Stop Prescribing One Eating Disorder To Treat Another: Why Under And Overeating Are Not “Opposite Pr

Throughout my recovery journey from anorexia with a propensity for compulsive exercise, I have often heard, in a tone full of self-judgment, “I have the opposite problem.”

What the person is typically referring to is that they feel they eat too much, exercise too little, or both. The self-judgment usually reflects the way society places a positive value on undereating and over-exercising and negative connotation on the opposite. The interactions demonstrate quite loudly that society has decided that one eating disorder is more favorable than another. While I can speak deeply and strongly about why anorexia needs to stop being glorified — that will need to wait for another day. Today, let’s talk about why we need to stop making people feel ashamed for “overeating” and why, in the context of eating disorders, overeating behaviors are much more similar to undereating behaviors than they are different — definitely not “opposite” — and how we can change the approach to discussions on food and exercise so that we are not inadvertently prescribing one eating disorder to treat another. I’ve already discussed BMI in a similar context, so if you’ve missed it, check out “Eating disorders thrive in secrecy, so let’s talk about it. Starting with BMI.”

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On the surface, yes, eating and/or exercising “too little” versus “too much” sound like opposite issues. However, that’s a superficial assessment. Human relationships with food and exercise are much more complex, and for people with eating disorders, food and exercise are key players used for coping with stress, trauma, overwhelming emotions, and/or desire for control in one form or another. Whether an individual avoids or consumes food to deal with feeling unworthy, ashamed, stressed, anxious, depressed, out of control; the similarity is that the food is used as a coping mechanism, no longer as just fuel for the body. Exercise may also become a similar tool to use for coping, which may or may not be healthy depending on the individual’s beliefs around exercise and approach to exercise. When I say human relationships with food and exercise are complex.

When it comes to eating disorders, I’ll stop briefly to disclose: I do not have formal training to treat patients with eating disorders. My evidence and research come in the form of living with an eating disorder in a research project I call “life” while analyzing the information and observations every step of the way. I welcome any views and insights that agree or disagree as we work to understand eating disorders and best support those that live with them. Here’s my take.

At the core, food and exercise are tools to help cope for people with eating disorders. For me, anorexia feels like an addiction full of rules and behaviors that help me to feel better at the moment despite knowing that the behaviors come with harmful and often detrimental long-term consequences. Eating disorders may be fueled by low self-worth and challenges coping with strong emotions in a healthy manner. I know that has been true for me, and recovering has meant working on self-worth and improving my outlets for processing my strong emotions, such as writing and speaking openly about it on a blog.

The harm that I see when not stopping to consider the root reasons that people under or overeat is the oversimplification of the solutions targeting the symptoms: Just eat less/more and exercise less/more. In a society that tends to be more harsh on the overeaters, it’s painful to hear the advice given: the exact rules that my restrictive eating disorder has created in my mind that I have spent years trying to combat. From my perspective, it sounds like patients are being prescribed one eating disorder for another. My perception is that this approach is likely due to the fact that we live in a society where it’s more socially acceptable to undereat than overeat. If the patient is struggling with an eating disorder and we use my view of anorexia/eating disorders as an addiction; that’d be trading one addiction for another while not working to support the individual to develop healthier ways to cope with the issues that are at their core.

Further, prescription of restrictive diets often sets the patient up for binges. Taken all together, not only are we not treating the core problems, we may be exacerbating both the core problems and the symptoms.

So what are the solutions? While I cannot cover all, here, I will share good places to start.

First, start by listening. Consider the whole person and start by prescribing self-compassion for the patient. I have not met one patient with an eating disorder that would not benefit from increased self-compassion.

While listening, create a psychologically safe environment for patients to share openly and feel heard. Too often, I hear patients avoid doctors out of fear of being shamed for their diet, exercise, or weight. Since eating disorders thrive in secrecy, the avoidance and shame may then further the eating disorder grip. Thus, we need to change our approach to these sensitive discussions. We need to practice asking questions in a non-judgmental way from a place of humble inquiry. If that term is new, I highly recommend checking out the book, Humble Inquiry: The Gentle Art of Asking Instead of Telling by Edgar H. Schein.

Also, please know that food is a bigger part of the solution than it is the problem. I like references that consider food as medicine for people with eating disorders. When not eating appropriately (regardless of weight), malnourishment may sustain the problems that contribute to eating disorders. Due to the complexities, I highly recommend a treatment team (i.e., dietitian, psychologist and/or psychiatrist, and medical physician) that specializes in eating disorders when possible.

And importantly, please stop prescribing one eating disorder for another. Restrictive diets should never be glorified.

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