When Does a Diet Tip the Scales & Become Disordered?
There’s no doubt that the US is obsessed with dieting. A pathological combination of unhealthy body images in our media and the soaring obesity and obesity-related disease rates, there is never not a fad diet go on. Atkins, South Beach, Paleo, Keto, intermittent fasting – and we haven’t even gotten to those snake-oil Hollywood lemon and cranberry cleanses. Which, let’s be honest, do little more than scrape all the good stuff out of your intestines and dehydrate you.
But this collective easy-fix-weight-loss hysteria is more serious than growling stomachs and perpetual hungriness; it’s actually contributing to eating disorders in some pretty disturbing ways. When you diet without attention on nutrition and nourishment, you’re starving your body as well as your mind; it’s a slippery slope from discipline to disorder.
How Has Diet Culture Affected Rates of Eating Disorders?
Disordered eating tends to develop most often in teens and young adults, though diet culture has contributed to an uptick in rates of eating disorders in people 25-50. According to the National Eating Disorders Association:
- US consumers spend upwards of $60 billion on dieting each year.
- 3% of teenage girls and 28.8% of teenage boys report trying to lose weight.
- Half of teen girls and 1/3 of boys report engaging in unhealthy eating behaviors like vomiting, smoking and skipping meals.
- 35-57% of teenage girls engage in extreme dieting behaviors like fasting, vomiting, taking diet pills, etc.
- In a study of 14-15 year olds, moderate dieting increased the risk of developing an eating disorder by 5x, where extreme dieting made them 18x more likely to develop at eating disorder.
- Girls who regularly diet are 12x as likely to binge eat as those who don’t diet.
The reasons these statistics are so scary is because that slippery slope we talked about is filled with disordered thought patterns that can have permanent repercussions. Comorbidity studies show the development of these disordered thoughts make the slope much more slippery for some than others.
- A study of 2400 eating disorder patients showed that 97% had one or more co-occurring conditions:
- 94% had mood disorders
- 56% had anxiety disorders, including:
- 20% OCD
- 22% PTSD
- 22% alcohol and substance use disorders
- 2/3 of people diagnosed with anorexia nervosa showed symptoms of anxiety-related disorders prior years several to their eating disorder.
- 8% of women who are hospitalized for an eating disorder regularly self-harm.
- In a national survey, 95% of respondents with bulimia, 79% with binge eating disorder and 56% with anorexia met DSM criteria for at least one other psychiatric disorder.
Understanding the Signs of an Eating Disorder
Often, people who struggle or have struggled with an eating disorder will tell you it happens gradually, until suddenly it doesn’t, which is why it’s important to understand the signs of an eating disorder. Because the mental and physical processes feed off of each other, creating dysfunctional neural pathways, organ and bone damage, early detection and treatment is key to recovering from an eating disorder.
The main components of anorexia nervosa include an inability to maintain a healthy weight, unhealthy weight loss, and body dysmorphia. Affecting up to 2% of females at any given time, it presents as obsessive control over eating, including excessive calorie restriction, extreme dieting, vomiting, bingeing/purging, and excessive laxative/diet pill use. Signs include:
- Making excuses to skip meals and/or not eat in front of other people
- Is preoccupied with calories, fat, weight and weight
- Dramatic weight loss
- Wearing oversized clothes to hide the weight loss and/or stay warm
- Cessation of menstrual cycle
- Thinning of hair on head with development of fine hairs all over body (lanugo)
If untreated, anorexia can result in permanent cognitive issues as well as severe organ, bone, muscle, and skin damage. This eating disorder also reaches a point of no return, where the body has made such an effort to accommodate the starvation that the patient cannot physically begin to eat enough food again and die of malnourishment, which is why early detection is so important.
Binge Eating Disorder
Binge eating disorder was officially recognized in the DSM-5 in 2013, and has quickly become one of the most commonly-diagnosed eating disorders in the country, mostly occurring in overweight and obese people. Characterized by episodes of extreme and rapid food consumption followed by feelings of shame and guilt but not doing anything to fix the pattern. Signs include:
- Evidence of bingeing – large amounts of food gone, hidden piles of wrappers, etc.
- Hoards food in strange places
- Has anxiety about eating in the presence of others
- Is obsessed with body image and weight
- Frequent but short-lived dieting
- Noticeable weight fluctuations
Almost as well-known as anorexia is bulimia nervosa. This eating disorder presents as a cycle of binge eating episodes followed by purging episodes of vomiting or other compensatory means. The repeated vomiting can cause irreparable esophageal damage, including ulcers and tears. Contrary to popular belief, most people with bulimia are either a normal weight or overweight. However, the purging and obsessive food control can still cause the same malnourishment issues as anorexia. Signs of bulimia include:
- Behaviors that point towards weight loss and dieting as a primary focus in daily life
- Frequent trips to the bathroom after eating
- Excessive use of mints and gum (to cover the smell of vomit)
- Stained and discolored teeth
- Calluses and/or abrasions on backs of hands and knuckles from inducing vomiting
- Purges after binge sessions via vomiting, laxative use, diet pills, exercise, fasting, etc.
This eating disorder is a direct result of the rising of diet culture in the US; the term orthorexia wasn’t even coined until 1998. Though still not officially-recognized by the DSM, orthorexia is nonetheless an all-too-common disorder. Defined by a preoccupation with healthful eating that has become pathological, people with orthorexia take control over their nutrition to the point of hurting their health. Signs include:
- Cutting out entire food groups because of nutrition concerns
- Obsessively checking nutrition labels and ingredients lists
- An obsession with the health of ingredients
- An obsession with the health of other people’s food choices
- Excessive following of or participation in health-related social media accounts
- Anxiety when presented with unexpected foods at events
Orthorexia may or may not come with issues about body perception and weight.
How to Get Help if You Think You Have a Problem with Eating
Here’s what we have to remember amidst all the noise of diet fads, advertising, and social media:
- Exercise should be self-care, not a punishment
- Size does not equal health
- Practice intuitive eating over restrictive eating
- Focus on health gains instead of weight loss
And if you think you’re developing an eating disorder, or currently have one and need treatment, know that you’re not alone, and there are resources to help you grow into a healthy relationship with food again. Nutritionists, wellness doctors and mental health professionals all over the country treat these disorders every day. For additional resources, visit: