Misconceptions About Eating Disorders, Orthorexia, and More
In today’s episode, we talk all things eating disorders with Dr. Evelyna Kambanis from Massachusetts General Hospital. How common are each of the eating disorders? What are some of the most common misconceptions surrounding them? What is orthorexia? How does social media affect EDs? And what are the best treatments? We cover all this and more on today’s episode in honor of the upcoming National Eating Disorders Awareness week.
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Juna: Just a quick warning for our listeners today. We're going to be talking about some touchy subjects, including disordered eating and eating disorders. First of all, Eddie, I want to welcome some new listeners to our podcast.
Eddie: Yes, January is always a great time. A lot of people coming to the show, Apple featured us, we and also over on our membership, we went 31 days helping people to change their attitude about exercise.
Juna: It was a lot. It was Eddie and you and I every day for 31 days. I don't know how people made it through, but they made it through.
Eddie: So if you're listening to us and you say like, oh my God, I don't want any ads. Well, we did actually write a book.the talk
Juna: Yes. For all the new listeners that are just joining us. Eddie and I wrote a book all about this stuff, and we read the audiobook, so we just wanted to shout that out for the people that are new.
Eddie: And guess what the name of the book is. What's the name? Food. We need to talk.
Juna: Whoa, whoa, Eddie, how did we come up with that? That's so original. Anyways, guys, I want to check in on Eddie's New Year's resolutions because it's the end of January. It's already done. It's February. What is going on with the New Year's resolutions?
Eddie: Did you do? Yeah. So my first New Year's resolution, which I am sticking by, is not to make any resolutions. Oh. So if I. So unfair. No no, no. It got worse than that because then I made a resolution. So I broke the first. Oh my God.
Juna: Oh my goodness.
Eddie: So I'm just dammed. But I am moving into more set of strength training. Yay! And I've come to understand that just lifting hand weights is not going to be sufficient for weight. Oh my gosh. So.
Juna: So crowd goes wild.
Eddie: So we, my wife and I are moving more towards. Let's get someone to show us what we really need to do to see what our bodies are made of.
Juna: So when are you getting them?
Eddie: We're going to, you know, have a personal trainer.
Juna: When, when?
Eddie: It's it's the, the next step of, of planning is happening and I will keep you in the loop.
Juna: Okay, okay.
Eddie: Pictures to follow.
Juna: He's he's he's putting off telling us what's going on. I'm just going I'm just going. Okay, well, I have to report that my New Year's resolutions have a not been even written down or thought of, and b have no chance of being done because I got a new dog. You guys, I have no life. All I do is take care of the dog. He's four months old. But I do have to say, like, I haven't even had time to think about whether or not I can make a resolution to do anything.
Eddie: So is what if the resolution were to get a dog?
Juna: Ohmygod. Great idea. Guys have already.
Eddie: Had a major resolution and reached.
Juna: It. I already did.
Eddie: It. Oh, congratulations.
Juna: Oh. Thank you.
Eddie: And the dog's name is.
Juna: The dog's name is Pooh Bear p o h. Okay, everybody. Everybody's like. And he's a shitzu Pomeranian. shitzu. Poom. Iranian. Do you got it, Goober? I'm just saying it's because he's a sweetie pie and pupusa sweetie, and he's a sweetie. Anyways, onto the more, heavy topic of today's go.
Eddie: From a cute dog to.
Juna: No.
Eddie: Eating disorders.
Juna: Exactly, exactly. Let's do it. Okay, because National Eating Disorder Awareness Week is coming up at the end of February. We wanted to dedicate some time to it because as you guys know, it's a very important topic to both Eddie and I. In the book, there's two entire chapters dedicated in disorders. The only other thing like that is exercise. So the two things we care the most about are e-scooters and exercise.
Eddie: And we covered this actually way back when we first got together. So that was like 2020. Yeah. So some four years ago. So we thought maybe it's time for an update.
Juna: Right. So on today's episode we're going to be talking about all things eating disorders. What are the most common eating disorders. We go over one I haven't heard much about our food. And we even talk a little bit about orthorexia and what that is. And then the very tricky topic of what to do if someone close to you is exhibiting symptoms of eating disorders and you don't know how to talk to them about it, I am.
Eddie: And I'm Doctor Eddie Phillips, associate professor at Harvard Medical School.
Juna: And you're listening to Food We Need to Talk, the only podcast that can go from cute dogs to eating disorders in my. The span of two minutes. Welcome to another episode! Today we are joined by Evelina Cabaniss, who is a clinical research fellow at the Eating Disorder Clinical Research Center at Massachusetts General Hospital. Did I say all that correctly?
Eddie: Oh, that was good.
Evelyna: So my goal in research program.
Juna: Oh you guys.
Evelyna: Same old, same old.
Juna: Okay, cool. Well, thank you so much for joining us, Evelina. This is a topic that's really important to both Eddie and I and obviously to you as well.
Evelyna: Thanks for having me.
Juna: So first, can we kind of cover the basics about what the most common eating disorders are and at what rates they affect the population?
Evelyna: Yes for sure. So we'll kind of start with what we think of as like the core three. Of course those are anorexia nervosa, bulimia nervosa, binge eating disorder. And then there's also avoidant restrictive food intake disorder, which is new as of the DSM five and 2013. And I'll talk a little bit about that as well. So starting with the most common, that would be binge eating disorder. And we see, prevalence at about one ish to up to 3.5% in females and then up to about 2% in males. So that's the most common one.
Juna: Cause I just your question. Yeah, for sure. With binge eating disorder or I guess with all that eating disorders. We'll see you soon. It seems like the rate is higher in females than men. Do we know if that's like a thing that men reported less, or is it actually they affect men less than they affect women? Sorry not to derail us.
Evelyna: No, you're totally okay. That's a really good question. I don't know that we have the answer necessarily to that question. I definitely think that men are underrepresented in eating disorders research, due to, you know, lack of awareness, maybe stigma, maybe fewer men reporting. So I'm not entirely sure if it's, you know, I'm giving you these numbers. That's what we know based on the research. But it could certainly be higher, in males. And what I'm reporting, if that answers your question.
Juna: Okay. Sorry to interrupt. You keep going.
Evelyna: Yeah. No, you're totally okay. Bulimia nervosa. At about up to 1.5% in females and 0.1% in males. And then for anorexia nervosa, 0.9 percent in females, 0.3% in males, and for avoidant restrictive food intake disorder, or RFA. Because it's more new, we generally know less about it, but it would probably be at about two ish percent across genders.
Eddie: And you just go over the last category and slow it down. Yeah, for me a little bit.
Juna: We've gotten a few questions asking about our fit and I'd actually never know what it is.
Evelyna: I can talk day and night about our food, so I'm happy to answer any questions that you might have. So our fed Avoidant Restrictive Food Intake Disorder was introduced as a feeding and eating disorder in the DSM five. So in 2013 it's characterized by avoidant or restrictive eating that causes all sorts of difficulties. Things like weight loss, failure to gain weight, vitamin deficiencies, nutrient deficiencies, dependance on supplemental feeding or just general psychosocial impairment. And the kind of big thing with our fit is in contrast to other feeding and eating disorders or other eating disorders. I should say it's not driven by any kind of shape and weight concerns. So people with our food generally don't really have, many concerns about their body or they like their bodies, they don't want to lose weight, but rather what we see our feet is being motivated by is, three profiles is what we call them. The first is sensory sensitivity, which is, just sensitivities to the sensory properties of food like texture, taste, smell. The second one is fear of aversive consequences of eating. And this refers to things like choking or vomiting. And a person has had a really kind of like traumatic event happen to them and they begin to restrict their food intake following that traumatic event. And then the third is lack of interest or food of eating. And what that means is that someone just has like premature fullness or doesn't really feel hungry all that often, doesn't particularly like or care or enjoy food.
Eddie: So I spent a good part of my career taking care of older adults, and in some circumstances, especially late in life, we've got older adults that sort of start like losing interest in food or they actually lose their appetite. Is that fit under this category now?
Evelyna: Yeah, it'd be hard to say. It can't be due to another medical conditions or I think we'd have to kind of take it with a grain of salt for whether or not we could apply our fit in that situation. I don't know if there's like a cut and dry yes or no answer. It kind of would depend on the patient's presentation and what other consequences they're experiencing and what else is going on for them. And also like whether or not this is just something normative observed in the population with older age.
Eddie: And, just to review the DSM five that you mentioned is let me get it straight, the Diagnostic and Statistical Manual of Psychiatric illness.
Evelyna: So mental disorders.
Eddie: And mental disorders. So I can answer my own question. In that case it's not like a hormonal thing or lack of taste or something. Whether this is something more of categorized as a mental disorder.
Evelyna: It is it could certainly be associated with. Hormonal abnormalities or something like that, but it is recognized as a mental disorder or psychiatric illness.
Juna: So, zooming out a bit, so I know we talked a bit about each eating disorder. Can we talk about why anorexia, I think, is the most known in the media or the most? I don't even want to say glamorized is a word for eating disorders, but I do think anorexia is a bit glamorized, or at least it used to be. Even though binge eating disorder is the most prevalent in the population. Why do we never talk about binge eating disorder? And why do we see or picture an eating disorder as anorexia?
Evelyna: Yeah, that's a really good question. So I think first and foremost, anorexia is often highlighted in media and popular culture, perhaps more so than binge eating disorder. Believe in or Rosa. And I think that in part leads to increased awareness and recognition. The second component of that is that the visible symptoms of anorexia. So typically, you know, not typically, actually in order to meet criteria for anorexia, your BMI has to be underweight. And that's very much something that you can see, right? You can see someone has an underweight body mass index. So I think the visible symptoms that are associated with this diagnosis may make it more noticeable. And that's more commonly thought of as an eating disorder. That being said, when we think about mortality, anorexia nervosa has a really high mortality rate. And I think that's it about 4%, right. And so people frequently say that it has one of the highest mortality rates of all psychiatric illnesses. And that's true. And we also see increased mortality and bulimia nervosa at pretty similar levels, as well as this other category called other specified feeding or eating disorders, or Oxford. All eating disorders are really serious, and I think it is the visible components of this one specific eating disorder and the prominence of it in the media. But that doesn't diminish the significance of the other eating disorders.
Eddie: The world of mental health over the last number of years, I think appropriately has gotten away from, you know, this yes or no? Do I meet this criteria or not? And there we talk more about there's a whole literature on like almost alcoholic or that sort of thing. Is that consistent with a discussion of disordered eating, meaning that you're if I understand it right, you're not meeting this formal criteria, but you still got a problem. Can you speak or explain to us about disordered eating and what that looks like and the prevalence of that?
Evelyna: Yes for sure. So when I think of disordered eating, I think of someone who's exhibiting some eating disorder symptoms in some way, but doesn't necessarily meet full criteria for the eating disorder diagnosis. So maybe, you know, I don't I hesitate to give specific examples of what I'm thinking, just because I know that you have a lot of listeners, and I don't want to influence any kind of thoughts or feelings or anything like that. But if you're if you're finding as though, you know, my friends don't really do this, this doesn't really feel normal. I'm doing this because I want to influence my body shape and weight. And, you know, that's the only thing I'm doing and I'm not really doing anything else. And it's just this one particular thing that might fall under the category of, like, eating disorder psychopathology, more so than it would, just like a full fledged eating disorder diagnosis. I'm not sure if that entirely answered your question. It's hard to, I think, parse apart, but essentially when I conceptualize disordered eating, I think about just symptoms rather than a diagnosis. So not like a syndrome level thing.
Juna: We've been talking a lot about kind of the clinical side of eating disorders. But we have a lot of parents that listen to the show. And a big question people will ask is like, what are things to look for in my kids on whether or not they have an eating disorder. Obviously, a lot of parents, especially when your kids become teenagers, you're away from your child or I guess, young adult, whatever. For most of the day, like they're not eating near vicinity. And then a lot of the time, like, they might not be even eating dinner with you anymore if they're like at friends houses or whatever. So what do you encourage people to look for?
Evelyna: So I'll start by saying that not everyone who does the things that I'm about to mention has an eating disorder. I think it's important to just note that caveat, that it's definitely possible that people are engaging in these behaviors and don't actually need criteria for an eating disorder. So in terms of like psychological behavioral things, one thing to kind of look out for is excessive exercise. So, you know, normative exercise is healthy for you and people, you know, we're told by our general physicians that we should be engaging in normative, healthy exercise, but looking for when exercise becomes driven or compulsive. And what that looks like is someone feels as though they must exercise, even when you know the weather's bad and it's raining, they're still going to go for a long run. Or even if they're really sick or injured, or if their friends have plans, they would miss out on those plans to go exercise, or they would go exercise when they're not feeling well, or feeling really distressed and agitated when they don't have the opportunity to engage in typical exercise. So those that can kind of be like things to look out for. So. Withdrawal. Avoidance of social events, especially those involving food. Kind of like increased isolation from friends and family. Might be another thing to look out for, as well as things like secretive behavior. So hiding food, hoarding food, eating in private, going to really great lengths to kind of conceal eating habits from others, unusual food combinations. So things like mixing really sweet foods with really savory foods and unusual combinations. So not something that we would ordinarily think of mixing, or even like avoiding entire food groups can be a manifestation of eating disorder symptoms. And then one that I think kind of might be a little bit more obvious is frequent self weighing. So people who might weigh themselves more than once per day, or even if they're not weighing themselves more than once per day, but any slight change in the scale is accompanied by this, like really severe, significant emotional response or anxiety or distress that like this minor fluctuation on the scale.
Eddie: I feel like you've just described America. I know literally and and the and the and the internet. Right. And the internet and like all of the conversations that you and I have had for five years now about what it looks like out there, I'm sort of sitting there going like, oh, yeah, all right. I know someone who does that, I know, wow.
Juna: But I was thinking, so as someone who has struggled with any sort of in the past, I feel like I'm hyper attuned to seeing these behaviors in other people. And, it's 100% true that not everybody that has these behaviors has an eating disorder. Like, I know people who I don't know are just super passionate about exercise, but like, they definitely do have needs where they're just like, you know, they're super into their training or whatever. But I also know people that I can clearly tell that they are currently struggling with an eating disorder, like right now. And it's really, really obvious to me. And I just haven't said anything because I know when I was going through it, like nothing anybody could have said would have made a difference to me, and that like, I had to come to the conclusion myself because like, I truly like didn't think I had a problem and I was just so obsessed with weight loss that it didn't really matter what somebody else. I was like, oh my God, like, you have to whatever, I wouldn't care. So I haven't said anything and I know other people close to them are very concerned as well. And they also haven't said anything, even though it's kind of obvious to everybody. So in a situation like that, like what do you do to help the person? Like, do you contact somebody? Do you ask them to talk to a therapist? Like how do you talk to them about it without it sounding accusatory?
Eddie: Or the the original question was what to parents, what to look for. So like at what point by noon, as a question, at what point do you call in someone who's expert in this?
Evelyna: Yeah, it's a really tricky spot to be in, to have that family member friends struggle and to not really know how to approach it. And you're recognizing all these signs and signals of an eating disorder that the person themselves is like, no, this is totally normal. Like, this is just who I am and what I like.
Juna: I just love health and fitness. Haha.
Evelyna: Yeah, exactly. No. I think it's important to be really gentle and recognize that, you know, they might not be ready to change. They might not be ready to acknowledge the fact that this is a problem. And, you know, you could do your best to very kind of gently approach the subject like, hey, is everything okay? You know, I've kind of noticed these things. Would it be okay with you if I shared what I've noticed? Just because I'm really concerned about you? And I think that going into that conversation, it's important for the person that's kind of approaching that conversation to be aware that it's it might not go well. So I would say that, like, I myself would always tend to approach someone, even if they're not themselves ready to hear it, because maybe they just have never considered it. Or maybe this is the conversation that they needed to make a change and to realize that other people are noticing their behaviors and they're really concerned for their health.
Juna: And then this question is like, super out of left field. But I just I'm so curious about how the whole ozempic thing had impacted the eating disorder, kind of because.
Eddie: We've made it through 20 minutes before saying the word ozempic.
Juna: I know, I know, literally, let's not even discuss the fact that people who are, you know, normal weight and don't need it for medical reasons are taking those on big just to like lose another 10 pounds or whatever like that in and of itself is already like extremely problematic. But I mean, people who are on these medications oftentimes like if you just looked at how they eat, they eat so much less because the medication is taking away their appetite. Right. But it seems like you wouldn't qualify that as an eating disorder because they're not feeling super restricted. And I don't know, it seems a little different than you would characterize. And even sweater where somebody is like fighting all day to not eat or purging to get rid of food. And so how does like the whole weight loss medication industry impact how you see patients with eating disorders, or do those patients count as having new disorders? How do you like what if there's crossover between those two?
Evelyna: Gosh, that's a really hard question to answer. And I think we're still trying to kind of understand that because the right. Ozempic is so new. Personally like that, you know, we've made so much progress, so, like, body positivity movement and like the new generation of, like, teenagers feeling confident and comfortable, and then all of a sudden families, the kids in the market. Right. For me, you can definitely be an example that can have an eating disorder. Like the two are not mutually exclusive. You to be taking weight loss medications and the criteria for an eating disorder. I think it's just one of those things that requires careful assessment and evaluation to understand. You know, first of all, what were the motivations for for beginning this weight loss medication? Right. Presumably like a doctor has prescribed this medication. What was the rationale behind the prescription? Why did the doctor prescribe it? And I think you also mentioned that people who are in, you know, average bodies have been also relying on these weight loss medications, which I think makes for a little bit more of a confusing picture as to like how that was prescribed and why that was prescribed and why the patient initiated that. What I'm trying to say is I tried very carefully and definitely not. I would never say that because someone's taking this medication they can't possibly have an eating disorder. I would I would want to assess for that and then kind of move forward accordingly. Does that answer your question?
Juna: No it does. I just think it's like it's all just so confusing now. I feel like body positivity took like ten steps forward and then ozempic and it was like, haha, never mind. Yeah, I know exactly.
Eddie: We're going to take a quick break and come back and speak a little bit about orthorexia. And we're back with Doctor Evelina Cabaniss from Mass General Hospital. The question that I had actually comes from, oh, I don't know, just some random house where I brought up three children and along with my wife and we did our really best, best to provide really good food using the means that we have to have family dinners and while also kind of experimenting. My wife and I were not immune from trying everything from like Whole30 to the zone diet back in the day to all sorts of things and part out of interest. And I don't know. But we then heard that part of what we were doing was probably interpreted and became orthorexia. And our middle child and our daughter, who, as we write up in the book food, We Need to Talk. Went on to a full blown anorexia and required a partial hospitalization. And when we sort of sorted it out, I was introduced to the idea of orthorexia or sort of like, you know, to translate it straight, eating that, that our attempt to eat cleanly sort of went overboard. Where did we go wrong? And how can other people avoid this?
Evelyna: Yeah, really good question. So I'll start with like just the definition of orthorexia. And when we say orthorexia, typically what we think is. But you explained is this obsession with healthy eating and a kind of like fixation on eating like pure healthy foods. Orthorexia nervosa is not a recognized eating disorder diagnosis. However, it does share many similarities with anorexia nervosa. So when I think about the criteria for anorexia nervosa, the first criteria that you have to me is restriction of energy intake relative to requirements. That leads to an underweight body weight. It doesn't say anything about the types of foods that you should be eating. It's just restriction of energy intake. So this clean, healthy eating fixation could certainly result in restriction of energy intake if you're eliminating other food groups for the pursuit of eating healthy. So does it make sense how that criterion translates? Yes. Okay. And then the second criterion for anorexia nervosa is intense fear of gaining weight or of becoming fat, which some people with these orthorexia symptoms might deny. However, the second component of that criterion is persistent behavior that interferes with weight gain.
Eddie: Like over exercising.
Evelyna: Over exercising. It could even be like, you know, again, back to this healthy eating, clean eating, not eating foods that are, perceived to be fall outside of the umbrella of clean or healthy eating. So, I don't know, something like a brownie, let's say.
Juna: Because I feel like so many people are into healthy eating. And I'm sure a lot of people listen to this podcast and healthy eating, right? But just also, like anybody you follow on Instagram, like every influencer or whatever, everybody's into eating healthy and blah, blah, blah. How do you know when that crosses over into orthorexia versus somebody who's just like, really into whatever they think is healthy eating.
Evelyna: Something that I think of as flexibility. So as we talked about with like driven and compulsive exercise, you're exercising even though it might interfere with other commitments, even though you're sick, even though there's other things that you should be doing, or you're feeling really sick or anxious and distressed when you're not exercising, implementing that similar kind of conceptualization to healthy eating. Are you eating like are you making food choices at a restaurant where all your friends are eating one thing? You're ordering something like a salad because it fits with your beliefs? Are you able to go to friends houses and eat the food that they've prepared, or does that cause a lot of like a distress and impairment you consider not even going? Is there avoidance of situations in which you're healthy food? Your preferred food might not be available? Do you spend a lot of time like health defying food recipes? I know that's, you know, sometimes common in patients with eating disorders is we see like they're trying to make a recipe for chocolate chip cookies. But you know, we're replacing flour with, you know, something like almond flour because that's perceived healthier and less refined. So is it causing distress. Is it causing impairment? Is it causing you to avoid other situations in which your preferred food might not be available?
Eddie: Can I just interrupt and plead guilty to a new a new thing for me? I'm really into health offering. Okay, this just doesn't.
Evelyna: Mean, you know, eating disorder.
Eddie: I don't think I have any.
Evelyna: How do you know?
Eddie: Yeah, it's just so, like, I don't. I'm an I'm just by way of introduction, like, I'm not much of a cook or a baker. I'm a really good sous chef, and I help my wife with everything. And I could tell you that you could use applesauce and and in lieu of some of the oil. And then we definitely would trade out, you know, different flours and always use a lot less of the sugars that that's recommended because we don't prefer that. Sweet.
Juna: But maybe.
Eddie: If I'm guilty.
Juna: I feel like you don't. This is, I think, the difference for me, for a lot of things. I feel the same way. I feel like I straddle this weird line where I'm like, I don't feel anywhere near what I felt like when I had in disorder. But then I'll be like, oh no, I'm doing this. Is this an eating disorder? And I'm like, no, because it's not causing me to have emotional distress like before. It was so tied to like anxiety around gaining weight and eating unhealthy food and like if this, then that catastrophizing all the time. Whereas like, I don't know, I feel like you do it. You're like you're joyful in the way that you I feel like it's like more fun when you're baking. You're trying to figure out different ways to do things or whatever. Anyways, that's just kind of how I think about it. But I guess we'll let doctor.
Eddie: I'm sorry, but as as you and I go on, you're the expert. Yes, please. Yeah. Is it the last of the stress that makes it not an eating disorder?
Evelyna: I would encourage you to think about. You don't have to answer this here, but I would encourage you to think about how you would have felt if you couldn't do those things. If you couldn't substitute your oil for applesauce, if you couldn't cut down on the amount of sugar you're putting in your baked goods, would you still eat them? Would you still enjoy that? Would that cause you?
Eddie: So the answer is yes, you can ask. And yes, I will answer. When we cook something like Indian food at home, we, you know, health ify and we sort of cut back on the oils and the butter and then occasionally we'll eat out and we'll bring in this delicious Indian food where clearly they've used all the ghee in the world or whatever butter they want. And it's, it's wonderful. And I and I really enjoy it. Now we choose again not to eat that frequently, but I so I don't I would say I don't feel badly.
Evelyna: So you're flexible. You can eat it one way, you can eat it another. Your personal preference for your home is to do it this one certain way. And that's okay. Again, just as long as it's not causing you to avoid eating out. Indian restaurants that use a lot of ghee, right? Like if you were to say to me, no, no, no, I could never. Because what about all the amounts of stuff they're using that I'm not using? I'll just make at home. That's definitely something I'd be like, oh, that's a red flag, right? That might say, yeah, there's a problem. But you're describing it as that, this like delicious thing that you got and it's wonderful when you eat it. You just choose not to eat it all the time. And that's okay. That's that. That feels healthy to me. That feels like you have a healthy relationship with food. Does that feel consistent with what you're experiencing? Yeah.
Eddie: Yes. And I'll let you talk in just a second, but I'll just share. Like one other thing. I've had the opportunity to travel overseas, last few months, one trip to the Middle East and one trip to South America. And what I was struck by is that when people offer you dinner, it's it's, it's not like a whole discussion and disclosure and your diet preferences, dietary preferences. And what what will you eat? What can't you eat? What don't you choose to eat? You know, how much health offering do we need to do is I would now learn to say, and it's just like, here's dinner. And I actually tried a new diet. I think I shared this with you. You know, I'm on these trips, which was which I never, ever do, which is if it's offered, I will try. It sounds great. Yeah, yeah, yeah, I tasted things that I never thought that I would taste before, and I just sort of tried to do as they were doing in the, you know, when in Rome it was the Romans. I just sort of say you eat the food that's put in front of you and you engage in conversation and not remorse over.
Juna: That's like the only way to travel, honestly, because you can't, like, you'll be so miserable trying to restrict your travels to like your food at home at all. So that's one of the fun parts of traveling is like trying new foods.
Evelyna: I think you learn a lot about culture through food, and so having the ability to just say yes to anything you're offered probably gives you a really rich cultural experience.
Juna: Yeah, totally. I just had a quick question about misconceptions around eating disorders. As we kind of wrap up, what do you think are some of the biggest misconceptions around any disorders that we have in the public?
Evelyna: Yeah, so we'll start with, one of the big ones, which is for bulimia nervosa. The misconception that I'd like to talk about is the fact that, many people think that believe in a row. So you have to be purging through vomiting in order to be criteria for this disorder. So when we think about bulimia, we think about binge and vomit. That's not true. So individuals can be criteria for bulimia nervosa by compensatory behavior. That includes non purging methods and purging methods. So when I say purging the term purging is an umbrella term for things like laxatives and vomiting and diuretic use. So purging does not mean vomiting kind of first of all. And then for non purging intervals you can use these inappropriate compensatory behaviors like fasting which is defined as going for eight or more waking hours without eating anything and engaging in driven and excessive exercise following a binge. And this still classify as an appropriate compensatory behavior. So you can still meet criteria even though you're not vomiting. So that's kind of like one more like pop culture one. I think we typically think, oh, bulimia. They're definitely vomiting.
Juna: Okay, so that's one misconception. And then what's another one?
Evelyna: I'm just going to talk a little bit about binge eating disorder and talk through a little bit of what binge eating actually is, because I think a lot of people kind of use that term colloquially when they've just eaten a lot of food. So when we think about what objective binge eating means, it means eating an objectively large amount of food in a short period of time and experiencing a sense of loss of control, so feeling as though you cannot stop eating. Which is very different from kind of like normative overeating and both binge eating disorder and bulimia nervosa. And the binge purge subtype of anorexia nervosa are characterized by these recurrent episodes of eating objectively large amounts of food. So again, not just like your common place over eating that we're all kind of like guilty of engaging in occasionally.
Eddie: So just a moment ago, you brought up, another whole area of fasting, and we've done separate shows on this, and I'm fascinated by the popularity of intermittent fasting. But, and of course, listeners will know that there's everything from just don't snack after dinner and have a proper, you know, overnight and then break your fast in the morning. That kind of sounds a little healthier to me, down to only eat for a a feeding window of whether it's 12 hours or 10 hours or 8 hours or 6 hours, whatever. But did you suggest that there's actually a number, like if you don't eat after waking up for a certain number of hours, that then you qualify for some sort of eating disorder?
Evelyna: So in the eating disorders world, we kind of define fasting as going for eight or more waking hours without eating anything in order to influence your body shape and weight. So it doesn't necessarily mean you meet criteria for any eating disorder. It's just a behavior that we kind of look out for. And that's the, operational definition that we use to kind of see people are reporting this behavior.
Eddie: And if I or a listener were to not eat for the eight hours after while being awake, but not necessarily to lose weight, but because it's believed to be. Or there's some science that shows that it's healthy that would not meet that criteria, then.
Juna: I don't know.
Evelyna: I'd be I want to do a little bit more asking.
Eddie: Okay.
Evelyna: So I just I just kind of take it and run with it. I want to find out a little bit more about what you're kind of thinking of as healthy, and why you're doing it, but. Yeah.
Juna: And then what are the most common treatments for eating disorders?
Evelyna: Oh, really? Great question. Typically we'll use family supported treatment, for patients who are, say like under 16 or have a lot of weight to gain, and then individualized treatments for patients who don't have a lot of weight to gain or are older and can kind of engage in the treatment without the support of their family members. Cognitive behavioral therapy for eating disorders is one option that has, really good evidence to support it. And actually, really excitingly, we're moving towards more abbreviated versions of this treatment. So typically it would span like 20 to 30 sessions and we have no treatment that's only ten sessions long and seems to be working just as well as the original 20 to 30 session version of that treatment. And then family based treatment, for particularly anorexia nervosa. But younger individuals with eating disorders who need that family support have a lot of weight to gain. That one's also a pretty common and good efficacious treatment for eating disorders as well.
Juna: And with that, guys, we are out of time on our episode. There's so much more to talk about, I know, but we are going to go over to the membership and we're going to do a whole episode on actually binge eating, which we just talked about and what to do after you binge eat. So first of all, I want to say thank you so much, Elena, for coming on today's episode. It was so helpful. I'm sure to so many people. And we will link to her on our website. Thank you for coming on.
Eddie: Thank you.
Evelyna: Thank you for having me. This is awesome.
Juna: If you want to hear our bonus episode called You Binge Now what? Head over to food. We need to talk.com/membership or click the link in our show notes. You can find me at the official YouNow on Instagram and on YouTube and TikTok. You can find Eddie starting.
Eddie: To lift heavier weights. We do good.
Juna: Food. We Need to Talk is produced by me and is distributed by.
Eddie: Our mix engineer is Rebecca Seidel, and.
Juna: We were co-created by Kerry Goldberg, George Hicks, Eddie Phelps and me.
Eddie: For any personal health questions, please consult your health provider. To find out more, go to food. We need to talk.com. Thanks for listening.
