating disorders: A qualitative study. Food & Nutrition Research, 67.