November 7, 2020 • 24 mins
Content warning: Eating Disorder tendencies are described. Please consider your intention before listening to this episode.
Eating Disorder Registered Dietitian Michelle Pillepich helps us discern the difference between an eating disorder vs. disordered eating. She defines binge eating, anorexia, and bulimia, and reminds us that no matter the severity of your disordered eating, YOU DESERVE HELP.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Maybe that's Lisa, and we're just two girls that want
to have a conversation with you. Dear sixteen year old
Andrea hey gorsgeous, Dear younger Lauren. Each episode is stories
from people I would deprive myself. Why myself obsessively? Because
I was eating healthy? I couldn't understand that I had
a problem with food. Losing my period scared me the most.
My story starts when I was around seven. That's when
(00:24):
I started to hate my body. Body image is like
our inner picture of our outer self healthy behaviors. I
had a much bigger role at all health than the
actual number on the scales. Internal dialogue can be so
powerful and often it's super negative and critical in a
way that we wouldn't talk to other people that we
care about. When you start to share your story, that
(00:44):
gives other people the courage to share theirs. I know
you would be proud now of how far you have
come in your relationship to food, exercise, and to yourself.
I felt freedom, I've gained relationships. I've found my true
sense of self worth. There's one thing I need you
to take away. You're going to be okay, welcome to
(01:05):
outweigh this is an intro that you know if you're
listening to this podcast. We don't always do an intro,
but if you hear us do one, it's because we
had an afterthought and we want you to know it.
Or we actually might need to put a trigger warning,
and I want you to hear me now and receive
this trigger warning and take it seriously. You're your own person.
(01:25):
You can make your own decision what you're going to
listen to. But this is an episode I would have
maybe listened to to try to figure out what else
I could do to help my body lose weight or
do whatever it is I want to do. So my
encouragement to you would be we're gonna try to talk
about everything on Outweigh episodes. We don't want to censor
(01:46):
and edit our content. We think that this is a
very serious matter, and I would just encourage you mentally,
if you're not in a place to really hear this
episode and take it as help instead of part of
your toolbook that you use to fuel you're eating disorder
or disordered eating patterns. Then I would encourage you to
press pause now and say this episode for when you're
(02:08):
in a better place. Yeah, Hey, fam, I definitely piggybacking
on what Amy said. This episode is so important. We're
joined by an amazing eating disorder registered dietitian, and I
think what you'll hear her say, but I want to
just say it right now before you even move forward,
is what is your intention in listening to this episode?
So what is your intention? Ask yourself right now, and
(02:28):
if it's coming from a place of I want to
best support my body, then go for it. And if
anything is coming up, as you know in your gut
of I want to take advantage of what might be
said here to further along and live in secrecy and
have more tools to get away with what I've been
getting away with, then perhaps pause this episode and don't
don't take a listen. Lisa and I care about y'all,
(02:49):
and that's why we feel it's important to share that
with you before certain episodes that could be triggering. So
there you go, that's our trigger warning. We hope you're
enjoying all the guests and experts that we're having on
and Michelle is amazing, and after you hear this, you'll
realize why we'll definitely be having her back on Welcome
back to Outweigh Today we have on eating disorder registered
(03:12):
dietitian Michelle Pillow Pitch. You can find her on Instagram
at Michelle two Els Pillow Pitch Nutrition. We'll drop that
in the show notes because it's a little bit of
a hard one and we're going to be learning all
about how to discern if you have an eating disorder
or disordered eating. So welcome, Michelle. We're so excited to
have you. Thank you, thanks for having me. I'm excited
to be here. So let's jump right in to the
(03:35):
good stuff and help our listeners learn how to discern
if it's disordered eating orn't eating disorder. What can we
be on the lookout for. Yeah, it's a great question,
and I think that there's a lot of crossover. So
a lot of the disordered eating symptoms and traits like
maybe counting calories or over exercise or things that are
super common in our society are also present in eating disorders.
(03:59):
What is the distinction is, I would say the intensity
of both the symptoms, so maybe they happen more frequently,
as well as the distress caused by food or the
thought of weight gain. So, for example, if somebody has
let's say anorexia, nerrosa, they would be really anxious to
(04:19):
the point of like almost panic about eating foods that
might cause weight gain. It's this real fear of a
larger body size and with anoxia. Ing on that topic,
the weight can also be a diagnosable factor, and I
do like to really really emphasize that low weight is
not necessary to have an eating disorder. Plenty of people
(04:41):
have eating disorders, even anorexia, without being underweight. But if
someone is underweight to the point of being medically unstable,
having lab values that are off, feeling faint and dizzy,
very often not being able to stand up too fast,
those things can be signs that your weight is also
a part of the diagnosis. That is part of that
criteria for anorexia, and then for other disorders like bulimia
(05:05):
or binge eating disorder, the frequency of behaviors is also
part of that diagnosis. So the d s M five,
for anyone who doesn't know, is the Diagnostic and Statistical
Manual of Mental Disorders. I think that's the exact title.
So that's like the Dictionary of Mental Illnesses. And so
there are criteria for all these disorders, and for bulimia
(05:27):
and binge eating disorder, the binges and the purges are
occurring for I think it's once a week for at
least three months to classify a diagnosis. If it's happening
once a week and it hasn't been three months yet,
that doesn't mean oh, don't get help yet. You know,
anything that is disrupting your life is of course deserving
of help. But that frequency is also kind of a key.
So can we actually get just a quick definition of
(05:49):
anorexia and bulimia and I guess binge eating disorder? Are
those the three main eating disorders that you work with? Yeah,
I would say those are the main ones. And then
I mean orthorexia is a really big one. I think
you guys have touched on it before. I don't think
it's in the d S, m um, it would be
considered eating disorder otherwise like unspecified something like that. But
that's another main one. So anorexia is primarily a restrictive
(06:14):
eating disorder, so limiting food intake to an inappropriate level
based on your age and height and your calorie needs.
Also that intense fear of weight gain and weight changes
and body image. It can also have an aspect of
body dysmorphia. And not seeing your body as it accurately appears,
and low weight is part of that diagnosis. There's also
(06:36):
something that is very unfortunately called a typical anorexia, which
would be a restrictive eating disorder without low weight. And
I would say probably every eating disorder professional is fighting
against that name because obviously, like, that's not a typical
that's just a human who is not at a severely
low weight. So with the anorext it's primarily the restriction.
(06:58):
Bulimia involves purjey, so that would be compensating after a binge.
And I also like to define binge because a lot
of people think, oh, I'm binging because I ate a
bunch of Halloween candy and Halloween is on my mind.
What classifies a binge is having a quantity of food
that is larger than what is typically needed or what
(07:20):
you would have in like a normal average meal to
meet your needs in a distinct period of time, and
having this feeling of being out of control, like you
can't stop even if you wanted to. So that kind
of compulsive and out of control feeling is also really
characteristic of a binge. If it's Thanksgiving dinner and you
eat a lot of extra pie because you only have
(07:42):
it once a year and you just love it. Like,
that's not necessarily a binge, you know. We can also
choose to eat past fullness because it's enjoyable and we
want to and those are completely normal things that like
mentally distressing feeling of being out of control is really
characteristic of a binge. Um, so that is kind of
binge eating, just order having those frequent once a week
(08:02):
episodes at least of binge eating eating those larger quantities
of food. And then bulimia is primarily the purging, so
having a purging episode every time there is a binge,
and anorexia can also have binge purge as a form
of compensation for eating. So there's so much overlap. People
don't often fit into just one little box. Can you
(08:23):
also speak to what a purge might look like, because
for some people, they're probably thinking in their heads that
automatically means throwing up, but that could mean going to
the gym for five hours exactly. Yes. Um, that's a
really good point. So purging is really any form of
compensation for food eaten. So it could be making yourself vomit,
(08:43):
it could be purging getting rid of those calories and
from over exercise, so exercising much more than your body
kneeds or wants. It could be taking laxatives after meals,
or diuretics and using that type of medication. It could
be even like sitting in a sauna for a ton
of time, all sorts of things. So primarily I would
(09:06):
say the vomiting, the exercise, the laxatives, and diuretics are
the main things. Um And yes, those are all forms
of purge, which I would say could be kind of
interchangeable with compensation. For the purpose of someone identifying and
just for people listening right now that may feel shame
around anything she just said, specifically laxatives or sitting in
a sauna for long periods of time, Lisa can speak
(09:29):
to her experience. But I've done every single thing you
just mentioned, so there is no shame and we need
to be talking about it. Because I didn't even realize
my sauna sessions were harmful. But in college I would
go sitting there after I'd already done tons of work
out at the gym, and I would put saran wrap
around my stomach and sweat it all out in the
(09:50):
sauna for like forty five minutes and then I would
The pleasure I would get from unwrapping the suran wrap
is such a mental thinging But also I was completely miserable,
but didn't really know that that what I was doing
was wrong. But I still hit it from everybody. And
I remember one time my roommate found a bunch of
(10:10):
suran wrap in my trash can, and I was mortified.
I just ignored it. But I mean, I still remember
that clear as day, and that was twenty years ago.
I remember on Season one about way you talked about
the suran wrap and the sauna, And there's actually been
a resurgence of that trend at a popular wellness I'm
putting in quotes. I don't know anything about it. I'm
(10:31):
not like mocking it, but like a wellness spot in
New York City where a lot of models are doing
this and and and it became very popular and it's
really important. Not everybody, I'm sure that does the suran
rap has a disordered relationship to food or an eating disorder,
but you know when you're doing it excessively compensatory lee
and so forth. So there's a line. And you know,
(10:51):
this year, I think it was this year has been
a weird year, but it was this year I wrote
about my use of laxatives, and it was something I
never spoke of out because even I've I've shared so
much about my disordered eating journey, laxatives like that made
me feel so disgusting and shameful. And I'm just gonna
say it again here because it's so not okay. How
(11:13):
you know, easy it is? But I pooped in my
pants once as a college student. I can't blame gonna
say this on that way. But the body is not
supposed to do that. Like I was destroying my inside
and that didn't stop me. By the way, that was
just a moment of Wow, I'm doing something serious. I
you know, maybe put a pause on it for a moment,
(11:33):
But not okay at all. And what's even more not
okay is any shame you may feel around something that
you've done in the past. So that's why I told
that very embarrassing story. So the one thing I just
want to ask Michelle, is you know, with laxatives for me,
it's very open about her story with binging and purging.
I took laxatives, but it wasn't you know, three times
(11:54):
a week for six months, so I was in that
gray area. Again. If I'm not a clinical eating disor order,
what am I? That doesn't make it okay? So what
would you say to somebody who is using or participating
in compensatory behaviors such as the shana or over exercising,
or laxatives or diuretics, but not at the frequency that
makes it, you know, bulimia, get help. I always say
(12:18):
it's important for anyone to get help, to reach out
to talk to a therapist, dietitian, someone close to you
before that if that feels like too big of a step,
because sure, maybe you didn't have a clinical eating disorder,
but clearly that behavior was disrupting your life. You know
that's not something that we want anyone to be doing.
So I always always, always say, I probably say this
(12:39):
a thousand times a day, what is your intention? The
intention matters? I ask every single client that whenever they
say is it's good, is it's bad? So if you're
taking laxatives once because you're really backed up, you went
on a trip, whatever, like okay, normal. If you are
taking it because you ate something that you feel guilty about,
or because you want to lose weight and it's clearly
(12:59):
too many peelate your body. That's disordered intention that deserves
help and attention. So I would say, reach out and
the shame is something so important to talk about. I'm
so glad that you guys are both sharing your stories
because I mentioned at least earlier, I used to work
in a residential treatment center and new clients when I
(13:19):
was meeting them for the first time, would always say, Oh,
I don't think I need to be here. I really
don't need to be here. I'm just doing it because
my parents told me to blah blah blah whoever. And
I always told people if we accepted clients based on
who thinks they need to be here, I'd be out
of the job. We would never have anyone nobody thinks
they need help. But if you are resonating with any
of these intentions in any of these stories, then you
(13:40):
deserve help, and it's really important to reduce that stigma
and to be able to reach out and get it.
I'm just gonna throw something else in the laxative conversation,
because again, trying to recognize whether or not you need help,
maybe you're not taking laxatives like that, say laxative on
the box, but you're drinking smooth Move tea every day
(14:02):
or every night before bed, because I certainly was doing that.
That is an easy way to disguise it because it's
this organic herbal tea and it's like, oh, I just
kind of need to go to the bathroom. And I
would drink that publicly and openly in front of my
family and be like, oh, I gotta make a smooth move,
and that was more acceptable than I'm gonna go pop
my laxative pills. So that is a warning. Look at
(14:24):
that behavior as well, anything you're using to disguise. Yeah,
that's actually how it started for me. At my college roommate.
You know, we went to a health food store. Again,
a health food store, so I assumed anything I'm buying
from a health food store is good for me, and
it's tea tea is good for me. And you know
this is before Instagram with you know, now we see
(14:44):
these laxative teas all over, So that was really important point. Amy,
Thanks for bringing that up. You talked about lab values
in anorexia, and I think that's something that a lot
of people don't understand. When we talk about anorexia, we see, oh,
they're just a thin person. You know, they're fine. What
is going on health wise for somebody with anorexia? A
lot of things can be going on, and it's also
(15:08):
so individual, so in terms of lab values, they can
be off in any sort of thing, like a lot
of nutrient deficiencies, because of course you're not eating a lot.
But I will say that it's actually fairly uncommon to
have lab values that are really off. And that's another
reason why so many clients come to me and say,
(15:28):
I don't really need this, I'm fine, My labs are fine,
and our bodies I know, Lisa, you know this as
a dietician. Our bodies are so complex and work so
hard to keep everything in balance, and I just always
tell people it's normal till it's not. So maybe they're
fine now, but if you continue down this path, it's
not going to be fine. Bone health is really big,
(15:51):
so even before things show up as off, I would
say bones can be deteriorating osteopenia and osteoporosis. So using
bone strength is very common in young people who suffer
from anorexia, so that is of course not something we want.
Hormones and your menstrual cycle can be affected. And again
(16:12):
I always want to give a disclaimer that it doesn't
always happen, and so some people are super sensitive and
if they lose two pounds, they lose their period. Some
people I personally have worked with clients who have had
a twenty thirty year long battle with anorexia never lost
their period, had children, and been severely underweight the whole time.
(16:32):
So if you still have your period, that doesn't necessarily
mean I don't have a problem. But if you lose
your period, that's definitely a sign that something is off.
I like what you said, it's normal until it's not.
That's a really good reminder, and I would think, and again,
we've spoken about this and we shared our stories on
the first four episodes of Our WAGH. But I was
(16:53):
once told when I was much younger, by a mentor
to me that every time I threw up, it was
a slow suicide. And so can you just speak to
the harm that we're doing to our bodies all to
fit into some whatever box of what we think we
should look like. Describe what that really means, because I
feel like that can sound really drastic to someone that's like,
(17:16):
what stop like slow suicide? Don't even but it's it's
so true. Yeah, no, it is. There are so many
things that are harmful and people only think about I
shouldn't say only, but tend to think about the external
and well, I don't look thin enough where my teeth
aren't ritting out of my head. But yeah, especially like
with purging, the integrity of your esophagus and digestive system
(17:39):
is being damaged. I don't want to be like a
horror story here kind of scaring people, but I think
it's important to know what's possible that it can get
to a point where you can't stop the sort of
opposite flow of your digestion and there is involuntary regurgitation
that happens. Even just your digestive health being off poor
(17:59):
neutral and absorption as your intestines are being damaged, really
your whole digestive system being totally ruined. I've seen people
end up with a colostomy bag from an eating disorder
and other complications of it. You know, it's kind of
interesting that, like gut health is so trendy, but at
the same time, people are doing these behaviors to change
(18:20):
their body that really impact your digestion, your bone health,
you know, being able to so easily break a bone
at a very young age having fractures. Heart health is
also really really dangerous, and I tell people when you're
not eating enough, someone who has a restrictive eating disorder,
your body, if it doesn't have enough carbohydrate to use
(18:41):
for energy, then it goes to breaking down fat and muscle.
And people think, oh, yeah, I'm going to use up
all my fat, but also protein and muscle, and your
heart is a muscle, and your heart can deteriorate. Your
heart can stop from purging too much from refeating syndrome.
If you restrict too far and then reintroduced food when
(19:01):
your body is not ready for it or too quickly,
that can cause electrolyte imbalances. It's really dangerous for heart rhythms.
So it's a serious thing. I think a common statistics
thrown around is the anorexia is the deadliest mental illness,
and people don't really realize that. So, yeah, that's actually
a great pivot because eating disorders so much right now
(19:22):
on the internet is to blame quote unquote diet culture.
And obviously, you know there is this pursuit of thinness
ingrained in all of us. But one thing that I
think is kind of getting lost in the mix, is
that eating disorders in the nature that we're discussing them
today are not just because of diet culture. Right, What
are some of the factors that could go into causing
(19:43):
and eating disorder? So many and it's never just one thing.
So you know, if someone is listening and has a
child or parent or best friend with an eating disorder,
nothing is your fault or any one person's fault. They
are biopsychosocial disorders. So there's a biological component. It is
ingrained in our biology of our body. There is a
(20:04):
genetic component. I actually researched that for my master's degree.
It was really interesting and psychological. So there is a
mental health component. These are mental disorders, so there's that
whole piece, often probably always co occurring with anxiety, depression,
any type of other psychiatric diagnosis, and social So yes,
(20:25):
there is the diet culture piece, the people you're around,
the sports you're in, the cultures and activities that can
also influence things. And it has to be that perfect storm.
So you know, one person might be in competitive dance
or something that is a community in which eating disorders
are prominent, and maybe they don't have the genes that
(20:46):
predispose them to the eating disorder, and they're fine. But
somebody else does have that genetic makeup and that psychiatric
makeup and they do develop an eating disorder. So it's
really complex, certainly. And so for somebody listening that resonated
with either the arexia the bolimia, somebody might be listening
and they're they're nervous. What is the first step that
they should take, because I think that's where a lot
(21:07):
of people actually get stuck. Yeah, the first step is
I would say tell someone eating disorders thrive in secrecy,
So putting it out there to whoever you're comfortable with, Well,
then get the ball rolling with somebody holding you accountable,
helping you get help, helping you make the phone call
to a therapist or a dietitian or your doctor or
(21:30):
whatever you need to do. That is the first step
that you feel comfortable with. But just sharing is really important,
and I think especially for the eating disorders that are
so shameful, I'm so glad that you guys brought up
the shame piece because anorexia tends to be this like
glorified eating disorder. Oh, everyone wants to be thin, and
(21:50):
nobody wants to talk about their binge eating, And that
is kind of an over generalization, but that's what I
see the most. So if you're binging, telling someone is
probably the last thing in the world you want to do.
And that's why it's the most important, because these are
also relational disorders. You know. Eating disorders can cause lying
and stealing and hiding things, and so putting it out
(22:12):
in the open is what's going to squash it. The
more people who know, the more you are saying out
loud that you're wanting to beat this thing, the more
capable you will be of beating it. Oh, I'm so
glad you brought up that piece, and some people listening
may have, Like you said in the beginning, you may
not fall into one category. I certainly have dabbled in
all of them, not so much anorexia, but I was restricting,
(22:35):
which then led to my binging, and then I purged,
and then I have suffered from orthorexia, which I didn't
even know was a thing until recently. But I had
that for way longer than before I ever heard of it.
But I always kind of in my head secretly wished
I just struggled with anorexia, because that would have been
easier to talk about and more I hate to use
this word acceptable, but it seemed more like that would
(22:59):
be something where people like, oh, okay, yeah, I get
that too again, talk about all the other things you
have going on, and even now I would maybe put
orthorexy in that category of like people don't really know
what it is, so I can be like, yeah, yeah, orthorexia,
you know I have that, and that's just wanting to
eat so healthy, and then people are like, oh, yeah, okay,
I can get on board with that disorder. But they
(23:22):
all need attention and they all need help. That's the
purpose of this and your work too. Of course, just
thank you for being a part of this conversation of
getting it all out there. All of them need attention,
and not one of them should be glamorized more than
the other or more acceptable to talk about. We should
be talking about every single thing so that other people
(23:44):
can strip the shame and we can all start healing together. Yeah.
I think we definitely need to have Michelle on again
because there's so many different details that we could have
dove into, but for this one, I just wanted to
cover how to tell if you have disordered eating versus
eating disorder, and I think you you provided us so
much valuable information. So you can find Michelle again at
Michelle Pillow Pitch Nutrition. We will put that on the
(24:08):
show note and we'll also put the website so if
you are in the New York region, perhaps you can
book a session to work with Michelle directly. Thanks for
being here, Michelle, awesome. Thank you guys so much.
Maybe that's Lisa, and we're just two girls that want
to have a conversation with you. Dear sixteen year old
Andrea hey gorsgeous, Dear younger Lauren. Each episode is stories
from people I would deprive myself. Why myself obsessively? Because
I was eating healthy? I couldn't understand that I had
a problem with food. Losing my period scared me the most.
My story starts when I was around seven. That's when
(00:24):
I started to hate my body. Body image is like
our inner picture of our outer self healthy behaviors. I
had a much bigger role at all health than the
actual number on the scales. Internal dialogue can be so
powerful and often it's super negative and critical in a
way that we wouldn't talk to other people that we
care about. When you start to share your story, that
(00:44):
gives other people the courage to share theirs. I know
you would be proud now of how far you have
come in your relationship to food, exercise, and to yourself.
I felt freedom, I've gained relationships. I've found my true
sense of self worth. There's one thing I need you
to take away. You're going to be okay, welcome to
(01:05):
outweigh this is an intro that you know if you're
listening to this podcast. We don't always do an intro,
but if you hear us do one, it's because we
had an afterthought and we want you to know it.
Or we actually might need to put a trigger warning,
and I want you to hear me now and receive
this trigger warning and take it seriously. You're your own person.
(01:25):
You can make your own decision what you're going to
listen to. But this is an episode I would have
maybe listened to to try to figure out what else
I could do to help my body lose weight or
do whatever it is I want to do. So my
encouragement to you would be we're gonna try to talk
about everything on Outweigh episodes. We don't want to censor
(01:46):
and edit our content. We think that this is a
very serious matter, and I would just encourage you mentally,
if you're not in a place to really hear this
episode and take it as help instead of part of
your toolbook that you use to fuel you're eating disorder
or disordered eating patterns. Then I would encourage you to
press pause now and say this episode for when you're
(02:08):
in a better place. Yeah, Hey, fam, I definitely piggybacking
on what Amy said. This episode is so important. We're
joined by an amazing eating disorder registered dietitian, and I
think what you'll hear her say, but I want to
just say it right now before you even move forward,
is what is your intention in listening to this episode?
So what is your intention? Ask yourself right now, and
(02:28):
if it's coming from a place of I want to
best support my body, then go for it. And if
anything is coming up, as you know in your gut
of I want to take advantage of what might be
said here to further along and live in secrecy and
have more tools to get away with what I've been
getting away with, then perhaps pause this episode and don't
don't take a listen. Lisa and I care about y'all,
(02:49):
and that's why we feel it's important to share that
with you before certain episodes that could be triggering. So
there you go, that's our trigger warning. We hope you're
enjoying all the guests and experts that we're having on
and Michelle is amazing, and after you hear this, you'll
realize why we'll definitely be having her back on Welcome
back to Outweigh Today we have on eating disorder registered
(03:12):
dietitian Michelle Pillow Pitch. You can find her on Instagram
at Michelle two Els Pillow Pitch Nutrition. We'll drop that
in the show notes because it's a little bit of
a hard one and we're going to be learning all
about how to discern if you have an eating disorder
or disordered eating. So welcome, Michelle. We're so excited to
have you. Thank you, thanks for having me. I'm excited
to be here. So let's jump right in to the
(03:35):
good stuff and help our listeners learn how to discern
if it's disordered eating orn't eating disorder. What can we
be on the lookout for. Yeah, it's a great question,
and I think that there's a lot of crossover. So
a lot of the disordered eating symptoms and traits like
maybe counting calories or over exercise or things that are
super common in our society are also present in eating disorders.
(03:59):
What is the distinction is, I would say the intensity
of both the symptoms, so maybe they happen more frequently,
as well as the distress caused by food or the
thought of weight gain. So, for example, if somebody has
let's say anorexia, nerrosa, they would be really anxious to
(04:19):
the point of like almost panic about eating foods that
might cause weight gain. It's this real fear of a
larger body size and with anoxia. Ing on that topic,
the weight can also be a diagnosable factor, and I
do like to really really emphasize that low weight is
not necessary to have an eating disorder. Plenty of people
(04:41):
have eating disorders, even anorexia, without being underweight. But if
someone is underweight to the point of being medically unstable,
having lab values that are off, feeling faint and dizzy,
very often not being able to stand up too fast,
those things can be signs that your weight is also
a part of the diagnosis. That is part of that
criteria for anorexia, and then for other disorders like bulimia
(05:05):
or binge eating disorder, the frequency of behaviors is also
part of that diagnosis. So the d s M five,
for anyone who doesn't know, is the Diagnostic and Statistical
Manual of Mental Disorders. I think that's the exact title.
So that's like the Dictionary of Mental Illnesses. And so
there are criteria for all these disorders, and for bulimia
(05:27):
and binge eating disorder, the binges and the purges are
occurring for I think it's once a week for at
least three months to classify a diagnosis. If it's happening
once a week and it hasn't been three months yet,
that doesn't mean oh, don't get help yet. You know,
anything that is disrupting your life is of course deserving
of help. But that frequency is also kind of a key.
So can we actually get just a quick definition of
(05:49):
anorexia and bulimia and I guess binge eating disorder? Are
those the three main eating disorders that you work with? Yeah,
I would say those are the main ones. And then
I mean orthorexia is a really big one. I think
you guys have touched on it before. I don't think
it's in the d S, m um, it would be
considered eating disorder otherwise like unspecified something like that. But
that's another main one. So anorexia is primarily a restrictive
(06:14):
eating disorder, so limiting food intake to an inappropriate level
based on your age and height and your calorie needs.
Also that intense fear of weight gain and weight changes
and body image. It can also have an aspect of
body dysmorphia. And not seeing your body as it accurately appears,
and low weight is part of that diagnosis. There's also
(06:36):
something that is very unfortunately called a typical anorexia, which
would be a restrictive eating disorder without low weight. And
I would say probably every eating disorder professional is fighting
against that name because obviously, like, that's not a typical
that's just a human who is not at a severely
low weight. So with the anorext it's primarily the restriction.
(06:58):
Bulimia involves purjey, so that would be compensating after a binge.
And I also like to define binge because a lot
of people think, oh, I'm binging because I ate a
bunch of Halloween candy and Halloween is on my mind.
What classifies a binge is having a quantity of food
that is larger than what is typically needed or what
(07:20):
you would have in like a normal average meal to
meet your needs in a distinct period of time, and
having this feeling of being out of control, like you
can't stop even if you wanted to. So that kind
of compulsive and out of control feeling is also really
characteristic of a binge. If it's Thanksgiving dinner and you
eat a lot of extra pie because you only have
(07:42):
it once a year and you just love it. Like,
that's not necessarily a binge, you know. We can also
choose to eat past fullness because it's enjoyable and we
want to and those are completely normal things that like
mentally distressing feeling of being out of control is really
characteristic of a binge. Um, so that is kind of
binge eating, just order having those frequent once a week
(08:02):
episodes at least of binge eating eating those larger quantities
of food. And then bulimia is primarily the purging, so
having a purging episode every time there is a binge,
and anorexia can also have binge purge as a form
of compensation for eating. So there's so much overlap. People
don't often fit into just one little box. Can you
(08:23):
also speak to what a purge might look like, because
for some people, they're probably thinking in their heads that
automatically means throwing up, but that could mean going to
the gym for five hours exactly. Yes. Um, that's a
really good point. So purging is really any form of
compensation for food eaten. So it could be making yourself vomit,
(08:43):
it could be purging getting rid of those calories and
from over exercise, so exercising much more than your body
kneeds or wants. It could be taking laxatives after meals,
or diuretics and using that type of medication. It could
be even like sitting in a sauna for a ton
of time, all sorts of things. So primarily I would
(09:06):
say the vomiting, the exercise, the laxatives, and diuretics are
the main things. Um And yes, those are all forms
of purge, which I would say could be kind of
interchangeable with compensation. For the purpose of someone identifying and
just for people listening right now that may feel shame
around anything she just said, specifically laxatives or sitting in
a sauna for long periods of time, Lisa can speak
(09:29):
to her experience. But I've done every single thing you
just mentioned, so there is no shame and we need
to be talking about it. Because I didn't even realize
my sauna sessions were harmful. But in college I would
go sitting there after I'd already done tons of work
out at the gym, and I would put saran wrap
around my stomach and sweat it all out in the
(09:50):
sauna for like forty five minutes and then I would
The pleasure I would get from unwrapping the suran wrap
is such a mental thinging But also I was completely miserable,
but didn't really know that that what I was doing
was wrong. But I still hit it from everybody. And
I remember one time my roommate found a bunch of
(10:10):
suran wrap in my trash can, and I was mortified.
I just ignored it. But I mean, I still remember
that clear as day, and that was twenty years ago.
I remember on Season one about way you talked about
the suran wrap and the sauna, And there's actually been
a resurgence of that trend at a popular wellness I'm
putting in quotes. I don't know anything about it. I'm
(10:31):
not like mocking it, but like a wellness spot in
New York City where a lot of models are doing
this and and and it became very popular and it's
really important. Not everybody, I'm sure that does the suran
rap has a disordered relationship to food or an eating disorder,
but you know when you're doing it excessively compensatory lee
and so forth. So there's a line. And you know,
(10:51):
this year, I think it was this year has been
a weird year, but it was this year I wrote
about my use of laxatives, and it was something I
never spoke of out because even I've I've shared so
much about my disordered eating journey, laxatives like that made
me feel so disgusting and shameful. And I'm just gonna
say it again here because it's so not okay. How
(11:13):
you know, easy it is? But I pooped in my
pants once as a college student. I can't blame gonna
say this on that way. But the body is not
supposed to do that. Like I was destroying my inside
and that didn't stop me. By the way, that was
just a moment of Wow, I'm doing something serious. I
you know, maybe put a pause on it for a moment,
(11:33):
But not okay at all. And what's even more not
okay is any shame you may feel around something that
you've done in the past. So that's why I told
that very embarrassing story. So the one thing I just
want to ask Michelle, is you know, with laxatives for me,
it's very open about her story with binging and purging.
I took laxatives, but it wasn't you know, three times
(11:54):
a week for six months, so I was in that
gray area. Again. If I'm not a clinical eating disor order,
what am I? That doesn't make it okay? So what
would you say to somebody who is using or participating
in compensatory behaviors such as the shana or over exercising,
or laxatives or diuretics, but not at the frequency that
makes it, you know, bulimia, get help. I always say
(12:18):
it's important for anyone to get help, to reach out
to talk to a therapist, dietitian, someone close to you
before that if that feels like too big of a step,
because sure, maybe you didn't have a clinical eating disorder,
but clearly that behavior was disrupting your life. You know
that's not something that we want anyone to be doing.
So I always always, always say, I probably say this
(12:39):
a thousand times a day, what is your intention? The
intention matters? I ask every single client that whenever they
say is it's good, is it's bad? So if you're
taking laxatives once because you're really backed up, you went
on a trip, whatever, like okay, normal. If you are
taking it because you ate something that you feel guilty about,
or because you want to lose weight and it's clearly
(12:59):
too many peelate your body. That's disordered intention that deserves
help and attention. So I would say, reach out and
the shame is something so important to talk about. I'm
so glad that you guys are both sharing your stories
because I mentioned at least earlier, I used to work
in a residential treatment center and new clients when I
(13:19):
was meeting them for the first time, would always say, Oh,
I don't think I need to be here. I really
don't need to be here. I'm just doing it because
my parents told me to blah blah blah whoever. And
I always told people if we accepted clients based on
who thinks they need to be here, I'd be out
of the job. We would never have anyone nobody thinks
they need help. But if you are resonating with any
of these intentions in any of these stories, then you
(13:40):
deserve help, and it's really important to reduce that stigma
and to be able to reach out and get it.
I'm just gonna throw something else in the laxative conversation,
because again, trying to recognize whether or not you need help,
maybe you're not taking laxatives like that, say laxative on
the box, but you're drinking smooth Move tea every day
(14:02):
or every night before bed, because I certainly was doing that.
That is an easy way to disguise it because it's
this organic herbal tea and it's like, oh, I just
kind of need to go to the bathroom. And I
would drink that publicly and openly in front of my
family and be like, oh, I gotta make a smooth move,
and that was more acceptable than I'm gonna go pop
my laxative pills. So that is a warning. Look at
(14:24):
that behavior as well, anything you're using to disguise. Yeah,
that's actually how it started for me. At my college roommate.
You know, we went to a health food store. Again,
a health food store, so I assumed anything I'm buying
from a health food store is good for me, and
it's tea tea is good for me. And you know
this is before Instagram with you know, now we see
(14:44):
these laxative teas all over, So that was really important point. Amy,
Thanks for bringing that up. You talked about lab values
in anorexia, and I think that's something that a lot
of people don't understand. When we talk about anorexia, we see, oh,
they're just a thin person. You know, they're fine. What
is going on health wise for somebody with anorexia? A
lot of things can be going on, and it's also
(15:08):
so individual, so in terms of lab values, they can
be off in any sort of thing, like a lot
of nutrient deficiencies, because of course you're not eating a lot.
But I will say that it's actually fairly uncommon to
have lab values that are really off. And that's another
reason why so many clients come to me and say,
(15:28):
I don't really need this, I'm fine, My labs are fine,
and our bodies I know, Lisa, you know this as
a dietician. Our bodies are so complex and work so
hard to keep everything in balance, and I just always
tell people it's normal till it's not. So maybe they're
fine now, but if you continue down this path, it's
not going to be fine. Bone health is really big,
(15:51):
so even before things show up as off, I would
say bones can be deteriorating osteopenia and osteoporosis. So using
bone strength is very common in young people who suffer
from anorexia, so that is of course not something we want.
Hormones and your menstrual cycle can be affected. And again
(16:12):
I always want to give a disclaimer that it doesn't
always happen, and so some people are super sensitive and
if they lose two pounds, they lose their period. Some
people I personally have worked with clients who have had
a twenty thirty year long battle with anorexia never lost
their period, had children, and been severely underweight the whole time.
(16:32):
So if you still have your period, that doesn't necessarily
mean I don't have a problem. But if you lose
your period, that's definitely a sign that something is off.
I like what you said, it's normal until it's not.
That's a really good reminder, and I would think, and again,
we've spoken about this and we shared our stories on
the first four episodes of Our WAGH. But I was
(16:53):
once told when I was much younger, by a mentor
to me that every time I threw up, it was
a slow suicide. And so can you just speak to
the harm that we're doing to our bodies all to
fit into some whatever box of what we think we
should look like. Describe what that really means, because I
feel like that can sound really drastic to someone that's like,
(17:16):
what stop like slow suicide? Don't even but it's it's
so true. Yeah, no, it is. There are so many
things that are harmful and people only think about I
shouldn't say only, but tend to think about the external
and well, I don't look thin enough where my teeth
aren't ritting out of my head. But yeah, especially like
with purging, the integrity of your esophagus and digestive system
(17:39):
is being damaged. I don't want to be like a
horror story here kind of scaring people, but I think
it's important to know what's possible that it can get
to a point where you can't stop the sort of
opposite flow of your digestion and there is involuntary regurgitation
that happens. Even just your digestive health being off poor
(17:59):
neutral and absorption as your intestines are being damaged, really
your whole digestive system being totally ruined. I've seen people
end up with a colostomy bag from an eating disorder
and other complications of it. You know, it's kind of
interesting that, like gut health is so trendy, but at
the same time, people are doing these behaviors to change
(18:20):
their body that really impact your digestion, your bone health,
you know, being able to so easily break a bone
at a very young age having fractures. Heart health is
also really really dangerous, and I tell people when you're
not eating enough, someone who has a restrictive eating disorder,
your body, if it doesn't have enough carbohydrate to use
(18:41):
for energy, then it goes to breaking down fat and muscle.
And people think, oh, yeah, I'm going to use up
all my fat, but also protein and muscle, and your
heart is a muscle, and your heart can deteriorate. Your
heart can stop from purging too much from refeating syndrome.
If you restrict too far and then reintroduced food when
(19:01):
your body is not ready for it or too quickly,
that can cause electrolyte imbalances. It's really dangerous for heart rhythms.
So it's a serious thing. I think a common statistics
thrown around is the anorexia is the deadliest mental illness,
and people don't really realize that. So, yeah, that's actually
a great pivot because eating disorders so much right now
(19:22):
on the internet is to blame quote unquote diet culture.
And obviously, you know there is this pursuit of thinness
ingrained in all of us. But one thing that I
think is kind of getting lost in the mix, is
that eating disorders in the nature that we're discussing them
today are not just because of diet culture. Right, What
are some of the factors that could go into causing
(19:43):
and eating disorder? So many and it's never just one thing.
So you know, if someone is listening and has a
child or parent or best friend with an eating disorder,
nothing is your fault or any one person's fault. They
are biopsychosocial disorders. So there's a biological component. It is
ingrained in our biology of our body. There is a
(20:04):
genetic component. I actually researched that for my master's degree.
It was really interesting and psychological. So there is a
mental health component. These are mental disorders, so there's that
whole piece, often probably always co occurring with anxiety, depression,
any type of other psychiatric diagnosis, and social So yes,
(20:25):
there is the diet culture piece, the people you're around,
the sports you're in, the cultures and activities that can
also influence things. And it has to be that perfect storm.
So you know, one person might be in competitive dance
or something that is a community in which eating disorders
are prominent, and maybe they don't have the genes that
(20:46):
predispose them to the eating disorder, and they're fine. But
somebody else does have that genetic makeup and that psychiatric
makeup and they do develop an eating disorder. So it's
really complex, certainly. And so for somebody listening that resonated
with either the arexia the bolimia, somebody might be listening
and they're they're nervous. What is the first step that
they should take, because I think that's where a lot
(21:07):
of people actually get stuck. Yeah, the first step is
I would say tell someone eating disorders thrive in secrecy,
So putting it out there to whoever you're comfortable with, Well,
then get the ball rolling with somebody holding you accountable,
helping you get help, helping you make the phone call
to a therapist or a dietitian or your doctor or
(21:30):
whatever you need to do. That is the first step
that you feel comfortable with. But just sharing is really important,
and I think especially for the eating disorders that are
so shameful, I'm so glad that you guys brought up
the shame piece because anorexia tends to be this like
glorified eating disorder. Oh, everyone wants to be thin, and
(21:50):
nobody wants to talk about their binge eating, And that
is kind of an over generalization, but that's what I
see the most. So if you're binging, telling someone is
probably the last thing in the world you want to do.
And that's why it's the most important, because these are
also relational disorders. You know. Eating disorders can cause lying
and stealing and hiding things, and so putting it out
(22:12):
in the open is what's going to squash it. The
more people who know, the more you are saying out
loud that you're wanting to beat this thing, the more
capable you will be of beating it. Oh, I'm so
glad you brought up that piece, and some people listening
may have, Like you said in the beginning, you may
not fall into one category. I certainly have dabbled in
all of them, not so much anorexia, but I was restricting,
(22:35):
which then led to my binging, and then I purged,
and then I have suffered from orthorexia, which I didn't
even know was a thing until recently. But I had
that for way longer than before I ever heard of it.
But I always kind of in my head secretly wished
I just struggled with anorexia, because that would have been
easier to talk about and more I hate to use
this word acceptable, but it seemed more like that would
(22:59):
be something where people like, oh, okay, yeah, I get
that too again, talk about all the other things you
have going on, and even now I would maybe put
orthorexy in that category of like people don't really know
what it is, so I can be like, yeah, yeah, orthorexia,
you know I have that, and that's just wanting to
eat so healthy, and then people are like, oh, yeah, okay,
I can get on board with that disorder. But they
(23:22):
all need attention and they all need help. That's the
purpose of this and your work too. Of course, just
thank you for being a part of this conversation of
getting it all out there. All of them need attention,
and not one of them should be glamorized more than
the other or more acceptable to talk about. We should
be talking about every single thing so that other people
(23:44):
can strip the shame and we can all start healing together. Yeah.
I think we definitely need to have Michelle on again
because there's so many different details that we could have
dove into, but for this one, I just wanted to
cover how to tell if you have disordered eating versus
eating disorder, and I think you you provided us so
much valuable information. So you can find Michelle again at
Michelle Pillow Pitch Nutrition. We will put that on the
(24:08):
show note and we'll also put the website so if
you are in the New York region, perhaps you can
book a session to work with Michelle directly. Thanks for
being here, Michelle, awesome. Thank you guys so much.
Hosts And Creators
Amy Brown
Leanne Ellington
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