ED – Joanne Arena MS, RD

This weekend I was reminded of the power of a cookie. I was at a social gathering which was a very joyful celebration filled with laughter, games, children, and great food. As with most summer time picnics that are pot luck, people bring their favorite dishes or desserts to share. Being someone who loves to cook and get new recipes, it is a fun experience for me. I tend to skip the dishes I can make myself (simple potato salad, coleslaw, plain old chocolate chip cookies, etc) and always enjoy trying things where I don’t even know what is in it! For example, there was an interesting quinoa salad with avocado and kale that was amazing (it looked a bit sketchy but tasted great!). Someone made buffalo chicken appetizer balls with a blue cheese dip that I am definitely getting the recipe for. You get the picture, great food, great day, great fun.

But near the end of the night a woman came out to the dessert table looking for a cookie. There had been a few platters of cookies but most of the guests had left and apparently the platters were gone too. She seemed really desperate for a cookie, so I looked around and found a small plate which I showed her. She quickly grabbed one and gobbled it up. I was glad she was happy until a few seconds later when her mood drastically changed. I was thrown when she started to say “why did I eat that cookie? I feel so guilty! I have to fit into my dress next week! What was I thinking!?” I suddenly felt bad for being a part of this, as she was truly upset. But then my dietitian mode kicked in as I tried to convince her one cookie truly would have no effect on her body. It took some time but eventually she seemed to let it go.

It struck me later that reactions like this to a cookie are not uncommon. Have you ever witnessed someone reacting to what they have eaten is such a dramatic way? The reaction is one you might expect from someone who truly did something really bad. The primary feeling is one of guilt. The word “guilty” came up several times. To me, that word is a strong one. It means you did something really wrong, something you regret and don’t want to do again because you feel so bad. How does one cookie make someone feel like that?

Part of it could be the “black and white” thinking many people have about food and eating. Food is “good” or food is “bad”. Who decides what foods fit into what category is the individual and how they define the word as well as how they judge the particular food. To me “good” means it tastes good. To someone else, good means it is good for you, a “healthy” food. So for me, those buffalo chicken balls with the blue cheese dip were definitely good! But to someone else, they may be considered “bad”. Peanut butter cookies may be “bad” to someone who thinks sweets are bad because they don’t consider cookies “healthy”, but to me they are bad because I just plain don’t like peanut butter cookies (sugar cookies however are definitely good).

Another way to explain some people’s guilty overreaction to eating just one cookie might be the “diet jail” I referred to in a previous post Are You in Diet Jail? When people are dieting to lose weight (which often happens when they are getting ready for a specific event, such as a reunion, holiday or wedding, big party, etc and want to fit into specific clothing) they put themselves in diet jail where most normal foods are forbidden. Even one bite of a food that is not in their diet world of foods in diet jail can set someone off.

It also seems like a “perfectionism” kind of approach to food and eating. The word “perfection” is interesting because I think we all have areas in our lives where we strive for it. To my grandfather back in the day, it was his lawn. It was perfect. He would have a fit if a neighborhood dog would set foot on it, and heaven forbid, pee. I remember being very careful as a child when we went to my grandparents home, being sure to stay within the manicured border of the small sidewalk leading to the door. Don’t step on the grass!!

My husband is a bit of a perfectionist when he entertains friends. He spends a lot of time on cutting foods perfectly so the presentation is the way he wants it to be. I, however do not have that kind of patience, and tend to throw it all together. Other people need to have a perfectly organized closet. One woman I worked with had all of her clothes hung up by color, and her shoes all labeled. I, on the other hand, still have sweaters stuffed in my closet mixed in with the sun dresses…never did get around to switching those clothes around. My perfectionism tends to involve being a bit overly concerned that I make everyone happy if they are coming to my house for a get together. It is important to me that everyone has a great experience and I truly do enjoy the cooking and entertaining. It is stressful though to be thinking so hard about pleasing everyone, and I am working on having it be “good enough”.

So maybe that is the take home message. Why can’t everything be “good enough?” Why isn’t your body good enough? Why isn’t your diet good enough? Not that I promote looking at calories, but the truth is your body certainly does not care if you eat 100 calories from an apple or a cookie, it is probably just happy to have the energy. Yes, you should care about nutrition and getting the nutrients you need, and yes, your health does matter. Assuming you are not allergic to it and don’t have some other health condition such as diabetes, one cookie truly does not have the power to affect your body in any significant way.

So the next time you catch yourself reacting dramatically from eating something, try to stop and do a reality check. Do you really need to waste so much time feeling guilty about something that has no affect on your body or your health? For some, this is much harder than for others. Some have spent months and years with this mindset and it does not change overnight. But even just being aware of your own experience is a step in the right direction. Try not to accept this and instead start questioning yourself. Look at the big picture and all the positive things you do to be the best you can be. To me, being perfect means being imperfect.

And the truth is a cookie has no power at all.

I first was introduced to ED back in 1996. I had just finished graduate school and took a part time job at an eating disorder program. As a dietitian, my main interest was in health promotion and disease prevention. It made sense to me that it seemed smarter and easier to help people prevent disease if possible through promoting a healthy lifestyle. It is much harder to treat illnesses that may have been prevented. I specifically remember a middle aged man who I met during my very first job as a dietitian in a small hospital. He was admitted after having a heart attack. His lifestyle was not healthy at all (smoking, unhealthy diet, no physical activity). I remember thinking that he should not have been there.

I left the hospital after just one year and changed my focus to helping people be healthy. I worked for WIC (Women, Infants and Children) and loved teaching young mothers about healthy eating. I also did some private practice and that is when I knew I needed more skills with counseling, and went back to graduate school (with a focus on counseling). It was while working on the college campus that I encountered students with “sub-clinical” eating disorders. In other words, they were restrained eaters who dieted yet had not developed an eating disorder yet. I did my research on “cognitive restraint” because I felt if we could stop people from dieting and focus on health instead, we could possibly prevent an eating disorder.

Although working with eating disorders was something I never planned to do, after doing my research, I ended up connecting with many eating disorder professionals and got my job at the eating disorder program. It was here where I was introduced to “ED”.

I got to observe group sessions and then got to run my own. Every patient is different however one of the common connections all of the patients related to was a “voice” that was constantly in their heads. Meet ED. I eventually imagined a little ugly creature sitting on my patient’s shoulders, feeding them thoughts and ideas, rules and insults, misinformation about themselves, food, their bodies, absolutely everything. This voice (ED) would follow them around all day long, into the night. It never stopped. It was a learning process for me as I learned about how this voice contributes to all of the distortions and beliefs individuals suffering from these eating disorders experience.

Here are some of the things my patients have told me ED says (warning, it will make you sad):

you can’t have that, it will make you fat
why did you eat that? you are worthless, you have no willpower!
don’t listen to her, she is lying, she wants you to gain weight
white flour is bad
meat is bad
you can’t eat fried food
you can’t have that, it has sugar in it
you need to burn that up, when are you going to do it? figure it out, you ate it, now you need to get rid of it
you look fine, they are just jealous because you lost weight. You need to lose more. Don’t listen to them
you are disgusting
you didn’t do enough. You need to do more, more laps, more sit-ups, more more more.

Get the picture? Depending on where someone is in the recovery process, talking about this voice does come up. It is a slow process, but helping individuals fight this voice is critical. Exposing ED for the liar that he is takes a lot of work and energy. Of course, every patient needs therapy to work through their specific issues that led to the eating disorder in the first place. As a dietitian, I focus on teaching the truth about foods, eating, weight, etc. Sometimes, during a visit with a patient who is fighting hard and finally aware of what a “healthy” voice is, ED still weasels his way back in. I admit to falling into the trap of arguing with ED, and then it hits me, and I stop. I have often said to patients “wait a minute, I am not going to engage ED, can I talk to YOU?!” Once I had a patient get up and dramatically rip ED from her shoulder and throw him in the waste basket! She said “I have lots of family celebrations this weekend and I want to enjoy them. ED is not invited!” I will never forget that strong visual.

Another thing people don’t often realize is that individuals with eating disorders are just that. Individuals who unfortunately struggle with this disease. They are not an “anorexic” or a “bulimic”. They are people. I have met the most extraordinary people who have had ED on their shoulders and have had to fight him daily. I have met lawyers, dancers, chefs, professors, soccer players, football players, mothers, aunts, fathers, sons, daughters. I have enjoyed getting to know these individuals and especially as ED fades away and they can be their very interesting, fun, loving, energetic and happy selves again. That to me has been rewarding beyond explanation.

And what about you? Unfortunately, I hear people mumbling out loud about food, their bodies, what they ate, exercise, etc. in ways that are not always healthy, and sound way too much like ED. He is a villain that somehow has become culturally acceptable (which makes it real hard for those struggling). Remember, prevention is a lot easier than recovery. When you hear a berating, negative voice in your head about anything to do with eating or your body, just try to be aware. Stop ED in his tracks. Say “you are full of it!” If you can’t stop that voice, you may want to consider getting some help. Maybe someday, our culture will normalize it’s view of eating and body size and he will fade away. Until then, I hope you continue to fight the craziness in your own way.

Joanne Arena MS, RD

Tag: ED

The Power of a Cookie

Who is ED?