Three Benefits of Early Intervention and Treatment on Eating Disorder Recovery
As many as 18.6 percent of women and 6.5 percent of men will face an eating disorder during their lifetime. However, only 50 percent of people will reach full recovery. Of the remaining 50 percent, 20 to 30 percent will remain chronically ill (1).
Fortunately, early intervention and treatment can have a significant impact on symptom severity, quality of life, and mortality rates. However, a recent study review revealed that only 17 to 31 percent of individuals struggling with eating disorder symptoms seek eating disorder-specific treatment (2). This delay in treatment, often motivated by low rates of detection, treatment barriers, stigma, shame, and a lack of motivation, may lead to significant physical, psychological, and emotional repercussions.
In today’s blog post, let’s consider three benefits of early intervention and treatment when it comes to eating disorder recovery.
A better understanding of the eating disorder
For many patients, their eating disorder feels out of their control. It often takes on a life of its own. Dietitian Elaina Efird, RDN, CD, CEDRD, CSSD even talks about an “eating disorder voice” in her YouTube videos. Thanks to early intervention and treatment, patients gain an understanding of the eating disorder from a psychological perspective. With professional help, they can identify its roots and also learn to recognize symptoms and concerning behaviors.
Ultimately, an eating disorder is about more than food and eating habits; it’s a mental health issue that must be healed. Eating disorder treatment helps to address the problem from the inside out, reducing the chance of relapse and improving the possibility of full recovery.
Healthy coping mechanisms
For many patients, an eating disorder is a way to cope with stress, pain, or a lack of control. A big component of treatment, then, is to help patients identify and use healthy coping mechanisms instead. As they actively choose these responses over their eating disorder behaviors, they build strength and resilience, learning to say “no” to that powerful eating disorder voice.
Identification and treatment of co-occurring conditions
Anxiety, depression, bipolar disorders, and other mental conditions often occur along with an eating disorder. One study even revealed that 94 percent of patients hospitalized for eating disorders also had a mental health mood disorder (3). In order to fully recover, both conditions must be addressed and treated.
Ultimately, to increase early intervention efforts, it’s important to bridge the gap between symptom recognition and access to treatment services.
In Vermont, we are working tirelessly to catch the signs of an eating disorder earlier and offer more treatment options to our residents. In 2022, after the pandemic, an eating disorder workgroup was founded to study and improve access to treatment services. The goal is to train more experts to recognize the signs before patients reach a breaking point. To learn more about these efforts, click here.
To talk to a professional about eating disorder treatment, please reach out to our staff or schedule an appointment at The Kahm Clinic today.
References
Mills R, Hyam L, Schmidt U. A Narrative Review of Early Intervention for Eating Disorders: Barriers and Facilitators. Adolesc Health Med Ther. 2023 Dec 5;14:217-235. doi: 10.2147/AHMT.S415698. PMID: 38074446; PMCID: PMC10710219.
Koreshe E, Paxton S, Miskovic-Wheatley J, Bryant E, Le A, Maloney D; National Eating Disorder Research Consortium; Touyz S, Maguire S. Prevention and early intervention in eating disorders: findings from a rapid review. J Eat Disord. 2023 Mar 10;11(1):38. doi: 10.1186/s40337-023-00758-3. PMID: 36899428; PMCID: PMC9999654.
NEDA (2022) Anxiety, Depression, and Obsessive Compulsive Disorder. Retrieved from https://www.nationaleatingdisorders.org/anxiety-depression-obsessive-compulsive-disorder
The Science Behind Binge Eating Disorder: How It Affects the Body and Mind
Binge eating disorder (BED) affects people in many ways, impacting not only their physical health but also their emotional well-being and quality of life.
Today, we’re exploring how binge eating behaviors can influence the body’s metabolic processes, not from a weight-loss perspective, but to understand how the body works and why restoring balanced eating patterns can play an important role in recovery.
What Happens to the Body During a Binge?
To start, it helps to distinguish between different types of binge episodes. A subjective binge is when someone feels like they ate more than usual but didn’t lose control, while an objective binge involves eating a large amount of food in a short time with a sense of loss of control.
In this case study, our patient experienced objective binge episodes nearly every day, consuming anywhere from 5,000 to 7,000 calories per binge. This pattern reflects a cycle of restricted intake earlier in the day, leading to a strong physical and psychological drive to binge in the evening.
Many people experience shame and frustration with this cycle, and it can affect other areas of life, from emotional well-being to financial strain.
How Binge Eating Disrupts Metabolism
When looking at how binge eating affects metabolism, it’s essential to understand the body’s natural fuel cycle. Typically, the body alternates between using carbohydrates (sourced from recent food intake) and stored fat as fuel, depending on whether a person has eaten recently or not.
This transition between energy sources is simply the body’s natural way of maintaining balance; it has no bearing on body size, weight loss, or morality. For individuals with BED, however, large, concentrated intakes of food can create disruptions in this cycle.
At our clinic, we use metabolic testing (MT) and body composition analysis (BCA) to assess how the body is currently processing nutrients. In this patient’s case, her results showed that her metabolism was higher than typical due to frequent high-calorie binges.
Additionally, her body was prioritizing carbohydrate breakdown more than expected, which left her fat metabolism somewhat lower than what we typically see. This means her body had not yet shifted to using fat for fuel because it was still processing the large carbohydrate intake from her recent binge.
While this pattern might sound technical, understanding it can provide valuable psychoeducation, helping patients see how their metabolism responds to different eating patterns and why balance can help regulate this cycle.
Breaking the Cycle: Why Balanced Eating Matters
One of the most effective ways to reduce binge episodes is to ensure the body is consistently fueled throughout the day. When working with this patient, we encouraged her to begin with a balanced breakfast that provided enough calories and protein to support her energy needs.
Understandably, someone who feels shame or distress around binge behaviors may feel hesitant about adding more food to their day. However, through gentle coaching and discussing the science behind the cycle of restriction and bingeing, we helped her see how eating consistently could ease the physical drive to binge later on.
Over time, this shift helped reduce the frequency and intensity of her evening episodes. Alongside nutritional adjustments, she worked with her therapist to address some of the emotional triggers underlying her eating patterns.
Building a Path to Recovery and Well-Being
Our goal in treatment is not about calorie reduction but about supporting people as they find relief from behaviors that impact their well-being and quality of life.
BED can be emotionally and financially draining, and by providing individualized education through metabolic data, we aim to empower patients with a greater understanding of their bodies and support them in achieving a balanced and fulfilling relationship with food.
Subscribe to our YouTube channel for more video content. To talk to a professional about eating disorder treatment, please reach out to our staff or schedule an appointment at The Kahm Clinic today.
Weight Gain and Metabolism Restoration
Patients often wonder if they will gain weight as they work to restore their metabolism. For instance, if you struggle with a low resting metabolic rate (RMR) due to restrictive eating, what will happen to your body as you work to increase both your intake and your RMR? Unfortunately, there’s not a one-size-fits-all answer. Each individual has a different trajectory and experience as their bodies adjust to dietary changes.
In today’s blog post, let’s explore two different case studies of patients working to restore their metabolism.
The first case study looks at a female patient who is five feet, eight inches tall. In March 2018, when she first came to The Kahm Clinic, she weighed 133.8 pounds with a lean mass of 90.7 pounds. At this point, her metabolic rate was 1,090 calories per day — much lower than it should be for her height and weight. At her final visit in June 2020, she weighed 157.6 pounds with a lean mass of 110.3 pounds. Her metabolic rate was up to 2,000 calories per day — a huge difference!
So what changed in her diet? As dietitian Elaina Efird, RDN, CD, CEDRD, CSSD explains, to start, she followed a very strict vegan diet, eating only 900 calories per day. By the time she finished working with our team, she still followed a primarily plant-based diet, but her calorie intake increased to 2,400 calories per day.
As you can see, this patient learned how to properly fuel her body. Even though she gained weight, she found an eating pattern that worked for her body’s internal function and her lifestyle. “She more than doubled her intake,” Elaina says. “She had better energy. She reduced her cravings, and she stopped obsessing over food.”
The next case study for metabolism restoration looks at a female patient who is five feet, two inches tall.
She gained only six pounds during her time working with us — a much different trajectory than the first patient! “What’s really interesting here,” Elaina shares, “is this patient also more than doubled her intake.”
At her first appointment in October 2019, she weighed 110.1 pounds with a lean mass of 83.9 pounds. Her RMR was incredibly low at only 810 calories per day. It dropped so much because she was restricting her intake to the point of an eating disorder, eating about 600 calories per day.
At the end of her time working with us, in December 2020, she weighed 116.5 pounds with a lean mass of 87.7 pounds. “She went from being very restrictive in her eating disorder to more than quadrupling her intake to 2,700 calories per day,” Elaina shares. Her RMR increased to 1,340 calories per day, and even with her highly increased intake, she only gained six pounds.
Do you want to explore the topic of metabolism restoration even more?
Check out our YouTube video, where Elaina analyzes these two case studies as well as three more!
Subscribe to our YouTube channel to see our video content. To talk to a professional about eating disorder treatment, please reach out to our staff or schedule an appointment at The Kahm Clinic today.
Five Signs You're Not Eating Enough
When many people embark on a weight loss journey or take a new approach with their eating habits, their first step is to Google how many calories they should eat per day. Unfortunately, this number is often way too low. Many women will see a recommendation of just 1,200 calories per day, while men find one of only 1,500 to 1,600 calories per day.
If you follow these recommendations, you’ll end up decreasing your metabolic rate — a topic we discuss frequently on our blog. You may also notice other signs and wonder if they’re a normal part of weight loss and diet changes. Before we dig in, it’s important to note that these symptoms — although they are also common for patients with eating disorders — do not indicate that an individual has an eating disorder or even disordered eating habits. They simply show that, in an effort to improve their health, these individuals ultimately restrict their calories too severely.
For today’s blog post, let’s look at five common signs that you’re not eating enough.
1. Persistent bloating
As dietitian Elaina Efird, RDN, CD, CEDRD, CSSD explains in a video on our YouTube channel, this problem is one that patients bring up constantly. When you’re not taking in enough food, your gut responds and slows down. Then, when you do eat, you experience bloating.
Additionally, your body may stop producing enough digestive enzymes. Your body needs energy to make these enzymes, and when it doesn’t get enough fuel, it slows down this production. Then, when you eat food, there aren’t enough enzymes to break it down.
2. Loss of your period
People tend to normalize this symptom as a typical part of weight loss, but it’s not normal at all! “Losing your period is not a normal response to losing weight if you’re doing it healthfully,” Elaina explains. “If you are losing weight at a slow pace and focusing on controlled fat loss, you should not lose your period.”
Similar to the decrease in digestive enzymes, your body just doesn’t have the energy to make those hormones and expend it on your period. To get your period back on track, you have to start eating more food — which, yes, may lead to weight gain. The longer you go without your period, the more at risk you are for developing other issues, such as osteopenia and osteoporosis (low bone density).
3. Hair loss or dull and brittle hair
When you restrict your calories, you inadvertently starve your body of important nutrients and vitamins. Without enough nutrients, your body cannot fully function and begins to only send these nutrients and vitamins to the most essential systems (like cardiovascular and respiratory). Other non-essential body functions, including hair health, growth, and retention, don’t receive the required nutrients and stop working.
4. Poor energy and sleep
Poor energy and poor sleep are both a result of not fueling your body enough. When you’re not eating enough calories, specifically enough protein, your energy is likely going to drop. “Your body simply doesn’t have the fuel to expend on day-to-day activities,” Elaina shares.
Poor energy goes hand-in-hand with poor sleep. Even if you don’t feel hungry, your body may wake you up in the middle of the night, hoping that you’ll eat something. If you consistently wake up hungry, that’s a good indicator that you need to increase your calorie intake, specifically in the morning.
5. Always feeling cold
This symptom indicates that your metabolic rate has dropped too low. Your body doesn’t have energy to warm you up, so you feel cold all of the time.
Now that you know the symptoms of not eating enough, how can you ensure that you do eat enough?
Remember that your calorie deficit should be off of your total caloric need for the day. You need to consider your resting metabolic rate (RMR), your general movement (going to the bathroom, cooking a meal, etc.), and your exercise expenditure. You should only subtract a very small amount — just 200 to 500 calories. “What I find is, people often create a deficit of 1,000 calories or more,” Elaina shares. “That will result in these symptoms, as well as other issues, which serve as a really good sign that you need to take in more food.”
Subscribe to our YouTube channel to see our video content. To talk to a professional about eating disorder treatment, please reach out to our staff or schedule an appointment at The Kahm Clinic today.
How the Body Heals from Restrictive Eating
If you are someone who has followed fad diets or severely restricted your diet to quickly lose weight, you will likely have to gain some weight before you can healthfully lose fat — regardless of your starting weight. This approach can be discouraging, but it is vital if you want to truly recover from the negative impact of restrictive eating.
In today’s blog post, let’s consider an example of an individual with a past of restrictive eating and discuss the benefits of allowing your body to heal.
In a video on our YouTube channel, Elaina Efird, RDN, CD, CEDRD, CSSD outlines a case study of a six-foot tall patient at The Kahm Clinic who had been struggling with restrictive eating for about two years. He honestly didn’t know how to approach dieting. He tried cutting calories and limiting his sugar intake as well as intermittent fasting, which led to binging. At one point, he lost 15 pounds but ultimately gained it all back. He realized that nothing was working for him.
His initial metabolic testing results were lower than what we predicted. We expected him to be burning 2,400 calories per day, but he was burning 2,135 calories per day. “This happened because the body was compensating for being under-fueled,” Elaina explains. He was not consistently eating enough calories, so his body lowered his metabolic rate to conserve energy.
Our goal, then, was to increase his metabolic rate to 2,400 calories per day by letting go of his restrictive eating habits.
If we don’t correct this issue first, this individual will find himself in the same cycle of losing and regaining weight or maintaining his weight despite restriction. In order to burn more calories, he must eat more calories — quite a bit more, in fact. We increased his calories to 2,800 calories per day to accommodate his resting metabolic rate (RMR) of 2,135 calories, plus any general movement and exercise.
It’s not surprising that this person initially gained some weight. When he first came to The Kahm Clinic, he weighed 284 pounds. After our recommendation to increase his daily calorie intake, he gained over 15 pounds in three months, weighing 309.1 pounds. Not only did this weight gain work to correct his metabolic rate (it increased to 2,403 calories per day), but it also led to other non-scale victories, like increased energy levels and decreased restrictive eating and binging habits. This shift also increased his lean mass, which is beneficial for immunity, longevity, injury prevention, and more.
Additionally, his hormones became more regulated. As Elaina shares, studies show that restrictive dieting negatively impacts your hormones; these changes can last for up to two years. By allowing him to heal before we focused on his weight loss goals, we helped all of the systems in his body return to their baseline.
Now, it was safe to adjust his calorie intake to allow for healthy weight loss.
We decreased his intake to 2,400 to 2,500 calories per day — right at his RMR — to see what would happen. About a year later, we repeated the body composition analysis. His weight was down to 269.2 pounds (15 pounds below his starting point!). His lean mass maintained itself, but his fat mass decreased by over 12 pounds. “Note that it was a slow, steady process,” Elaina points out. “This approach is so much more effective at preventing weight regain.”
In other words, it’s okay if your weight loss journey feels like a long, winding road!
Subscribe to our YouTube channel to see our video content. To talk to a professional about eating disorder treatment, please reach out to our staff or schedule an appointment at The Kahm Clinic today.
The Truth About “Saving Up” Calories
Have you ever “saved up” calories? It’s a common practice for individuals trying to lose weight: They have a small breakfast and lunch and then eat a large dinner with a majority of their daily caloric intake. Does this approach really work though?
For today’s blog post, let’s dig into the truth about “saving up” calories.
To start, let’s look at a patient at The Kahm Clinic whose metabolic testing results show how this disordered eating pattern impacts the body. She was trying to stick to 1,800 calories per day but was finding it challenging because she was “saving up” calories.
For breakfast, she’d have a cup of yogurt with granola or two hard-boiled eggs and a piece of fruit. For lunch, she’d have a big salad that was mostly leafy greens and vegetables with three to four ounces of protein and some dressing. It’s not surprising that, as the day wore on, she got hungrier and hungrier. Around 3 or 4 p.m. each day, she’d start to snack. She’d begin with a reasonable snack, like nuts, but continued reaching for more food as she finished her work day and headed home to cook dinner.
Then, she’d eat a very big dinner. It was a healthy, home-cooked meal that included meat, starch, and vegetables but in large portion sizes. She’d sometimes grab a second helping and have dessert or an after-dinner snack. Between her afternoon snack and end-of-day eating, she was consuming around 1,800 calories.
Well, it makes sense that she was so hungry! Unfortunately, these intense hunger cues made it hard to listen to her body during her evening meal. Research shows that, if you don’t take in enough calories and protein in the early part of the day, you’re more likely to crave carbohydrates and sweets in the afternoon and evening.
For her initial metabolic test, her resting metabolic rate was 2,076 calories per day — significantly higher than the expected number of 1,688 calories per day.
Ultimately, she was eating enough calories (just not at an ideal time of day), which kept her metabolism up. Her protein metabolism was also normal. However, her fat metabolism was 24 percent below normal, and her carbohydrate metabolism was 20 percent above normal. Note that carbohydrate metabolism isn’t just carbs; it’s all food in general.
For the resting metabolic rate test, individuals are fasted for a minimum of four to five hours. This individual had actually fasted overnight because she came in for a morning visit. These results show us that her body was still breaking down 20 percent of what she ate the night before. As we prepare to go to bed, our metabolism naturally slows down. In other words, her metabolism, which naturally slows down at night, couldn’t keep up with her high intake at the end of the day! As a result, it’s not as effectively burning fat, which is why this number was below normal.
Given these results, we recommended that she aim for 2,400 calories per day and try to front load her calories rather than “saving up” for the end of the day.
If we look at a full day of food, breakfast and lunch should be the biggest meals of the day and dinner should be the smallest. Ultimately, food is fuel, and you need that fuel to get through your day. You can eat after 7 p.m. and partake in a multi-course dinner from time to time, but there’s no reason to “save up” calories in order to do so.
Subscribe to our YouTube channel to see our video content. To talk to a professional about eating disorder treatment, please reach out to our staff or schedule an appointment at The Kahm Clinic today.
Summer Body Image and Eating Disorders
It’s not surprising that body image issues often increase during the summer months. Some research suggests that over 90 percent of women are disappointed with their bodies (1) — and many of these insecurities are put on full display as the weather heats up, with short shorts, skimpy tank tops, and swimsuits.
This uptick in negative body image is particularly challenging for individuals with eating disorders, as there’s a strong correlation between body image and eating disorders.
In fact, body dissatisfaction is one of the most consistent risk factors for eating disorders and also a common predictor of low self-esteem, obesity, and depression. Body image is ingrained in individuals from a young age, giving these distorted thoughts a deep stronghold as time goes on. The media often preys on this insecurity by focusing on diet culture, impossibly thin models, and “bikini-ready bodies.” This pressure is made worse by comparison on social media against filters and photoshopping, which set an unrealistic bar when it comes to body type.
Fortunately, there’s a current push for body positivity — the idea that healthy and happy bodies come in all shapes and sizes. The body positivity movement promotes acceptance and love of the body in a hope to improve body image and boost self-esteem. It also aims to challenge the unattainable standards of appearance that we so often see online and in the media.
Ultimately, adopting a positive body image is up to each individual.
With that thought in mind, here are three simple steps to improve your body image.
1. Nourish your body well.
During the summer months, it’s normal to be out of your typical routine. You may be eating out more often or gathering with friends for happy hours or barbecues. To give you a sense of control despite these disruptions, develop a structured and balanced meal plan. Stick to it whenever you can, knowing that it’s okay to stray from it sometimes. Proper nutrition will also support your mental health, making you more prepared to handle eating disorder triggers and challenges.
2. Practice positive self-talk.
The way you talk to yourself matters. Treat yourself with the care and compassion that you would show a good friend struggling with body image. When you look in the mirror, focus on the body parts you like. Think about how your body allows you to play with your kids or take your dog for a walk. Replace negative criticism with statements like “I am strong” or “I nurture my body with wholesome foods.”
If you struggle with this exercise, consider writing encouraging words on Post-It notes and sticking them around your house. You can even set a daily reminder on your phone!
3. Move your body in a joyful way.
Focus on what your body can do! Whether you’re training for a 10k or aiming for 10,000 steps per day, set small, achievable goals to keep you on track. If you’re ready to step out of your comfort zone, consider learning a new physical activity by taking a dance class with friends or signing up for a multi-day hike. Enjoy moving your body and appreciate all that it can do.
Remember: Eating disorder recovery is not a linear journey.
It requires continuous effort and constant support, especially in the face of negative body image and other triggers that tend to increase during the summer months. It’s important to be aware of potential setbacks and prepared to navigate these challenges with your treatment team and loved ones.
To talk to a professional about eating disorder treatment, please reach out to our staff or schedule an appointment at The Kahm Clinic today.
References
Grabe, S., Ward, L., & Hyde, J. (2008). The role of the media in body image concerns among women: A meta-analysis of experimental and correlational studies. Psychological Bulletin, 134(3), 460-476.