Eating disorders are an epidemic in this country, especially among young women. In May and June, according to a specialist Mental interviewed, spots in residential recovery centers are often hard to come by, because many college students wait until after the spring semester to start treatment or move from outpatient to virtual.
According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), a reported 28.8 million Americans—or 9 percent of the population—will have an eating disorder in their lifetime. But the actual number is probably much higher, because so many people hide their eating disorder (ED). In addition, more than 10,000 people die each year as a direct result of an eating disorder. These are preventable deaths, which is why awareness and early intervention are so important.
Eating disorders are highly misunderstood. Here are answers to four common questions from the Mental community.
Question #1: Is wanting to lose weight inherently bad for your mental health?
No, says Chantal Gil, Psy.D., a clinical psychologist and disordered eating specialist with Duke Health. And losing weight isn’t bad for mental health either if you do it in a way that’s both physically and mentally healthy.
Dr. Gil says to first think about why you want to lose weight. If it’s to ease joint pain or improve blood pressure, you’re doing it for the right reasons. But if it’s because of societal pressures or thinking you’ll be happier, your mental health can suffer. Dr. Gil suggests meeting with a therapist to explore these issues more.
The key to success mentally and physically is avoiding anything extreme—whether it’s restrictive dieting or excessive exercising—and focusing on balance, says Sarah-Ashley Robbins, M.D., a family medicine doctor at the Gaudiani Clinic, which gives medical care for people with eating disorders. Instead of thinking about what you can nix from your plate, think about what you can add instead. Can you boost the number of different veggies you’re eating per week? Experiment with new types of proteins? Cook with new combinations of spices?
Question #2: Why is dieting a bust for most people?
You may have heard of the Set Point theory, which suggests that we all have a specific natural weight and that dieting increases that number over time.
Truth is, it’s not a specific number. “It’s a weight range in which our body feels most safe and comfortable,” says Katherine Metzelaar, R.D., cofounder and CEO of Brave Space Nutrition, which specializes in helping people struggling with disordered eating. Each person has a different range—for some, it might be 15 pounds. For others, it’s 50.
Food restriction increases our range over time, says Metzelaar. How so? The body can’t distinguish between existing in a famine environment and intentionally losing weight. As you consume fewer calories, the body responds by hoarding them and breaking down muscle and bone—and the loss of muscle can result in a slower metabolism.
“The body is trying its best to survive,” Metzelaar says. “When we start eating regularly again, the body’s like, Okay, let’s make sure that doesn’t happen again.” You gain more weight back, and your range goes up. “This is partly why I say the best way to gain weight long-term is to go on a diet,” Metzelaar continues. “Losing weight becomes harder because the body is trying to resist famine.”
Question #3: Why does society seem to prefer thinner bodies, and can our minds be retrained?
Research has found that the more we’re exposed to different body types, the more we have a preference for them, says Metzelaar. So in the case of fat versus thin, we have a century of legacy mindset to shift.
“We all, everyone, have internalized fat stigma,” she says. “In my practice with my clients, we start by understanding their preference for a thinner body. What’s evoked when they see fat? How they view their body does change over time. They become more open to body diversity.” One first step to make: Check that the people you’re following on social media have a variety of body sizes and shapes.
Question #4: I (or someone I care about) is in recovery for an eating disorder, but lapsed. What should I do?
Setbacks happen. If or when one does, reach out to a therapist to talk through the situation to better understand that this is normal, says Dr. Gil. Above all else: “Continue to eat!” she says. “Sometimes when there is a setback, people feel tempted to engage with their eating disorder. It’s important to learn how to be flexible and try to focus on recovery goals. Call a friend, family member, or a partner so you have support.”