Maybe I Have an Eating Problem

A Continuum of Body Image

Concerns about diet, weight and attractiveness are prevalent among Stanford students. These image-driven concerns can lead to unhealthy preoccupations with body weight and image, affecting personal self-esteem, well-being and vitality. When preoccupations become serious, they can lead to significant health problems.
Eating problems fall within a broad range of eating-related feelings, attitudes and behaviors. Consider the following continuum:

Confidence about body shape/size; flexible eating
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Preoccupation with body shape/size and eating
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Distress about body shape/size and eating
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Eating disorders

Body image confidence is characterized by mostly positive feelings about your body shape and size. In this range, your body is seen as a good part of you that can help you enjoy life. For confident people with a healthy body image, all foods fit into an overall healthy diet. There is no need to categorize some foods as "good" and others as "bad."

Preoccupation with body shape, size and eating involves frequently thinking about food, eating and your body. You may think about what you ate at your last meal and feel a need to "make up for it." You may be a little inflexible about what you allow yourself to eat. You may have moments when you feel guilty or bad about what you've eaten. You might consistently feel that you could lose a few pounds. However, in general these feelings do not interfere with enjoying life and engaging in situations involving food.

Eating or Body Image Distress refers to preoccupation with eating and body size/shape that interferes with daily interactions and activities. You may think a great deal about food or your looks. In this range of the continuum, you may be fairly rigid about eating patterns and may work hard to change your body size/shape. You may do some compensating for eating (e.g., vomiting, fasting or extreme exercising). However, you typically experience only an insignificant amount of weight loss.

Eating Disorders most commonly refer to Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder.

Anorexia Nervosa involves major fear of gaining weight or becoming fat. It involves restricting food intake to the point of significant weight loss and even starvation. Although these individuals may be extremely underweight, they see themselves as "fat." They deny problems with eating habits and resist others' efforts to get them to eat and return to a healthy weight. People who struggle with Anorexia Nervosa may or may not engage in compensating behaviors, such as extreme exercising. Women with Anorexia Nervosa typically stop menstruating.

Bulimia involves episodes during which a person eats large amounts of food (often in secret) and feels unable to control their eating. Then they try to counteract the bingeing by purging. This may involve self-induced vomiting, use of laxatives, prolonged fasting and/or exercise to offset the food eaten. People with Bulimia feel out of control with the cycle of bingeing and purging.  

Bulimia Nervosa describes patterns of binge eating and compensating that occur at least twice a week for three months. People struggling with Bulimia Nervosa often evaluate themselves extremely critically on the basis of their body shape and weight.

Binge Eating Disorder describes patterns of binge eating (two days a week for a six-month period) without the compensating behaviors.

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Difficulties Often Associated with Eating Problems

People who struggle at the Preoccupation, Distress or Eating Disorder levels experience behavioral, emotional, psychological, social, and/or physical symptoms. The following checklist includes many symptoms, although it is not intended to determine whether you have an eating disorder. It’s designed to help you think more specifically about your behaviors and feelings, regardless of your position on the continuum.

If you’re concerned about any of these symptoms, you might want to speak with a counselor, physician or nutritionist. You may want to place a check next to the symptoms you’re experiencing and bring the checklist with you.

Behaviors

___ You routinely restrict calorie or food intake for the primary purpose of feeling more in control (e.g., "I'm going to limit how many calories I eat" or "I will only eat ‘good’ things”).

___ You experience episodes during which you feel out of control while eating.

___ You feel compelled to exercise (sometimes excessively) in order to compensate for the food you’ve eaten.

___ You self-induce vomiting.

___ You temporary fast in order to compensate for food you’ve eaten.

___ You use drugs to control eating or weight gain (e.g., diet pills, amphetamines, laxatives, diuretics and more).

___ You have rituals surrounding food (e.g., not allowing food to touch your lips; cutting your food into small pieces).

___ You frequently weigh yourself.

___ You count calories.

Emotional

___ Depressed mood

___ Mood swings

___ Irritability

___ Guilt about eating

___ Intense fear of fat

___ Low self-esteem

___ Eating when upset

___ Emotional discomfort after eating

___ Difficulty tolerating the feeling of being full

___ Shame about eating behaviors

Psychological

___ Perfectionism

___ Preoccupation with food

___ High need for structure

___ Rigid eating schedule

___ Alternating between being in control of eating and "letting go"

___ Difficulty concentrating

___ Fluctuating body image (i.e., having "fat days" and "thin days")

Social

___ You frequently eat alone.

___ You eat in secret.

___ You avoid friends.

___ You avoid situations where food is involved.

___ You have strained relationships due to food-related issues.

___ You have difficulty being assertive.

Physical

___ Amenorrhea (i.e., menstruation has stopped)

___ Throat problems

___ Frequent weight fluctuations

___ Significant weight loss or gain

___ Swollen glands

___ Hair loss

___ Puffy cheeks

___ Broken blood vessels under eyes

___ Fainting/dizziness

___ Fatigue

___ Unexplained tooth decay

___ Developing fine hairs all over your body

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How Do People Overcome Eating Problems?

Although people with eating problems deny this and are reluctant to seek help, their friends and family often notice. Direct, nonjudgmental care and concern for their health from family and friends is a vital first step that enables them to seek appropriate treatment.

It’s important to remember that hope and a variety of treatment options exist for those who suffer from eating problems. Proven approaches can effectively prevent, reduce or stop troublesome behaviors while helping people develop new ways of coping with underlying feelings.

An important first step to overcoming an eating problem is acknowledging that you have an eating problem. Often this can be the most difficult step. An important aspect of this is realizing that your eating behaviors and distressed feelings are about more than food.

The next step is talking with professionals who are experienced in working with people who have eating problems. Treatments for eating problems are composed of many elements including medical monitoring, nutritional counseling, education and individual/group counseling.

The first benefit these professionals provide is relief from keeping this issue a secret. They help improve self-esteem, challenge negative body-image messages and guide you toward a healthier lifestyle that supports developing healthy relationships.

After regaining balanced eating attitudes and behaviors, some people take proactive steps to alter environments that contribute to developing eating problems. This may include working to change cultural expectations and oppressive attitudes about size and shape. These people may also encourage others to find coping strategies that are healing and productive.

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Vaden Services

The Wellness and Health Promotion Services’ nutritionist offers students assistance with nutrition, weight management, body image and disordered eating. Help includes educational activities, individual nutrition counseling, consultation and referral.

Assessment and Treatment at CAPS offers help with a wide range of nutritional, body image and disordered eating concerns.

Medical Evaluation and Management provides help with nutritional disorders, disordered eating and their complications.

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Websites

These sites investigate the relationship between the food we eat and good health. They also address how ineffective diets and disparaging your body image can lead to serious health problems.

Body Positive Site is dedicated to fostering self-esteem and a positive relationship to food and our bodies.
www.bodypositive.com

National Eating Disorders Association has information on the origins, prevention and treatment of eating disorders.
www.nationaleatingdisorders.org

Mayo Clinic offers a summary of many weight control issues and concerns.
www.mayohealth.org

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