Category Archives: Eating Disorders

Feelings of Fullness

“I feel full after eating a small amount”

“When I eat more than usual my stomach feels uncomfortable and bloated”

“I feel like I have a food baby”

These are phrases I often hear from clients with eating disorders as we work on increasing their meal plan. Unfortunately there is no magic cure here and it is a stage that has to be worked through. What can help is understanding what is happening.

Dietitian UK: Feelings of Fullness

The Science:

In someone who has been under-eating for some time, the digestive track slows down. As a result food moves slower through the system. That feeling of the food remaining in the stomach for a long time can be true and is known as “delayed gastric emptying”. This can also lead to a heightened sensitivity to feelings of fullness and bloatedness. It is not necessarily that you are fuller than anyone else, but you may feel that way.

If you have an eating disorder you are likely to have been blocking out those feelings of hunger and of fullness too, there is a disconnection and a loss of sensitivity to them. Fullness is regulated by the hypothalmus in the brain. 20 minutes after you eat a signal is sent to the brain. This is an easy system to overide so it needs your sensitivity. This connection has to be rebuilt and relearnt which takes time. It may feel like you cannot trust the signals the body is sending. Actually it is your reading of these signals that is the issue, sticking to a balanced, regular intake of meals and snacks will help to realign your thinking with your feelings and food.

Thoughts are powerful. If you think you should be full or are full then this can trigger anxiety leading to feelings of fullness. Try to keep mealtimes relaxed and have a period of time afterwards where you distract yourself with something like art, craft activities, phoning a friend, reading a book. It takes 20-40 minutes for the feelings of fullness to subside. 

Number 1 tip for staying on track with your eating.

Whatever changes you have decided to make to your eating there is something that can really make a difference to making or breaking that habit. 

It’s a commonly known fact that it can take 6-8 weeks to form a new habit, so if you have set yourself a healthy habit to form you need to stick with it. 

Whether you are gaining weight because you are underweight, losing weight or maintaining your weight, this applies across the board. 

I know because it is something I personally do and it is something that makes a real difference to the clients I work with. 

So here it is.

MEAL PLANNING. It isn’t rocket science I know, but it is everyday common sense science.

Dietitian UK: Meal Planning.

If you want to make a healthy change to your eating, you need to plan it into your day and week. Just deciding on a change will not make you stick to it. To give yourself the best chance to suceed you need to have the right mindset, the right food in stock, have the right time to prepare it and have the right recipe to hand.

Here is an example. If you need to increase your diet in order to gain weight, you could just say to yourself “I will eat more at each meal”. When it comes to that meal 1. Will you remember? 2. Will you have extra food to hand? 3. Will you panic and decide not to do it? Using a meal plan is a useful tool as it make you plan out exactly how you will meet your goal. So where you will increase your current meal plan and exactly what extra foods you will add in. This means you can now prepare practically by making sure you have the foods available at the right times and prepare mentally so you are focused.

If you make a plan you are more likely to stick to it than if you have no plan.

There are several ways of meal planning. Some people like to use a whiteboard in the kitchen (this is what I do), others like a notebook they carry around with them and others like a printout stuck up in the kitchen. Think about keeping your meal plan visible and available at meal times as a reminder.

Make meal planning a regular part of your week and it will really help you hit your goals.

Men Get Eating Disorders Too

Eating disorders are not something we generally associate with men, there is a huge stigma attached if you do have an eating disorder and it’s not an issue frequently discussed. So I was so pleased to come across the Men Have Eating Disorders Too (MGEDT) charity. I was even happier to find they had a conference running within travelling distance for me. So off to Brighton I went. Below are some of my take home points.

Eating-Disorders-Have-No-Gender

The prevelance of ED in men is 40%, this is a huge statistic and I certainly don’t find this in my clinical practice which suggests there are men with ED who are not seeking help. A recurring theme throughout the day was the lack of specific treatments and treatment pathways for men. Services are aimed at treating females not males.

Gender differences mean that there needs to be a different approach to treat men. Therapy, group work and literature all needs to be adapted. One talk was looking at whether we need a specialist inpatient unit for men. Rather than fitting men into a standard ED unit, which can lead to them feeling isolated  and like they stick out, how about providing a place specficially set up to treat and help them? It’s an interesting question and I can really see the benefits of doing this.

Back to the gender differences that came out over the day. These show how our current society can lead to incorrect beliefs and values that are unhelpful and can perpetuate an eating disorder. Have a think about whether any of these are core beliefs you hold.

 Incorrect Core Beliefs/Assumptions:

  1. THE BELIEF: Eating disorders are something only women get, so I am less of a man if I have one. Sexuality: eating disorders are primarily a female issue so there can be a thought that if you are male with an eating disorder you are less of a man…… or you are homosexual as gay men are usually more concerned with their weight and shape. The statistics actually show that this is not true, most men with eating disorders are not gay and a lot of men have an eating disorder it is just not talked about often.
  2. THE BELIEF: If I have an eating disorder I am weak. Male Identity – the image of a man being strong, muscular and able to cope. Having an eating disorder makes you vulnerable, it breaks you. Asking for help can be the hardest thing to do. It can therefore be hard to seek help.
  3. THE BELIEF: Men have to look a certain way. Body Image – over the years the media stereotype has changed to one of a man being muscular with broad shoulders, a large chest and a small waist. Not a very achievable look of course. Often we see the female stereotype and not the male one. 
  4. THE BELIEF: Men eat and drink a certain way, I need to do this to fit it. Male eating habits – it is seen as ok for men to eat large portions and overeat which can make binge eating acceptable. Certain foods and drinks are seen as more “manly” – beer and red meat for example. What if you don’t actually like those foods or are not the kind of man who likes going to the pub for a pint? 
  5. THE BELIEF: Real Men don’t cry, express emotion or talk about how they feel. Men don’t always like to talk about their feelings – again this can be linked to not wanting to be seen as vulnerable as this is a sign of being a girl or being weak. So it can make it even harder for a man to step out and seek help. Whereas actually we know that talking about your feelings really works and helps.

 Men come in all kinds of shapes and sizes, like all kinds of foods, can love to express their emotions and are all INDIVIDUAL. Don’t be afraid to be the man you were made to be. Seek help if you need it, therapy is an amazing tool.

If you are a professional be aware, there are more men out there with eating disorders than you may think. 

For posters and resources see the Men Get Eating Disorders Too website.

 

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How often should I weigh myself?

In my role as an eating disorders specialist I come across a lot of people who weigh themselves daily or even several times a day. So this post is written from an eating disorders perspective. Now whilst regular weighing can seem like a sensible idea to help keep you on track here are my thoughts on why you want to step away from the scale at times. 

Dietitian UK: How often should I weigh myself?

1. You are not just measuring one change in your body. When you weigh yourself it is not just your body fat that you are looking at but also your muscle, bones, organs, body fluids, glycogen, cells, tissues and any water products that are being measured.  Plus we know that muscle weighs more than fat. If you have been working out more and building muscle then this can cause your weight to increase. So you can increasing your stores of glycogen from eating more carbohydrate. Or conversely using up your glycogen stores through exercise or not eating carbs will look like weight loss. 

2. Your weight fluctuates over the day and week. Whilst you may think this is to do with body fat, it isn’t! This is usually down to fluid, you will weigh less at the start of the day, before breakfast, after doing to the toilet. During the day you eat and drink which means you take in food and fluid, which increases your weight. By the end of the day you will weigh more than at the start but this is not necessarily true weight. Responding to daily changes in your weight will make you become fixated on your eating and weight.

3. Your hormones and your monthly cycle (for women) will affect your weight. You know how you often feel bloated and heavier around your period. Well that’s because you retain fluid and you do weigh a bit more. It’s perfectly normal and not something to worry about. Your weight will have a natural fluctuating cycle that happens over a month.

4. Constipation can have an impact on your weight too. So if you haven’t been for a few days then remember the waste in your body will weigh something. 

So you can see that weight is a complex issue. Within my clinical practise in eating disorders I don’t take a one off weight in isolation but always look for the trend. If you want to weigh yourself regularly then go for no more than weekly. Track your weights and look at the trend, you need at least 3 weights to do this. Do not freak out about a one off change in your weight but wait and see what the next reading does as it may not be a true reading. Look at the bigger picture – are you constipated, what have you been eating, are you dehydrated, where are you in your cycle? Weight needs interpretating with filters and googles. 

My last and biggest tip: Don’t use weight alone as your judge and guide. How you feel, your body shape, how your clothes fit and how happy can be better ways to focus on you. Step away from the scales once in a while.

Eating Disorder or Disordered Eating ?

 There is a difference between an eating disorder and disordered eating, but it is hard to distinguish. Just because a person has a pre-occupation with food, shape and weight, does not mean that have an eating disorder. For lots of people that can come as a relief. You can have some of the signs and symptoms of an eating disorder but not actually meet the criteria for the label of one. Let’s look into it a bit further. 

Statistics:

 NICE  1.6 million in UK affected by an ED, 11% are male.

1/4 of adults admit they feel guilty after eating and think they would be happier if they were thinner (when they are not overweight).

6/10 women cannot stand the way they look and only 1 in 25 are totally happy with their body. 

Dietitian UK: Eating Disorder or Disordered Eating?

 The difference between an eating disorder and disordered eating:

The key difference is in the degree of symptoms and behaviour. Someone with disordered eating may be engaged in the same type of behaviours as someone with an ED but at a lesser frequency or severity. For example you may feel obssessed with food, be counting calories, be checking your body in the mirror a lot and weighing your food and yourself. These behaviours can all happen to a lesser and greater extent. An eating disorder specialist will be able to use specialist questionnaires to establish if you have an eating disorder or not. 

An eating disorder is usually more secretive in nature. Often showing dramatic weight loss, hiding under clothes and a real obsession with food, weight, fat, exercise and body shape that does not go away and takes over life. There are often set rules about food and exercise.

Disordered Eating can involved restriction, purging, bingeingg, exercise, counting calories and being very aware of body shape and weight. This may be fuelled by beliefs, culture, education and learnt behaviours.

Either way it is highly likely that you need some support from a therapist and a dietitian. Although the term disordered eating may not seem as significant as an eating disorder it can mean that your nutritional intake is not providing your body with what it needs and can have an impact on your physcial, emotional and psychological health.  Sometime disordered eating can also be the start of an eating disorder and without help one may develop later. 

 

 

How to prevent a binge.

When most people think about eating disorders the image of a low weight person who restricts their food intake comes to mind. Anorexia Nervosa is the most commonly talked about and known about eating disorder. However there are other kinds. I also work with people who suffer from Bulimia Nervosa, binge eating disorder and a mixture of all the above.

Whilst restricting your food intake can sometimes be understood as “dieting that has gone too far”, bingeing is less socially acceptable. In my mind both of these ways of eating are problematic and indicate underlying issues that need to be worked through. An eating disorder is a horrible illness that is hard to understand for those around the person, it can be consuming for the person and it takes a lot of willpower, guts and hard work to conquer it. I hugely admire the people I work with who make those steps towards beating this nasty mental illness.

A true binge involves eating a large amount of food in an uncontrolled manner. We are not just talking half a packet of biscuits. Some binges can range into several thousand calories. Some people describe a switch being flipped, they are unable to stop and are almost in  trance like state. After a binge you are likely to feel very uncomfortable physically due to the amount eaten and you may feel uncomfortable emotionally and psychologically. Many people have an urge to compensate – for example exercising, purging (vomiting) or restricting their food to make up for the binge.

 

The science

You cannot vomit up all the calories you have eaten. The maximum you get rid of is 60%. Absorption starts in the oesophagus so by the time food gets to your stomach you have already absorbed some.

Restricting after a binge leads you into a cycle. When you restrict you end up really hungry at some stage which then leads to another binge. 

You would need to do a lot of exercise to burn off all the calories from a binge. 

So the best answer is to try to prevent a binge from happening in the first place. Now this is easier said than done. It will take time and be a work in progress. My top tip is to not expect to just stop bingeing and to expect a relapse to happen. When it does, it is ok. Just get back on track as soon as you can.

 

Preventing a binge:

1. Identify the key times you binge. Think about the Why, Where, When and How it happens. 

Why – how do you feel before a binge? Bored, tired, upset, angry, hungry?

Where – is it linked to being on your own, in a certain place?

When – does a binge happen at a certain time of day?

How – how do you get the foods you binge on? 

2. Use the above information to think about how you could stop a binge occurring. Is there an activity/place you need to avoid? Can you limit access to the binge foods?

3. There should be a point just before a binge occurs when you are thinking about bingeing. The idea is in your head. This is the point to stop it. Jump in there and say NO. At this stage you need a distraction. So write out a list of things that could take you away from the binge, that keep your mind and hands busy. Good options can include doing something crafty, calling a friend on the phone, having a shower, journalling how you feel, having a bath.

4. Look at your meal plan – it need to be structured with regular meals and snacks to prevent you getting too hungry. It may be that building a snack in at a key time will help prevent a binge. 

If you do binge DO NOT PANIC. Get right back on track with your normal eating plan as soon as possible to stop that restriction, bingeing cycle. 

You can do it. I know it.

Boosting your nutritional intake – the healthy way to weight gain.

I work in the topsy turvy world that is eating disorders. Most of the media focus, food manufacturers, shops and nutrition business is on how to lose weight. whilst I work with people on how to gain or maintain their weight. Gaining weight may sound like it is easy to do but it often isn’t. You need to increase your dietary intake by 350-500kcals per day to start gaining weight. Now if you don’t have an eating disorder that may seem like no hard thing. A latte and slice of cake will easily hit the mark. However often the clients I work with are keen to increase the energy density of their diet in healthy ways. Now I’m all for eating plenty of veggies but you will have to eat a whopping amount if you are going to gain weight on extra veggies alone As I had to explain to one client recently – 350kcals extra in salad alone would mean you would be eating salad all day long. However there are options, if you can keep an open mind. 

Foods like nuts, seeds, avocado, dried fruit, nut butters, hummus, yoghurt, cheese, eggs, olive or rapeseed oils and fruit juices, will provide a nutrient dense way to increase the calories of your diet.

Dietitian UK: Why almonds are so good for you

 

Some of these foods may be on the scary side but they all provide nutrients that the body needs.

Dietitian UK: Gaining weight the healthy way for eating disorders

Here are some of my top suggestions of ways to boost up your intake by around 350kcals:
 
Add 1 tbsp seeds and 1 tbsp dried fruit to your normal cereal then top with your usual milk plus 2 tbsp yoghurt and add a glass of fruit juice.
Make your own snack boxes with nuts, dried fruit and small crackers (e.g: 15 almonds, 5 dried apricots, 7 rice crackers).
Homemade smoothies with yoghurt, chia seeds and fruit (e.g. 1 banana, 100g yoghurt, 100ml milk, 1 tbsp chia seeds and 1 handful blueberries).
1 serving Granola with 1 serving of Greek yoghurt.
1/2 avocado on 1 slice toast with a glass of fruit juice.
2 tbsp almond butter on 3 oatcakes with 1 banana sliced on top.
3 peanut butter cookies with a portion of fruit.
 
To read my healthy eating tips for Eating Disorders go here.

 

Ignore the Numbers and Ditch the Scales.

Weight. It’s a complex issue and I think we often oversimplify it. I can be guilty of this too. Working in weight management and eating disorders has shown me that the numbers on the scales do not always do what you expect them to do.

 You may be eating enough for weight gain and just not see it and vice versa for weight loss. I find it can be very confusing for people when they know they should have lost/gained weight and yet the scales say they have maintained. So let’s think it through.

  1. The body does not work in days or weeks like we do. I always advise people if they weigh themselves to stick to once a week on the same day at around the same time. It could be a couple of days later and you will get a different reading.
  2. Sometime there is a lag phase where your body takes a while to adjust and realise you’ve changed your dietary intake. 
  3. Weight is not just determined by what you eat. Your hormones, fluid intake and the time of the day can play a role too amongst other things. You will weigh more at the end of the day, when you have your monthly cycle and when you drink more.
  4. Muscle weighs more than fat, so if you are exercising more you may be building muscle and weigh more.

So let’s not focus on the individual numbers too much. Instead look at the trend over a few weigh-ins or if you are trying to lose weight why not think about ditching the scales and look at waist circumference measurements and how your clothes fit. I have one client who has to have her clothes taken in each time she visits the tailor which is a sure sign things are going the right way!

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Mealtime Guidelines for Eating Disorder Sufferers.

 When you have an eating disorder or disordered eating it can lead to mealtimes becoming a stressful, hated time. For parents, carers, loved ones and friends it can become an anxious minefield. With everyone treading on eggshells, what should be a relaxing eating experience turns into an emotional melting pot.

I’ve spent a number of years eating more meals than I can count with people suffering from all types of eating disorders. In that time I’ve worked with hundreds of clients and listened to their stories of meal times, spent time finding ways to make eating more bearable and sat with them practising it. I’ve had food thrown at me, been shouted at and watched all kinds of odd food behaviours. I’m no stranger to tears at the table, tantrums and food mysteriously disappearing. I’d pretty much say I’ve seen it all and this means I know how hard it is for the sufferer and for the carer too. So here are my top tips for sufferers on making mealtimes easier.

Planning and Preparation.

Plan out in advance what is going to be eaten, don’t get caught out by the element of surprise. If you are preparing the food yourself then keep it simple as the act of preparing the food can put you off eating it.

Distraction is your Friend.

Find some good ways of distracting your mind from your food.

  1. Have someone sit with you and talk to you, but set boundaries such as not talking about food, diets and body image. Having a list of topics to discuss can help the person sitting with you. Good topics include holiday destinations, movies, music, topical TV shows. If you get stuck have the paper to hand to get topics or even read a quotations book aloud.
  2. Have “feel good” music on in the background or the radio, but not the TV.
  3. Read a magazine/book.

Keep Calm and Carry On Eating.

Eat in a calm, quiet and comfortable atmosphere and place. Keep it as stress free as possible. As soon as you feel anxious your “fight or flight” pathway kicks in. Think about it. Your heart beats faster, you may feel hot and sweaty, you may feel shaky and clammy, your throat constricts, your appetite gets less – so it will definitely be harder to eat!

Portion Perfect.

Only put on your plate what you need to eat. Don’t overload it as it will seem overwhelming.

Meal Motivation.

Keep in mind the reasons why you need to eat these foods. Either think it through in your head or have a list of reasons written out to refer to at the table or just before your meal. Use your long term goals, physical health reasons or any others that are positive. 

Reflect.

After a meal reflect on what went well/not so well. If you struggled, think through how you could improve this for next time, what would help/did not help. There will always be highs and lows in recovery. That is normal, the trick is to not give up.

After Activity.

Have something planned to do afterwards to distract yourself and to help you relax. Listen to relaxing music, watch TV or phone a friend are all good options. 

If you need one to one support, an individual meal plan and more guidance on this, please get in touch. An eating disorder is a very difficult illness to live with, live through and for some to let go and live without BUT it CAN be beaten,

Healthy Eating for Anorexia Nervosa

I’ve worked in the field of eating disorders for about 10 years. It’s an area that both frustrates me and brings me to life. I find it challenging work, emotional at times and I have to constantly remember to celebrate every small thing. Yet I absolutely LOVE this work.

In a world where obesity is on the increase, healthy eating and low fat eating predominates. The Eat Well plate has been developed as a way to demonstrate healthy balanced eating. I use this visual guide as a talking point but with the emphasis that this is aimed at a healthy population trying to maintain weight or at overweight people trying to lose a little weight. Therefore the proportions may not be correct if you are trying to gain weight.

 

Here is my walk through the Eat Well Plate for Anorexia Nervosa:

 Fruit and Vegetables:

Most people with anorexia nervosa I come across have no problems in meeting the 5 a day target, in fact they can have the reverse issue and be eating too many portions!

  • These foods should make up about 1/3 of your plate at each meal and no more.
  • It’s important to eat a range of colours and types so you get the full range of nutrients.

Dietitian UK: Healthy Eating in Anorexia Nervosa, Fruit and Veg

 

Starchy Foods/Carbohydrates:

These foods are often thought to be the villains. Yes over-eating these will lead to weight gain, but not eating them will mean your body does not have enough energy. Carbohydrate foods (bread, rice, pasta, cereals, potatoes etc..) are the bodies preferred energy source so that means it will choose to burn them off as fuel over anything else.

  • Include them at every meal.
  • Go for wholemeal, whole grain versions where possible.
  • The more active you are the more you will need.

 

Dietitian UK: Healthy Eating for Anorexia Nervosa

Dairy Products:

Dairy foods are important as they provide the body with calcium, protein and in some cases Vitamin D. Super important for your bones. When you are a low weight and not eating enough the kidneys remove calcium from your bones to supply the body with needed calcium, leaving your bones weakened. This needs replacing!

 

  • Eat 3-4 portions per day (e.g. 1 glass milk, 1 small yoghurt, 30g cheese).
  • If you are weight gaining steer away from the low fat options, often these just have more sugar and additives in them anyway.
  • Think about the long term impact of having weak bones, it’s a great motivator.

 

Dietitian UK: Healthy Eating for Anorexia Nervosa

Meat, Fish and Other Proteins:

This includes eggs, tofu, soya, beans, pulses, lentils, nuts and seeds. Include these foods twice a day in your meal plan either as a main meal or a snack.

Dietitian UK: Healthy Eating for Anorexia Nervosa

 

Fats and Sugars:

These are included as part of healthy eating. Your body needs fat and sugar in order to function. There is a layer of fat around your internal organs acting as insulation and protection, there are essential fatty acids that your brain needs to function well and monounsaturated fats are good for your heart – so fat is not all bad.

 

  • Work up to including healthy fats in your diet – avocado, olives, oily fish, rapeseed oil, nuts and seeds.
  • Build in a challenge each week to eat a “scary” food.

Dietitian UK: Healthy Fats