Indeed, experts estimate that at least 1.5 million people in the UK - of which 25% are male - have an eating disorder like bulimia. This evening Andrew (Freddie) Flintoff is opening up on BBC1 about his long-term struggle with bulimia.
When dealing with long term weight loss targets, and low-grade disordered eating, I don’t start with diet at all. I start by helping people feel better about the journey. This can take 4-6 weeks minimum. Working alongside psychologists is often required in more special cases.
PHASE 1.
- Restoring balance and building energy
- Supporting brain function with high dose omega 3 and brain training
- Reducing inflammation, especially for the hippocampus (the hunger centre of the brain), and increasing health-giving foods and nutrients
- Being mindful + self-awareness
- Planning and strategies – building routines, 1 step at a time
- Avoiding the pursuit of perfection
MINDSET
I think this area is really the key to the journey.
Many people are potentially in the vicious cycle of dieting circle, which is reinforced by low self-esteem. You can see how this works in this chart here.
Many readers may well benefit from some cognitive, behaviour therapy, CBT, work – but starting with the basics, goal setting, affirmations, planning etc. will be essential then you can unravel things more when you are ready. Using a CBT or personal coach is key.
There’s usually a strong need to focus on getting you healthier and happier 1st, also sleeping, exercising and eating better will start to help you feel better.
This is about balance and not feeling overwhelmed. In order to prevent feeling overwhelmed you need a plan.
Plans can to be guided by me, but and this is really important – any plan you make is your plan. You can contact me about having me guide you through a journey towards better health and wellness. matt@aminoman.com
The vision you have is key here.
Which is part of the goal setting we go through during the consultation process. Starting to set up routine and establish the lifestyle means, you’ll enjoy the journey and not focus all the time on the outcome. I’ve written plenty about goal setting here.
SLEEP + WELLBEING FIXES
Many people struggle with poor sleep and low-grade inflammation.
To aid sleep and inflammation starting on some higher dosed fish oils, a good multi-vitamin and some night-time aminos will be a great idea.
These have been shown to help restful sleep, serotonin and reduce inflammation so they will help make your mind and body feel better whilst you improve your health, food and movement.
PHASE 2
- Starting with self-awareness and kindness is the first step
- Trying not to change too many things too fast is also critical
- I would suggest this week you focus just on healthy evening meals
- Take each day, 1 at a time. Start with today.
- Then the following week you focus on a protein rich meal for your first meal of the day. Then you can look at daily steps and getting 1 exercise session done that week
- Always reach out for help and support if you are in this mindset or suffering from any of the disorders outlined below.
https://www.psychologytoday.com/us/blog/nurturing-self-compassion/201703/8-steps-improving-your-self-esteem
https://cloudninekitchenblog.wordpress.com/about/
Write down the opposite of each of these feelings, along with a way to achieve the opposite feeling.
E.g. I’m useless = change too “I can change”
I’m a failure to = “I’m only 1 meal or 1 walk away from feeling better again”
“I can deal with setbacks”
It’s important these are in your own words too.
https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00062/full
Disordered Eating: An Introduction
It’s not unusual to see athletes with ‘disordered eating’ or an eating disorder – either suspected or diagnosed. This can be more common in female athletes, but also occurs in males, especially in sports that require the individual to stay at or reach a specific weight – e.g. fighters, bodybuilders, runners, dancers or gymnasts (of both sexes). Young athletes in particular can be vulnerable, as coaches and parents may unknowingly contribute to the eating disorder by encouraging weight loss in order to reach training goals.
Your work with clients won’t necessarily involve helping them to recover from an eating disorder (although your work together may be part of their eventual recovery plan) but you will at least need to know how to recognise the signs in a client, so you can refer them back to their doctor for support. Therefore in this lesson we will be looking primarily at the characteristics of each disorder rather than how to treat or support an individual with the condition.
Referral to doctor: Note that if you suspect that your client may have an eating disorder but he or she hasn’t already had a diagnosis, it is important to first of all refer the person back to their GP. You can continue to work with that individual if appropriate, but the GP should be notified. ‘Disordered eating’ that isn’t at the level of an eating disorder is a bit more of a ‘grey area’ regarding whether a referral is needed.
You may also want to go back to our lesson on female athletes (Week 38) where we looked at the condition of female athlete triad, which often involves disordered eating.
Risk factors for developing an eating disorder include [1,2]:
- Sports that emphasize appearance or low weight, as mentioned above.
- Individual sports are said to bring a higher risk than team sports.
- Endurance sports such as running or swimming.
- Low self-esteem
- Perfectionist personality
- Parents who place a lot of pressure on the son/daughter to do well in their sport
- Family members, friends or peers with eating disorders
- Chronic dieting in the past
- Traumatic life experiences
- Mental health disorders – e.g. depression, anxiety or obsessive-compulsive disorder
- Coaches who focus primarily on success and performance rather than on the athlete as a whole person.
It’s worth noting that diagnosed eating disorders are classified as mental health conditions as well as physical conditions. There is often a strong link with emotional distress, fear and control.
References
1. https://www.nationaleatingdisorders.org/athletes-and-eating-disorders
2. http://www.mayoclinic.org/diseases-conditions/eating-disorders/basics/risk-factors/con-20033575
Anorexia nervosa
Anorexia nervosa is a condition where the person severely limits their food intake to keep their body weight low. The person may have a distorted image of themselves, thinking they are ‘fat’ or still need to lose weight, when they may already be underweight.
Anorexia is rarely just about food or weight or even appearance. The following can be key factors:
Control: There is a feeling of control through restricting food intake, and so (in the general population or in athletes) anorexia may manifest at a time when the person feels unsafe or insecure or feels they have a lack of control over their life in general.
Fear: Even if the person knows they are underweight, there is often an extreme fear of ‘losing control’ and gaining lots of weight if they start eating more.
Achievement and identity: losing weight can also give a sense of achievement and identity, perhaps even more so in athletes, especially if they receive positive reinforcement from coaches, parents or peers when they lose weight.
Signs of anorexia may include:
- Being obviously underweight yet not recognising it, or not seeming willing to eat more or address the problem
- Preoccupation with body weight
- Distorted perception of body shape or weight
- Counting calories in everything / strict dieting / eating only low-calorie foods
- Fear of eating fat and/or carbohydrates, or any food they think is fattening
- Fatigue
- Loss of muscle size or strength
- Low blood pressure
- Low body temperature / feeling cold most of the time
- Loss of menstruation in women (see also Female Athlete Triad)
- Hair falling out
- Hiding their habits from family, e.g. pretending they have eaten when they haven’t (this will be difficult to judge from a consultation, of course)
- A multitude of nutrient deficiencies, especially with long-term anorexia
For more information, see: http://www.b-eat.co.uk/about-eating-disorders/types-of-eating-disorder/anorexia
Bulimia nervosa
Bulimia nervosa is a condition where the individual binge eats and then purges – typically by either vomiting or using laxatives. This may alternate with restricting food intake at other times.
The signs of bulimia can be quite different to anorexia. In particular, the individual is not generally underweight – their weight is often within a normal range.
Signs of bulimia can include:
- Regular changes in weight
- Preoccupation with body weight
- Distorted perception of body shape or weight
- Any signs of vomiting – such as scarred knuckles
- Swollen salivary glands, making the face appear rounder
- Frequent visits to the bathroom after eating
- Use of laxatives or diuretics
- Excessive exercising
- Eating in secret
- Fatigue
- Digestive problems including gastric pain, constipation, bloating
- Mood swings, feeling anxious or tense
- Loss of menstruation in women
- Nutrient deficiencies
As well as the general consequence of nutrient deficiencies, long-term complications of bulimia can include dental problems, irritation of the oesophagus and throat, permanent constipation (due to laxative use), imbalances of electrolytes in the body and even heart problems.
For more information, see:
http://www.b-eat.co.uk/about-eating-disorders/types-of-eating-disorder/bulimia
http://www.nhs.uk/Conditions/Bulimia/Pages/Complications.aspx
Orthorexia
The term ‘orthorexia’ is not yet recognised as an official diagnosis. It refers to an obsession with healthy eating or ‘clean eating’ that starts to have a negative impact on the person’s health or life. Contrary to anorexia and bulimia, it is not usually related to the desire to lose weight, although may be more common in someone who has a history of other eating disorders.
Orthorexia can often start out as an intention to eat more healthily. This may include cutting out junk foods or processed foods, fat, sugar or carbohydrates, animal foods or gluten, or any other foods or food group considered unhealthy to that person.
For most people, cutting down on some of these foods (especially processed and junk foods) and increasing intake of ‘real’ or healthier foods is obviously a positive move. For others, however, it may become an obsession and become overly restrictive and rigid. This may involve:
- Cutting out more and more foods, until the diet is very limited, even to just a handful of ‘pure’ foods. This is often accompanied by low calorie intake and missing out on one or more macronutrients necessary for health, e.g. fat or carbohydrates.
- Becoming obsessive about not being exposed to any ‘unhealthy’ foods, to the point where the person is afraid to go out and socialise, or they miss out on other activities.
- Their obsession starts to affect their relationships with partner, family or friends, perhaps because they are so preoccupied with food that anything else takes second place.
The consequences can be similar to other eating disorders, including nutritional deficiencies, excessive weight loss, health deterioration, social withdrawal and depression.
Orthorexia may be more likely if the person has a history of another eating disorder, such as anorexia, or if they already had a limited diet, e.g. a vegan or a raw food diet.
For more information, see: https://www.nationaleatingdisorders.org/orthorexia-nervosa
Binge eating disorder
Binge eating disorder is characterised by binge eating on a regular basis, but without purging afterwards. This is less commonly seen in athletes than the other types of disorders discussed here. Contrary to the other eating disorders, binge eating disorder is said to affect men just as much as women.
In a way, binge eating disorder can be seen as the opposite end of the spectrum to anorexia, as there is a complete loss of control over eating and the person is often overweight or obese. However, the ‘mental’ side of the disorder does have some common factors with these other conditions, including low self-esteem and lack of confidence, self-harming, secretive behaviour, and the disconnection between eating and hunger.
As for bulimia, periods of bingeing may alternate with restricting food intake at other times – or follow a period of strict dieting – which then increases the compulsion to binge eat.
Signs of binge eating disorder can include:
- Gaining weight (sometimes rapidly, but not always)
- Eating in secret
- Low self-esteem
- Feelings of guilt, shame or disgust
- Digestive problems including gastric pain, constipation, bloating
- Depression and anxiety
- Anxiety or distress around weight gain
- Long-term complications of binge eating disorder are similar to those for obesity – namely, high blood pressure and cholesterol, heart disease, type II diabetes and so on.
For more information, see:
http://www.nhs.uk/conditions/binge-eating/pages/introduction.aspx
http://www.b-eat.co.uk/about-eating-disorders/types-of-eating-disorder/binge-eating-disorder
Disordered eating
‘Disordered eating’ is a wider term referring to any abnormal relationship with food or eating behaviour that does not meet the criteria for a diagnosed eating disorder. It may share characteristics with any of the disorders outlined above – such as binge eating, obsessively controlling calorie intake, skipping meals, only eating a limited group of foods, purging/using laxatives; or other unusual behaviours such as ‘night eating’. The primary difference is generally in the frequency and/or severity of the behaviour, which is not taken to the same extreme as someone with a diagnosed eating disorder. The primary reason for disordered eating is to reduce body weight or control body shape, but there may also be other motives.
Disordered eating may be much more common than diagnosed eating disorders, because it is really just a set of symptoms that occurs on a continuum between ‘healthy dieting’ and having a true eating disorder.[1] Anyone who has restricted their calorie intake to lose weight and then ended up binge eating as their body craves nourishment could be said to have experienced disordered eating – probably most of us at some time or another!
Mild disordered eating may not cause any immediate health problems; however, it can lead on to more extreme behaviour such as a full-blown eating disorder. This is why it is important to look for the signs and help to stop the person progressing to the next stage.
I hope you found this article useful. Here is a link to another great article on binge eating: https://www.neverbingeagain.com/stop-binge-eating/