But she/he doesn´t look ill. She/he can’t have an eating disorder. Yes, she/he can!
By Dr. Rosanna Mauro de Maya, MS, RD, CEDRD
The Eating Disorder Truth #1 states ”many people with eating disorders look healthy, yet may be extremely ill.”
This cornerstone statement makes us reflect on the fact that any person, regardless of their figure, shape or weight, could develop an eating disorder. Traditionally it was believed that someone should seem extremely thin, frail and pale to be truly ill with an eating disorder. Fortunately, we now understand that we cannot judge by physical appearance whether or not someone is suffering from an eating disorder, or whether the illness is life-threatening.
Eating disorders are serious diseases that, if left untreated, can take a person into a path filled with struggles, discomfort, unhappiness and weakness; and even death. On the positive side, those who become ill with an eating disorder can achieve full recovery, when and if they have access to a specialized, evidence-based treatment provided by highly trained professionals in the field.
As health professionals, it is common to utilize quantitative indicators such as weight, body fat percentage or blood labs to raise an alert or become suspicious that a patient may have an eating disorder. However, these indicators don´t always reveal a deficiency, leading to many cases going undetected. In certain cases, with great courage because this illness thrives on secrecy, shame and stigma, some people who seek help are greeted by professionals with the typical (and highly stigmatized) phrase: “but you don´t look ill, you can´t have an eating disorder”.
Sadly, this throwaway comment can end the only opportunity that this person had to receive life-saving, high quality care.
We need to break down this stigma and understand that eating disorders are devastating mental illnesses that come in all shapes, sizes, colors, socioeconomic backgrounds and creeds. Low body weight and body mass index (BMI) are at best general parameters to assess risk, but they exclude many people and are not required to fulfill the diagnostic criteria for an eating disorder. To overcome this problem, we can employ the following, easy to use questions, described in the SCOFF questionnaire (S=sick, C=loss of control, O=lost one stone, equivalent to 6 kg approximately, F=feel fat, F=food dominates life [SCOFF]) to screen for eating disorders in our patients, also in the general population, to help detect cases that otherwise could go unnoticed:
- Do you make yourself sick because you feel uncomfortably full?
- Do you worry you have lost control over how much you eat?
- Have you recently lost more than 6 kg in a three-month period?
- Do you believe yourself to be fat when others say you are too thin?
- Would you say food dominates your life?
An answer of ‘yes’ to two or more questions warrants further questioning and more comprehensive assessment and the necessity for referral to a trained eating disorders specialist.
In the same way as a low body weight is not the most precise way to detect an eating disorder, it is neither an indicator of full recovery. Full recovery from an eating disorder does not happen when only weight or body fat percentage have returned to a natural and normal level. From a nutritional perspective, full recovery occurs when a person has healed his/her relationship with food, has legalized foods, has become connected with full hunger/satiety signals, feels comfortable in a wide array of social situations, and has learned to live with more flexibility and variety, among other indicators. On a psychological level, a person who has fully recovered from an eating disorder has healed his/her relationship with oneself and significant others, has discovered who he/she is and what he/she enjoys doing away from the eating disorder, has learned a wide variety of tools to deal with stress and conflicts in a more productive way, among many other indicators.
As healthcare professionals we most find reliable sources to learn about and become trained in eating disorders, so we can appropriately and effectively treat our patients who are suffering from eating disorders. By enlarging our vision of eating disorders and breaking down the weight stigma around them, more cases will be detected and many more opportunities for early treatment and full recovery from eating disorders will arise.
About Rosanna
Dr. Rosanna Mauro de Maya, Central American Chair of IADEP´s International Chapter, is a registered dietitian with a Masters in group psychology, a certified integrative health coach, and a certified eating disorder registered dietitian through iaedp. She is the first and only eating disorders specialized dietitian recognized by the College of Nutritionists of Costa Rica. Rosanna has 16 years of experience in the prevention and treatment of eating disorders and is an active lecturer and professor in the field, both in Costa Rica and abroad. She is co-founder of the Rosanna Mauro Wellness Institute and Fundación Cambio Vital, a non-profit organisation which promotes healthy lifestyles and a culture of wellness, including prevention and treatment of eating disorders. She is recovered from an eating disorder and lives happily in Costa Rica, with her husband, daughter and son.
