Food Variety in Eating Disorder Recovery

Food Variety in Eating Disorder Recovery
Jose Luis Pelaez Inc, Blend Images, Getty Images

Many patients with eating disorders will only eat a restricted range of foods. As your eating disorder has evolved, you may have stopped eating foods that you thought were fattening or that contained sugar. Or maybe you went starch- or gluten-free or decided to “eat clean.” Maybe you became vegetarian or vegan. Or maybe you shun vegetables because you are anxious about choking on them, or you don’t allow yourself to eat desserts because you don’t believe you can limit yourself to a normal portion.

If any of these restrictions is a symptom of your eating disorder, recovery will require you to increase your food variety.

Consequences of a restricted range of food intake can include nutritional deficits, maintenance of a weight too low for your body, and getting stuck in a cycle of bingeing or purging. Each of these in turn could cause serious medical complications. Increasing the range of foods eaten is a primary goal for patients of any eating disorder diagnosis, whether anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder (OSFED), or avoidant restrictive food intake disorder (ARFID).

Reasons to Increase Food Variety

There are many good reasons for any eater to broaden his or her diet, and this applies especially to individuals in recovery:

  1. Success in cognitive behavioral therapy for bulimia and binge eating is associated with becoming a more flexible eater. Cognitive behavioral therapy (CBT) for eating disorders is the most studied and validated treatment for bulimia nervosa and binge eating disorder. It is based on the cognitive model, which finds that restrictive eating maintains a cycle of bingeing and purging. Treatment to break the cycle requires reducing dietary restraint. Research shows that patients who adopt a habit of flexible eating exhibit reductions in binge eating and purging.
  1. Successful treatment for anorexia nervosa is associated with a more varied diet. One significant symptom of anorexia nervosa is a restricted diet; expansion of this dietary range is an important treatment goal. Research has revealed that individuals who were successful in sustaining recovery from anorexia nervosa consumed a more varied diet. It also shows that they ate foods that were higher in fat and calories.
  1. A more varied diet reduces the chance of overeating any single food that contains substances unhealthy in larger quantities. It seems that every week we discover a new food is correlated with some terrible health risk. One year it was bacon. In years past, the dangers we worried about were MSG, soy, or the mercury in fish. While many of these risks have proven to be hyped or simply not true, the best way to hedge against them is to broaden your diet and moderate intake of any single food. This reduces the risk of high exposure to any single substance dangerous either in theory or actuality. Not incidentally, eating a variety of foods maximizes the chances of getting all the nutrients needed for good health.
  2. Flexibility is important to people sensitive to an energy imbalance, taking in less calories than one needs, (as are many patients with eating disorders). Individuals who eat a limited diet can be at a greater risk of getting insufficient food when their choices are limited. For example, taking a road trip on the interstate, during which the only food option may be a rest-stop fast food restaurant, could be problematic for an individual only willing to eat a side salad. Unwillingness to eat sufficient energy-dense foods could trigger an energy imbalance, which could in turn reactivate an eating disorder.
  1. A limited variety of food intake can significantly hinder social opportunities, many of which have food as a focus. Individuals who are uncomfortable eating in different settings and consuming different cuisines may not be able to join friends in certain activities, or may feel compelled to eat alone. This restriction may pose limits on a person’s ability to have fun and connect with others.
  2. A limited range of food intake may shrink your world. Experiencing new foods is an almost inescapable aspect of travel, and one of the most exciting. People with eating disorders who travel during times of illness or even during early recovery generally struggle with unfamiliar foods. Some have traveled to countries known for amazing cuisines and not even taken a single taste—lost opportunities!
  1. While eating the same foods repetitively might give a sense of security, it often leads to food “burnout.” Eating a range of foods helps maintain a healthy interest in food. Some people with eating disorders who repeatedly eat the same food often report getting bored of that food. They also tend to report less interest in eating and less satisfaction from eating. Research supports the intuition that most people would quickly tire of even their favorite food if it were their only option, and might even reduce their intake far enough to lose weight, which could increase risk for relapse.

In summary, while a restricted dietary range might serve to decrease one’s anxiety in the short term, this comfort it is not without costs. When it comes to food, variety not only is the spice of life, but may hold the key to recovery.

How to Approach Increasing Food Flexibility

Increasing food flexibility is not usually one of the immediate goals of recovery unless the range of foods is extremely restricted, weight gain is important, and weight gain is not possible without at least some increase in flexibility. Most often, increasing flexibility is addressed a little further along in treatment once the patient is consuming meals more regularly.

Once the patient is ready to begin addressing food flexibility, it is common to begin by making a list of forbidden foods. These are typically food items the patient does not allow him or herself to consume (or only consumes in the course of binges). The next step is to slowly introduce these foods into the diet in moderation. This is an example of exposure therapy. In exposure therapy, patients face situations and things that make them anxious. Over the course of repeated exposures to the feared thing, they learn that nothing bad happens and their fear lessens. Exposure to forbidden foods can be scary, but it is very effective. By contrast the longer you avoid something, the scarier it gets.

Tips for Caregivers

If you are caring for a child with an eating disorder, you will also want to help increase the flexibility of his or her diet. The goal for your child should be to return him or her to eating all the foods that he or she used to eat about two years before there were any signs of an eating disorder. In retrospect, many parents realize that their children slowly eliminated foods from their repertoire for sometimes up to two or three years before the eating disorder was actually diagnosed. It is for this reason that it is recommended that you go back this far or farther to form a baseline for your child’s eating behavior. Do not allow your minor child to stop short of full reincorporation of fear foods. Helping your child to enjoy the broadest range of foods will help ensure his or her full recovery and a life of freedom.

A Word From Verywell

Recovery from an eating disorder takes time and courage. Once you successfully incorporate your fear foods you will be able to enjoy a more relaxed relationship to food.

Sources

Epstein, Leonard H., Jennifer L. Temple, James N. Roemmich, and Mark E. Bouton. 2009. “Habituation as a Determinant of Human Food Intake.” Psychological Review 116 (2): 384–407. https://doi.org/10.1037/a0015074.

Latner, J. D. & G. T. Wilson 2000. “Cognitive-behavioral therapy and nutritional counseling in the treatment of bulimia nervosa and binge eating.” Eating Behaviors 1: 3-21.

Schebendach, Janet E., Laurel E. Mayer, Michael J. Devlin, Evelyn Attia, Isobel R. Contento, Randi L. Wolf, and B. Timothy Walsh. 2011. “Food Choice and Diet Variety in Weight-Restored Patients with Anorexia Nervosa.” Journal of the American Dietetic Association 111 (5): 732–36. https://doi.org/10.1016/j.jada.2011.02.002.