Nutrition For Eating Disorders: Risks And Recovery
Eating disorders can pose a variety of risks to interpersonal functioning and mental well-being, but they can have damaging physical effects as a result of their disruption to nutritional health as well. Some of these types of conditions can lead to severe shortages of food energy and key nutrients, while others may eventually lead to problems like obesity and diabetes.
Seeking professional support is recommended for those experiencing signs of an eating disorder, as working with a registered dietitian and a licensed therapist may help affected individuals recover. Some patients may also need substantial medical oversight to avoid dangerous medical complications related to nutrition. Learn more about nutrition as it relates to eating disorders below.
Food restriction in eating disorders
Several kinds of eating disorders involve symptoms related to severe self-imposed limitations on food consumption. Examples of such disorders include:
- Anorexia nervosa: This well-known eating disorder is characterized by deliberate avoidance or restriction of food consumption out of a compulsive desire for thinness and weight loss. This restriction is sometimes exacerbated by excessive exercise or purging behaviors like self-induced vomiting or inappropriate use of laxatives.
- Bulimia nervosa: Bulimia is characterized by binge eating episodes followed by purging. People with this condition may also engage in significant dietary restriction between episodes.
- Avoidant/restrictive food intake disorder (ARFID): People with ARFID eat only very particular foods or only very small portions. Unlike those with anorexia, their behaviors are due to sensory discomfort or fears of choking or vomiting rather than concerns about body image.
- Other specified feeding and eating disorder (OSFED): This diagnostic category may be used to describe patients whose symptoms don’t precisely fit other eating disorder criteria, but who may exhibit a range of disordered eating behaviors such as extreme food restriction and purging.
Nutritional impacts of anorexia nervosa and other restrictive eating disorders
Because conditions like anorexia typically involve eating significantly less food than the body needs to function, they may result in a variety of nutritional abnormalities. For example, a 2017 study indicates that people living with these disorders may exhibit deficiencies in vital nutrients such as:
- Folate: Also known as vitamin B9, folate is needed to produce DNA and blood cells.
- Vitamin B12: Another “B” vitamin, B12 plays an important role in blood production as well as gastrointestinal and neurological health.
- Magnesium: This mineral is used for multiple critical functions in human cells, such as the synthesis of DNA and the energy transport molecule ATP.
- Manganese: Manganese is used in a variety of enzymes, and its absence is associated with skeletal weakness and poor wound healing.
- Zinc: This mineral plays a role in many biological systems, including the immune and nervous systems.
- Calcium: Calcium is a crucial element for nerve signaling and bone health.
- Potassium: Like calcium, potassium is necessary for nerve transmission as well as other functions including gastrointestinal mobility, electrolyte balance, and production of glucose and insulin.
- Sodium: This nutrient is necessary for the regulation of blood pressure and pH.
- Phosphate: The body’s cell membranes, energy storage molecules, DNA, bones, and teeth all require phosphate.
- Vitamin D: This vitamin is crucial for absorbing and regulating several other nutrients and has important functions in the immune system.
In addition to shortages of individual nutrients, people with eating disorders frequently display overall caloric restriction, or taking in less food energy than the body requires. One study from 2023 found that the average level of caloric restriction in inpatients with restrictive eating disorders was over 50%, meaning that those affected were regularly consuming less than half the energy they needed for healthy bodily functioning.
Health effects of anorexia nervosa and other restrictive eating disorders
The nutritional deficits described above can lead to a broad array of medical complications affecting nearly every part of the body. That’s why getting treatment for signs of anorexia as soon as possible can be paramount for health and even survival. Just some of many examples of potential health consequences of anorexia include things like:
- Weakness, dizziness, and fatigue
- Brittle hair, nails, and bones
- Shortness of breath
- Difficulty regulating body temperature
- Gastrointestinal difficulties
- Cardiovascular problems
- Brain atrophy and cognitive impairment (confusion, difficulty concentrating, etc.)
- Severe organ dysfunction and death
Binge eating disorder
Although most people associate eating disorders with caloric restriction, binge eating disorder is the most common eating disorder in the United States. This condition involves repeated episodes of compulsive, excessive eating, often accompanied by feelings of shame and helplessness. Unlike bulimia or the binge-purge subtype of anorexia, binge eating disorder does not involve compensatory attempts to prevent weight gain such as fasting, exercising, or purging.
Binge eating behavior also occurs in bulimia and some forms of anorexia. While affected individuals may try to “cancel it out” with purging behavior, this is often an ineffective weight loss strategy (in addition to its other negative health effects). The binge/purge cycle may also still result in patients consuming more food than they need overall. Binge eating disorder, anorexia, and bulimia are all serious and potentially dangerous conditions that require professional treatment.
Nutritional impacts of binge eating
Because binge eating involves repeatedly consuming excessive amounts of food, it can disrupt dietary health in several ways. The most common impact is unhealthy weight gain and a higher risk of obesity.
In addition, binge eating may trigger frequent spikes in blood sugar, which can have a variety of metabolic consequences. Insulin resistance, which can result from a persistently high glycemic index, is commonly associated with binge eating disorder.
Binge episodes also commonly involve excessive consumption of foods that feel satisfying but have poor nutritional value, such as sweets or salty snacks. This can lead to unhealthy excesses of certain nutrients, such as high sodium levels. At the same time, other important nutrients may be lacking in a person’s eating patterns.
Health effects of binge eating disorder
When binge eating leads to excess weight gain or obesity, it can place affected individuals at significantly higher risk for many different medical complications, including:
- Heart disease
- Sleep apnea
- Asthma
- Gallbladder dysfunction
- Poor joint health
- Depression
- Some forms of cancer
Elevated blood sugar and insulin resistance due to frequent binge episodes can also result in metabolic syndrome and type 2 diabetes. These conditions can have serious health impacts and have the potential to be fatal.
How nutritional problems can reinforce eating disorder symptoms
Along with the many other potential consequences of nutritional imbalances, they may also make it more difficult for an individual to recover from disordered eating behavior. Poor nutrition can have several counterproductive effects on the way the brain and body respond to food, such as the following.
Lack of appetite-related nutrients
Some of the nutrients commonly lacking in people with anorexia, such as thiamin and folate, play an important role in functions like eating and digestion. Deficiencies in these substances may diminish a patient’s appetite or cause gastrointestinal malfunctions that make healthy eating difficult.
Disruption of brain circuitry
Malnutrition in anorexia appears to decrease functional connectivity in various regions of the frontal and temporal lobes, some of which relate to functions like behavior control, taste perception, visual processing, fear, and anxiety. This effect may strengthen factors that contribute to eating disorder behavior, such as a distorted body image or an exaggerated fear of weight gain.
Hormonal changes
Calorie restriction can elevate levels of cortisol, a hormone that may suppress the desire to eat and speed up metabolism. This could increase the challenges with weight restoration in individuals with restrictive eating disorders.
Mental health effects
Obesity resulting from binge eating could contribute to feelings of depression. This condition may exacerbate negative eating disorder beliefs and a lack of motivation for positive behavioral change.
Nutrition counseling in eating disorder treatment
Resuming healthy eating habits after living with an eating disorder can be challenging. Receiving coaching and advice related to nutrition for eating disorders from a registered nutrition professional is usually required. The National Eating Disorder Association advises including nutrition counseling as part of the overall treatment plan for an eating disorder.
Nutritional therapy may be able to assist in your recovery in several ways, such as by:
- Offering insight into possible health effects of eating disorders
- Assisting with planning healthy meals and food intake
- Addressing fears about excessive weight gain
Because training requirements for nutrition professionals may be variable and hard to understand, choosing someone with an appropriate certification may be helpful. The American Dietetic Association recommends working with a registered dietitian (RD) as part of eating disorder treatment.
Risks of unmonitored food reintroduction with an eating disorder
Recovery from eating disorders can place you at risk of refeeding syndrome. This is a dangerous form of electrolyte imbalance that can occur when people who have been nutrient-deprived for a long time begin eating larger amounts. Effective medical supervision can prevent refeeding syndrome, so working with a doctor along with a dietitian is often advisable as part of treatment for eating disorders involving food restriction.
Psychological treatment for eating disorders
While nutrition therapy can assist with building healthy eating behaviors, it may work best as a supportive treatment alongside mental health treatment. Psychotherapy can play a significant role in helping an affected individual rebuild their self-esteem, reframe negative eating disorder beliefs, and work toward adjusting a distorted body image.
Some talk therapies that may be effective for eating disorders include:
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Acceptance and commitment therapy (ACT)
- Interpersonal therapy (IPT)
Online eating disorder treatment
Receiving therapy online can be an alternate option for mental health care for those with eating disorders. Many patients find virtual therapy through a platform like BetterHelp to be more convenient than face-to-face treatment due to the greater flexibility in scheduling it offers, and because you can log on to appointments from anywhere with an internet connection. Fitting in therapy alongside nutritional counseling, meal planning, and visits to a physician may be easier when you can attend remotely.
Online interventions for eating disorders are a newer approach, but evidence for their effectiveness is growing. According to a research review published in 2023, for example, current studies suggest that internet-based cognitive behavioral therapy can be effective for the “prevention, treatment, and relapse prevention” of eating disorders.
Takeaway
How are eating disorders related to nutrition?
Some of the most common eating disorders, such as anorexia nervosa, can introduce nutritional deficiencies that can potentially be life-threatening. Eating disorder patients often experience symptoms directly related to a lack of vital nutrients within their body, such as electrolyte imbalances, vitamin D deficiency, or gastrointestinal problems. Helping those with eating disorders develop healthier eating habits is not only important for weight gain but also essential for ensuring that necessary vitamins, minerals, and other nutrients are adequately represented in a patient’s diet during treatment.
What to give someone with an eating disorder?
Arguably, what those with eating disorders need the most is acceptance and support from those around them. A significant degree of stigma is associated with eating disorders, largely due to ongoing misunderstandings and misconceptions surrounding them. Many people believe that eating disorders are a choice or due to a lack of willpower, which is not supported by evidence. Research suggests that treatment and recovery are most achievable when a person has a robust support network. As with other mental health conditions, it is important to work alongside mental health and medical professionals to ensure the patient is adequately supported during their recovery.
How to get help for eating disorders?
You can start the treatment process for eating disorders in many ways. Many people access treatment by scheduling an appointment with their primary care physician, while others might schedule an appointment with a therapist or other mental health professional. Eating disorders are complex and often require a multi-disciplinary approach to treat effectively, but most health professionals are qualified to begin the treatment process for common eating disorders.
What are the nutritional tips for anorexia?
The exact nutritional needs of someone diagnosed with anorexia vary based on how long their treatment has progressed, the severity of their condition, and other factors as determined by their treatment team. Those with eating disorders often receive nutrition intervention from qualified nutrition counselors with the training and experience to determine their dietary needs. If someone needs nutritional tips related to anorexia or more general tips related to gaining weight, they should strongly consider reaching out to a qualified dietitian or nutritional counselor for guidance.
Do nutritionists deal with eating disorders?
Certified nutritionists and dietitians regularly assist those with eating disorders. Many people have a treatment team consisting of mental health, medical, and nutritional professionals. A nutritionist often helps their patient understand how certain foods and food groups may interact with their eating disorder. For some patients, such as those with anorexia, a nutritionist might be primarily concerned with ensuring the person has their minimum nutritional needs met. Other patients, such as those with binge eating disorder, may meet with a nutritionist to lose weight or develop healthy meal plans. Patients diagnosed with bulimia nervosa also often receive guidance from a nutritionist regarding how they can lower their body mass index safely without resorting to purging, excessive exercise, or laxative abuse.
How effective is nutritional counseling for binge eating disorder?
Those with binge eating disorder tend to gain weight when they binge eat, indicating that nutritional counseling may be an important part of treatment. Evidence indicates that a multidisciplinary approach consisting of psychological, nutritional, and medical intervention is an effective treatment for binge eating disorder. However, research suggests that nutritional counseling alone is unlikely to be an effective intervention for the condition. Best practices indicate that improving physical activity, treating underlying mental illness, fostering a strong network of friends and family members, and education about body weight are likely also required for successful intervention.
What is nutritional counseling for anorexia nervosa?
Anorexia nervosa is the most lethal eating disorder variant, and diagnoses are on the rise, most notably among adolescent girls. Anorexia is characterized by an overwhelming preoccupation with body shape, an intense fear of gaining weight, and severe calorie restriction. Common risk factors include a family history of anorexia, a history of mental health conditions, and exposure to unrealistic body standards, which are commonly encountered on social media sites.
Malnutrition due to anorexia can cause potentially deadly effects, including disruptions to a patient's vital signs and the risk of developing a cardiac arrhythmia. In both public and personal practice settings, nutritional counselors typically work alongside other professionals to ensure that patients have the minimum required nutrients in their diet during treatment. They may provide guidance directly to the patient or consult with the rest of their treatment team to ensure that dietary goals are met.
How do you treat bulimia nervosa?
Bulimia nervosa is characterized by episodes of binge eating, during which abnormally large amounts of calories are consumed, followed by periods of compensatory behavior. Common behaviors include vomiting, taking laxatives, or exercising excessively, all with the goal of counteracting the number of calories that were consumed during the binging episode. The compensatory behaviors associated with bulimia can have severe health effects, and bulimia is generally treated through a multi-disciplinary approach consisting of medical, mental health, and nutritional professionals.
Patients generally receive psychotherapy and nutritional counseling and may be prescribed medication by a medical professional. Nutritional counseling helps the patient develop a structured meal plan and resist body cues to binge. Therapy, such as cognitive-behavioral therapy or dialectical behavior therapy, helps address the underlying cause of the eating disorder. Some medications, most commonly antidepressants, can help reduce the urge to binge and purge, but medication typically works best when combined with psychotherapy.
What conditions are most associated with eating disorders?
Most conditions that commonly appear alongside eating disorders are mental health concerns. Often, substance use disorders, depression, and anxiety co-occur with an eating disorder, which can potentially complicate or prolong treatment. Some other mental health conditions, like obsessive-compulsive disorder, are also being investigated as potential co-occurring conditions that were previously misunderstood.
What medication is used for eating disorders?
Psychiatric medications such as antidepressants are most commonly prescribed to treat eating disorders. However, in some cases, medication can treat an eating disorder directly. One example is olanzapine, an atypical antipsychotic medication. Olanzapine is not prescribed to treat psychosis but rather to take advantage of one of the medication’s side effects. It is known to induce weight gain in many of the people who take it and is sometimes prescribed for those with severe anorexia nervosa.
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