Disordered Eating And Eating Disorders
In this episode, we explore the complicated and at times painful topic of eating disorders. How do you know if you should seek out help? What makes something an eating disorder? What separates an eating disorder from disordered eating? With science and personal experience, we explore what can go wrong when someone’s relationship with food takes over their mental health.
Experts in this episode include Dr. Jennifer Thomas, co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital and Dr. Kristin Javaras, clinical psychologist at McLean Hospital.
For resources, please visit the National Eating Disorders Association website.
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Guests
Dr. Jennifer Thomas is the Co-Director of the Eating Disorders Clinical and Research Program (EDCRP) at Massachusetts General Hospital and an Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School. Her research focuses on atypical eating disorders and she provides CBT to clients recovering from an eating disorder.
Check out Dr. Thomas’s book: Almost Anorexic: Is My (or My Loved One’s) Relationship with Food a Problem?
Dr. Kristin Javras is a Clinical Psychologist at MacLean Hospital whose research focuses on eating disorders and eating related problems.
Resources
National Eating Disorders Association
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Juna: Hey, listeners, so today's episode is actually about eating disorders. So if this is a topic that
you find upsetting, we just wanted to let you know right at the beginning of the show.
Eddie: And if you think that you have an eating disorder or maybe you know someone who does,
please contact the National Eating Disorders Association online at NationalEatingDisorders.org.
Speaker 2 So Eddie, do you remember back on the first episode of the podcast, we talked about
my freshman year of college.
Eddie Uh-Huh. Uh-Huh.
Juna While a lot of people go to college and maybe they start drinking, maybe they do drugs,
maybe they do both. I went to college, and I developed an eating disorder.
Eddi:e Oh, Juna, I'm so sorry. You know that I'm not an eating disorder specialist, but I also know
that you're not alone. And I think that we could probably find some experts to talk this through.
Juna: I think that's a really good idea because I know we joke around a lot, but this is definitely
something I've really struggled with.
Jenny Thomas: You know, I have heard of food being referred to as the good girls’ drug.
Juna: This is Jenny Thomas. She's an associate professor at Harvard Med,
Jenny Thomas: And the co-director of the Eating Disorders Clinical and Research Program at Mass
General Hospital in Boston.
Juna: She says food is like a good girl's drug because some people turn to it to rebel or to deal with
their emotions. So think of those times when you're stressed and you reach for the cookies or
reach for the chocolate.
Jenny Thomas: It's highly accessible in our society. It's not illegal. A lot of people attribute food
with love and think of it as something that's happy and celebratory. So I think there are a lot of
reasons that people may kind of start picking it up.
Juna: I'm Juna Gjata.
Eddie: And I'm Dr. Eddie Phillips, and this is Food, We Need To Talk.
Juna: And as we mentioned today, we're talking about eating disorders.
Eddie: This is actually a very serious issue, and we've spent a lot of time talking about what to eat,
what not to eat and our relationship with food. But today I thought we should do a little bit more
of a deep dive into when maybe you tip over the line and getting into an eating disorder and what
you can do about it.
Juna: Eating disorders are definitely not a laughing matter because I know for me it's been one of
like the biggest sources of distress in the past six years of my life.
Eddie: Where did it start for you, Juna?
Juna: I attribute my eating disorder personally to peanuts.
Eddie: Really?
Juna: Well, as I said on the first episode, I spent basically my entire freshman year super low
calorie, so like sub 12 hundred calories and working out twice a day.
Eddie: So, Juna, I think I should stop here for a minute. Just to say 1200 calories a day is not a lot of
energy, especially if you're so physically active. But I also noticed that if you go on a calorie
counting app, they all seem to default to 1200 calories a day. But if you're generally healthy and
you want to get enough nutrients and enough energy, you probably need 1800 to 2400 hundred
calories a day.
Juna: So that's part of the problem because I would get to the end of the day and I would just be
so hungry.
Eddie: And then what would happen?
Juna: And then I'd be sitting at my desk and I'd open it. And inside was a box of mini packs of
peanuts, which my mom had bought for me because I had complained about how bad the food
was at school.
Eddie: But so the nuts, they're a great snack. It's a good source of healthy fat. What's the
problem?
Juna: They may be when you're having like one handful. But basically, I would be sitting at my desk
and I would blink and the next thing I know I'd have a pile of wrappers around me and I'd be so
angry and so ashamed of what I had done.
Eddie: A lot of us overeat sometimes.
Juna: But it's not really the same thing because this was something I had no control over it felt
like. Like I would blink, and then 10 packs of nuts would be surrounding me on the table.
Jenny Thomas: Yeah, I mean, I think binge eating can almost be seen as like being in an alternate
universe with food. A lot of people who engage in binge eating also are engaging in restrictive
eating. So oftentimes somebody you know, will go all day trying to follow certain rules about their
eating. So to say, you know, no carbs or no sugar, or I can't have sweets or I can't eat processed
foods. And so not only are they hungry, but they're like psychologically depleted from trying to
self-regulate all day and try to say no to all of these cues.
Juna: Yeah. So this was definitely me. I would be sitting at my desk at the end of the day, hungry,
tired, psychologically drained. And then I might say something to myself like,
Jenny Thomas: OK, well, maybe I'll have this one bite of bread while I'm cooking dinner. Or, Oh,
you know, I'm so hungry, I'll just have this one chip.
Juna: And at that point, it is a game over.
Jenny Thomas: I've ruined this entire day. There's no way that it can be perfect now, and so I
might as well just let myself binge.
Juna: I would eat more in that hour than I would have eaten for five days total. You know what I
mean? And then it's like, why did I torture myself for five days to just undo it?
Eddie: So, Juna, let's summarize the kind of eating disorders that we're talking about. The most
common is what you've described so far, which is this binge eating disorder. And that's actually
somewhat prevalent about three and a half percent of women and about two percent of men. The
best-known one is actually anorexia. That's about one percent of women, extremely low body
weight.
Jenny Thomas: It also has to be associated with a disturbance in the way that you perceive your
body. And usually somebody with anorexia nervosa is maintaining their low weight by an extreme
degree of dietary restriction.
Eddie: And that's also where you see the fatalities. And another pretty well-known one is, of
course, bulimia.
Jenny Thomas: And those symptoms are when folks are eating really large amounts of food while
they're feeling out of control and then trying to get rid of those calories by using vomiting or
laxatives or diuretics, or maybe fasting for long periods of time, or exercising as a way specifically
to try to get rid of those calories.
Eddie: So thankfully, the prevalence of bulimia is actually low. Maybe one or one and a half
percent. But there's another broader category called disordered eating. So this includes the eating
disorders we just described. But it can also include people who maybe don't fit all the criteria for
these eating disorders, but who still engage in some of the behaviors. And that's a lot more
people, maybe 14 to 22 percent of the public.
Juna: I have to say that based on just like talking to my friends and stuff, I would have thought it
was so much higher because to me, it seemed so normal.
Eddie: How so?
Juna: I mean, I think it was pretty normal for people, if they felt like they over-ate, to not eat the
next day or over-exercise. That was something totally normal. Like, I never thought there was
anything wrong with what I was doing.
Eddie: Let me ask you, if you don't mind, like on the days that you did binge like the next day,
what did you actually do at that point?
Juna: When it first started, I would start maybe to eat a little less the next day. But then it would
be like, I can't eat anything until dinner the next day, or I'm going to try to burn 800 calories on the
treadmill. And the more and more I binged, the more and more drastic my compensatory
behaviors had to become. So eventually I just felt like everything was out of my control.
Eddie: And you know cognitively that this is not healthy. So what do you make of that?
Juna: It's kind of hard for people to understand because an eating disorder isn't really like a
rational way of thinking. It was more like I knew what I was doing was bad, but there was no other
way to be because I was so desperate to not gain weight. So I think it has a lot more to do with the
thoughts I had.
Eddie: And what thoughts in particular.
Juna: Definitely the thoughts about how important my perception of my body is to my self-
esteem. Jenny Thomas calls this overvaluation of shape and weight.
Jenny Thomas: And what that means is if you think about your self-esteem like a pie chart, right?
And you think about all the things that have to be going well in your life for you to feel successful
and to feel good about yourself, the ideal pie chart for somebody with healthy self-esteem would
be kind of like a stock portfolio that's diversified, where you'd have a lot of different pie slices.
Eddie: I love the pie slices. Like for me, I'm picturing I want to be a good dad, I want to do well in
my career, I want to have a good level of physical fitness, I want some good family relationships.
Juna: Yeah. So for someone with an eating disorder,
Jenny Thomas: somebody's pie chart can become so skewed that it's almost exclusively made up
of just their shape and weight. And so that number on the scale can define their mood for the day,
how they feel about themselves, how successful they feel as a human being.
Juna: This was definitely true for me. So if I woke up and I weighed myself and I weighed more
that day, the entire day would be ruined.
Eddie: Just because of that number.
Juna: Oh yeah. And then on the flip side, if I weighed less a day, then I'd be like, "Oh my god, yes, I
look so much skinnier today. Like, this all makes so much sense." But it's like, of course, I probably
looked the same from day to day to day.
Eddie: So what I'm hearing from all of this is that it's really crucial this whole like body image piece
is just really a crucial part of these disorders. Like I remember growing up and you know, there
were magazines, of course, you look at slim models, TV shows, but I cannot imagine today with
Instagram models that you're just seeing like an edited vision. Everyone else seems perfect.
Jenny Thomas: And then in the case of somebody with an eating disorder or somebody at risk,
they're going to compare themselves unfavorably always to all of those things and then feel even
worse.
Juna: I am definitely guilty of this myself. Logging on to Instagram. Seeing how I look.
Jenny Thomas: See how other people look, see how other people are eating and compare
themselves to that. You know, and of course, everything that everyone else is posting on social
media, you know, they're picking the most flattering photos. They're mason jar full of salad or
whatnot that makes them look so healthy they might not be posting the other parts of their life
that they're not wanting to showcase.
Eddie: So, Juna, let's talk about what an eating disorder looks like. One of the problems with
eating disorders is that even like your parents, doctors, friends, we have certain assumptions
about what a person with an eating disorder looks like. We're thinking of that anorexic individual.
Juna: This is exactly what happened to me when I went to see my endocrinologist. He, like, looked
at my hormones and he was like, "Ha ha ha, you have the hormones of somebody anorexic. Why
would your hormones be this way? It's so funny." And I was like, this isn't that funny.
Eddie: So your body, the way your body looked, was not befitting that of an anorexic person.
Juna: Basically, what he was insinuating was like, You don't look like you're anorexic. You don't
look like you're dieting. You don't look very, very skinny.
Eddie: But were you restricting at that point?
Juna: At that point, once a month, I literally wasn't eating for three days, like I was just drinking
water. And he didn't even bother asking, like, "Have you engaged in restrictive eating behaviors?
Like, “Are you eating normally"?
Eddie: But the labs didn't lie.
Juna: Exactly.
Eddie: That's really unfortunate. And I think that the care that would be optimal would be to ask
about your relationship with food. Because otherwise, I think disordered eating will be invisible to
doctors.
Juna: I mean, it's kind of invisible to everyone, because if you're binge eating, it's when you're
alone. It's never in front of people.
Eddie: You're hiding it.
Juna: Yeah, you're always hiding it because it's something that's like, very shameful, right? Or like,
if I was going to parties or something and I wasn't eating like, I would just get a plate of food to
look like I was eating and then I would sneakily throw it away when nobody was looking. And like,
people would make comments sometimes like at dinner, they'd be like, "How many calories are in
your dinner? 30?" Because it would just be like a plate of tomatoes. And I'd be like, "Oh yeah, I
already ate before." Or whatever, like I'd make up some lie.
Eddie: So, you know Juna, hearing about all of these behaviors, it's actually kind of crazy to think
that there's not even just isolated to people with diagnosable eating disorders. Food is just so
powerful in our society, and it's so easy to engage in these, these disordered eating patterns.
Jenny Thomas: A lot of people will use binge eating in particular as a way of escape from a
negative mood. And we know from research studies that actually binge eating tends to be
predicted by rising levels of negative mood prior to the episode. And then actually, negative mood
tends to decrease after the episode.
Eddie: Juna, just as you described it begins with the restrictive eating right?
Juna: Mm-Hmm.
Eddie: But then let's say you have a bad day or something didn't go quite right. You've got this way
of coping. You binge.
Juna: Yeah. And when it was happening, I wouldn't really feel better. I would just feel less bad and
kind of numb. But then afterwards, I would just feel so much worse.
Eddie: Well, it turns out that restriction is one of the biggest predictors of developing an eating
disorder.
Jenny Thomas: For many people, dieting might be harmless. You know, many of us are just going
to kind of give up the diet at the end of the day or the week, but some people are going to really
persistently follow it and start cutting back further and further that they're going to develop
anorexia nervosa. Some people will do that for a time, and then they're going to find that they
can't stand the dieting and develop binge eating because they're so deprived of those foods and
they're so hungry. So it just affects people in so many different ways. And in general, I think our
society would be a lot better off if we had a lot less dieting.
Eddie: Unfortunately, dieting is something that Americans do a lot of. Mm-Hmm. Let's get back to
that after this short break.
Eddie: So, Juna, most Americans at some point are on a diet.
Juna: Mm hmm.
Eddie: But let's be clear, most people who try dieting don't end up with an eating disorder.
Juna: No, like we shouldn't fearmonger and be like, "people on a diet, you'll get an eating
disorder!".
Eddie: No, no.
Juna: But over 95 percent of people who have an eating disorder have had a very restrictive past.
And it's also important to remember that certain behaviors are definitely a red flag like fasting,
unless it's for religious reasons, probably a red flag, right?
Eddie: Mm-Hmm.
Juna: Or like overexercising to compensate, probably a red flag.
Eddie: And here's another red flag. Think about all those food-related health fads that everyone
talks about these days. Jenny Thomas at Harvard Medical School says even that can be a precursor
to an eating disorder.
Jenny Thomas: It's interesting, too, because I think dieting used to be something that was very
kind of cool and acceptable, like back in the 80s and 90s. And now people don't talk about going
on diets as much. They talk about, "Oh I'm making a lifestyle change. I'm like paleo for life or I'm
clean eating forever." You know? So as opposed to these one-off diets, but whatever you call it,
it's like dieting in disguise.
Eddie: So what's interesting is instead of restricting the amount of foods you're eating, you're
restricting the types of foods, and that can actually lead to something that's now being called
orthorexia. It starts with someone who's just trying to quote, eat clean, cut out the sugar, cut out
the processed food, the diet in disguise.
Juna: Yeah, for sure. This is Kristin Javaras, a clinical psychologist at McLean Hospital.
Kristin Javaras: Oftentimes, people become very uncomfortable with even the thought of eating
foods that don't meet their definition of healthy. That can become problematic due to quality
more than quantity per say. And it's associated with being focused on a relatively broad definition
of healthy eating, and it may narrow over time so that over time, they're excluding more and more
foods and becoming more and more uncomfortable with eating foods that they don't deem
healthy. And so there's often a progression.
Eddie: You know, it's similar to fasting. Some people fast for spiritual reasons. You talked about
that, but that's not an eating disorder. But if you start too fast to compensate for the overeating,
like you've talked about, that can turn into the anorexia or even that binge purge cycle.
Juna: Yeah.
Eddie: So if your attempt at healthy eating has become like an obsession,
Kristin Javaras: that would make it difficult to spontaneously go out to dinner. If the proposed
destination wouldn't be a place where you would be able to have the foods that you wanted to
have. It could make it difficult to go to people's houses. And it could really end up impacting your
interpersonal relationships.
Juna: I definitely felt this way for years, so I wouldn't go to restaurants that I thought like the food
was unhealthy. And if my mom was home cooking, then I would always have to say, “No, I don't
want that.” And like, it was so hard for me to figure out reasons for why I had to say no to things.
It would hurt her feelings, and it would hurt my feelings to hurt her feelings. It was just like, such a
mess.
Eddie: This sounds like a vicious cycle. So we've talked about how to define eating disorders like
anorexia and bulimia. And we've touched upon how this is occurring in a culture. It's a crazy
culture. There's unrealistic beauty standards in our society. They affect women, but they also
affect men. How do you define healthy eating? And this might be different for different people.
But Kristin Javaras says there are three main ways to define normal as opposed to disordered
eating. The first is flexibility.
Kristin Javaras: So that means being able to adaptively change what one eats, being able to eat a
variety of foods.
Eddie: The second trait common to people who have normal eating habits,
Kristin Javaras: Being able to eat because you're hungry and stop when you're full and also eating
because you enjoy it and simply for the pleasure of it. Moving to a point where one views food as
a source of nourishment, both physical and emotional, and a place where food can be a pleasure
rather than food as sort of a source of guilt and shame and worry.
Juna: And hardest for me to accept is that no one can always eat perfectly.
Kristin Javaras: It's OK to sometimes eat more than you plan to. There is variation, and sometimes
we're hungrier than we expected to be. Sometimes there's something that looks really good and
that is totally OK.
Eddie: And then I think addressing some of those beliefs that really drive disordered eating is
absolutely crucial. So let's go back to that pie chart.
Juna: The self-esteem pie chart.
Eddie: Yes. And we want to actually get other slices on there so that you feel good about
yourselves. And it's not just all about your weight and your shape. For this, a lot of clinicians will
help people with cognitive behavioral therapy, or CBT. This is a therapy that works to crack the
vicious cycle of negative thoughts, leading to negative feelings that drive unhealthy behaviors.
Kristin Javaras And the goal is to try and effectively get some distance from the thoughts and
examine whether they are entirely true, or there might be some alternative explanation.
Juna So, for example, I have weighed twenty-five pounds less than now and,.
Were you happy?
No. So clearly it has nothing to do with the weight, and it has everything to do with how you see
yourself.
Eddie: So I know we've talked a lot about eating when you're hungry and stopping when you're
full.
Juna: Yes.
Eddie: But if you're in treatment for an eating disorder, Jenny Thomas says you may have to ignore
that particular advice for a little while.
Jenny Thomas: If you had an eating disorder for a long time where you've been starving yourself,
you've been binging, you've been vomiting, your body doesn't really know when it's hungry or full.
And so typically we'll ask folks to try to just be eating at regular intervals. You know, eat breakfast
even if you're not hungry. Eat lunch, even if you're not hungry. And then your body can actually
become trained to become hungry at those times.
Eddie: And remember when we talked about those forbidden foods?
Juna: Mmm-Hm.
Eddie: Jenny Thomas says sometimes having people systematically break their own food rules in a
therapy session can be extremely helpful.
Jenny Thomas: We have an experiment where they try to bring in a forbidden food and let
themselves eat kind of a regular portion of it, like one brownie instead of a whole tray. And some
folks have told me they've had the experience of they try the brownie and they're like, "Huh, you
know what? It's not even that good. I may actually prefer to have a different food."
Eddie: Again, we see this idea that if you let yourself have something, it becomes a whole lot less
attractive.
Juna: Yeah, I mean, this sounds like pretty cool therapy because basically you get to eat brownies
in therapy, right? But um,
Eddie: It's brownie therapy.
Juna: I think that as soon as you start to practice like, OK, I am going to eat this food that I'm afraid
to eat because I've always been out of control with it in the past. You'll just figure out that it's
really not as terrifying as you thought it was.
Eddie: And you could have that single peppermint star.
Juna: Yeah, and you can have the single peppermint star and not freak out and like, eat the box of
peppermint stars.
Eddie: Juna, you've been remarkably open about what sounds like a very trying episode or actually
a prolonged period in your life of an eating disorder. Where are you now?
Juna: I think the biggest difference was when I stopped, like counting everything and restricting
everything, and I finally had to just try to eat normally. And like the idea of not trying to lose
weight constantly was what finally kind of changed my attitude towards food and my body. And
also, really trying to focus on having my self-worth come from other things than just my body.
Eddie: That expanded pie chart?
Juna: Yeah, that was a crazy idea. Like, I didn't realize how crazy that was until I heard Jenny
Thomas say that out loud now is like, Oh yeah, of course, that makes so much sense. Because like,
my entire evaluation of everybody is always their body. Like, that's how I judge everybody,
because that's how I judge myself. And so shifting my thinking around that and really like thinking
about, do I think less of other people because of their weight and the answer no. So why should I
always be thinking less of myself because of my weight? And, I don't know.
Eddie: So how much mental energy is going into the calculations now?
Juna: Oh my God, none.
Eddie So that's the freedom.
Juna: No more calculations about food. Yeah. That's I mean, that's like a huge, huge relief.
Eddie: Are you enjoying food at this point?
Juna: Yeah. I think I look at food differently because I'm not as afraid of food as I was. Like, I was
terrified of food for a very long time.
Eddie: And how did you go about getting help? How did you begin this journey back to your place
of healthier eating?
Juna: So I actually found a psychologist who specialized in eating disorders and particularly in
people who had a history of very restrictive eating. And it really helped me to talk about it all out
loud with her because it really made me realize that it wasn't about the food and it was more
about the way I was valuing myself.
Eddie: And it sounds like an ongoing evolution.
Juna: Yeah, I mean, you're always working on these things. Like, it reminds me a lot of the way
people deal with addiction where like, you're never completely free, but you are much better at
coping with the impulses you might have, I guess.
Eddie: So the course of recording this podcast, I imagine, has been challenging at times for you.
Juna: Well, it's not just challenging. It's like sometimes I think I had to do this podcast because
once I had to write everything down and say everything out loud, it kind of made it obvious to me
how, like, messed up certain things were. If that makes sense.
Eddie: Mm-Hmm. And you're sharing it very publicly as well.
Juna: I mean, that definitely helps. And then just interviewing the experts on eating disorders,
really, like pointed out to me how much of a problem I had. Because I think when it's in your head,
you can kind of ignore it. And then when I like had to see what they were saying about people who
do have eating disorders, it's like, "Oh, yeah, that's me. Oh yeah, that's me. Oh, I did that. Oh, I did
that, too."
Eddie: So we can't prescribe podcasting for everyone with an eating disorder, but awareness is
crucial. And if you're listening to this and you really think you're having an eating disorder, seeking
out a specialist can be the difference between suffering in silence and getting better. If you want
to find a clinician, you can go to nationaleatingdisorders.org. Or if you're not sure if you have one,
you can take a quick survey at eat, that eat-26.org. It's a simple 26 item questionnaire to give you
some feedback about whether you need to seek further help.
Juna: And I just want to say that the reason I really, really want to make this episode is because I
was definitely one of the people to think that eating disorders were something that happened to
other people. But I think if you just take five seconds to take the survey, it's not going to hurt you
in any way, and it can only help you. And if you really do need to seek help, then it's important to
do that as fast as possible instead of letting it get out of control.
Eddie So, Juna, we've been talking quite a lot about body image and self-image as they relate to
eating disorders. But I think there's more to explore on this topic.
Juna Yeah. So if you don't have an eating disorder, your self-image and body image can definitely
still fuel some really self-destructive behaviors.
Speaker 6:You can have a body image. You can look at yourself and say, My body looks like this.
But my self-image, I am a good person. It's time to start taking care of myself like a good person
and then watch what happens.
Eddie We'll be back in two weeks with a brand new episode on Body Image and Self-Image.
Juna: This is going to be our final episode of our first season. It's an extra special episode. You do
not want to miss this, so we will be back in two weeks.
Eddie: Food, We Need To Talk is a production of WBUR.
Juna: Our editor and producer is George Hicks.
Eddie: Our supervising editor is Elisabeth Harrison. Our executive producer is Carrie Goldberg.
Juna: With editorial and technical support from Kathryn Brewer, [00:25:40]Paul Vikas [0.3s] and
the WBUR iLab. I'm Juna Gjata.
Eddie: And I'm Dr. Eddie Phillips. If you like the podcast, please go to Apple Podcasts or wherever
you get your podcasts and leave us a rating and a review.
Juna: It really helps us reach more listeners, and it's free.
Eddie: And don't forget to follow us on Instagram. That's our online home @FoodWeNeedToTalk.
Juna: And since we have a whole two weeks until we are reunited, you have so much time to fill
out our listener survey. WBUR.org/FoodSurvey and let us know if you want to hear a season two
and what you want to hear on it. WBUR.org/FoodSurvey. Eddie, see you in two weeks.
Eddie: See you then.
