"I did not have an eating disorder until I started studying nutrition"

September 7, 2022 11:20 AM

"If you've seen a nutritionist in private practice, you may already suspect that Fonnesbeck is not the only dietitian to have practiced with an active eating disorder. You sit across from a probably slender, probably white woman who extols the energy and clarity you’ll have when you follow the meal plan she recommends. She tells you not to worry if it seems like not that much food. “Detoxing” from gluten, dairy, sugar, and processed food will curb your cravings for them, and you can always fill up on Scandinavian fiber crackers with the consistency of pressed mulch." CW: discussion of disordered eating
posted by Lycaste (24 comments total)

I was just chatting with my GP about where the line is between diets like intermittent fasting (IF) and eating disorders. He talked about how in the same day he was counseling one patient to eat more, and then advising another to try IF.

He said the line is when the diet starts impacting health then it becomes a disorder, which was helpful for me to frame my approach to dieting and setting boundaries on being too extreme (If 16:8 is good then 20:4 must be better...and why not just fast for a week? Instant results!).
posted by jpeacock at 12:08 PM on September 7, 2022 [3 favorites]

interesting read. I have never interacted with a nutritionist but I guess this predilection to practice in a field that fits your obsession makes sense...sort of.

I am concerned with eating healthy, especially as I get older, and maintaining my weight etc., I happen to like scandinavian fiber crackers. but I can see how the line between healthy choices and orthorexia can blur and become a slippery slope. how does one even identify that they have a problem, much less brave the task of seeking professional help? (I am not worried that I have disordered eating) we put so much moral weight on the food choices we make, creating pressure, causing shame. our whole culture (US, Western?) has an unhealthy relationship with food, of course some people will manifest a pathology.
posted by supermedusa at 12:13 PM on September 7, 2022 [1 favorite]

After all, how do you avoid obsessing about food when thinking about it is literally your job?

I think it goes well he other way, too. People who obsess about what I hey are eating gravitate toward this profession. Same with people in the mental health profession. In my experience, many therapists have been in therapy themselves, some recovered more than others.
posted by waving at 12:28 PM on September 7, 2022 [4 favorites]

This is the key takeaway from the article, for me:

What’s difficult about addressing disordered eating in anyone, including dietitians, is that disordered eating and healthy eating often look a lot alike. Is going gluten-free a proactive effort to reduce inflammation or an acceptable rebranding of the low-carb diets of the late ‘90s and early aughts? Is cutting out sugar a gateway to years of binge-restrict hell or the only sensible option if you want to prevent diabetes?

According to eating disorder nutritionists, the difference actually has nothing to do with food. “It's impossible to say that someone who doesn't eat sugar is orthorexic,” Fonnesbeck says. “It has to do with the intention around those behaviors, how those behaviors are affecting quality of life. One person could be choosing to eat a certain way because they feel really good about it, and … someone could be eating the very same way and have it be pathological and dysfunctional.”

I have a friend who lost a significant amount of weight by adopting a Vegan diet (good for them to find something that worked)...but then they become obsessed with their diet, talking about how they "splurged" last night and had 6(!) almonds for dessert. They lost a lot of muscle mass and were not able to build any strength due to their anxieties about food.
posted by jpeacock at 12:29 PM on September 7, 2022 [8 favorites]

I think it's easier to delineate between an eating disorder (diagnosed), orthorexia (not in the DSM-V), and a fixation on diet is easier to identify when you don't live in a society that is systemically opposed to providing good, healthy food at affordable prices

at a default, eating a diet that's not intentionally controlled will have you eating just processed shit that's terrible for you. when you start controlling for things like macros, then you become hyperaware THAT you're living in a society cares so much more about profitability than it does about general social good, that the food that's widely available, affordable, and accessible are rarely good for your body
posted by paimapi at 12:31 PM on September 7, 2022 [9 favorites]

If you've seen a nutritionist in private practice, you may already suspect that Fonnesbeck is not the only dietitian

But it is widely known among nutritionists and the most powerful body in American dietetics that many dietitians

this is in no way surprising for a bustle piece but come on.
posted by queenofbithynia at 1:10 PM on September 7, 2022 [17 favorites]

My aunt is a PhD registered dietician, since the late 60s. She ran hospital cafeterias for a long time, had a catering company for a while, and ended her career doing meal planning for dialysis patients. I've never in nearly 50 years of eating out with her seen her order anything but the plainest chicken dish on the menu and extra napkins to blot it with.

I don't think she's cooked in her own kitchen in most of that time either, and my mother's cagey comment about that was "she doesn't like to have food in the house."

It feels like deep study of whatever era's current thinking about nutrition definitely presents a high risk of being overwhelmed by the idea that if you just control your diet perfectly you will never get sick and I guess never die, but it sure also looks like living with the feeling that one wrong move and you're dooooomed.

(She's been breaking bones at a rate of about 1 every other year for the past two decades. Her health has been fragile for a long long time and she's been super secretive about it in many cases, I assume because it would be a form of failure.)
posted by Lyn Never at 1:15 PM on September 7, 2022 [14 favorites]

What the hell?

When she began to have digestive issues, she eliminated more foods. Soon, though, she was eating only five foods total. Her joints ached, she was having regular migraines, and she fractured her pelvis. ...the guests were hobbling in so much pain...

Seriously? This is a professional eating expert?
posted by CCBC at 3:19 PM on September 7, 2022 [6 favorites]

I had a roommate going to school for their masters in nutrition. I think I never saw them eat something that wasn’t a plain egg white omelette with a side of plain steamed vegetables. Once I got a lecture about peas because of how much sugar they naturally have, and then turned around and told our other roommates to stop talking about their back fat because we all needed to have a healthy body image. Needless to say, I haven’t really been trusting of the advice from anyone in the nutrition industry. All the study groups at our flat were very obvious praise sessions for doing the best job at an eating disorder, and absolutely none of them were even slightly happy.
posted by Bottlecap at 3:33 PM on September 7, 2022 [8 favorites]

It's deeply messed up that the training for teaching people how to eat causes eating disorders in its practitioners who then go on to coach their clients into eating disorders, who came to them for help. Elizabeth Warren or someone needs to shut this entire hell cycle down. People aren't learning how to eat anyway so nothing will be lost.
posted by bleep at 3:35 PM on September 7, 2022 [2 favorites]

Yeah to expand on queenofbithynia, this article fails to distinguish between legitimate medical practitioners and their methods and practitioners of non-scientific “wellness” culture. I don’t know how much that impacts the conclusions of the piece, but it raises questions. If you see a nutritionist and they tell you to detox anything, you’re getting non-medical advice that’s potentially dangerous, or at least unhelpful and likely to make your life more difficult. Nutritionists aren’t credentialed. Registered dieticians went to school and should be expected to give medically sound advice. Information that’s scientifically grounded doesn’t automatically make you safe from disordered eating, of course, but your chances of having good outcomes are so much better.
posted by chrchr at 3:35 PM on September 7, 2022 [12 favorites]

It's like a contagious mental disease that people are getting paid to teach each other.
posted by bleep at 3:36 PM on September 7, 2022 [9 favorites]

Oooooof. Deep breath. Dietitian checking in (not a nutritionist; do not call me that).

I'm coming at this with equal parts "yeah this is totally a thing" and also a big ol' #NotAllDietitians.

I have absolutely known dietitians whose careers basically allowed them to have a professional eating disorder. But in my personal experience, they are definitely the exception. The dietitians I know and work with are largely MUCH more chill about food than the average person in my life. I came to this post after returning from a bomb-ass dietitian potluck that included, yes, fruits and veggies and avocado on whole grain toast, but also a giant dessert spread and pancakes (chocolate chip! blueberry!) and sausages and bagels and cream cheese. And we all ate to our heart's content and then some, because it was a celebratory day and the food was good, and we are all totally fine because we have balance in our lives, which includes stuffing yourself at a potluck sometimes. I've observed much more disordered behavior from the other medical professionals I work with. Sometimes when they see me observing said behaviors, they will truly say that they expect me to approve or be proud, which is just... the saddest thing.

But yes, it definitely is a thing. And the Academy is doing an absolute shit job of embracing weight-neutral/HAES/all foods fit counseling approaches, and is absolutely playing a role in propagating disordered behaviors in the name of health. It's embarrassing. There's a reason I'm not a member.

(But yes, I am also curious whether this article is about nutritionists [basically a meaningless title] or dietitians. The way those terms were just flip flopped around was real weird.)
posted by obfuscation at 3:41 PM on September 7, 2022 [41 favorites]

Hello I start sentences with “but yes” way too much
posted by obfuscation at 4:15 PM on September 7, 2022 [11 favorites]

This article does seem to (mostly) be talking about registered dietitians or students studying to be dieticians. But, it's not great that the author and editors don't seem to appreciate the difference between (registered) dieticians and (self-described typically) nutritionists.
posted by 3j0hn at 4:25 PM on September 7, 2022 [2 favorites]

I have a friend who is a registered dietician, and at the time I knew her best she was at a public hospital, so she described her job as 'consultant and prescriber of Boost Nutritional Drink'. I never thought about it at the time, but she lost a lot of weight between college and professional life, and has pretty much kept it off, so I hate to diagnose and she was nowhere near as disordered as these cases, but it wouldn't surprise me if the job gave her an eating disorder.
posted by The_Vegetables at 5:36 PM on September 7, 2022

this is in no way surprising for a bustle piece but come on.

consistent with most of the lead examples being dubious and faddish dietary advice, I guess
posted by atoxyl at 6:39 PM on September 7, 2022

I was surprised by some of the advice we got from the nutritionist... Stuff like switch from almond milk to WHOLE milk at breakfast because it has more protein so you will be full longer. And try to make half your plate at dinner be vegetables. Honestly sensible stuff. I suppose it depends on the person and also if you are seeing them to lose weight, or for some different health issue.
posted by subdee at 6:43 PM on September 7, 2022 [3 favorites]

I think maybe outside the US the dietitian/nutritionist distinction isn't so clear.

As I understand it, in most US states a dietitian is someone with a specific Registered Dietitian degree, and you cannot call yourself a "dietitian" without that degree. But you can call yourself a "nutritionist" without having any particular qualifications.

The article seems to use those terms interchangeably. Emily Fonnesbeck, who it starts off talking about, describes herself as a "nutrition therapist" and seems to not be a qualified dietitian.

Outside the US, I'm not sure this dietitian/nutritionist rule applies.
posted by TheophileEscargot at 4:18 AM on September 8, 2022 [2 favorites]

Registered dietitian is a thing in the UK, too. All the ones I've had referrals to and social contact with have had really healthy enthusiastic relationships with food, thankfully.
posted by ambrosen at 4:57 AM on September 8, 2022 [1 favorite]

The "RD" on her website means registered dietitian, which means she is credentialed by the governing body of dietetics in the US, unless she's misusing the credential, which seems unlikely.

But yes,* in the US, a person must have completed an accredited undergraduate nutrition & dietetics program as well as an accredited dietetic internship, and passed the dietitian registration exam in order to call themselves a dietitian. Beginning in 2024, newly graduated interns will also require a master's degree to be able to sit for the exam. Awful lot of training for how we get paid. I cannot speak to the process anywhere outside the US.

It gets a little stickier at the state level. I am licensed in Illinois as a "Licensed Dietitian Nutritionist," a credential I can theoretically share with people who are not dietitians, which doesn't feel super great.

*I SERIOUSLY CANNOT HELP MYSELF
posted by obfuscation at 5:53 AM on September 8, 2022 [8 favorites]

It says Emily was "nutrition director of the Biggest Loser Resort." Does anyone know if that's strongly connected to the TV show The Biggest Loser? Because that in itself would be a huuuuge red flag to me.
posted by needs more cowbell at 7:50 AM on September 8, 2022 [1 favorite]

I have felt for a while that the term 'diet' itself is misused. I prefer to think of diet as what you can do for the rest of your life to stay healthy. But is is now used to mean what you can do in the short term to lose a bunch of weight. Things like "juice diet" and such; which is geared towards losing a buncha weight after the winter so you can wear a bikini during spring break. If you do that for the rest of your life; it will probably kill you!

Which is why when I was diagnosed as a pre-diabetic and was recommended to talk to a dietician to discuss how to change my eating habits; I was skeptical. But the person I spoke with said something at the beginning of our meeting that made me comfortable straightaway. She said that we are going to work with what you already eat and like and see what changes can be made. She asked me to give an overall list of all the meals I had eaten over the past 2-3 weeks; to get a general idea of my eating habits. I am a vegetarian from South India; and she could see where the problem was. Too much Rice/Carbs. Instead of telling to me cut all that out and change all my eating habits; she helped me tweak the way I thought about my diet. The changes she suggested have been sustainable. The main point was that I should enjoy what I like to eat already, but start looking at my eating habits to see where the problem points are and tweak them. Changing to parboiled rice, looking at lentils and potatoes as carbs rather than a protein source or vegetable, making sure I had enough protein in every meal etc. My A1C numbers, cholesterol panel etc have become better.

I am happy that I met someone who was willing to work with a diet that is not as common in the US, rather than just tell me what to eat based on studies conducted on the 'typical american diet'. Plus the emphasis on weight and BMI rather than the metabolic numbers that show problems (like A1C, cholesterol panel, BP etc) needs to be addressed.
posted by indianbadger1 at 8:41 AM on September 8, 2022 [17 favorites]

> Seriously? This is a professional eating expert?

Well, yes, that's the point of the article.
posted by The corpse in the library at 11:48 AM on September 18, 2022