Healthy Eating Habits and Eating Disorders with Dr. Evelyn Attia

Faith: Hi, Faith here. This week, I’m passing the mic to Angelique Serrano, a managing editor at New-York Presbyterian.

For this episode, Angelique spoke with an expert in the treatment of eating disorders. So listen in for a fascinating discussion of healthy eating habits, treatments for eating disorders, and ways that families can support each other in building a strong and nourishing relationship with food.

Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Angelique Serrano.

Being mindful of your diet is a good thing – but how can you tell when your eating habits are starting to become unhealthy? To answer that question, and explore healthy ways to eat and to think about food, I spoke with Dr. Evelyn Attia, the director of the Center for Eating Disorders at NewYork-Presbyterian and Columbia.

Angelique: Hello, Dr. Attia. Welcome. Thank you so much for talking to us on Health Matters.

Dr. Attia: Thanks so much for having me, Angelique. It’s really a pleasure to be here.

Angelique: Well, we’re here to talk about healthy eating habits and also disordered eating. So generally speaking, what do healthy eating habits look like?

Dr. Attia: Healthy eating means we’re taking from all of the food groups, that we’re getting in all of our body’s needed nutrients, that we have times where we eat and times where that doesn’t seem to be something we need to do, and that overall that’s leading to growth if we are in our growing stage and we’re young, or general stability of health measures and weight, if we’re an adult. We also need to learn how to eat, right? So it’s not atypical for a young child to be a little picky or to have more comfort with foods that are familiar. And a part of the process along the way is to learn how to eat a variety of foods, learn how to try new foods, to recognize somehow that sometimes we don’t even know what we like and don’t like until we’ve tried it a whole bunch of times. And then it becomes a piece of what we find normal and satisfying and familiar and hopefully healthy.

Angelique: It is true. You have to learn how to eat and how to develop these eating habits. Well, now let’s cross into disordered eating. How would you define disordered eating? Can you talk a bit about some signs of disordered eating patterns?

Dr. Attia: So, disordered eating takes a number of different forms, but it may include leaving out some necessary nutrients. It may include alternating restriction of intake with eating or even with overeating. Eating is a social experience as well, so disordered eating may come with ideas and feelings that may lead someone to no longer eat comfortably with others, may eat more secretively, may no longer eat some of their favorite foods because again, they’re trying to make a certain kind of change, whether it’s to be more healthy or something else.

So there are folks who may decide that, um, carbohydrates aren’t healthy for them or, uh, the same for foods that contain fat. I’ll say just as an example, every cell in our body needs some lipids, some fat content to create a cell membrane. So if someone really stays away from one food group thinking that they’re doing something that might improve their health and they say, “I only want to eat fruits and vegetables now,” they may be lacking one of the essential building blocks for things their body needs.

We want to just keep eyes open, because those may be changes that, that somebody tries on for a little while, but they may go on to become more entrenched. They may go on to worsen and develop into a more formal disorder. And of course we want to be able to recognize that, intervene as quickly as we can and refer, uh, for effective treatment whenever possible.

Angelique: Can you share the difference between disordered eating and eating disorders?

Dr. Attia: Well, maybe it’s easiest if I start with recognized disorders, because it helps create a bit of a framework for what it is that we really do worry about, and there are several categories of eating disorders. So we’ve got anorexia nervosa, which is a long recognized illness that’s characterized by, taking in less than what the body needs, leading to the body’s landing at a significantly low body weight.

And this change is accompanied by a real fear of fat, sometimes fear of fat in the diet, fear of becoming fat. And there’s also, a real, overdeveloped attention to worrying about body shape and weight. So really those three categories of symptoms come together and can cause quite a serious problem that can affect just about every organ system in the body, and really psychological functioning in so many ways.

We have another eating disorder called bulimia nervosa. The problem is a pattern of eating episodes that really involve eating more than what is common for a given situation, an objectively larger amount of food, and those binge episodes are accompanied by episodes of a compensatory mechanism: purging or other behaviors that aim to prevent weight gain, when those episodes are happening with real frequency, like at least once a week, we call that condition bulimia nervosa.

There are other eating disorders as well. There’s binge eating disorder where we’ve got those binge eating episodes without the compensatory mechanisms. There are some individuals who really develop a very difficult pattern that has significant impact on their nutritional health or, or psychosocial functioning, where there’s great restriction, maybe fear of eating certain kinds of foods, maybe a difficult sense of tolerating the sensation of certain smells or, or feels of food. It has nothing to do with a worry about body shape or weight. So disordered eating may sound similar to some of what I’ve just described, but it doesn’t get to the point of such clinical concern or clinical consequences.

Angelique: So what types of treatments are available today for people who might be suffering from eating disorders?

Dr. Attia: For adult patients, some version of a cognitive and behavioral therapy, has been helpful across a range of eating disorders. As an example, I’ll say, someone may look at a situation and say, “boy, I’m having a tough day today. And the only way I can understand that is, you know, maybe something’s happening to my body or my nutritional state. I better skip lunch today.” And in a treatment, there’d really be an effort to say, “Hmm, let’s think about all the evidence for that thought you have. Let’s think about what other options or other possibilities might explain that you had a bad day today. And then let’s think about whether skipping that lunch or approaching a meal in a given way: really, do you have any evidence that that’s going to help the thing that you feel?” And you start to expand your list of options for what you do and expand the possibilities for how you think and set up a very different set of thoughts and behaviors that get you to a healthier place.

For our younger patients, often families are involved in treatments that help them change behavior. And there are a number of, structured family-based treatments that really try to empower parents to help their teen or loved one change what they do, and in turn start to return to previously more healthy behaviors and, and associated thoughts.

We’ve got a range of medications that can be helpful either as adjunctive to a therapy or sometimes for some individuals, they’ll choose a medication as their primary approach if that’s what makes the most sense for them.

Angelique: Do you have some tips for parents trying to help their children foster a healthy relationship with food?

Dr. Attia: Parents should confidently offer healthy, balanced, varied meals. Meals shouldn’t be just about what feels familiar or comfortable for the child. New foods should be introduced. Parents should talk about food and eating and, and body shape in terms of health and fuel and needed and, uh, happy, um, in whatever ways are possible because there’s no one way to be and no one way to eat.

But we want to make sure that a full range of nutrients are a part of everybody’s experience. Most young people and adult people should be eating several meals and sometimes up to a couple of snacks a day. It means three meals, which are a little bit larger and then quite possibly a comfortable snack or two, uh, in the course of the day. There should be some planning around that so that young people can really learn, about what it means to eat, eat healthy and happy.

Angelique: What are your feelings when we look at food as a reward or we withhold it as a kind of punishment if we didn’t do something that day? What are your thoughts on that reward based thinking around food?

Dr. Attia: So we are wired to think positively about food that we intake, right? You have to imagine we weren’t built for the 21st century. We were built to survive based on pursuing food and finding it very rewarding once we obtained it. So, um, we can’t help ourselves sometimes to connect food with some sense of the positive. But we now are in a world where there’s an abundance of foods and we don’t want to structure all of what we do with a specific sense that we need food to serve only as a reward or as you so wisely point out we could really get ourselves into trouble by thinking the reverse which is that we need to punish ourselves or treat ourselves in a different way based on how we feel or what we think yesterday’s rewarding meal might make us feel we need to do today. We need balance, we need structure, we need to remember that really it becomes a problem if we start to judge ourselves based on what we take in.

Angelique: For everyone in general, what are some tips to help us think about food in healthy ways and develop really good relationships with food?

Dr. Attia: Well, I would say it’s important to remember there are no good foods and bad foods. There always should be balance and, and variety to what someone eats. There’s no one recommended, body size or shape.  I would really recommend that anyone who is interested in making a change in what they’re eating, talk to their primary care provider and understand if there is any reason to be making a change in intake at all, or a registered dietitian, who might help in that regard.

We’re making nutritional decisions for ourselves many times each and every day, and each one of those moments is a new opportunity, uh, to take good care of ourselves. Food is how our bodies work and if it’s pleasurable along the way, that’s good. It really should be giving us a range of what we need and a little bit of fun along the way.

Angelique: Dr. Attia, thank you so much for taking the time to speak with us today on such a complex topic, and thank you for sharing such wonderful advice.

Dr. Attia: Pleasure. Of course!

Our many thanks to Dr. Evelyn Attia.

I’m Angelique Serrano.

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