Q & A: Mary Dye, Director of Nutrition Services

Mary Dye, MPH, RD, CEDRD, LD/N oversees all nutrition across Oliver-Pyatt Centers as the Director of Nutrition Services. In this weeks blog, Mary offers her unique perspective on the relationships between dieting, disordered eating and eating disorders.

What are some signs you should be aware of that a strict diet is turning into an eating disorder?

Isolation & Secrecy:

If counting and measuring food, only eating in a certain way or at a certain time starts to take priority over relationships and social opportunities then we have a problem. Think of that friend who used to meet up for brunch. If she’s now suddenly not available or comes but “has already eaten” these could be warning signs. If you realize she doesn’t seem to eat with you anymore and is always full, these could be signs that her eating is so rigid it can only be done at home, likely alone.

Guilt & Obsession:

Strict diets and/or exercise regimens can require so much time, counting and focus they can feel like a part time job. When adhering to an exercise or meal plan replaces pleasurable activities and breaking the plan results in guilt, shame and anxiety, or requires compensatory behaviors there is a problem. It’s tricky because often in our culture we praise people’s devotion to dietary rules but it can be a fine line between an interest and an obsession.

Self-worth based on diet, exercise and/or weight:

Many people on diets like to talk about their diet, exercise and weight. When this becomes the basis of a person’s identity, it can be a sign of a larger issue.

Rapid weight loss & continued loss:

This may or may not occur. But if it does, consider it a warning sign. Losing over two pounds per week can resulting in negative health consequences. Often people start a diet with the goal of losing a few pounds, but once they get into the obsessive mindset and receive positive reinforcement for losing weight (which we do a lot in our culture) the diet can spiral into something more serious.

Pre-occupation with food:

If all your friend is talking about is food and living vicariously through your eating while she claims to be full: warning sign. She’s probably really hungry and is struggling to allow herself to eat the foods her body needs.

Use of food rituals:

These can vary but might include: taking tiny bites, not eating in public, breaking foods into little pieces, drinking loads of water before meals, eating only at exact times, using excessive calorie free condiments, etc. They usually have to do with extending the eating experience and filling up on low or no calories.

Compensation:

Statements like “I have to go for a run because I ate a brownie” can sound benign, but they can be a major red flag. If a person is having to compensate for their food with exercise, purging behaviors or forms of self punishment or if a person is reducing or altering their food intake and denying their hunger cues to compensate for missing a workout, these may be reasons to be concerned.

What is the difference between having an “eating disorder” and having “disordered eating?”?

There are specific criteria for the four diagnosed eating disorders in the Statistical Manual of Mental Disorders-V (DSM-V). While many people don’t meet the full criteria for a diagnosed eating disorder, many do have an unhealthy relationship with food and weight that may put them at risk both physically and emotionally. The difference has to do with the degree or frequency that a person is engaging in the disordered behaviors. A person with disordered eating would engage in the behaviors with less frequency or with a lower level of severity, yet are at risk of developing a full blown eating disorder in the future. Disordered eating is dangerous in itself, and many times goes undetected until it is a full blown eating disorder because the warning signs are less severe and the person is often highly functional in other areas of their life (this high functionality can be the case in eating disorders as well). Sadly, we live in a culture that promotes a degree of disordered eating, so many people feel uncomfortable addressing these warning signs and write them off as normal.

How has our focus on healthy eating (especially on Instagram and Facebook) contributing to eating disorders? Could they be eating disorders in disguise?

Social media certainly has intensified the pressure to “eat right” – whatever that happens to mean on a particular day. It can fuel the false idea that perfection is attainable. Since social media is accessible 24/7 – it can be visited when people are feeling most vulnerable and looking for a way to fix themselves by scrolling through photos and getting ideas on how to “self-improve”. As registered dietitian doing private food recalls for over 10 years, one thing I can say with certainty is that what people are actually eating and what they present themselves as eating, are often pretty different. I tell my clients all the time: comparisons get you no-where.

Strict regimens are fueled by reinforcement, and what better way to motivate than to get countless “likes” for a way of doing something. It can also intensify the guilt and shame that are experienced if the regimen is broken both for the person in the social media post (a sort of dual identity) and for the person viewing it (I’ll never be like her, I just ate dessert and don’t have time to go running). We also have loads of people giving nutrition and fitness advice on social media that don’t have backgrounds in these fields, so that can lead to a lot of confusion and misinformation.

I think the social media stars that have recently come forward and disclosed their eating disorders has been a wake-up call that some of what we see is an illness in disguise.