It's no secret that in today's society we live at a lightning pace. Everything is fast now – fast internet, fast cars, trains, even fast food. In such chaos, it's easy to get lost and neglect your basic human needs. One of them is food.


A healthy relationship with food is probably the first skill that our parents try to teach us from childhood. Unfortunately, many of us neglect this skill as we go through life. And sometimes, along with various other emotional health problems, food becomes a tool used to cope with unpleasant feelings.


It can often be difficult to recognize what an eating disorder is and what may be disordered eating. It’s even harder to know what to do about it. That’s why this month’s newsletter
We share the thoughts of two specialists working at "Maali būti" about (un)healthy eating.

1. What is the difference between an eating disorder and disordered eating? When should you be concerned? What are the “red flags” that something is wrong?

PSYCHIATRIST – PSYCHOTHERAPIST INDRĖ KOTRYNA GRINEVIČIENĖ

Disordered eating is the boundary between healthy, normal eating and an eating disorder. Disordered eating can be characterized by such eating disorder symptoms as skipping meals, avoiding certain foods, overeating, irregular, unhealthy eating, a strong focus on weight loss, etc. In the case of an eating disorder, thoughts about food and the body begin to take up a lot of space inside a person and in everyday life: the person thinks about it a lot, begins to feel difficult feelings about it, and the person's life and choices become strongly related to the topic of food and/or weight.
The line between disordered eating and an eating disorder is quite narrow, and disordered eating can develop into an eating disorder.

PHYSICIAN AND DIETITIAN LINA BARAUSKIENĖ

Disordered eating can be defined as a variety of abnormal (non-physiological) eating behaviors that do not yet meet the diagnostic criteria for eating disorders. Unfortunately, such behaviors are very common and normalized in society. These can include skipping breakfast, not eating carbohydrates, fear of sugar, long periods of fasting, overeating, etc. It can also include various diets and their forms.
Disordered eating behavior is also when eating is used to regulate emotions or feelings.
Eating disorders and disordered eating have many similarities. The difference is that the symptoms of disordered eating are not as intense and pervasive, and they interfere less with daily life. Thoughts about food and body image are distressing, but they do not overshadow daily activities and responsibilities. Eating disorders have diagnostic criteria, and disordered eating does not meet all of them.
Red flags in eating (those signals that should be paid attention to when they appear):

  • Disordered eating, forgetting to eat
  • Desire to restrict food, interest in a new diet or eating method
  • Sudden change in eating habits
  • Decreased or increased amount of food eaten
  • Overexercising (too often, too much, too intensely)
  • Avoiding leaving home, meeting friends, attending events, especially where there will be food
  • Excessive interest in food, recipes, constant cooking for others
  • Excessive concern with one's appearance, criticism, comparison with others
  • Dividing food into good and bad
  • Sudden weight change – loss or gain

2. How to cultivate a healthy relationship with food?

PHYSICIAN AND DIETITIAN LINA BARAUSKIENĖ

A healthy relationship with food is an important part of a healthy diet. If we eat healthy foods but have an unhealthy relationship with food, it is not a healthy diet. How to cultivate a healthy relationship with food:

  • Eat a variety of foods, don't categorize foods as "good" or "bad"
  • Try to have all the nutrients on your plate most of the time during your main meals: carbohydrates (starchy vegetables, grains), proteins (meat, fish, beans, etc.), fats (oil, butter, seeds, etc.), fiber, and vitamins with phytonutrients (fruits and vegetables). However, you don't need to strive for this all the time - flexibility in eating is very important
  • Know that fun foods are part of a normal diet
  • Do not single out certain foods as more beneficial (e.g. proteins) and do not demonize others (e.g. carbohydrates)
  • Enjoying food. Eating without shame, fear or guilt, not punishing yourself by not eating.
  • Not having the conditions for food or eating (e.g.: I will eat THIS because I am going to exercise afterwards and will exercise; since I didn't eat breakfast, I can eat dessert, etc.)
  • Adjust meal times and food amounts based on your feelings of hunger and satiety
  • Eat delicious and enjoyable food

3. What difficulties do people with eating disorders most often face?

PHYSICIAN AND DIETITIAN LINA BARAUSKIENĖ

People with an eating disorder may experience a variety of unpleasant feelings as a result:

  • Constant anxiety about eating and food choices – what to eat, how much to eat, when you can and cannot eat
  • Eating disorders are characterized by a number of rigid rules and rituals (e.g., eating only at specific times, cutting food into small pieces, eating only with a small fork, eating food in a specific order, etc.)
  • Social isolation is common, communication with friends and relatives is interrupted, and people avoid going to places where food will be available. On the one hand, this is because food choices are difficult, on the other hand, if food is severely restricted, there is a lack of energy, and there are no resources to communicate.
  • Frequent mood swings are characteristic, which worsens relationships with loved ones and family members
  • In anorexia nervosa, due to malnutrition, the body goes into "saving mode" as if: metabolism slows down, the work of the digestive system slows down, which causes various ailments of this system (heartburn, indigestion, heaviness, early satiety, bloating and constipation), due to thermoregulation disorders, cold tolerance decreases, the person constantly feels cold, and the extremities become cold. Hormonal activity may be disrupted: thyroid, gonadal. The risk of osteoporosis increases. Women may experience amenorrhea - menstruation may be disrupted or disappear. Sleep may be disrupted. Headaches and dizziness may occur due to hypoglycemia and impaired blood circulation. Heart rhythm disorders are also possible
  • In the case of bulimia nervosa, electrolyte imbalances and fluid loss are life-threatening. The stomach, esophagus, and teeth are damaged.
  • If overeating is prevalent, weight gain may be a concern, leading to food restriction, which only reinforces the overeating. This leads to a vicious cycle of restricting-overeating-restricting disorders?
  • A lot of attention and energy is given to body image. It is often distorted, the image in the mirror does not correspond to reality. There is constant body checking and comparison with others

4, How is eating disorder treated during therapy?

PSYCHIATRIST – PSYCHOTHERAPIST INDRĖ KOTRYNA GRINEVIČIENĖ

Eating disorder behavior is largely a developed mental way of regulating feelings and is very strongly related to a person's self-esteem. A person begins to strongly associate their value, their sense of self with weight and/or food, and eating disorder behavior becomes a way to cope with unpleasant/intense feelings. Thus, during psychotherapy, the primary goal is to learn to recognize their feelings, learn to regulate them, i.e. to cope with them, discover and apply harmless ways of calming down. The goal is to strengthen a person's self-esteem.

However, it is important to emphasize that in parallel with psychotherapy, nutritional therapy and the restoration of regular and wholesome eating are also very important. Sometimes people have the idea that "I need to solve my psychological problems first, and then my eating will take care of itself." This thinking is wrong, because in the presence of
disordered eating behavior, nutrient deficiency, inevitably affects our body and psyche. Anxiety, tension, sleep disorders, even a huge intensity of thoughts about food can be and often are the result of nutrient deficiency (even with normal or higher weight). Therefore, analyzing a person's feelings and reactions without first restoring the eating regimen or nutrient deficiency may not be at all appropriate. In the treatment of eating disorders, cooperation between specialists in different fields is very important, because eating disorders affect not only the human psyche, but also the body. The team often includes a family doctor or internal medicine doctor, a physiotherapist, and sometimes the help of specialists in other fields is also needed, for example, a gynecologist.

5. How do consultations with a dietitian on this topic take place?

PHYSICIAN AND DIETITIAN LINA BARAUSKIENĖ

Consultations with a dietitian are regular and ongoing, initially once a week, but later, after assessing the situation, meetings can be held less frequently. The average duration of these diseases is 6-12 years, so the treatment is long-term.

The initial consultation assesses the health and nutritional status, complaints, duration of the disease and the onset of symptoms. The current diet is assessed. Height is assessed, if the weight is too low, body weight is measured and monitored or a body weight composition analysis is performed. The necessary tests are prescribed to assess the nutritional status.

Since in eating disorders, the feelings of hunger and satiety are out of sync, they cannot be trusted, and food choices cause great stress - in order to regulate nutrition, make it sufficient, regular, and balanced, a nutrition plan is created.

Such eating, which takes place according to a diet plan drawn up by a dietician, is called mechanical eating. This is the initial stage of nutritional rehabilitation. During it, the diet is restored, the goal of which is to ensure regular and sufficient eating, restore the missing body weight if it has decreased, or stabilize it if weight fluctuations are repeated. Later, efforts are made to diversify the diet by including different food products. Education is provided about the benefits, effects and need for nutrients for health and life. Efforts are made to gradually return the “terrible food” to the diet.

You will also be taught how to plan meals, feel and respond to hunger and satiety. You will learn the principles of intuitive eating step by step. Between consultations, it is recommended to keep a food diary, which will be discussed during the meeting with the dietitian.

A dietitian is one member of the eating disorder treatment team. Recovery is most effective when a team of specialists works together.

Today, disordered eating behavior is very much normalized, because there is a lot of information on social media about weight loss, regulation, dieting, and there are a lot of people in the environment who are on diets or trying to regulate their weight. However, we want to emphasize that it is not normal when a person's well-being, life and choices are determined by thoughts about food and weight, this can greatly affect our quality of life, and the longer the disordered eating/eating disorder continues, the more it "grows with our personality" and the harder it becomes to "get out of it", the more we can suffer from it in the course of life. Therefore, if you have even the slightest doubt about whether the topic of food/weight is taking up too much space in your life, I recommend sharing these thoughts and talking to a specialist with experience in eating disorders (dietitian, psychiatrist, psychotherapist).

If you feel that eating (or stopping eating) is difficult, or if you are bothered by constant thoughts about food and your body, this causes a lot of anxiety, or perhaps there are already clear symptoms of the disease - I would encourage you to seek advice, because the longer the disease lasts, the more chronic it is - the harder it is to recover. And recovery from eating disorders is possible! Sometimes it's a long and difficult journey, but when there is help, that journey becomes much easier and clearer.