Dietitian Blog | Mar 14 2023

Eating disorders: Facts and fiction

sad teenager girl with scale on wooden floor

As dietitians, it is not uncommon to encounter patients with disordered eating. In fact, 28.8 million Americans will develop an eating disorder at some point in their lives. To provide the best possible care for patients, we need to recognize the various types of eating disorders, common misconceptions, best practices for treatment, and how a dietitian’s involvement is an essential piece of the patient’s treatment plan. 

Types of eating disorders 

Anorexia Nervosa is characterized by purposeful restriction of energy intake to lose weight. In adolescents, anorexia may cause a lack of appropriate weight gain. Some with anorexia may also participate in purging behaviors. Many with this disorder experience a fear of weight gain or distress regarding body image. 

Bulimia Nervosa features repeated instances of binge eating followed by purging behaviors such as induced vomiting, misuse of diuretics or laxatives, food restriction, or excessive exercise. Like those with anorexia, disordered behaviors may be driven by weight or body image concerns. 

Binge Eating Disorder (BED) is characterized by repeated instances of binge eating without purging episodes. Although those with BED do not participate in compensatory behaviors, it is common to still have feelings of distress after binging. 

Avoidant/Restrictive Food Intake Disorder (ARFID), like anorexia, features restriction of amount or types of food that leads to weight loss and nutritional deficiencies. Unlike anorexia, those with ARFID don’t experience body image and weight concerns that drive behaviors. Restriction of foods with ARFID can be related to a range of things, such as sensory characteristics of foods or fears of choking.  

Other Specified Feeding and Eating Disorder (OSFED) was previously named Eating Disorder Not Otherwise Specified (EDNOS). The OSFED diagnosis criteria encompasses significant disordered eating behaviors that may not fit well into other eating disorder categories, such as purging behaviors in the absence of binge eating. 

There are also some disordered eating behaviors that are common enough to have coined their own terms but are not recognized as separate diagnoses by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Below are some terms you may hear when working with eating disorders. 

Atypical Anorexia Nervosa is described as a person meeting all behavioral criteria for anorexia but being of normal weight. 

Diabulimia is described as disordered eating behaviors in people with diabetes, usually Type 1, in which those affected manipulate insulin doses to lose weight.  

Orthorexia is an unhealthy concern for the nutrient profile of food groups and ingredients, which may cause restriction of foods deemed “unhealthy.”  

Common misconceptions regarding eating disorders 

Patients are aware that their behaviors are disordered. 

Not every patient you encounter will have a formal eating disorder diagnosis, and some may not even realize their behaviors are detrimental to their health. Fad diets, food tracking, and sports that require specific weights or physiques have the potential to encourage disordered behaviors. It may take some counseling with patients to help them discover that behavior change is necessary for overall health. 

If a patient has an eating disorder, it means they are underweight. 

Although being underweight is a characteristic of some eating disorders, a majority of people struggling with disordered eating patterns are of normal weight. Weight can also fluctuate often in those with eating disorders, depending on behaviors. 

Disordered eating behaviors are always food- or weight-driven. 

Disordered eating stems from a variety of biological and psychosocial attributes. Behaviors are sometimes used as a coping mechanism for life circumstances completely unrelated to food or body image.  

When a patient no longer participates in disordered eating behaviors, they are recovered. 

Although not participating in disordered habits is a huge step in recovery, eating disorders can still have a large impact on day-to-day life for those affected by negative body image or low self-worth. Improving eating behaviors is just one step in recovery. 

Best practices for nutrition care 

Use blind weights. Tracking weight trends are often a necessary part of treatment for those with an eating disorder. However, letting patients see their weight change can lead to increased disordered thoughts and discourage patients from recovery.  

Tip: Take a blind weight by having the patient step on the scale backwards or hiding the number from them. You can encourage other members of the treatment team to do this as well while the patient is working on recovery. 

Follow an “all foods fit” stance. It’s easy to label foods as “healthy” or “unhealthy,” but this can be an unhelpful mindset for patients with an eating disorder.  

Tip: Discuss foods with a neutral stance, allowing the patient to understand both the benefits and drawbacks of all foods. For example, whole wheat bread is beneficial for its fiber content and satiation factor but may make people feel full quickly. On the other hand, white bread digests easily and can provide quick energy but may not feel as satiating. 

Discourage the “all or nothing” mentality. Many patients with eating disorders have rigid rules when it comes to food and exercise. When an event comes up in life that doesn’t fall in line with the rules, such as eating a dessert at a birthday party or missing a workout after working late, patients may feel like they’ve failed and give up. This can lead patients to spiral and engage in disordered eating behaviors.  

Tip: Work with your patients to find a middle ground. Discuss how small deviations from plans are not a sign of failure but are part of everyday life. This will likely take practice for patients. 

Practice empathy. Try to understand each individual and their current situation. When you work with patients with disordered eating, they may not be considering recovery, or they may have been in recovery for years. Every patient’s story is different and no path to recovery looks the same. 

Tip: Meet the patient where they are. Find what they are willing to work on, rather than forcing them on a path they are not ready for. 

Who else helps to care for individuals with eating disorders? 

Eating disorders are complex. Treatment often requires a combination of physical and mental health interventions along with nutritional guidance to see significant changes. Dietitians are an essential part of multidisciplinary teams that treat those with eating disorders. Other healthcare professionals that make up these teams can include general practitioners, pediatricians, psychologists, psychiatrists, social workers, case managers, occupational therapists, and nurses.  

Dietitians On Demand is a nationwide staffing and recruiting company for registered dietitians, specializing in short-term, temporary and permanent-hire positions in acute care, long term care and food service positions. We’re dedicated to dietitians and helping them enhance their practice and excel in the workplace. Check out our job openings, request your coverage, or visit our store today! 

Eating disorder statistics: General & Diversity stats: Anad. National Association of Anorexia Nervosa and Associated Disorders. Published June 8, 2022. Accessed January 7, 2023.  
Eating disorders in males. Eating Disorder Hope. Published August 4, 2022. Accessed January 6, 2023. 
Information by eating disorder. National Eating Disorders Association. Published February 21, 2018. Accessed January 9, 2023.  
McCallum place | DSM 5 diagnostic criteria for eating disorders. Accessed January 10, 2023.  
Qian J, Wu Y, Liu F, et al. An update on the prevalence of eating disorders in the general population: A systematic review and meta-analysis. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. 2021;27(2):415-428. doi:10.1007/s40519-021-01162-z  

About Leah Amey

Leah Amey, MS, is a dietetic intern and has spent much of her clinical practice hours working with veterans at the VAMC of Richmond, VA. Leah also has experience teaching nutritution courses to undergraduate students at Drexel University. After become and RD, Leah hopes to continue sharing nutritional knowledge with others in a private practice setting.

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