Episode 054: Today’s episode of Real Health Radio is all about disordered eating and eating disorders.
Clients with issues around food make up a large part of my practice and they are something I’ve been helping women deal with for a number of years. As part of the show we look at the difference between an eating disorder versus disordered eating, why they happen (and it’s not always about managing someone’s weight), how they are passed on from generation to generation, as well as lots of ideas and suggestions to help someone think about their struggles differently and overcome their issues.
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Chris Sandel: Welcome to Episode 54 of Real Health Radio. You can find the links talked about as part of today’s episode at the show notes, which you can find at www.seven-health.com/054.
Welcome to Real Health Radio: Health advice that’s more than just about how you look. Here’s your host, Chris Sandel.
Hey guys, and welcome to another episode of Real Health Radio. This is another show where it’s me flying solo, just diving into a specific topic. This week I’m going to be covering disordered eating and eating disorders. This is an area that I’ve become hugely passionate about, and clients dealing with these kinds of issues make up probably about 50% of my practice.
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This is something I really fell into. When I first started as a nutritionist, this is not the kind of thing I thought I would be working on or saw myself dealing with. It really largely started by chance. When I first started working with clients, it was mostly women in their late twenties, early thirties – and it still is very much women who are my clients, but the age bracket has got much wider now, and I regularly see women up to the age of their late sixties or early seventies.
But in those early days, I wasn’t really specializing in anything. I was just finding my feet. I was figuring out what I wanted to be about, and was really just happy to see whoever would book in.
Whereas now I have an initial chat with someone before starting working with them, back then this wasn’t the case. If someone would send me an email saying they wanted to book in for a consult, I’d book them in. I might’ve asked a preliminary question in the email to find out what they were wanting help with, but that was kind of it. They would just turn up on the day and I would do that initial consult with them and find out what they wanted in that moment.
What started to happen was I would be having women who would turn up and they’d explain that they had this long list of different symptoms, whether it be around digestion or sleep or problems with their cycle or whatever it is, and that they also wanted to lose weight. Normally in their mind, the weight was the biggest concern. They also believed that if they could just lose that weight, the rest of these symptoms would start to go away.
What was often happening when these women were telling me this was my thoughts were, “This person is already incredibly skinny. I don’t know where they’re going to lose any more weight from.” We’d then go through their diet, and I would find that these women wouldn’t be eating very much at all. They’d be surviving off green juices or lots of chicken salad or quinoa. If they ate a chocolate or a croissant, they would feel like they’d really slipped up and it was like a reflection on their integrity or who they were as a person.
As I started to get more of these clients, I realized that it wasn’t so much a nutritional issue. Yes, they needed to have more food and they needed changes in their diet to better support their body and to improve their symptoms, but a huge chunk of what was going on was about their mental and emotional relationship to their body and to food and to self-esteem and feeling worthy and lovable and enough and all of these different concepts.
A couple of years prior to this, I had studied NLP, which is short for neurolinguistic programming. It is a terrible name for a very effective form of treatment. It really looks at, in a general sense, how language/stories/beliefs affect how we behave and the outcome that we see. A lot of NLP’s focus is on doing specific techniques or getting people to do certain patterns to help someone overcome whatever they may be struggling with.
This is probably a side of NLP that I don’t really use, but what was important to me, and what I got out of that training and subsequent reading around the topic, was looking at how we create our reality and how this largely happens within our mind. What we say to ourselves, the things we focus on, what we do with our physiology, all of this stuff is really important, and it has just as big an impact as the actual circumstances of our lives. Starting to talk about and work on this stuff with clients was how I started to help them with this.
It was also around this time that I started working with Frame. Frame is a gym in London. At the time when I started, I think there was a location in Shoreditch and a location in Queen’s Park, but since then they’ve added a number of other places. From working with Frame, I started to pick up lots more clients, and a lot of them fell into the category of being young middle-class women, very much perfectionist types, who were trying to be very health-conscious, chasing the dream of the perfect body. Despite the fact that the majority of them already had what society would consider a fit and attractive body, these women were typically pretty unsatisfied with what they were seeing when they were looking in the mirror and were trying to diet their way to something else.
These types of women really became quite a large percentage of the clients that I worked with, so I started reading and studying more about disordered eating and eating disorders, looking into over-exercise and food restriction and how diet culture and going on diets can be so damaging, and looking at research around body weight and health outcomes and where the truth really lies with a lot of this stuff.
With that long preamble, what I want to do today is just give you some thoughts and insights about all of this stuff. This may not be quite as cohesive as some of my other podcasts, but will be more a collection of ideas or things to think about. I will be linking to different exercises or different books or videos or documentaries that you can watch or read as part of this. I would say this is probably going to be a fairly longish podcast, so if you need to, just listen to it in chunks.
What I’m hoping to create as part of this is just a really helpful resource for those who are struggling with food and with body issues. If you find it useful and think that others will too, then please share it around.
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Before we get going, I just want to mention the difference between disordered eating and eating disorders. An eating disorder is something that has been formally classified. This means that it would appear in the ICD, which stands for the International Statistical Classification of Disease and Related Health Problems, which is a medical classification list by the World Health Organization (the WHO), or that it has appeared in the DSM. The most current version of the DSM is DSM-V, and DSM stands for the Diagnostic and Statistical Manual of Mental Disorders. This is the book from which psychiatrists make their diagnoses. So if it is in the book, you can be diagnosed with it; if it’s not in the book, you won’t get a diagnosis.
With eating disorders, they are formal diseases that come with a list of signs and symptoms that someone has to fall into to be diagnosed with having that disease. This would include things like anorexia nervosa, bulimia nervosa, muscle dysmorphia, and binge eating disorder. To be given a diagnosis of say anorexia nervosa, you then have to match up with certain criteria.
For example, with anorexia, you could have all the behaviors associated with it, but if your weight isn’t below a BMI of 17.5 or 15% below the average of your height, age, and sex, then a diagnosis won’t be given. This means there are lots of people who have issues, and often very severe issues, around food and body image who don’t fall into a given category that would allow them to be given a formal diagnosis.
On the other hand, when someone says “disordered eating” as opposed to an eating disorder, it is everything else that doesn’t get that formal diagnosis. Everything that doesn’t get a formal diagnosis of an eating disorder comes under the bracket, then, of disordered eating.
There used to be a category in the DSM known as EDNOS. EDNOS stands for Eating Disorder Not Otherwise Specified. This was where someone would have some of the symptoms of anorexia or some of the symptoms of bulimia, but it was maybe subclinical or they didn’t have enough for a full diagnosis, or where they’d have a combination of some of the things from the anorexia category and the bulimia category and the binge eating disorder category, but because they didn’t have enough of any one of the symptoms for one category, they were given a diagnosis of EDNOS.
EDNOS used to account for about 60% to 70% of the diagnoses made with eating disorders, but in the most updated version of the DSM – when it was updated from version IV to version V in 2013 – they dropped EDNOS as a diagnostic, so you could no longer be diagnosed using this classification. It we’re talking about the fact that 60% to 70% of the diagnoses used to be EDNOS, that’s now a huge chunk of people who are no longer getting that diagnosis.
As I said, disordered eating then includes anything that used to get the diagnosis of EDNOS, but then also anything that includes issues around food and body that wouldn’t have even got that diagnosis. Basically, starting at one end of the spectrum, you have someone who’s doing some kind of restrictive eating; at the other end, it’s more overeating or binge eating. It could include using exercise to control weight. It doesn’t have to be someone who’s vomiting or taking laxatives, in the case of something like bulimia.
What I think is important to realize with all of this stuff is that it happens on a spectrum. The difference between someone who restricts their food and worries about how they look versus someone who has a formal diagnosis of anorexia nervosa is just the degree to which they keep up these habits. And while there are definitely genetic and hereditary and physiological factors that impact how far someone can take this, I do think it can be a very slippery slope where someone starts out doing a diet and then finds themselves, not that far down the line, in a very dark place.
Hopefully that clears up the difference between an eating disorder and disordered eating. In case you’ve always wondered why, when people are giving interviews or when they’re talking about this stuff, they always mention both the terms and separate them out, that’s the reason. It can seem a little bit like semantics, but because one is referring to a condition where there is an official diagnosis and the other is not, it is important to mention both.
But for the remainder of this podcast, unless I specifically mention it, I’m just going to be referring to both disordered eating and eating disorders together. I will just be using the term “issues around food,” something like that, because as I said, I think this stuff happens on a continuum, and this information is relevant regardless of where someone falls on that continuum. Just to prevent me having to say “disordered eating and eating disorders” again and again and again, it’s just easier for me to refer to this category as “food issues.”
The first thing that I want to say is that when we think about someone with issues around food, we need to get away from a lot of the definitions and the very narrow definitions that we have when we think about this stuff. This can be both from a place of what someone looks like who has this problem and also the reason why people follow these behaviors.
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When we think of someone who restricts – and restricts in terms of someone having an eating disorder or having real problems around their food – we think of someone who is waif-thin, the stereotypical picture of someone who is skin and bones. But regardless of what someone’s outer appearance looks like, they can still be suffering with a restrictive disorder around food. Maybe in some situations it’ll alternate between restricting and binging, but I would say that you can’t ever just look at someone and know whether they do or don’t have an eating disorder or issues around food because it’s not always so obvious.
There’s a very powerful YouTube clip of Blythe Baird reading a poem called “When the Fat Girl Gets Skinny” that I’m going to link to in the show notes. It’s incredibly moving, and I suggest that you check it out. I think for me, it feels like a fantastic summation of how issues around food, especially those of a restricting nature, are thought about within this society.
To quote one of her lines, she says, “If you develop an eating disorder when you are thin already, you go to hospital. If you develop an eating disorder when you are not thin to begin with, you are a success story.”
The other part about beliefs around the types of people who have issues with food is we often think about it as being young white women who are in their teens or in their early twenties. Maybe they’re middle class or upper class. Often they’re thin to begin with, but their reason for picking up the disorder is that they want to become thinner. This is a very narrow definition, and really issues around food can happen across the board. Yes, they definitely affect women much higher than men, but men can also be affected. But they affect people all across the economic spectrum, all across different cultures and across different sexual identities.
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While we think that it’s about losing weight or to meet some cultural expectation about what it means to be attractive, this is not always the case. Sometimes people are trying to do the complete opposite of this thin stereotype. For others, it’s got very little or nothing to do with weight, and it can always be or is a lot about control.
There’s a fantastic book called Hunger so wide and so deep. Again, I’ll link to it in the show notes. This looks at a lot of different scenarios that we would think of as atypical in terms of disordered eating, but probably actually account for a huge part of why people develop a habit of using food as a coping mechanism.
It’s a collection of different interviews that they’ve done with lots of different women, and as part of it, a lot of the women were gay, but were living in communities where it was frowned up. They would then use food to cope because they didn’t know how to come out. Or women who had been abused or molested, and some would then use restriction to create some kind of semblance of control in their life, in what felt like a totally chaotic situation. Or others would overeat intentionally, with the goal in mind to become bigger and bigger, and hopefully less desirable to their abuser in the hope that they would stop.
There is another book called The Rainbow Machine by a guy called Andrew T. Austin. Austin is a therapist, and he was running a weight loss seminar. He asked the participants as part of that, “What happened at the time you were last at your ideal weight?” He said of the 14 overweight participants in the seminar, 13 of them really expressed surprise when asked this question, for all 13 of them had experienced some kind of serious stress of traumatic event at the time. For one, there was a bereavement. For another, they were assaulted. Another was made redundant and wondered if they’d ever get a job again at that age. Another got married to a man who turned out to be controlling and abusive and so on.
All except for one had his or her own unique story of trauma or stress that had been paired with them being at their ideal weight. Subconsciously, this weight is then associated with a negative time in their life, and they picked up food issues probably very subconsciously that prevented them from getting back to that weight because of that association, and using that as a protection mechanism.
Some of the other ideas talked about in Hunger so wide and so deep were cultures where thin isn’t the ideal, where women are meant to be curvy or voluptuous or “womanly.” Women are then using food to try and shape their body, but not in the way that most of us would think about this. Or women who are in certain cultures where they are clearly second-class citizens, where they are treated with the same respect as an animal, so food in whatever way they choose to use it can then provide for them some sort of comfort, even if it is only momentarily.
So, issues around food aren’t just about weight, and even when they are, they aren’t so straightforward. They don’t just affect thin white women. They affect people of all different shapes, all different sizes, and all different backgrounds. I really want people to start to keep this in mind.
This is why for me, when thinking about this stuff, we need to be looking a lot at someone’s behaviors and their symptoms and their thoughts about food, not just looking at how they look. You could have someone who is a certain weight and is following a certain way of eating and exercising, and this is healthy for them. They have positive thoughts about their body and the food, and when they are eating food, they think about it; outside of that, they pay very little attention to it, and they have a very normal relationship with food.
You then have someone who is the exact same age, the exact same weight, and who is eating and exercising in the same way, but this person experiences something completely different. They are plagued with symptoms, and their body is clearly not getting what it needs to be able to cope. They are mentally and emotionally not in a good place. They have thoughts about food that are pervasive, and even though on the outside it may appear that they have it all together, they then spend a huge chunk of their day, their headspace, thinking and worrying about this stuff.
So even though on paper they are doing the same thing with their diet and with their exercise, one of these people has issues around food and one of these people is really benefiting from eating this way.
The next point I want to make around food issues is that it is a learned behavior. People aren’t born with these problems. They are something that people grow into. Now, with this, I will say that there are definitely hereditary or genetic factors that can predispose someone to be more likely to develop issues around food, but our genetics or our hereditary factors don’t make things a guarantee. Other behaviors have to happen to then make this so.
I would also add, when I say that this is a learned behavior, it doesn’t necessarily mean that someone is consciously learning these things, that it’s a conscious process. It can seemingly happen via osmosis, or someone doing something very innocuous in terms of a diet that then really spirals. But again, there are behaviors that someone is following that then lead to this, and this is something that they’ve learned through experience, through seeing others, etc.
There’s a couple of things that I want to mention with this.
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The first is how impacted we are by people who are real key influencers in our life – things like parents or siblings or close friends. When I’m working with clients who have issues around food, it’s very common that when I ask about their family situation, they comment that their mom struggled with food and with weight and with dieting. This can really take two forms.
Some people, when I ask about their mothers, they say their mothers were very overt about their struggles. They would always make comments about their own weight and others around them. They were always dieting, and they weren’t really trying to hide this at all. And they’d often make comments explicitly to the client, who is their daughter, about their weight. In these cases, it’s not that surprising that this client then also starts to develop issues around food, because this is what they say day in and day out, and they’re just modeling that behavior.
The second option is where their mother struggled with food, but they really didn’t want this to impact on their children. They would make the children proper meals; they just wouldn’t eat it themselves. They would never comment about their weight or dieting in front of the children, and they tried to encourage the kids to be totally normal around food.
The unfortunate thing is, kids are pretty smart and impressionable. You can tell them to eat their meal, but if they notice that you never eat, they’re going to model that behavior, not what you tell them to do. So even though these mothers were very intentionally trying to help their kids not suffer in the same way in terms of body issues and food problems that they suffer with, in the end the kids still suffer the same fate.
This is really common when I speak to clients who are then suffering with this stuff who also have kids of their own. They tell me that they’re trying to model healthy behaviors to their kids by encouraging them to eat more and to eat everything, and not talking about diets in front of them, but the sad reality is that despite their good intentions, the kids are more likely to pick up and follow that’s not being said and what they see in their mother’s behavior rather than the positive verbal message that they’re trying to instill.
I find that this can sometimes be something that can help a client to overcome this stuff, because they realize that the façade of being healthy or healthy eating that they’re trying to show to their kids probably isn’t going to be enough. But if they can overcome their own issues and they can become completely authentic and congruent when they’re talking about this stuff because they’re actually following through with it themselves, then they can make a huge difference within their lives.
And it’s not just the mother’s role with this stuff. Fathers can have a big impact, too, and close friends and relatives as well.
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There’s a real tendency that I see to praise girls and women on how they look and saying how pretty they are or how gorgeous they are. I know this on the surface can appear like “what’s the harm?” or that it’s even like political correctness gone mad, that it’s crazy you can’t comment on how someone looks; you’re just trying to be complimentary.
The issue is that if this is the only thing that girls and women hear day in and day out, they begin to believe that their worth is based on how they look. This is why food and body issues disproportionately affect women over men. Yes, it’s happening more today with men as well, but this is a much more recent phenomenon, and it’s starting to happen more with men because men are starting to adopt the same standards for how a man’s body should look and the importance of this that used to be just placed on women’s bodies.
Historically, men’s sense of worth came from being powerful, from doing things in business or from money, and for women it was how they looked. Women could climb the corporate ladder, they could make money, they could do a million and one things in the world, but how they looked was still the pinnacle. This is why I say it’s so important for focusing on and praising and complimenting things with women and with girls that aren’t to do with how they look, because if this is what they constantly hear, it just further reinstates this message.
It also kind of explains why issues around food and body don’t necessarily match up with how attractive someone is in comparison to our beauty standards of the day, because if this was just how someone looks versus how they stack up with the beauty standards, we should see that in people who are thin, who are attractive (by our narrow definition of beautiful), they should be having issues around food be very, very rare, and for those people who are moving further and further away from that, who are heavier and heavier, it should be much more likely that they have issues around food – and really, this isn’t the case.
There’s many different reasons for this, but in respect to what I’m talking about here, the reason for this is because someone who is attractive probably has much more of their self-esteem riding on this characteristic. It’s the quality that defines them. They have so much more to lose, and there’s that feeling of “if I do start to lose this, what else do I have to base my self-esteem on?” An outsider can look at someone like this and not really get it because in your mind you’re thinking this person has everything going for them with their body in comparison to what society really likes. But for this individual, all they can think about is that they need to improve it even more. What’s going to happen in 5 years, in 10 years, in 15 years when they get older? All of this goes away.
There’s a fantastic author called Alfie Kohn who I really respect. He does a lot of writing about learning and schooling, and he’s very critical of the current schooling model, especially around tests and a lot of the way that we teach kids. One of the things that he talks about is the mistake with how we praise children for good results and doing well in tests rather than actually focusing on getting kids to enjoy the learning process. So not just passing a test and remembering some information for a very short space of time so they can move on and do something else, but developing an intrinsic motivation to learning and studying and starting to enjoy that.
I think the same message can really be applied here, like focusing on encouraging girls and women to pursue hobbies and interests and careers instead of the focus being on how pretty they are or how cute they are in some kind of dress.
There’s also a documentary called Miss Representation. It looks at this phenomenon of how women are praised so much for how they look and not much else, or when women make it into certain positions or situations, their appearance is commented on in a way that never happens with men. I think things like female athletes or female TV presenters are probably very good examples of this, and things that easily come to mind.
The film also looks at how unrepresented women are in so many areas of life, whether it be politics, heads of companies, these kind of things, and that this is very damaging in its impact because when young girls are looking to these people and they don’t see any role models or they don’t see enough role models, there isn’t someone there to inspire them, and they start to think “Maybe I’m not meant to be there. Maybe I need to put my importance in some other areas, i.e. how I look.”
It’s definitely worth a watch. I’ll put a link to it in the show notes, which again, you can find at www.seven-health.com/54. It’s called Miss Representation and you can find it on Netflix and other places online. Definitely check it out.
When I’m thinking broader than just family or friends as influencers, it’s then looking at the culture we live in, a culture that is very much championing the way that someone looks and looking a way that is basically impossible for nearly everyone within society, or a culture that is so diet-focused and where it’s very normal to be on a diet or regularly going on diets rather than avoiding diets altogether, or one that has advertising that consistently uses images of models that have been augmented to show something that is so unattainable, and yet everyone still feels like this is what they should be aiming for. Or social media accounts that display what feels like normal photos, but yet have been curated in the same way as an advertising campaign – highlighting only the best bits and picking a photo out of multiple, multiple attempts to tell a particular story and a story that is most likely not even true.
There’s a couple of comments that I want to make about this stuff.
00:30:40
The first is that people need to stop dieting. I know this is much easier said than done, but it is really important. Getting people to start to listen to their body and learn to hear what it is asking for is the way forward. I’ve done a whole podcast on intuitive eating which I would encourage you to listen to. I’m going to put a link to it in the show notes, but if you go on my website and just search “intuitive eating,” you’ll be able to find it. I also have a free email series all on quitting dieting. It walks you through different ideas and gives practical advice for all this, so again, if you come to my website, you will be able to see a thing that says “quit dieting” that you can sign up for.
00:31:20
The next idea is being very selective with what you expose yourself to. You may not get to pick what you see on a billboard or the advertising that you see on the tube or on a bus, but you do get to choose which magazines you read, which websites you visit, who you follow on Facebook or on Instagram. We get to create or curate what we see on a daily basis, and we have this ability like never before. This is really important because what we regularly see has a huge impact on our beliefs about body shape, body size.
To illustrate this point, I’m going to mention a fascinating piece of research, and I’m going to link to it in the show notes so if you want to check it out in more detail, you can head over and check out the link. But the research used females, and it involved them looking at different bodies on a screen. Some of these bodies were 3D CGI images, while others were pictures of women – it might be pictures of beauty queens or just women of different shapes and sizes in plain clothes. As I said, it showed women of different sizes and weights.
The point of the research was to look at how our preferences for body weight change based on what we see. To start with, there was a pretest section. This would be showing women different body shapes and sizes, and people had to rate these and then give an indication of what their preference was. They would then look at all of these ratings and be able to give it a number, make a determination of what someone’s baseline is in terms of how much they had a preference for thinness.
The next phase was the manipulation phase. This is where they tried out lots of different things to see how we are affected based on what we see and how that affects someone’s preferences. What they found as part of the research is if they started showing people thinner and thinner bodies, their preference for thinness increased. Where their baseline was and where they ended up after that manipulation phase was that they had more of a preference for a thinner body. If they showed them pictures of more of heavier bodies, their preference for thinness decreased, and what they felt was attractive for them, for others, was then heavier than their initial baseline.
Often when people look at this stuff or think about this stuff, they say that advertising doesn’t affect them, that they’re smarter than that. The thing is, it’s got nothing to do with smartness. It’s about what you consistently see. If what you’re exposed to consistently is young, thin women in advertising everywhere you look, you start to think that this is the norm and you start to evaluate your body based on this.
I think fashion is a perfect example of this. Go back and check out pictures of yourself from 10 years ago. Look at whatever haircut you had at the time, look at what you were wearing, and see what you think. If you are like most people, you’ll probably have a laugh thinking about what you used to wear – those shoes, that top, that hair, whatever it may be. But if we were to take you back in a time machine to that date 10 years ago, you probably felt very different. You felt cool or fashionable, and even if you had body insecurities, you probably thought you were doing your best on that time or at that date, and it would be a very different feeling to how you feel now when you look back at those photos.
This is the same thing. Your perception about what a body should look like is incredibly malleable. It is based on what you are constantly exposed to is where your expectations are.
00:35:20
This is why I actually think that nudity, when used correctly, can be so helpful. I now regularly encourage female clients to go to spas or to saunas or to baths where they are exposed to nudity. Not airbrushed, perfectly-lit nudity – real, live human beings. I want them to see what real bodies look like, and to do this regularly. It’s one of the things that clients talk about as being very helpful and very freeing, because previously their only point of reference was models or what they saw in movies or on TV, and now they’re getting a much more realistic point of reference.
I know this can be incredibly terrifying and is very difficult the first couple of times that people do this, but the more that they can do this, the more that they can start to shift what their beliefs are around how a body should look.
I think the same should be happening for men and for boys. For so many guys, the only nudity that they see is in magazines or if they watch porn, and this creates a totally unrealistic standard of what a body or a male should look like.
I think a part of the getting over issues around food is really starting to rally against the beauty ideals and the pressure that is placed on women. I find for some clients in the early stages, they have this goal that they want to get better, but they then almost just want to slop back into some certain ideal, and if this is the case, it is very difficult for recovery. Whereas if someone starts to look at this stuff and really starts to challenge and rally against the very narrow ideals that we have, this can be very helpful as part of someone’s recovery.
The final idea I want to mention in regards to this is that people should be educated on media literacy so that when you do see a piece of advertising, not only does it hit you unconsciously and you get the desired effect that that advertiser has, but you can then stop and be conscious about what you are seeing and be more critical in your assessment.
This includes things I mentioned before in terms of being conscious in telling yourself that this picture has been altered and expertly lit and Photoshopped, and that it isn’t real, but also being aware of what is the real message here, or what are they trying to accomplish via this advertising? Because a lot of the time, the goal is to make you feel worse about yourself, to make you feel unworthy, to make you feel that if you get said bag, said product, said face cream, that you are going to be more enough, and that if you have that sentiment expressed to you, you’re more likely to go out and buy and try to fill that void. Even if it won’t fill the void completely, it can mainly give you that momentary sense of relief that so many people are really searching for.
This idea of filling the void kind of leads on to the next area that I want to chat about in regard to issues around food.
00:38:35
That is, that people do this stuff because it is a coping mechanism, and for a lot of people, it is a very successful coping mechanism. There’s a fantastic documentary called The Other One: The Long, Strange Trip of Bob Weir. It’s a documentary about Bob Weir, who is one of the founding members and guitarists for the Grateful Dead.
They were a band I didn’t know much about musically, but had always heard referenced about their incredible live shows and also a lot of the drugs. They got started in the 1960s and were a big part of the countercultural movement. LSD was a huge component of how they began, and drug-taking was a real common thing for this band, probably in a similar way to a lot of bands around that same era.
Unfortunately for the lead guitarist, Jerry Garcia, his use of drugs continued on into later life, and at some point he got hooked on heroin. There’s a really interesting point in the film where Bob Weir is talking about this, and he says, “Jerry once told me that heroin takes all your troubles, all your concerns, all your worries, and ties them neatly into a little packet, which is ‘where’s my next hit?’”
This is typically where or how I see issues around food. Food isn’t the real issue. It’s a tool that someone uses to deal with their real issues. If you feel awkward in social situations, it’s easy to then tell yourself that “life would be easier if I was thinner.” You had a tough day at work because you messed up, you sent an email to someone you shouldn’t have; it’s easier to have a binge as a solution to help forget about this incident. Having troubles in say your relationship, it’s easier to convince yourself that it’s because your partner is no longer attracted to you, and so it’s time to start another diet.
It’s just so much easier for people to make everything about their food or about their weight than it is to deal with what would be quite messy parts of our lives.
Scott Abel talks about the five mood states of using external solutions – so using food, using eating issues – to deal with internal struggles. The five are, he says: false highs and feelings of entitlement to indulge, as in “I deserve this.” Unnecessary lows that you bring on yourself, so “I’m alone, no one cares,” and then you can use food as an indulgence or deprivation to deal with the anxiety as part of this process.
The third one is numbness. There’s just too much stress from too many sources that overwhelms you and alienates you from your connection with yourself, so you can then use a food indulgence, you can use food deprivation, or just the mental preoccupation that then serves as a mute button on that external stimuli.
The fourth one is emotional avoidance, like deep or intense emotions that are just too intense to face, or you feel so hurt, so it’s easier to have a food indulgence, it’s easier to deprive yourself of food as an external solution to soothe the soul, even though it does the opposite and adds to much more emotional torment.
Then the final one is emotional confusion, where you’ve just totally lost the ability to properly label an emotion, and because you can’t label it appropriately, you cannot feel it appropriately in order to let it go. In this case, you use food or eating in a certain way to simplify that confused emotion to some simple external that then makes it much easier to focus on.
00:42:20
There’s often a saying with eating disorders that these issues aren’t really about the food. I remember reading Harriet Brown’s Brave Girl Eating. This is a memoir by Brown about her experience with her oldest daughter, Kitty, who developed anorexia. She comments in the book that people tell her that it’s not about the food, but she just cannot understand this. She says, “how can I not focus on the food” when if she’s not focusing on that, her daughter will continue to starve herself?
While I firmly believe that these issues really aren’t about food, this doesn’t mean that food is completely ignored and forgotten about. What I believe via the statement that this isn’t about food is, just getting someone who is suffering with these kinds of issues to eat like a normal person won’t itself repair the situation.
Starvation in itself can lead to lots of mental illness and it can change someone’s perspective on themselves and their view of the world, and this has been demonstrated in a very detailed way in the Minnesota Starvation Experiment. I did a whole separate podcast on this, so I would highly suggest that you listen to that one. It’s at www.seven-health.com/042. Again, I’m going to be putting all of the show notes for this episode at /54. So definitely check out that podcast, because it will explain this in much more detail.
Getting someone to eat more and do that consistently is really crucial to recovery, but it is not going to be just the only piece of the puzzle. Just getting someone to eat more doesn’t completely repair the situation. This is a coping mechanism that someone is using, so we need to know what they are trying to cope with, and we need to then either resolve that situation permanently, if this is even an option – but what happens more often is instead just teaching someone coping skills that don’t involve food or restriction or over-exercise.
For me, this is a process. I deal with it in lots of different ways, looking at it from lots of different angles, and I wanted to share a couple of those with you.
00:44:45
The first exercise I want to chat about, I’ll do pretty much all the time when I’m dealing with someone who is struggling with food and body issues. This could be anything from binge eating to using food to numb emotions, it could be restricting, it could be over-exercising. Really, it could be for whatever reason.
But in this example I want to talk about, it is in a way that I see very commonly in practice, which is someone who has, maybe for a number of years, been pretty successful at restricting, but as time has gone on, they’re now starting to binge or feel very uncomfortable around food. This is often when people contact me, because it’s at this stage when they’re not able to continue restricting that they feel like it’s no longer working and that this is now a real problem for them.
I get them to get a sheet of paper and create two columns on that sheet of paper. At the top of one of the columns, I get them to put the heading, “What are the fears that cause you to have your eating issues?” Basically, what are you trying to deal with or mediate or avoid by having your specific food behaviors? In the second column, I get them to put the heading, “What are the biggest fears because of your eating behaviors?” In a sense, what do you currently see as the negative consequences for following through on this behavior?
I’ll advise them to spend as much time as possible thinking about this stuff and to write whatever comes to mind – not to censor themselves, but to be really honest about this stuff.
I’ve done this a number of times now for a number of years, and so I’m pretty sure about what responses will come back. They’re always fairly standard. But let me just run through some of them as part of this example.
In the column that asks about fears that lead to someone having eating issues, it’s normally things like “I will get fat,” “I will lose my status in society because I’m not thin,” “to avoid feeling guilt or shame from eating,” “no one will ever love me,” “I won’t get attention from men” or “my husband won’t find me attractive,” “I won’t be a good enough role model for my children,” “I won’t love myself,” “I won’t respect myself,” “no one will be my friend,” “I’ll feel depressed,” “I’ll lose total control,” “I’ll eat too much,” “I won’t be confident in social situations.”
Then in the other column – this is the responses to the fears that are a consequence of their eating issues – in this column it will be things like, “I won’t live a long life,” “it’s causing me serious health problems” – no cycle, no sex drive, could be losing their hair, they’re always cold, they have depression, hey have OCD, there’ll be a lack of energy – “my marriage will collapse because of the strain it’s placing on our relationship” or “my relationship will fall apart,” “I’ve isolated myself to the point where I don’t have any friends or I hate social situations,” worry about “my kids are going to follow my patterns of behavior,” “I’ll be stuck like this forever,” “this disorder really controls me,” and “I won’t ever be able to eat normally again.”
What is interesting about this exercise – and that’s why I get clients to do it – is because so many of the exact same things appear in both columns. Rather than being the solution that so many of them thought it was going to be, they still experience most of the fears that they were initially worried about. Then on top of this, they’ve then created this whole extra list of problems that weren’t there before.
What I find is that by seeing in black and white that their supposed solution isn’t working for them, it makes it harder for someone to continue doing this behavior. This doesn’t mean that they instantly drop doing it or stop doing it, but they start to understand the futility of this in a way that they probably haven’t experienced before or hadn’t become aware of before.
A lot of what I’m doing when I’m doing these different exercises with clients is that I don’t expect one thing to just transform their whole life. It’s more about just poking holes in their experience or poking holes in their belief so it gets to the point where they’re like “okay, this definitely isn’t working” and they start to make that transition.
00:48:55
Another big component of my work with clients around this stuff is getting them to understand that how we view and experience the world is largely based on what happens in our head – the stuff that I talked about with NLP at the beginning of this podcast.
What are the things that we constantly say to ourselves? What are the memories that we choose to replay versus the memories we choose to ignore? What are the future scenarios we create in our mind? What are the meanings that we attach to what would otherwise be very mundane situations/events/comments by other people?
While I think circumstances have an impact on our lives, how we interpret these circumstances, the meaning we attach to the circumstances, the action we take because of this, is much more important. I’m a big believer that someone’s internal environment is directly responsible for how they feel about food and how they feel about their body.
Another exercise I do with clients when I’m dealing with this stuff is I ask them to imagine that someone has comet o them and they want to know how they can be just like them with their food and their body image. So rather than being a problem, I want them to imagine someone wants to learn from them, and I want them to share their knowledge and their wisdom of what they’ve learnt through their experience with this individual.
I get them to write down all the things that they say to themselves before eating a meal, during the meal, after the meal. I get them to write down what they say to themselves while looking in the mirror. I ask them to write a list of the regular comments that they make to themselves that leave them to feel down or more likely to use food for comfort or wanting to restrict. I get them to describe all the past memories or the future scenarios that are painful that they constantly play to themselves.
They answer all of these questions, and in a sense they have a blueprint now for what they could give to someone else to help develop these issues around food and their body. I ask them, if I got someone to follow exactly what they are saying for the next 6 months or the next year, do they think that that person would develop the same issues that they have? Most people would agree that they would develop them. Maybe not to the same degree, but would develop them to some level.
Rather than this individual that I’m working with then feeling upset about this situation, it’s then not really surprising. The way that they talk to themselves, what they focus on, etc., has created the most likely outcome, which is their current situation.
Then the second part of the exercise is to create a new blueprint for something else they can be doing. I get them to write down how they believe a normal eater thinks before, during, and after a meal. How does a normal eater know when they’re full? What does someone say to themselves who has a healthy body image when they look in the mirror? What events from their past or from the future can they constantly play that would change their beliefs bout their body or their life or who they are? What are the phrases or comments that they could say to themselves that would make them feel more positive?
As part of this, I want them to make it real. For example, if someone is 5 foot tall, they aren’t meant to look in the mirror and try to convince themselves that they’re 6 foot. Or if someone is a size 20, they aren’t meant to be trying to convince themselves that they’re a size 6. It’s about being aware of what are their facts and what are their stories. With the stuff that are stories, how can this be reframed in a different light that is more supportive than destructive? Because being delusional doesn’t help anyone, whether we’re talking about someone being delusional where it’s causing damage in terms of them being restrictive, or trying to get someone to be delusional in a way that’s meant to help them.
I then get them to keep a copy of this blueprint that they have written down and to follow it as much as possible. Even if they don’t think that it will make a difference, I want them to say these things to themselves. I want them to focus on these particular memories. I want them to do the certain things they have said someone would do when they’re eating if they’re a normal eater.
During the times when they’re feeling poorly about their body, about their food choices, I want them to ask themselves, which one of these blueprints are they following? Are they following the old one or are they following the new one?
This can take time to change. They are normally very habitual with talking to themselves in a certain way, in a very negative way, or habitual in terms of the way they focus on food or certain past events. Just because they then change this for a day or two, isn’t going to change anything for them instantly. But just like this was a learned behavior where they’ve learned to be unkind to themselves or they’ve learned to obsess over food, they can also learn to be compassionate and supportive of themselves and see food in a different light if they keep doing this and they keep doing it consistently enough.
There’s a great book called The Brain That Changes Itself by Norman Doidge, and it features numerous case studies of patients suffering from neurological disorders and details how each of these people had their brain then adapt to compensate for their disabilities. For example, someone who’s had a stroke, and this stroke led to damage to the brain for an area that controls the motor skills, so they’re now unable to walk. But by doing lots of training and specific exercises, as he talks about in the book, they were able to then learn to walk again. When they then scan their brain, they find that other areas of the brain have been able to take over the role of helping this individual.
In some ways this is what it feels like it is for these clients who are relearning to do this stuff. They’re learning to break free of habits and behaviors that feel so ingrained to them that it’s like a part of who they are. But by doing different exercises and by keeping up new behaviors, it starts to change the way that they think about things and the way that their brain works.
00:55:00
A big part of this actually is discovering whether someone really wants to get over their issues. Now, I know at some level they do want to get over it, but there’s often barriers to this, and I think there’s a couple of big ones I want to mention.
The first is that for a lot of people, these issues are a big protection mechanism. Geneen Roth talks about this in her book, Breaking Free from Emotional Eating, which I want to share a quote from. She said, “When I weighed 145 pounds, it was different. I was prepared. If I was rejected, I knew why. When I weighed 145 pounds, it was my fat that was rejected, not me. My fat surrounded me, it protected me, it hid me, but it was not me. I was inside. I was soft and vulnerable and sexy, and I was thin. I was a wonderful, delicious secret. If at a party no one approached me, it was because they didn’t know. They couldn’t see the secret of me beneath all that flesh, not because they saw the secret and still turned away.”
She talks about how it easier for her to be heavier than it was for her to be light because when she weighed less, she was vulnerable and she didn’t have her weight as an excuse. What I would say with this stuff is it’s not just about weight. It can be for many reasons – setting up a business, being in a relationship, lots of other examples. If I struggle with food and I set up a new business and it fails, I can always blame my issues around food. “Life would be so much easier if I didn’t have these issues, but obviously I do,” and so it is then the perfect excuse for someone.
But if they then get over these issues, they then set up a business and it still fails, then what? What excuse do they have then? This can be incredibly scary for people because they then don’t have an excuse to fall back on or use as a lifeline. Even when they do truly want to get over these issues, they still have this desire to be protected and have this protection option for them.
00:57:00
The second part of wanting to get over these issues but really struggling with it is not wanting to accept the reality of what recovery means. People want to do the things where it just goes back to the way it was before. They want to go to sleep, the next day they wake up, and it’s all been like a bad dream and now everything’s fixed and it’s back to how it was. The reality is this is never, ever going to happen.
As part of recovery, most people will have to put on weight. Some of this is necessary from a physiological function; for others, it’s just part of the process of them becoming neutral around food. For some people, the weight gain will be permanent, for some people it will be temporary, but it is part of the process.
It takes work to look at where these issues really stem from, to look into areas like self-worth, confidence, identity, to look at our own biases and prejudices against body weight or size, to deal with insecurities or areas where we feel shame. As I talked about earlier on, if people have been abused or had other things going on, these are not easy issues to deal with.
This is what the process of recovery really looks like. When people are often told this, they don’t want it. They don’t want to feel the way they do now, but they don’t want to do the work to then change that. They don’t want to have to deal with the changes to their body or the discomfort of eating more food or the tough questions about why they do what they do.
I will always say that people will change when they get to the point that their current situation causes more pain than the pain to change. This is often described as someone’s rock bottom, where they have some realization that no matter how tough things get, they know that they just cannot keep living like this.
The second part with this is that they become realistic about what is actually involved and are prepared to put in the work, where they stop the constant search for “how can I do this some other way that won’t lead to the weight gain, or where I won’t feel so uncomfortable?” The more people continue to believe that there’s some alternative out there and that that alternative is much easier, and it’s just waiting for them to discover it, the more people will stay stuck and avoid making these changes, because they’ll always be hanging on to finding the easier way of doing it.
00:59:20
As I’ve said, this stuff is a process and it takes time. In the beginning, someone’s focus is largely going to be on recovery and what are the things that need to be done right now to help their body to repair. They focus largely on their meals or meal planning, or getting them not to plan meals, if that’s what’s needed. They may focus on learning to be okay with their body and exercises that are specific to this.
But as time goes on, this will start to shift. This is something that Kaila Prins talks about, and it was a concept that I had worked on with clients before, but she’s phrased it really nicely. She says that you transition “from recovery to discovery.” In the beginning, recovery takes up all your time and your headspace, and really, it should be, because it’s really important that you are doing the eating, you are doing all of these different exercises.
But over time, this needs to shift. You need to start focusing on what are the things that you now want to be including in your life? What are the new hobbies, what are the new interests that you want to be taking up that have nothing to do with your body, that have nothing to do with food, that have nothing to do with all of the things you have been focusing on for so long?
Because for people with food issues, a lot of them have been defined by these issues. It has become a part of their identity. The point of discovery is about building a new sense of identity and discovering how you want to be spending your time. The more you can be filling your life with other activities or taking pleasure in the things that you’re already doing, the less you then have a need for those food issues, and they’re not then going to be desired to fill some void or gap that someone has in their life.
I think a big part of this is also discovering about what your body can do – not what it looks like or what you can force it to put up with, but starting to be really appreciative of all the things that your body does on a day to day basis and how magnificent that is as opposed to just constantly being overwhelmed and disgusted and disappointed in all the areas that it falls short.
That is it for this week’s podcast. I hope that has given you some different things to think about, that it’s been insightful. Maybe there’s some practical tips in there that you can start to be using if this is something you’re dealing with. As I mentioned at the beginning, if you do find it helpful and feel that others will too, then please share it, because it’s a topic I’m really passionate about. It’s something where I really want to get the word out about this stuff.
Next week I will be back. Next week will be with another guest. Until then, look after yourself, and I’ll see you soon.
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