As dietitians, we dedicate years to learning how to help people be the healthiest they can be. We learn what to eat in what amounts, how food and movement can help avoid diseases, and much more. We focus so much on “health” that we might fail to notice when these so-called “healthy” habits are taken to the extreme. Here are 4 habits that are generally considered beneficial, but could be warning signs of disordered eating (DE) or an eating disorder (ED). It is important for dietitians to recognize these red flags and address them with clients.
Eating a lot of fruit and vegetables
While consuming nutritious produce is great, it can also be consumed for not-so-healthy reasons. Oftentimes, individuals suffering from DE/ED eat vegetables in excess to help them feel full on fewer calories. Diet culture tells us eating produce helps with weight loss. As a result, fruits or vegetables might be consumed in place of typical grain sources like bread, rice, and pasta because it feels “safer.” Practiced in excess, dieting behaviors like these can be the starting point for an eating disorder.
Heavy intake of fruits and vegetables can result in the restriction of other nutritious foods. For example, if someone has an extra-large serving of veggies at meals, they might get full before they can eat their grain, protein, and fat servings. Make sure a client’s overall caloric consumption matches their needs and comes from a wide variety of foods.
Maintaining a consistent exercise schedule
Making time to exercise on a regular basis is great for overall health. Most of us live busy lives, so sticking to a regular fitness routine can help ensure we actually do it. However, being mindful to not be too rigid is equally important. There are several warning signs of an unhealthy relationship with exercise. Some of these include skipping out on time with friends, running late to appointments due to a workout routine, or increased anxiety when one’s routine is thrown off (i.e. due to sickness, vacation, etc.).
Similarly, one should engage in enjoyable movement activities, not simply exercise to lose weight or alter one’s body. There should be an adequate amount of rest days and flexibility in a routine to accommodate our ever-changing schedules and lives. Promote exercise routines that are enjoyable and realistic.
Avoiding dessert
Avoiding sweets, or fast food, white carbs, regular soda…. insert whatever “unhealthy” food you like... can become overly restrictive and ultimately unhealthy. Unless there is a religious or medical reason, no food should ever be cut out or totally avoided. If food avoidance is present, there is also the likelihood of an unhealthy relationship with food. Unfortunately, constant dieting is very common, which can make it even harder to recognize a true eating disorder. In fact, dieting is a risk factor for developing an eating disorder or disordered eating. In one study, dieting teens were found to be 5-10X more likely to develop an eating disorder compared to those who didn’t diet (1).
Pay attention to how your client is talking about food. If they frequently label foods as “good” or “bad” or even identify themselves using these words in relation to their eating habits (i.e. “I was so bad today, I ate dessert”), then it’s time for an intervention.
Having a “normal” body mass index (BMI)
Pardon me if I get on my soapbox when discussing BMI. Health professionals are taught to treat BMI as a gold standard of health. If someone is within “normal” BMI standards they are assumed to be healthy while someone classified as “overweight” or “obese” is automatically categorized as unhealthy. There are multiple problems with this. First, although we learn much about BMI, we rarely learn how it was developed. In 1850, Lambert Adolphe Jaques Quetelet, mathematician and astronomer, was interested in “society's average man.” He was not interested in health risks and based his calculations on white males only. It was renamed BMI by Dr. Ancel Keys in 1972 and is still widely used today as an assessment of healthy body weight.
BMI is an outdated tool that does not consider body or size diversity and lacks evidence for use in individuals, despite its broad acceptance and use. Research shows individuals with a higher BMI can live just as long, or longer, than those with a “normal” BMI (2). As an eating disorder dietitian, I have observed this time and time again. Clients with BMIs that “look good” are oftentimes overlooked when in fact they are struggling with an eating disorder. In contrast, many of my clients who are their healthiest in larger bodies receive disconcerting feedback that they need to lose weight because their BMI is too high.
It is important not to reduce clients to simply a number on the scale. We need to look at our clients' overall habits, including their relationships with food, exercise, and body image.
You’ve probably noticed this post challenges many traditionally “healthy” nutrition practices. The longer I work in this field, the more I realize how much more education is needed about disordered eating and eating disorders. If you are interested in learning more, please follow me @dietitian2dietitian on Instagram or Facebook. I am happy to consult individually as well!
Learn more about Taylor Lechner, MFN, RD, LD; read her story on the Community Page.
“Our world is stuck in its own eating disorder, normalizing restriction and stigmatizing fat bodies left and right.” ~ Ashley Seruya, therapist
Sources:
Statistics and research on eating disorders. NEDA. https://www.nationaleatingdisorders.org/statistics-research-eating-disorders. Accessed July 21, 2021.
Bacon L, Aphramor L: Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal. 2011;10:9.
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