“I’m a normal BMI so I don’t have an eating disorder.” I can hear the pain and protective defensive stance of Julie as she sits across from me. “Everyone tells me I look great, that I should be proud of my weight loss.” Julie bravely continues sharing with me her diet journey—losing half her body size, the preoccupation with food and weight, rigid eating pattern, calorie counting, avoidance of life-giving nutrition and food groups that has led her to this point. Are these anorexia symptoms or “just dieting”?
As a dietitian in the eating disorder field, my mind is open to the pain and hurt behind food and body behavior. I ask her to describe her relationship with food and her body while she was growing up. Julie grew up as a child in a larger body; she was bullied and made fun of because of her size. She discovered weight loss tips and diet books as a means of comfort. She started dieting and quickly became immersed into the thickness of diet culture. “I think if I lose just 10 more pounds, I will be able to do so much more in my life, get a better job, have more friends.” She talks about weight loss as if it holds promises that weight is synonymous to worth and value as a human being.
Her intake dwindled down to a limited number of food groups, excluding most for fear of weight gain. Her energy intake became only enough to help her brain and heart function at a sub-optimal level. Her body is now half of what it was two years ago. She mentions her body feeling the effects of malnutrition—all physical anorexia nervosa symptoms:
- difficulty concentrating
- muscle weakness
- dizziness while standing up
- frequent fainting
- stomach pain
She sits across me with her cup of water, brittle nails, dry skin, and a layer of lanugo around her arms and face—her body’s resilient attempt to keep her warm. This is not just dieting, although our culture may think these are all “normal and good” attempts to keep a body small. These are symptoms of anorexia.
She describes every waking hour spent thinking, measuring, obsessing about food—the calories, the volume, the grams of this and that, when to eat, what to eat, how much, how and where. Her relationship with food was permeated with anorexia symptom behaviors. She circled back to why she reached out to a dietitian in the first place. “Do you think I have an eating disorder?”
Anorexia nervosa is a mental illness included in the DSM-5, with criteria only a mental health provider can diagnose. However, Julie demonstrated a gamut of anorexia symptoms and was physically, emotionally, and psychologically malnourished in her relationship with food. Diet culture is so prevalent that it can often mask anorexia symptoms as “normal, healthy, clean eating” in the early stages of an eating disorder. The pursuit of health through weight loss can become blinding, and your psychological, mental, emotional, and relational health will suffer.
The good news is that there is hope for full recovery from an eating disorder, as well as from the beliefs of diet culture. Your weight is not your value, worth, or a direct marker of health. At Alsana Eating Recovery Centers, balancing both nourishment and pleasure in food is not just about nutrition, but is about supporting your physical, mental, emotional, and relational healing.
Amy-Claire Grisham McMurtrie, MS, RD, LD