Conscious Choice: Food Fight

May 1999

Food Fight

Understanding and Recovering from Eating Disorders

by Niquie Dworkin, Ph.D.

As human beings we all share the need to eat. Food sustains life and brings us pleasure. We eat at social gatherings and celebrations. Food makes us feel nurtured and cared for. However, for many of us, particularly women, our relationship with food is fraught with pain and conflict. Instead of a miraculous source of vital energy, food becomes an enemy to be reviled and feared. Our bodies’ natural signals of hunger and satiety are ignored and forgotten as we slide progressively into chronic dieting, disordered eating, and, ultimately, full-blown eating disorders. How and why does this occur and how can we heal our disrupted relationships with food and our bodies?

The causes of eating disorders are multidimensional and complex. Societal, familial, psychological, biological, and many would argue, spiritual factors each play a role. Accordingly, complex recovery from food and body disturbances must address each of these components in order to restore balance to lives which have become askew.

The Culture: On Thin Ice

We’ve all heard the expression "thin is beautiful," but in our current cultural context "thin" has come to represent much more than physical beauty. A thin body has become synonymous with self-discipline, success, and control. This phenomenon becomes evident when we examine our views of those with larger, above average body weights. These individuals are viewed as lazy, undisciplined, emotionally unstable, and as likely failures. Our culture views weight as being within an individual’s control, rather than, as research suggests, determined mainly by genetic factors (Stunkard et al., "An Adoption Study of Human Obesity," New England Journal of Medicine 314, 4, pp. 193-97) .

Fat people have become scapegoats in America as other types of prejudice have become less acceptable to express. The word "fat" now carries the pejorative impact and hatred of a racial slur. Elise D’Urso-Fischer, a nutritionist specializing in eating disorders, recognizes the impact American culture has on her clients: "I had a woman [client] from France and a woman from South America this year. Both these woman had no problem with their eating when they lived in their native culture."

A study that looked at the body weights of Miss America contestants from 1959-1988 found that weights have steadily decreased, and that the cultural ideal for women’s bodies is 13-19 percent below expected weight (Wiseman et al., International Journal of Eating Disorders-1992, Vol. 11, No. 1, 85-89). Body weight this far below normal is one of the main indicators of Anorexia Nervosa, the most severe of the eating disorders. In other words, in order to meet the current standard of female beauty, women need to attain the weight of an anorexic.

Jessica, an average-sized woman who has struggled with eating and body image issues describes the profound impact the media has had on her self-image: "I don’t look like the attractive women that I see in the media so I feel like a huge hulking monster. I don’t look like them and they are beautiful, therefore I feel there’s no way out."

Men are not exempt from the destructive barrage of media images. The cultural standards for men have also become increasingly stringent, placing more emphasis on having a very muscular body with little body fat. As might be expected, eating disorders in men appear to be on the rise.

Other cultural pressures further exacerbate our unhealthy eating patterns, including consumerism and capitalism. D’Urso-Fischer explains these influences: "There are thousands of people who are trying to get us to eat their product, who are pushing products down our throat." Clever advertising campaigns convince us to buy over-processed food, touted as low fat or convenient, but containing few wholesome ingredients. D’Urso-Fischer also points out that in our workaholic culture we do not respect mealtimes, admitting to working through her own lunch hour in order to give this interview. These forces conspire to lead all of us away from valuing well-prepared, healthful, satisfying meals.

Finally, our present culture implies that happiness is to be found in material possessions, sexual gratification, status, and other transitory and superficial pleasures. The fundamental lack of emphasis on a more socially responsible, humanitarian, or spiritual world view creates a climate where a single-minded focus on thinness can thrive.

However, not everyone exposed to the influence of American culture reaches the point where food and weight become terrifying preoccupations. In order to understand this final descent into profound suffering, we need to look closer to home.

The Family: Quest Or Approval

Our family is the vehicle through which cultural ideals are handed down to us. The family setting is where our values and goals begin to take shape. But perhaps most importantly, our early experiences in our family teach us who we are, how we relate to others and how we can express our selves in order to get our needs met. Our personalities appear to be based on a combination of temperament factors: basic personality traits we are born with, and our family environment. There is not one particular type of family that "causes" eating problems, but certain patterns are fairly common:

1. A focus on external appearance — Children model themselves after their parents, and if parents are not comfortable with food and their bodies it is unlikely that children can learn healthy attitudes. Sometimes parents put their children on diets at an early age. This teaches children not to trust their bodies and erodes their self esteem.

2. Controlling parents — Children need to know that they are free to have their own opinions and make their own choices (within safe limits). When this need is thwarted, food might become the way children assert their individuality, either by refusing to eat or by eating "forbidden" foods.

3. Feelings and needs are not acknowledged — When parents are not in tune with a child’s emotional needs the child does not feel taken care of. She may then turn to food as a source of comfort when parents are not available. When a child feels it is not okay to express herself, she may turn to food to escape from sad or angry feelings.

4. Chaos and unpredictability — Families in which there is alcoholism; untreated mental illness; or physical, emotional or sexual abuse create feelings of helplessness in the child. The children may then turn to compulsive eating or starvation in order to gain a sense of control

Peggy, a recovering anorexic and bulimic, describes her childhood: "I was twelve years old, we had moved a lot and we had just moved again, my parents weren’t getting along and my Dad was drinking. That summer, one of my best fiends was raped and murdered; she was only twelve herself. I can remember the day I saw a special on "Sixty Minutes" about anorexia, and it was like the light went on. I was an athlete, and I began to practice for five hours a day on no food. That summer I dropped 25 pounds in a two-month period. There was nothing else I could control, I couldn’t fix my parents, I couldn’t bring back my friend, I couldn’t fix school, so I could fix food, I could fix my weight."

Typically, problems in early relationships leave people with poor self-esteem, a sense of emptiness, and a feeling of never being good enough. Instead of looking within themselves to discover who they are, they begin to turn to others for validation. This makes these individuals particularly vulnerable to cultural pressures. Emotional eating or starvation may feel like the only way to gain some sense of self worth, but they do not fill the internal emptiness or address the individual’s deep needs for love and validation. Amy Grabowski, a therapist who has worked with clients with eating disorders for over 12 years states, "A lot of times at the root (of the eating disorder) is a feeling of‘I want comfort but I’m not worth it."’

The Body: An Abandoned Temple

Negative attitudes toward our deepest self get taken out on our bodies. Years of dieting in order to raise self-esteem and attain society’s standard of perfection teach us that our body is not to be trusted. From a dieter’s perspective, the body tells us to eat "bad food," and refuses to take on the "right" shape. So the dieter rejects and discounts the body, refuses to listen to its vital signals and provide it with what it needs. Nutritionist D’Urso-Fischer, discussing attitudes toward the body, states: "In order for a person to take care of themselves they have to feel like they’re worth it...if you really love a car, you take it for a tune up, wash it. Culturally we’re taught that if you accept your body you just get fatter; really it’s the opposite."

The consequences of self-imposed malnutrition are severe. Because the body is starving, food becomes an obsession. Entire days are spent thinking about food, planning meals, and worrying about calories and fat grams. If restriction continues, physical symptoms begin to occur, including stomach problems, headaches, dizziness, weakness, and other maladies. The most extreme eating disorders result in death. Peggy describes the experience of being severely underweight: "Anorexia hurts. I remember standing in the shower in pain because the bones of my feet were cutting into my flesh."

The Spirit: Missing Meaning

The final factor in the development of eating disorders is the neglect of the spirit. In order to attain a sense of fulfillment in life, a person needs some sense of purpose, a sense of being connected to the world and of having some impact on it. Throughout history, human beings have been asking themselves the same set of fundamental questions: What is the meaning of existence? How should we live our lives? What actions are right and wrong? Whatever our religious, spiritual, or philosophical beliefs, there is a part of all of us that seeks answers to these questions. And though we may find guidance from spiritual teachings and practices, or by studying great philosophers, in the end we must use our own deep intuition to determine our personal answers.

Because individuals with disordered eating have not developed a sense of who they are, they have often not yet begun to ask themselves these questions. Just as they have cut themselves off from a basic sense of their body, they have shut down this intuitive part of themselves. This creates a void which is filled by the eating disorder. Peggy reflects on the lack of meaningful aspirations during the height of her disorder: "Whereas everybody else wanted to be a teacher or whatever, I wanted to be thin. That was my goal in life for 20 years."

The Way Out: Finding the Core Self

Given the myriad factors that go into creating an eating disorder and the depth with which these problems take hold, recovery must be holistic, focusing on the behavioral, nutritional, emotional, interpersonal and spiritual aspects of the problem. The Awakening Center, a treatment center specializing in treatment of eating disorders, offers an integrated treatment approach which includes individual therapy, group therapy, support groups, movement therapy and nutrition counseling. The staff work together to coordinate the various components of treatment. They believe it is possible to recover fully, making peace with eating and the body. However, healing is a long process and requires a great deal of patience.

To combat cultural pressures, recovering individuals need to create their own culture, a safe space in which a new set of values can be defined. One way to accomplish this is through support groups. The National Association of Anorexia Nervosa and Associated Disorders (ANAD) is an organization founded in the Chicago area to provide free services for individuals with eating disorders and their families. ANAD sponsors self-help support groups led by recovering individuals. Support groups reduce the shame and isolation associated with eating disorders. Group members often exchange telephone numbers and contact each other when they need someone talk to. The Awakening Center hosts two ANAD meetings which are open to anyone with food issues. There is no commitment to attend meetings regularly; members can drop in whenever they wish.

Another way to counteract popular media messages is by reading magazines which offer alternative images as an ideal. Mode and Radiance magazines feature larger women as models and address political and psychological issues along with fashion tips. As of yet, there are no publications for men featuring a variety of male body types, but perhaps men’s magazines will someday follow suit.

Group and individual psychotherapy address the emotional issues which underlie eating disorders. Amy Grabowski, who founded The Awakening Center, describes her approach: "We all have many parts. There’s the part of the person that wants to be perfect, there’s the part that feels vulnerable. I try to help [the client] get in touch with their core self, a deep-seated, quiet strength." Grabowski cautions that this process takes time. Jessica, describing her experience in therapy, concurs: "It’s changing my thinking but it’s not yet changing my feelings. It’s hard because [my new way of thinking] doesn’t feel true, like that it’s okay to eat ice cream and you can eat dessert. It seems like other people can eat them but I can’t."

Kate Fiello, who has a master’s degree in social work and a background in dance therapy, uses movement therapy to help clients bridge the gap between mind and body: "The movement therapy helps them get in tune with the rhythm of their body. If a client has some feelings coming up I ask them to notice changes in their body so that physical feelings can give them clues to how they are feeling emotionally. Eventually, clients learn to differentiate between physical hunger and emotional hunger by simply checking in with their body."

Finally, when a client is ready, a therapist can help her begin to explore her sense of purpose. Jessica, who has just begun to get in touch with a sense of spirituality, asserts: "I think that’s the answer; I think that [my recovery] is going to have to have a spiritual component if it’s going to work."

Amy Grabowski gently challenges her clients to begin to examine their deeper values: "You have to look at what is really important to you, how you fit into the world. I have yet to have a client say,‘I want to be on the cover of Cosmo and I want to be remembered for wearing a size two."’

While most of us do not need the help of a treatment team to help us restore balance to our relationship with food, we could all stand to examine this area of our lives. D’Urso-Fischer offers this advice: "I think we could all use encouragement to take care of ourselves, love ourselves, take the time to eat well. Give up rigid rules about eating, look for variety and balance, and respect the body by eating when you’re hungry and stopping when you’re full. Do what makes you feel good! The rest of it comes naturally; we know how eat, babies know how to eat, so it’s just a matter of getting back to that."

Resources

The Awakening Center, 3166 N. Lincoln Avenue, Chicago, IL; 773-929-6262

National Association of Anorexia Nervosa and Associated Disorders, Box 7, Highland Park, IL; 847-831-3438

Northwestern Medical Faculty Foundation Eating Disorders Program, 303 E. Ohio, Suite 550, Chicago, IL; 312-908-7511

Reading List

For more information on eating disorders, body image, and related topics:

Erdman, Cheri. Nothing To Lose: A Guide to Sane Living in a Larger Body. HarperCollins, 1995.

Hall, Lindsey, and Leigh Cohn. Bulimia: A Guide To Recovery. Gurze Books, 1992.

Hirschman, Jane, and Carol Munter. Overcoming Overeating. Fawcet Columbine, 1988.

Hirschman, Jane, and Carol Munter. When Women Stop Hating Their Bodies. Ballantine, 1995.

Hutchinson, Lucia. Transforming Body Image: Learning To Love the Body You Have. Crossing Press, 1985.

Kano, Susan. Making Peace With Food. Harper and Row, 1989.

Kinoy, Barbara, Estelle B. Miller, John Atchley, and the Book Committee of the American Anorexia/Bulimia Association. When Will We Laugh Again? Living and Dealing With Anorexia Nervosa and Bulimia. Columbia University Press, 1984.

Seid, Roberta Pollack. Never Too Thin: Why Women Are At War With Their Bodies. Prentice Hall, 1989.

Siegel, Michelle, Judith Brisman, and Margot Weinshel. Surviving an Eating Disorder: Strategies for Family and Friends. HarperCollins, 1988.

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