As a dietitian and eating disorder professional, I find myself answering the same types of questions week in and week out. There are common themes to the sorts of concerns held by the men, women and adolescents in my office. On one hand, it is troublesome to see the chaos caused by diet culture and to contend with it daily in the stories of my clients and their families. On the other hand, I see that the shared experiences provide an opportunity to gain clarity, apply language and make meaning of our chaotic relationships to food and body. Let’s take a look at some of the most common concerns brought regularly to my office.
Question 1: “How do I know what to eat? How much should I eat?”
On the surface, this might look like a very appropriate question to ask a registered dietitian. I mean, after all, we are the food professionals – right? Wrong. YOU are the food professional when it comes to your own appetite, preferences, desires and choices. Not me. The fact that nearly 100% of my clients come to me desperately wanting an answer to these questions indicates a deeply fractured relationship with their bodies. The heart behind this request is quite child-like. Embedded in this question is a desire to “be good,” “be right,” “be healthy,” “be secure,” and “be safe.” These are core longings common to the human experience. The troubling truth is that my clients (most of whom are adults) should not be needing anyone or anything external to answer these questions for them. Think about how stressful it must be to feel uncertain everytime your stomach grumbles, or conflicted when invited out to lunch, or confused about when to stop eating your meal. Our bodies signal for food every few hours, so for many, this means days on end of uncertainty and chaos. No wonder they are asking me what to do!
I feel so much compassion for these clients. Unfortunately, I am not able to give them a quick answer. (If they want a quick answer, they can ask google for a meal plan.) The answers lie in understanding how they have come to be disconnected from their appetites. In other words, how have they come to distrust their bodies? We are all born with hunger cues that tell us when to eat, receptors that tell us when we are full, taste buds to tell us what we like and brains to register pleasure and satisfaction. These are receptors are intact for each and every client that comes into my office, yet so many are unable to hear the cues or respond to them. The answer to the questions, “How do I know what to eat? How much should I eat?” are found in reconnecting to your own innate systems and relearning how to trust them.
Question 2: “What is the best way to lose weight?”
This question is one of my favorites. Again, a very appropriate question to ask the food professional. After all, we all know that dietitians put people on diets. It’s in the name. Well, maybe the dietitians of the 1980’s prided themselves on being the dieting experts, but thankfully, the field has evolved alongside medical research, and this is no longer the case.
So here is my answer to the weight loss question: restrictive eating and forced exercise are ineffective ways to lose and maintain weight loss. The most generous research suggests that 20% of dieters maintain a 10% weight loss for up to a year. In most long-term diet research, the results are closer to only 5% of dieters maintaining weight loss over a year. Another way to look at this would be to say 90-95% of dieters regain all of their weight (and most regain more weight) a year after stopping their diet. Any chronic dieter will tell you that the emotional and physical stress of losing and regaining weight is a terrible experience. These research conclusions mean that when people come to my office wanting to know how best to lose weight, I am ethically bound to tell them about the research and to urge them NOT to diet. This advice is contrary to what most people think. The weight loss industry makes it seem “easy to lose those pesky 50 pounds!” but upon closer examination of the medical research, this is clearly not the case in the long term.
Question 3: “Can you help me get back to my XXXXX weight?” (pre-baby, college, wedding, etc…)
Many clients hold the belief that they ought to maintain their weight through all of their adult life. Even teenagers have picked up on this belief and will ask me to help them “get back to” what they weighed when they were 12 or 13 years old! It is very important to understand that bodies are supposed to change over time. Bodies grow, soften, stretch, lose elasticity, and decrease in muscle tone as we age. This change is normal, and actually, weight gain may be physiologically beneficial during the later decades of life. Individuals in the “overweight” category according to the BMI chart have longer life expectancies than those in “normal” weight categories. Instead of resisting the 10 pounds that you have maintained after giving birth, or the 15 pounds you gained in college, we need to take movements toward acceptance.
When clients are insisting upon reaching a specific weight, I will often urge them to explore what they think they will gain by reaching this target. Typically, the answers sound something like, “I will be happier, healthier, more confident.” I affirm these desires because of course, we want to be moving toward these states of being, but I challenge them to pursue these things NOW, rather than associating them with a particular weight.
Question 4: “What caused my eating disorder? What caused my child’s eating disorder?”
This question elicits so much compassion from me as an eating disorder professional. Underneath this question is a desperate desire to understand the complexity, powerlessness, pain and chaos that accompanies eating disorders. There is no straightforward answer to this complex question. Eating disorders are multifactorial and involve a thorough examination of societal, familial, psychological, and emotional factors underpinning the eating disorder behaviors. A good treatment team will spend time with clients and family members to give through examination of each of these factors, but this comes later. The initial stages of treatment must focus on nutrition and weight rehabilitation and psychological stability. The deep dive into the root causes of the eating struggles will be explored after the brain and body are nourished and medical safety is established. Because of the multifactorial nature of eating disorders, it is critical to establish a treatment team that includes a variety of eating disorder professionals. A dietitian can help you better understand your diet and weight history and how some of your early patterns of restriction started showing up in your story. The therapist may explore the impact of family and social pressure, or may encourage you to examine your tendencies toward perfectionism and over-control.
If you find yourself contending with these sorts of questions, or are concerned about your relationship with food and body, please reach out to your medical providers or contact us at Integrated Care Clinic. We are a group practice that provides outpatient care to individuals struggling with eating disorders all across the spectrum.
