Regulate the Diet Industry

Disorganized and disordered eating have a profound impact on all body and brain function. The knowledge in our culture about dieting, fasting or unusual eating patterns is that these behaviors can be healthful and positive for our overall well-being. This false thought process opens the door to many negative health effects.

The diet industry continues to expand its reach into the modern psyche. So much time, energy and money has gone into changing eating habits. However, none of these changes involve normalizing eating but instead overvalue changes that undermine health.

There is no data to prove that fasting, avoiding certain kinds of foods or eating certain amount at certain times of day are beneficial. The diet industry is legally able to promote health effects of their plans without a shred of evidence. For a public desperate to exert power of food and body, these measures feel miraculous, even though they are never effective.

The endless attempts at finding the right diet is demoralizing and promotes a constant sense of failure. This is not a positive way to live.

However, the health effects of ineffective diets are even worse. Eating irregularly, avoiding necessary variety in a diet and periods of fasting cause poor health. People often experience fatigue or develop physical symptoms from eating a diet with limited nutrition. People often feel more depressed or anxious and have trouble concentrating. They can have gastrointestinal problems such as constipation or severe bloating. The large majority of these diets don’t work and actually cause medical and psychological problems if followed regularly.

And most concerning is the link between dieting and eating disorders. The number one risk factor for developing an eating disorder is dieting. It’s never clear how someone is programmed to respond to chronic dieting. Not infrequently, the result of a diet is the gradual development of an eating disorder.

There needs to be much clearer regulation of the diet industry. The money behind this business leads to endless false claims intended to confound and mislead the public. Without clear guidelines, the diet industry only exacerbates the general food and weight obsessions of our society.

Beware the Medical Community Prejudice of Eating Disorders

The bias towards people with eating disorders in the medical community is very prevalent. Doctors have little medical background or information about eating disorders and thus tend to conflate their own personal beliefs with clinical acumen. The result is a lot of anger and unprofessional behavior towards patients with eating disorders and, just as concerning, subpar care.

The greatest missing link from doctors treating eating disordered patients is compassion. It’s very difficult for doctors not to blame patients and their families for the illness. They struggle to comprehend that an eating disorder is a psychiatric illness that is difficult to treat. It is even more unfathomable that someone could not get better despite adequate treatment.

Doctors frequently tell these patients unceremoniously that they are wasting medical attention and money, will die anyway or are abusing the system for their own personal benefit. Families are often berated by medical professionals and are forced to endure unacceptable treatment in order to support their loved one who is getting medical attention.

Unfortunately, this attitude tends to allow doctors to feel justified in making poor decisions for their patients. If one’s attitude towards a patient is judgmental and angry, it is harder to feel compassion and thus harder to make the wise decision for a patient. It can be easier to make a safer decision, whether or not it’s best for the patient, since it is more difficult to trust a patient with an illness that makes no sense.

This attitude may lead a doctor to ignore otherwise concerning symptoms like chest pain or dizziness, to hold off on blood tests or scans or even suggest surgery even if other less invasive treatment is available. No doctor will make these decisions maliciously. But if a doctor has difficulty understanding the true medical situation, it’s harder to make wise clinical decisions.

Often I find myself arguing with doctors to consider the entire patient when making critical decisions. However, the bias runs deep in the medical world. The willingness to open one’s mind to new concepts becomes harder over time, and the medical community is still closed to understanding how to treat people with eating disorders.

One key step to change the circumstances is education. The more doctors understand these illnesses, the easier it will be to coordinate care. Another way to consider these patients’ best interest is through the discipline of medical ethics. This branch of medicine encourages doctors to think more broadly about clinical decisions and to consider all outcomes.

Perhaps through opening the eyes of doctors, the medical world can see the scourge of eating disorders more clearly and provide the care these patients deserve.

Diverging Paths of Eating Disorder Treatment: How to Treat the Chronic Eating Disordered Patient

A recent conversation with a colleague reached a sticking point: what options are there for an undernourished patient who is not able to go to a program and become nourished?

She said that she cannot work with someone who is malnourished. Since a starved brain doesn’t work, any form of therapy is ineffective and meaningless. Until the patient is ready to seek help, therapy is pointless.

I said that although that may be true, how can a clinician reject a patient because she is so stuck in her illness? Isn’t it the obligation of the treater to stand by the patient and shepherd her into beneficial care?

This conversation reflects a larger issue with eating disorder treatment. What is to be done about the people with chronic eating disorders who are unable to seek more intensive help?

Standing one’s ground about becoming nourished has its merits. Treatment will be challenging for someone who is working hard to follow a meal plan, but there will inevitably be progress. Creating new thought and behavior patterns around food naturally evolve from actively working on a meal plan. And for the clinician, it is easy to feel secure in the direction and goals of treatment. There is little risk for the therapist.

Working with someone unable to start a meal plan is a different, challenging and potentially dangerous endeavor. The risks of serious medical consequences are high. The effects of being malnourished or compensatory behaviors such as purging or laxatives are concerning. And there is no guarantee the patient will find a way to start to eat more regularly again.

This path demands patience from a therapist to tolerate a high level of illness and the brutal honesty of seeing what someone in an active eating disorder looks like. Yet the potential rewards of taking the more dangerous route are great.

The effect of standing by someone too sick to begin a path towards recovery is significant. The patient feels heard and understood. She realizes she is not a pariah but instead someone with an illness who wants and needs to get help. She starts to see that she can be cared for in her illness and she won’t be alone in the process of recovery either.

Those messages are necessary to create the trust that opens a heretofore invisible road to wellness.

So it’s not that I disagree completely with my colleague. But maybe there are multiple ways to help someone with an eating disorder see the opportunity to get better. Flexibility and the willingness to find that road are sometimes more important than anything.