Just picture this. Your office colleague tells you that she has stopped eating carbohydrates completely because she wants to lose weight. In a similar scenario, your brother always counts the number of calories before binging on a plate of chhole bhature or some slices of pizza and prolongs his morning walk the next day to make up for the ‘unhealthy’ food that he has consumed. You also hear about a friend who feels guilty every time he eats samosas or jalebis at a roadside stall — to the point of preoccupation.
Situations like these are revealing a new normal in today’s world that doctors would like to refer to as ‘disordered eating’. However, mind you, ‘disordered eating’ is different from ‘eating disorder’ that we all know of and hear often. So, what exactly is disordered eating?
The distinction between disordered eating and an eating disorder lies in the presence of a clinical diagnosis, says Dr Dinika Anand, clinical psychologist, BLK-Max Superspeciality Hospital, New Delhi. “Disordered eating may refer to occasional reliance on food as a coping mechanism or deviations from one’s regular eating patterns in specific situations or circumstances. On the other hand, an eating disorder involves a clinical diagnosis, indicating a pervasive problem that extends beyond occasional behaviours or tendencies,” she adds.
Disordered eating does not meet the typical criteria for an eating disorder, but it still holds potential consequences in both the short and long terms. “Additionally, it is worth considering disordered eating as a precursor to developing an eating disorder if one’s eating patterns or disruptions are inconsistent with what is considered ideal or beneficial for their well-being,” explains Dr Anand.
Earlier this year, Hollywood actress Gwyneth Paltrow faced widespread criticism over her ‘restrictive diet’ that consists of mostly liquids. Experts labelled her diet as ‘disordered eating’ and said this kind of eating regime does not provide adequate nutrition or support optimal health.
In fact, disordered eating is becoming worrisome. In a recent study published in the journal JAMA Pediatrics, which involved 63,181 participants from 16 countries, 22% children and adolescents showed signs of disordered eating. The proportion was further elevated among girls, older adolescents and those with higher body mass index.
Worrying signs
Disordered eating encompasses a range of behaviours that resembles eating disorders but fall short of diagnostic criteria. “Symptoms include avoiding certain food groups, binge eating, extreme dieting, changes in weight, emotional eating and engaging in elaborate food rituals. It can also include abnormal behaviours and patterns similar to eating disorders, such as cleanses, diet pills, excessive exercise, and laxative abuse,” says Dr Ravindra Srivastava, director, neurosciences, Primus Hospital, New Delhi. So, whenever we say disordered eating, it means that the caloric balance or nutritional balance of the food is not proper for that particular individual. “It may include the timing and amount of food that is taken into the system. Disordered eating is much more harmful in the sense that it can lead to lifestyle disorders like persistent weight gain that lead to abdominal adiposity,” says Dr Harshal Ekatpure, consultant endocrinologist, Ruby Hall Clinic, Pune.
And abdominal adiposity can predispose to the development of type 2 diabetes mellitus, hypertension, which is increased blood pressure and blood cholesterol levels. “At the same time, this obesity can predispose the individual to an increased risk of vascular disorders like myocardial infarction or stroke, etc,” adds Dr Ekatpure.
Disordered eating may or may not lead to long-term mental and physical health issues. “However, the causes for this condition range from cultural influences and mental health conditions to stress, trauma and body image distortions. Therefore, recognising and addressing disordered eating is crucial to prevent further complications and promote overall well-being,” adds Dr Srivastava of Primus Hospital.
Many people who suffer with disordered eating patterns either minimise or do not fully realise the impact it has on their mental and physical health, says Deepti Khatuja, head clinical nutritionist, Fortis Memorial Research Institute, Gurgaon. “Detrimental consequences can include a greater risk of obesity and eating disorders, bone loss, gastrointestinal disturbances, electrolyte and fluid imbalances, low heart rate and blood pressure, increased anxiety, depression and social isolation,” she explains.
Disordered eating is a serious health concern that may be difficult to detect since a person with disordered eating patterns may not display all of the classic symptoms typically identified with eating disorders. “It’s important to remember that even a person exhibiting disordered eating habits and behaviours also may be experiencing significant physical, emotional and mental stress,” adds Khatuja.
Fad diets to blame?
Fad diets cannot be solely held responsible for the development of disordered eating patterns. However, they do play a significant role, says Dr Anand of BLK-Max Superspeciality Hospital. “In this context, there is a prevalent cultural tendency to stigmatise and attach negativity to certain foods or food groups. Consequently, an individual’s relationship with food can be adversely affected, making it challenging for them to maintain a balanced and nutritious diet,” she adds.
Known for their drastic changes in eating patterns, fad diets are often blamed for triggering disordered eating behaviours, says Dr Srivastava of Primus Hospital. “These diets are popularised quickly on social media which involves fasting, eliminating entire food groups unnecessarily, consuming only one type of food, restricting calories, or even eating non-food items in an attempt to lose weight. While certain diets like keto and gluten-free have valid medical applications, they should be done under the supervision of a diet expert. Due to these attractive approaches for rapid weight loss, individuals get allured by fad diets and become vulnerable to developing disordered eating conditions,” he adds.
Fad diets continue to make noise till we stop believing in quick fixes for weight management. “Fad diets can result in a drastic change that you observe on a weighing scale. But monitoring yourself through a body composition scale, which enables you to know the change in your fat, muscle and metabolism, is the recent approach to weight management rather than chasing just your weight and completely unaware about internal change. Fad diets are unhealthy and misleading which carries a negative impact on your long-term health,” says Dr Edwina Raj, head of clinical nutrition dietetics, Aster CMI Hospital, Bengaluru.
No guilt or shame
It is crucial that we shift away from guilt and shame surrounding food and adopt a more understanding perspective. We often encounter conflicting messages, such as the promotion of apple cider vinegar one day and the endorsement of low-carb diets on another. However, it is essential to recognise that the importance of specific nutrients can vary depending on the circumstances. “A thought-provoking ad that I came across depicted a 1960s’ setting where a woman served breakfast to a man. Each time she presented a plate, a person emerged from a wall to criticise a particular ingredient. This pattern continued until the original plate was restored at the end of the advertisement, showcasing that various components, including meat, eggs, bread, vegetables, and cheese, were problematised at different times. This highlights the need to question our current standpoint and consider that our food choices are influenced by factors such as climate, geographical location, socioeconomic access, and cultural norms,” says Dr Anand of BLK-Max Superspeciality Hospital. For example, while avocados are readily available in Delhi, they may not be locally grown. “Moreover, we must be cautious not to overly stigmatise non-vegetarian diets, as they can be crucial for individuals in certain regions or with specific socio-economic circumstances, particularly in cold climates where meat provides necessary protein,” adds Dr Anand.
The way forward for healthy nutrition is to have a healthy balanced diet. “The healthy balanced diet consists of all macro and micronutrients in the required amounts which the body needs. This healthy balanced diet (small and frequent meals with healthy snacking rich in fibre and proteins) can bring a key for managing disordered eating. Balanced nutrition along with regular physical activities for 30-45 minutes not just help in weight management but also result in better psycho-social development,” adds Khatuja of Fortis Memorial Research Institute.
Eating mindfully when you are hungry and following an ‘intuitive eating’ is the key which will keep you physically, emotionally and mentally healthy rather than following a restrictive eating pattern which negatively impacts your overall wellbeing, says Dr Raj of Aster CMI Hospital. “Seeking help from a registered clinical dietitian is more important. Thorough assessment and frequent monitoring of your body composition are necessary rather than following a conventional weight loss regime without any medical supervision,” she adds.
Growing concern
- Disordered eating may refer to occasional reliance on food as a coping mechanism or deviations from one’s regular eating patterns in specific situations or circumstances
- On the other hand, an eating disorder involves a clinical diagnosis, indicating a pervasive problem that extends beyond occasional behaviours or tendencies
- Symptoms include avoiding certain food groups, binge eating, extreme dieting, changes in weight, emotional eating and engaging in elaborate food rituals
- Disordered eating can also include abnormal behaviours and patterns similar to eating disorders, such as cleanses, diet pills, excessive exercise, and laxative abuse
- In a recent study published in JAMA Pediatrics, 22% children and adolescents showed signs of disordered eating
- The proportion was further elevated among girls, older adolescents and those with higher body mass index
- Rather than following a restrictive eating pattern, eating mindfully when you are hungry and following an ‘intuitive eating’ is the key to keep yourself physically, emotionally and mentally healthy