Tag: eating disorder treatment

When Eating Disorders Complicate Pregnancy and Postpartum

It is not uncommon for women to experience mixed emotions during pregnancy.  One moment, a woman may find herself feeling extremely excited for her new bundle of joy and the next moment worrying about the changes with her body and weight gain.  For some who have a preexisting eating disorder, pregnancy could exacerbate their symptoms and behaviors while some who have a history of eating disorders may find themselves fearful of a relapse.  Women who do not have an eating disorder history may find themselves experiencing disordered thoughts related to food, eating, and body image during pregnancy, which can be a disconcerting development.

The National Eating Disorder Association (NEDA) states that according to national surveys, 20 million women in America are estimated to have an eating disorder at some point in their lives [1].  These disorders include anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder BED), or OFSED (other specified feeding or eating disorder).  NEDA notes that an eating disorder can be triggered by pregnancy itself. 

In addition to the emotional ups and downs of pregnancy, when a woman is faced with the challenge of discontinuing eating disorder behaviors, the battle between the disorder and the need to protect their unborn child can be intense.  Many women adopt a ‘mama bear’ stance once they become pregnant: they focus on their baby’s needs for nutrition and care, and this determination helps them to abstain or reduce behaviors in order to protect their baby’s health.  

Joanie S. (not her real name), who received treatment for her eating disorder in a partial hospitalization program, shared her experience.  “I didn’t want my baby to have issues and I just needed to be healthy for nine months. There was an end date”, she said. By reminding herself about the importance of her baby’s needs and the fact that pregnancy is time-limited, she was able to hold on to the ‘mama bear’ mentality .  Although this perspective may help some women refrain from using eating disorder behaviors, others find that being pregnant and having an eating disorder cannot be separated and “ were bound to interact” [2]. 

After her baby is born, a woman’s body image dissatisfaction as well as negative attitudes toward food and eating can increase [3].  For individuals recovering from an eating disorder, negative body image is the greatest predictor of relapse.  In fact, 80% of women who had a postpartum relapse reported significant body image distress and dissatisfaction [4].  Many women find themselves trying to lose the “baby weight”, and are in danger of triggering or exacerbating their eating disorder.

Joanie described her relationship with food and her body during pregnancy as being singularly focused on taking care of her unborn child.  Becoming a “mama bear” during pregnancy staved off the eating disorder, and she didn’t experience a resurgence in behaviors until after the birth of her child.  Joanie explained that it became easy to rationalize restricting her food intake during the postpartum period.  “I felt better about myself when I wasn’t eating. I was taking care of my baby.  I was losing weight.”  Being a busy mom focusing on the needs of her infant child became an effective cover for Joanie’s eating disorder, while she was putting her own health at risk.  

Although weight gain and body changes due to pregnancy are usually associated with something natural and/or positive, for women who have an eating disorder it can be difficult to grapple with how triggering their pregnant body shape can be.  Many reported feeling fearful around weight checks with obstetricians during and after their pregnancy. Some women describe feeling fearful about how the information about their weight gain was shared with them by their physician [2]. While the postpartum period is an important time to attend to in their own healthcare, women with an eating disorder will often avoid physician visits out of shame and anxiety.

Many physicians do not screen for eating disorders or understand how to treat them.  Due to ambivalence about asking for or receiving treatment, women are often reluctant to disclose diagnoses and/or behaviors. Further, there are often gaps in coordination between maternity care and other care providers.  Joanie S., who is diagnosed with an eating disorder, stated, “I wasn’t educated about my eating disorder during pregnancy and after having my daughter.” She explained that she received an abundance of information on what to expect in terms of her child’s health and development, but did not receive any support for her eating disorder during pregnancy or postpartum.  Like Joanie, women with an eating disorder benefit from professional before, during and after pregnancy to improve their health without harmful dieting and eating disorder behaviors.

According to ANAD, eating disorder symptoms may decrease during pregnancy, which could lead to the false assumption that all is well [5].  While women are busy with their newborns, revealing their difficulties and seeking help for their eating disorder can become even more challenging.  However, eating disorders are serious disorders, and self-care is essential.  Women are encouraged to talk to their obstetrician, gynecologist, or primary care doctor about any issues that arise during and after their pregnancy.  Bringing in a list of questions/concerns during a postpartum visit is recommended.  A postpartum visit should include a full assessment of physical, psychological, emotional, and social well-being.  Reproductive life plan, including birth control, health conditions or pregnancy complications, etc. are discussed during postpartum visits. It is also important to consult with a registered dietitian, seek individual therapy and/or support groups during this time.

If you believe you have an eating disorder, there are many online screenings. Bright Road Recovery offers a screening as well as the option to print up a letter to take to your doctor.


About the author:

Joanna Bosque, LMFT-Clinical Therapist at Bright Road Recovery

Joanna Bosque, LMFT is a clinical therapist for Bright Road Recovery.  She is passionate about working collaboratively with her patients to explore their lives on a deeper level and gaining insight on how their experiences influence the choices they make. She believes in empowering patients, assisting them in achieving their goals, strengthening their relationships, and supporting them in developing a healthy relationship with food. 

When she is not working, she spends most of her time with her two children and husband. She also enjoys finding great deals, baking, catching up on TV shows, and listening to music.


References

1.NEDA. What Are Eating Disorders. The National Eating Disorder Association. 2018

2. Claydon, E.A., Davidov, D.M., Zullig, K.J. et al. Waking up every day in a body that is not yours: a qualitative research inquiry into the intersection between eating disorders and pregnancy. BMC Pregnancy Childbirth 18, 463 (2018).

3. Kimmel, M.C. Ferguson, E.H. Zerwas, S. et al. Obstetric and gynecologic problems associated with eating disorders. International Journal of Eating Disorders. Mar2016, Vol. 49 Issue 3

4.  Astrachan-Fletcher E., Veldhuis C. et al. The reciprocal effects of eating disorders and the postpartum period. A review of the literature and recommendations for clinical care. J Womens Health (Larchmt) 2008, p227-230

5. Santucci, P. Eating Disorders and Pregnancy: A comprehensive book for women and healthcare professionals. The National Association of Anorexia and Associated Disorders (2019), p129-130

Orthorexia

When Healthy Eating Becomes Dangerous

By Claire St John, MPH RD

Diet buzzwords are everywhere these days, from eating ‘clean’ to ‘pure’ to paleo to raw veganism. Although these terms have nebulous definitions, many people take up the banner of their personal food plan, encouraging others to do the same.

For some people, eating better means buying whole foods and organic produce when possible. But for others, eating a ‘perfect’ diet becomes an unhealthy obsession that takes over their lives. At its worst, it can result in malnourishment, mental, behavioral and health issues.

It’s ironic that an effort to eat better could compromise health, but that’s what Dr. Steven Bratman noticed in the 1990s when he coined the term ‘orthorexia,’ derived from the Greek for ‘correct eating.’ Before he was a doctor, Bratman lived on a commune with people who argued against cutting vegetables for fear of losing nutrients. Others avoided plants from the nightshade family, such as tomatoes, potatoes and eggplants. Although many of his friends and eventually patients touted their healthful diets, Dr. Bratman observed their health declining.

As a Registered Dietitian who works with eating disordered patients, I’ve seen the effects of orthorexia first-hand. People with orthorexia tend to focus on what they eat rather than how much they eat,as in cases of anorexia nervosa. The results, however, are similar. Both the anorexic and the orthorexic tend to be dangerously underweight, and their labs show low iron and low total protein.

“It’s important to know that someone can start out with orthorexia and slip into the psychological symptoms of anorexia,” said Tamson Overholtzer, Director of Bright Road Recovery in Claremont Village and a licensed Marriage and Family Therapist. “When this happens, the focus is not just on the perfect diet, but also on fear of weight gain.”

Unlike anorexia, orthorexia can hide in plain sight, and is often unwittingly encouraged by friends and family who admire the orthorexic’s willpower and dedication to diet.The disorder can begin innocently, with something as simple as a resolution to eat better.

Magazine articles, news segments and a billion Internet sites constantly promote the “hot, new diet.” People cut out gluten without knowing what, exactly, it is. Dairy is demonized daily and sugar and carbohydrates are called poison by people with Ph.Ds. It’s no surprise that people don’t know what to eat, and as the headlines pile up, they might cut foods out of their diet almost randomly.

Eliminating entire food groups can lead to nutrient deficiencies, but as health fails, the obsession with healthy eating can intensify. Feelings of fatigue are assumed to be due to toxic foods lingering in the diet. Insatiable cravings for ‘forbidden foods’ are chalked up to the addictive attributes of the American food supply instead of simple hunger and undernourishment.

Because the diet is so restrictive, it becomes difficult to eat at restaurants. The orthorexic might carry his food around with him, because restaurants and stores can’t meet his high standards.

Eating at friends’ houses is out, because it’s burdensome listing all the foods he can’t eat. People don’t seem to understand anymore. They say he’s lost too much weight, but losing weight is a good thing, right? When the right foods aren’t available, the orthorexic will skip meals rather than contaminate his body.

Oftentimes, neither the orthorexic nor his family and friends realize there is a problem until it becomes very serious. Because healthy eating has taken on nearly religious status in our culture, those who eliminate ‘bad’ foods are celebrated.

When someone comes to me  for help with their restrictive eating patterns, I start them on a meal plan that includes starches, proteins, fats, fruits and vegetables in amounts that will support their bodies. In Meal Support sessions we eat together, allowing me to help each client through the anxiety of eating ‘forbidden foods.’

In these sessions, I usually remind my clients of the basic nutrition information that they’ve replaced with an ornate structure of food rules, misinformation and fear.

Yes, she knows essential fatty acids are necessary for survival, that protein is required for life, that carbohydrates are the best source of energy and the brain runs on glucose. But their diets were so healthy!

Treatment isn’t always necessary if early intervention is possible. If you or someone you love might be slipping into orthorexia or anorexia, a meeting with a therapist or Registered Dietitian who understands eating disorders can be life-changing..

“It’s hard to overstate the importance of early intervention,” Overholtzer said. “The sooner the symptoms are addressed with a dietitian or therapist, the more likely you are to have a positive outcome and avoid needing additional treatment intervention.”

Many people just need a reminder of what healthy eating looks like, what the body needs for peak performance and some real information about food and nutrition.

 

–We originally posted this article June 2016.