Dr Carrie Decker ND reviews a common screening issue and offers some practical tools.
One of the topics that comes up when working with patients in all types of medical or nutritional practices is how to ascertain if disordered eating patterns or attitudes surrounding food may exist. Although a historic eating disorder is not an absolute contraindication to recommending dietary changes, it is important to be aware of as dietary restrictions may trigger deep-rooted reactions very similar to that which existed when one was active in their eating disorder.
As a naturopath who sees many individuals with conditions of autoimmunity and digestive dysfunction, I often make suggestions of dietary modifications such as the avoidance of gluten, dairy, and other foods which one is found to be sensitive to via food sensitivity testing. However, this is not the case for all individuals, in particular those who have a significant history of an eating disorder.
Understanding if an eating disorder is a potential issue of concern is not a straightforward manner, as for many people who struggle with food it also is an issue of secrecy. Unless someone is coming in with an eating disorder for which they are seeking treatment, they may actually be seeking nutritional guidance from a professional to help them further their restrictive eating patterns, or as a means to try to establish control over binge eating patterns. Unfortunately in the long run, advising dietary restrictions in this population only leads to further difficulties downstream, particularly if their condition worsens enough such that they are in need of in-patient therapy. Identifying foods as “good” or “bad” can greatly worsen the internal dialog of an eating disorder, as this is seen to be equivalent the statement “I am bad for eating A, B, C, or D,” and play into issues of perfection and obsessive-compulsive behaviours for one engaging in restrictive patterns.
One of the resources I refer to are the questions suggested by the National Eating Disorder Association (NEDA), discussed further in the document “Screening for Eating Disorders by Primary Care Physicians,” written by Margo Maine, PhD and Kimberli McCallum, MD. Taken from this resource, topics to inquire about include weight fluctuations, historic or current dieting, exercise, feelings of lack of control around food intake, actions taken to control or alter weight, and comfort with current weight and shape. Other questions which are more direct concern use of supplements or medications such as laxatives or appetite suppressants, self-induced vomiting, and loss of control in periods of eating. One also should inquire in a thorough intake about family history of eating disorders, depression, obesity, and substance use. As holistic practitioners, a diet diary or record of meals in the last day or two is often a part of intake, and this should be screened for possible restrictive patterns or imbalanced eating behaviours.
As questions may not be answered in a frank manner due to shame or desire to hide these behaviours, other clinical signs should also be noted. This includes having a low body mass index (BMI), amenorrhea, bradycardia, metabolic disturbance, syncope, dehydration, reflux/regurgitation, hypoglycaemia, and chronic constipation. Although by no means are any one of these things, or even many, indicative of an eating disorder, if they are observed in combination with attitudes around food and dietary patterns that are concerning further and more direct inquiry may be in order. Thoughtful consideration of a therapist to suggest, possibly just as general support for health and stress management, may help a client to open up surrounding struggles with an eating disorder. And with anything, there is greater trust placed in a provider with time, and continuing to be observant and supportive for your client with caution around diet will help an individual struggling with an eating disorder to be more open with their concerns.