nutrition

“We live in a diet culture world,” my therapist at Center For Discovery often told me in our sessions. We are all susceptible to falling into the trap of society’s obsession with weight loss and thinness at times. Those who are currently suffering or in recovery from an Eating Disorder are more sensitive to these cultural messages. How many times have you heard a colleague in the break room making small talk about intermittent fasting, avoiding carbs, cutting out sugar, or the latest juice cleanse? How often does the new mother speak of losing the baby weight, “walking off” her lunch, and damn the temptation of those Holiday cookies!

We live in a world of excess; any cuisine we could want or need is at our fingertips and we don’t even have to leave the house to get it. This may explain why 70% of Americans are overweight, and 40% are obese (Drs. Vikki & Rick Petersen, 2022). Obesity increases the risk of heart disease, diabetes, strokes, certain types of cancer, and more. It is no secret that these conditions can, and eventually will, lead to death. Thus, I do believe weight loss can be motivated by health. Keep in mind, though, that 25% of dieters will develop and Eating Disorder (Paul Schlider, 1978). Why do we so often misconstrue the intent of weight loss from taking care of ourselves to a superficial obsession with thinness? How do we prevent weight loss from becoming mental bondage that can negatively impact someone’s life even more than being overweight did?

In ABA, it’s known as a shift from respondent to operant conditioning. In respondent conditioning, the desired outcome of weight loss is controlled by the behaviors that precede it (e.g. exercise, eating less, making healthier choices). In operant conditioning, weight loss behaviors are shaped by the consequences that follow (e.g. compliments from people, fitting into old jeans, seeing results on the scale or in the mirror). We must be leery of the shift from habitual, positive lifestyle changes to only chasing external reinforcers.

Starvation

Any time you ignore hunger signals and deprive your body of the nourishment it needs, it has a physiological response. This is why those who’re struggling with an ED commonly lose their hunger and fullness cues. The body simply prioritizes other functions in order to keep the heart beating and blood pumping to other extremities. In ABA, we call this selectionism. Author and Eating Disorder Recovery coach Tabitha Farrar explains the genetic adaptations to starvation in her book “Rehabilitate, Rewire, Recover,” as your body telling you to move more and eat less. This is why eating disorders are addictive; your body can’t tell the difference from an actual famine. If you didn’t have access to food, you would need to 1; search and hunt for it and 2; survive off of a lower quantity.

In “Sick Enough” by Jennifer L. Gaudini, she explains how these genetic adaptations vary from person to person. While one starved body may experience a decreased heart rate, another may have cold hands and feet. While one body may look emaciated, another body of similar stature and caloric intake may grow hair in peculiar places but maintain the same weight. These genetic variabilities cause many Eating Disorders to go undetected or underestimated. Luckily, a visit to a Doctor who noticed my trending weight loss pointed me towards my first treatment center in 2017. When I had a relapse in 2021, I recognized the signs and sought help before I became sicker. Had I not been aware, an outsider wouldn’t have suspected an eating disorder due to my body’s physical adaptations to starvation.

Intuitive Eating

In ED treatment, they teach the 10 principles of “Intuitive Eating” by Elyse Resch and Evelyn Tribole. If you’re interested in reading what they are, I will link the book in the Resources page. While I think there is value in rejecting the diet mentality, eating psychologically satisfying foods, shifting away from labeling foods as good vs bad, etc. I’ve struggled to apply Intuitive Eating in my recovery journey. One reason is it feels like the gold standard for how to eat “normally” or “perfectly.” Ultimately, everyone has disordered eating habits to some degree due to the societal influences listed above. There is no “perfect” way to eat. Rather, it’s about finding what works best for your body and lifestyle.

Eating Disorder recovery coach Brianna Campos also brings to light the harmfulness of telling someone in recovery that while they are becoming intuitive eaters, their weight may or may not change. She is transparent with her clients that likely becoming an intuitive eater will mean weight gain and holds space for them to grieve their pre-recovery bodies. On her podcast interview with Dylan Murphy from Free Method Nutrition, Dylan authentically shares that she’s found herself using a catch-all slogan “let’s put weight on the back burner” and recognizes how that can be dismissive. If you’re anything like me, weight gain is at the forefront and the largest barrier to recovering. I respect professionals who emphasize that recovering may involve changes to your weight and hold space how for how much more challenging that is in a fat-phobic society.

My dietician puts it this way: for some, that means packing all of your calories into two meals a day because that’s when you have time to eat. For others who may not be comfortable reaching that level of fullness, they may eat six smaller meals every 2-3 hours throughout the day. It’s the same genetic variability discussed in starvation adaptation. This is why I view recovery on a continuum. It should ebb and flow, just like your level of activity, rest, productivity, etc. varies on any given day. It is when we get into a black and white or all or nothing mentality that we become too rigid and disordered patterns may begin to develop.

However, it’s important to note that initially, structure is necessary in recovery until you regain your true hunger and fullness cues. I remember being frustrated with my dietician because the meal plan I was prescribed in treatment contained three meals and three snacks per day. “But I don’t ever see myself eating three snacks in one day!” I told her. Her response was that we practice so we are okay with it when/if we do need that much food. There are days now when I’m on the go or traveling and I don’t have time to sit down and eat one full, balanced meal. I am thankful that I’m used to eating at the frequency that I did in treatment because it is easier for my mind to accept grazing throughout the day.

Restriction

Have you ever drunk a protein shake for lunch when you craved a Harvest bowl and felt unsatisfied? While the shake might’ve been filled with similar macronutrients and equal calories to the bowl, your brain wanted to chew on something! There’s a lot of power in listening to what you’re craving. Prior to my ED diagnosis, I was definitely privy to overeating “healthy” treats and depriving myself of anything with butter, table sugar, and white flour. As I’ve learned in recovery, your body doesn’t know the difference when breaking down a gluten, dairy, and sugar free cookie or a tollhouse straight from the tube! In treatment, the concept “all foods fit” is taught because everything has some nutritional value.

I do not believe it’s healthy to give in to every craving you have at any time. Contrary to what is preached in Eating Disorder treatment (where you are taught to ignore and even counteract every food rule that pops into your brain), dietician Sarah Grace says that restriction can be well-intended. As mentioned earlier about the intent behind dieting, the same applies here. If your intent to restrict yourself from having a third or fourth chocolate chip cookie is to avoid feeling nauseous and spoiling your appetite before dinner, it is coming from a place of love and care for your body. If your intent is to restrict yourself from having anything sweet because you want to lose inches off your waistline, this is coming from a place of hatred towards your body. Notice the difference? In ABA, dinner would be an abative effect, because it decreases the frequency of consuming more cookies. Losing inches of your waistline would be an abolishing operation because it makes cookies less appealing (reinforcing).