Cutting-Edge Therapies forEating Disorders by Jessica Setnick, MS, RD
Three strategies that dietitians can employ when counseling eating disordered clients include the apple test, the transitive property of fat, and recognition of the benefits of the eating disorder.
The apple test:
Eating in response to emotions can lead to overeating, compensating, and/or unwanted weight gain. The apple test is a way to help clients distinguish emotional needs from physiological hunger (Note: This strategy is not appropriate for patients who avoid eating.) At the onset of food thoughts or cravings and prior to eating anything that is offered, clients are advised to ask themselves: “Would I eat an apple?” Since apples are usually considered plain but nourishing food, the goal is to determine if you are truly hungry (“Yes, I would eat an apple”) or not (“I would eat a donut, but Iwouldn’t eat an apple”). If clients determine that they would eat an apple, they follow the guidelines provided by their dietitian or meal plan regarding what and how much to eat. If they find that they would not eat an apple, they follow the guidelines provided by the dietitian or mental health professional for identifying and managing emotional needs.
The transitive property of fat:
Because the “language of fat” is spoken so frequently in our culture, we learn to blame our bodies for our bad feelings. To help clients find non-eating disordered ways to cope with their feelings, they must first recognize that they are having feelings. Otherwise, they will continue to feel“fat,” a situation that has only one solution. Each person has a different definition of “fat.” Feeling “fat” indicates that a person is also feeling how he/she believes “being fat” feels. Clients may disagree with that statement and tell the dietitian they are only feeling fat, and nothing else. However, clients are really saying that because theoretically there is a solution to being fat, while there maybe no solution to other feelings. Using this strategy, dietitians can ask clients to walk through the grocery store and when they see a “fat”person (whatever they consider fat), think about what they assume that person’s life must be like. The dietitian might say to the client: “I know you don’t judge people based on appearance, but if you did, what might you think you know about this person? Is he lazy? Unproductive? Ugly? Lonely? Does he eat too much, eat the wrong things, let himself go?“ Whatever you think you might know about this person, this is what you equate with ‘fat.’ If you think that fat people are lonely, whenever you are lonely, you are bound to feel fat. If you believe that fat people are ugly, whenever you feel ugly, you are going to feel fat. Ugly and lonely don’t always have solutions, but when you know your definition of “fat,” you can discuss with your therapist how to handle that feeling, instead of turning to your eating disorder behaviors.”
Recognizing the benefits of the eating disorder:
Because eating disorders are a response to stress, they develop in response to underlying problems. Viewing an eating disorder as solely bad and shameful only makes a person feel worse for having it; the disorder prevents sufferers from finding the ways that it is actually “helping”them. Ask the client: “If you were to view your eating disorder as a solution, in what situations has it come in handy? How has your eating disorder helped you to get what you want, avoid what you hate, or express your true feelings? Your true problems are the very things that your eating disorder has helped you with. Once you have found the things that your eating disorder has helped you with, find non-eating disorder methods to solve them. When you are feeling strong, you won’t need your eating disorder to do your work for you.”
Eating: From Disordered toOrder—“What is Normal”?
by Reba Sloan, MPH, LRD
Many of my eating disordered clients have asked me to define “normal eating.” Whether clients are struggling to be free from the bondage of extreme dietary restraint or wrestling with the drive to binge on food, the goal is to help them arrive at a normal relationship with food, eating, and activity. This involves abandoning the “all or nothing” thinking and discovering a life lived in the “middle ground.”The first task is to help clients understand which aspects of their relationships with food are disordered. Most clients understand from a rational standpoint that their behaviors are imbalanced in this area. The powerful hold of their eating disorder can hinder them from accepting and living out this intellectual truth. Here are a few areas that dietitians can explore with clients in an effort to uncover disordered eating behaviors or cognitions:
Are you adhering to irrational rules regarding food and eating? (ie, “I can only eat 1,000 calories per day.” or “Carbs are bad/fattening.”)
Have your eating practices/behaviors contributed to a disconnect withyour hunger/full/satisfied cues?
Has the way you are eating and the activity you are getting or not getting contributed to “artificial” weight loss or gain?
Does your current relationship with food disrupt your emotional, social, or spiritual life?
After the client acknowledges thatdisordered eating is present, factors that may have contributed to this imbalance need to be addressed. Thisc an include emotional triggers that might cause someone to eat or not eat continually over a period of time, frequent dieting that stems from unrealistic weight or size goals, or living in a social-cultural melee that complicates finding the middle ground withour food, activity, and weight. Thereis no clearly defined crossover point where disordered eating becomes an eating disorder. Even if one does not meet the diagnostic criteria for an eating disorder, disordered eating can destroy peace of mind and quality of life. My experience has been that many clients struggling with disordered eating fit the diagnostic criteria for Eating Disorder Not OtherwiseSpecified (ED NOS). This initial work with a client lays the foundation required for the journey towards “the middle ground” of normal eating. I have come to see normal eating in the following terms:
Eating that does not cause chaos inone’s thoughts and behaviors with food.
A relationship with food that is not guilt- or shame-based.
Eating that is thoughtful and connected, not obsessive.
Eating that is satisfying and enjoyable.
Eating that is flexible, and, occasionally“disordered.”
Achieving normal eating is even harder than defining the term. It is a process that involves a “hammer and chisel” approach. Our job is to assist clients in this pursuit by helping them identify and change faulty beliefs regarding eating, food, and weight, and giving them nutrition advice to encourage variety, balance, and moderation and to promote “style of eating”work that allows for more effective connection to the body’s signals. In a nutshell, normal eating is a result of realistic and practical goals. This might be best summarized by a quote I once heard and have long since forgotten the source: “Moderation in everything, including moderation.”
Reba Sloan, MPH, LRD, is a nutritiontherapist in private practice inNashville, Tenn.
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