Disordered eating refers to a wide range of abnormal eating behaviours, many of which are shared with diagnosed eating disorders. Disordered eating differs from an eating disorder in the level of severity and frequency of the behaviours. However, disordered eating should still be taken seriously as it is often a pre-cursor to developing an eating disorder.

Disordered eating can have a negative impact on a person’s emotional, social and physical wellbeing. It may lead to fatigue, malnutrition or poor concentration. It can affect someone’s social life (when socialising is restricted due to anxiety around food and eating), and can lead to anxiety and depression.

Disordered eating behaviours and attitudes include:

• Binge eating
• Dieting
• Skipping meals regularly
• Self-induced vomiting
• Obsessive calorie counting
• Self-worth based on body shape and weight
• Misusing laxatives or diuretics
• Fasting or chronic restrained eating

What is considered ‘normal’ eating?

What is considered ‘normal’ in terms of quantities and types of food consumed varies considerably from person to person. ‘Normal eating’ refers to the attitude a person holds in their relationship with food, rather than the type or amount of food they eat.

It is normal to:

• Eat more on some days, less on others
• Eat some foods just because they taste good
• Have a positive attitude towards food
• Not label foods with judgement words such as ‘good’, ‘bad’, ‘clean’ etc
• Occasionally over-eating and occasionally under-eating
• Crave certain foods at times
• Treat food and eating as one small part of a balanced life

Mindful eating

Mindful eating is a life skill which can lead people to enjoy a satisfying, healthy and enjoyable relationship with food. It is a skill that can help people break free from ‘food rules’ and begin to enjoy flexible and relaxed eating practices. Mindful eating is not a diet. Mindful eating is about the way we eat, not what we eat.

Dieting is the number one behavioural risk factor in the development of an eating disorder.

Physical effects of dieting

The strict, restrictive and often unsustainable nature of many diets can leave people feeling constantly hungry and deprived. People on diets often ignore this hunger for a short time, but such deprivation can eventually lead to powerful food cravings and over-compensatory behaviour such as bingeing. This can, in turn, lead to feelings of shame and failure, which contribute to negative emotional associations with food and eating.

Fluctuating weight is common for people who diet frequently (‘yo-yo’ dieting), as most people regain the weight they have lost after a diet within a few years. Diets disconnect people from their natural bodily responses through imposed food related rules and restrictions, which may overlook hunger, physical activity and a person’s individual nutritional requirements.

Dieting can:

• slow the body’s metabolism
• cause food cravings and an increased appetite, leading to over-eating
• reduce the total amount of muscle tissue and bone density
• cause constipation and/or diarrhoea
• lower the body’s temperature in order to use less energy
• cause headaches
• cause insomnia and fatigue
• reduce the ability to feel hungry and full, making it easier to confuse hunger with emotional needs

Psychological effects of dieting

Dieting can lead to feelings of guilt over ‘lack of self-control’, low self-esteem, a poor body image and obsessive thoughts and behaviours surrounding food. In addition, people who diet frequently are more likely to experience depression.

Competitive dieting

Competitive dieting is a dangerous phenomenon that can lead to an obsession with food and weight obsession, as well as disordered eating behaviours. Television shows such as The Biggest Loser have seen a marked trend in competitive dieting programs across many workplaces and gyms, whereby people are encouraged to participate individually or as teams to lose the most amount of weight in a specified time period, often for a prize or some form of reward.

Competitive dieting may also occur in the context of physical activity, such as in athletes. This can be equally as dangerous for the development of disordered eating or eating disorders.

The restrictive nature of dieting does not work. In fact, 95% of people who diet regain the weight and more in one to five years (Bijlefeld & Zoumbaris, 2003).

Weight-loss and fad diets involve restricting food intake to levels that often leave a person constantly hungry and in some cases, lacking the necessary nutrients they need to maintain physical health and energy levels.

Physical response

Famine response

When food intake is reduced, bodies respond as if they are in famine or starvation. This natural human survival instinct has kept our species alive for millions of years, slowing down our metabolism (the amount of energy we use) to maintain bodily functions when food is scarce. Of course, our bodies cannot tell the difference between a diet and starvation, so when it feels like it is being deprived of food, the famine response is triggered. This means less fat is burnt, making it progressively more difficult for anyone to keep losing weight and difficult to keep it off.

Leptin

Leptin is a hormone produced by the fat cells in our bodies. It exists to blunt the appetite when a person has had enough to eat, reduce cravings, increase energy and increase the metabolic rate. But when body fat decreases, so does the amount of leptin. Our bodies will therefore try to compensate for the loss in leptin, responding by increasing hunger urges.

Social and emotional response

Food in social settings

Food is often associated with social occasions and family gatherings, such as going out to dinner or having a BBQ. People who are dieting often avoid social situations and family mealtimes so they aren’t ‘tempted’ by the food, leading to feelings of isolation and a loss of support.

The diet/binge cycle

When a person diets, they often get stuck in a cycle of food deprivation, feelings of extreme hunger, consequent binging and feelings of shame. The cycle can be very difficult to break and have a dramatic impact on the health and wellbeing of a person.

Figure 1: The diet/binge cycle

Health At Every Size® (HAES®) is an approach to health policy and care that supports people of all sizes to take care of their health and well-being, without weight stigma.

At EDV, we encourage a non-diet and weight inclusive approach to healthcare and recovery, as championed by the Health at Every Size® movement. We understand that for some, this approach may take some time to understand. It can be considered counter-cultural to be ‘anti-diet’, particularly when many healthcare providers encourage the pursuit of weight loss.

Unlearning diet culture thoughts and behaviours can take time. If you are new to this journey and would like to continue learning, please see the below list of resources.

Many religions engage in fasting as part of their practices, such as in the Islamic holy month of Ramadan, the Christian season of Lent, or the Jewish holy day of Yom Kippur. Engaging in these practices presents additional consideration for people at risk of an eating disorder, experiencing an eating disorder, or in recovery.

Engaging in fasting practices while experiencing or in recovery from an eating disorder is often a decision that involves consultation with a person’s treatment team, support people and spiritual leaders. In general, people are not encouraged to engage in religious fasting if they are not healthy enough to do so. This includes mental health concerns or eating disorder issues.

Across the religions, fasting is often about becoming closer to your God(s), or refocusing your mind on spirituality. There may be other ways to observe religious practice without fasting, such as a non-food ‘fast’, extra prayer, or giving back to the community. Remember, the purpose of fasting is not to punish, and if there is a risk of harm, religious leaders will be able to work with you as an individual to create an acceptable alternative.

Ramadan

In Islam, you are excused from fasting if you are suffering from a health condition. Ibn Qudaamah (may Allah have mercy on him) said in al-Mughni (4/403):

“The kind of sickness in which it is permitted to break the fast is intense sickness which will be made worse by fasting or it is feared that recovery will be delayed.”

“The healthy person who fears that he may become sick if he fasts is like the sick person who fears that his sickness may get worse, they are both permitted to break their fasts.”

This could be interpreted to mean that if you are recovered (healthy), but fear fasting would cause you to relapse, this is valid reason not to fast. If you do not fast, you instead pay Fidya to feed someone for each day you do not fast.

Whether or not you decide you are healthy enough to fast, Ramadan may still be a very challenging time as your community’s behaviours are centred around fasting. It’s a good idea to create a supportive environment around you during this time.

Remember that in Ramadan, a person abstains from food not because the food offered up is bad, but because it is good. It is a way of resisting what is good for you so that you are also able to resist what is bad. However, if resisting the goodness of food leads you towards harmful behaviours or negative feelings, this denies the purpose of Ramadan.

You can still participate in Ramadan other ways. Ramadan is also about restraining anger, doing good deeds, exercising personal discipline, and preparing oneself to serve as a good Muslim and a good person.

Lent

Churches have some variation in how they participate in Lent, but ultimately the rationale is to challenge yourself to become closer to God. Remember, you are not expected to fast if this is a health risk. If you have an eating disorder or are in recovery, the biggest challenge might be to not give in to the pressure to fast, and to seek God’s guidance through this time.

If you’d still like to fast in another way, you can consider the following:

• Fasting from media and/or technology.
• Fasting from negative self-talk, or from comparing your body with others.
• Think of something you tend to buy in excess of your needs. Give up buying these during Lent, and donate the money you would have spent to a charity you care about.

Remember Lent isn’t all about fasting. You can still participate in prayer and almsgiving. Instead of giving something up for Lent, consider taking something on. This could be community service, extra prayer, or donating to charity.

Yom Kippur

For many in the Jewish community, fasting is an important and difficult spiritual exercise, reminding them of their attachment to the physical, and helping them focus on teshuvah and spiritual growth.

For individuals who have an eating disorder or are in recovery, eating on Yom Kippur can actually be a holy act. Rather than finding ‘purity’ or ‘spiritual growth’ through denying yourself food, the act of eating itself can be an act of teshuvah.

Before eating or drinking, you can offer a small thought, or kavanah (intention), and the traditional blessing over that item.

Hinduism

In Hinduism, there are a diverse range of fasting practices that depend on factors such as personal beliefs, local customs and preferred deities. Consider carefully whether fasting will help you refocus your spirituality and lead you towards peace, or if it may cause health difficulties at this time in your life and lead to spiritual conflict. There are also ongoing dietary practices that many Hindus follow that you may find difficult during recovery. You may like to work collaboratively with a dietician to create a meal plan which leads you towards recovery while maintaining your spirituality.