Body Image, Body Acceptance and Body Neutrality

Poor body image is common. It is also important to address as it can significantly contribute to the development or maintenance of an eating disorder.

Societal pressure, weight stigma (even within the medical industry), unrealistic beauty standards and comparison with others may all contribute to poor body image.

This may lead us to resort to extreme measures to change our appearance, including restrictive eating or excessive exercise. From there, it can be a slippery slope to disordered eating or an eating disorder.

Poor body image may worsen self-esteem and overall psychological well-being and perpetuate a negative cycle within an eating disorder. Feelings of shame, guilt, and inadequacy associated with body dissatisfaction can fuel the desire to control food intake or body weight, further reinforcing disordered eating behaviours.

A credentialled eating disorder team (Dietitian, Psychologist and GP) can help to support body image improvements, as you seek help for the disordered eating or eating disorder behaviours.

Body acceptance and body neutrality are both approaches that aim to promote a healthier relationship with one's body, particularly in the context of eating disorder recovery, but they differ in their focus and emphasis.

Body Acceptance:

Body acceptance involves actively embracing and appreciating one's body as it is, including its flaws and imperfections. It fosters a positive attitude towards one's body, regardless of societal standards or ideals. This approach encourages individuals to recognize and celebrate the inherent worth and beauty of their bodies, irrespective of their shape, size, or appearance. In the context of eating disorder recovery, body acceptance involves acknowledging and respecting one's body as it changes throughout the healing process, without judgment or criticism.

Body Neutrality:

Body neutrality, on the other hand, emphasises cultivating a more neutral or indifferent stance towards one's body. Body neutrality encourages individuals to focus less on their physical appearance and more on what their bodies can do and how they feel. It involves shifting the emphasis away from appearance-based evaluations and towards a more balanced perspective that acknowledges the body as a functional entity rather than an object of scrutiny. In the context of eating disorder recovery, body neutrality can help individuals detach from the constant preoccupation with their bodies' appearance and redirect their attention towards other aspects of their lives, such as their relationships, passions, and personal growth.

While both body acceptance and body neutrality can be valuable tools in promoting body positivity and supporting eating disorder recovery, the most suitable approach will be dependent on the individual and their own values and goals. Ultimately, either approach will aim to foster a healthier and more compassionate relationship with your body, free from the constraints of unrealistic standards and harmful self-judgment.

Eating disorder recovery is possible.

Find support when you are ready.
https://www.insightdietetics.com/

Find a credentialed treatment provider:
https://connected.anzaed.org.au/treatmentproviders/

Neurodivergent affirming care

Neurodivergence and Eating Disorders

It is estimated ~ 4% of the Australian population are experiencing an eating disorder at any given time. Neurodivergent people are over-represented, however. For example, avoidant/restrictive food intake disorder (ARFID) is reported in 21% of children with autism and eating disorder risk is three times higher for ADHD children (31.4%) compared to non-ADHD children (12.4%). Importantly, the factors underlying the disorders are often very different to neurotypical people.

Accordingly, adapted and tailored supports and intervention for neurodivergent eating disorder treatment is required.

What is neuro-diversity affirming care?

A neurodiversity affirming approach respects, celebrates, and values all neurocognitive profiles equally, and works to address inequities underlying minority stress.

It is important to incorporate an understanding of the neurodivergent profile into the assessment and all interactions. This requires that the clinician has:

- Foundational understanding of neurodiversity

- A commitment to working to understand the intersectionality of environment, biology and psychosocial factors and how these influence feeding, eating, body image, psychological wellbeing, and health more broadly.

The authors of Eating Disorders and Neurodivergence: A Stepped Care Approach (Cobbaert and Rose, 2023) suggest fourteen treatment considerations.

1. Neurodivergence-informed therapy: focus on the flourishing of a positive neurodivergent sense of self.

2. Quality of life: explore the neurodivergent individual’s conceptualisation of quality of life or ‘life worth living’.

3. Demand avoidance: adapt treatment and utilise alternative approaches if the individual experience demand avoidance, eg. Encourage connection with internal motivators.

4. Psychological trauma: utilise trauma-informed care approaches (higher risk of PTSD in neurodivergent populations).

5. Financial accessibility: consider the need for eating disorder care options that support equitable access.

6. Communication: avoid making assumptions about abilities and preferences. Make an effort to identify individual preferences and understanding.

7. Sensory processing: understand sensory processing differences and adjust service and treatment recommendations to meet individual needs (eg, consider eating environment, meal plan and food offerings in context of sensory profile of neurodivergent individual).

8. Interoceptive confusion and alexithymia: ethical care requires that if a neurodivergent individual indicates that they are in pain or feel unwell but their facial expression and/or body language does not necessarily reflect that, their testimony must be respected and acted upon to avoid medical gaslighting.

9. Pain threshold differences: investigate all health-related suspicions regardless of pain expression, reporting, and body language.

10. Stimming: endeavour not to restrict stim behaviours unless there are medical concerns of they are unsafe, as this can contribute to dysregulation, sensory overwhelm, and increased anxiety.

11. Routines and executive functioning: provide detail as early as possible, allow time to process, do not rush. Practice patience, compassion and a non-shaming, non-judgmental attitude.

12. Dyslexia and dysgraphia: take into consideration during treatment (eg, when giving written resources).

13. LGBTQIA+ affirming care: being neurodivergent is positively correlated with gender and sexual diversity. A gender-affirming care approach involves challenging simultaneously both neuronormativity and heteronormativity.

14. Neurodivergent-led peer support: offers potential as an addition to treatment to help foster a sense of belongingness and positive neurodivergent identity.

Taken from and inspired by: Cobbaert, L. Rose, A. (2023). Eating Disorders and Neurodivergence: A Stepped Care Approach; which aims to “encourage reflection, discussion, and collaboration amongst stakeholders to inspire future co-production and co-design of appropriate, effective, and culturally valid neurodiversity-affirming feeding and eating disorder supports across all levels of care.”

Available from: https://nedc.com.au/assets/NEDC-Publications/Eating-Disorders-and-Neurodivergence-A-Stepped-Care-Approach.pdf

Eating Disorder Red Flags

Often the early warning signs of an emerging eating disorder may be well hidden and hard to spot. Early intervention improves the speed of recovery, reduces eating disorder symptoms, and improves the likelihood of long-term recovery.

Here are 10 signs that may indicate an emerging eating disorder:

1. Obsession with food: Constantly talking about food, calories/kilojoules, or dieting, and having rigid food rules.

2. Dramatic weight changes: Rapid weight loss or gain without a medical reason, often accompanied by extreme dieting or binge eating.

3. Skipping meals: Regularly avoiding meals or making excuses not to eat, such as claiming they’ve already eaten or they’re not hungry.

4. Excessive exercise: Working out excessively, even when tired or injured, and feeling guilty or anxious if they miss a workout.

5. Secretive behaviour: Hiding food, eating alone, or going to the bathroom immediately after meals.

6. Body dissatisfaction: Constantly criticising their body or appearance, feeling ashamed or disgusted with themselves.

7. Social withdrawal: Avoiding social situations that involve food, such as parties or dinners, due to fear of eating in front of others.

8. Mood swings: Irritability, anxiety, or depression, especially surrounding issues related to food, weight, or body image.

9. Physical symptoms: Feeling cold all the time, dizziness, fainting, or experiencing stomach issues like constipation or bloating.

10. Distorted perception of body image: Viewing themselves in a distorted way, obsessing over size comparisons with others.

If you notice these warning signs in yourself or someone you care about, it is essential to

approach the problem with empathy and concern. Professional help is available from credentialed Eating Disorder Clinicians.

Why Diets Do Not Work

Why Diets Do Not Work

Whether in recovery for an eating disorder, struggling with disordered eating, or just stuck on the diet yo-yo train, it is important to be aware of the mechanisms for why dieting does not work.

Addressing any level of dieting or disordered eating is a delicate matter, and promoting ambivalence towards dieting can be a step towards fostering a healthier relationship with food. Here are five reasons why diets often fail and why it may be worth reconsidering their approach:

1.              Short-Term Focus, Long-Term Disappointment: Diets typically offer quick fixes and immediate results, but they often lack sustainability. Many people find it challenging to maintain the strict rules of a diet over the long term, leading to feelings of failure and disappointment when the desired outcomes are not achieved or maintained.

2.              Metabolic Adaptation: The body has a remarkable ability to adapt to changes in energy intake. When you restrict kilojoules for an extended period, your metabolism will slow down as a survival mechanism, making it harder to lose weight and easier to regain it once normal eating patterns resume.

3.              Emotional Toll and Negative Self-Perception: Diets can contribute to a negative relationship with food, fostering guilt, shame, and anxiety around eating. Constantly categorising foods as "good" or "bad" can lead to a distorted self-perception and harm mental well-being, reinforcing the cycle of disordered eating.

4.              Unrealistic Expectations: Many diets promote unrealistic expectations regarding weight loss and body image. These expectations can set individuals up for failure, as achieving and maintaining the proposed outcomes may not align with body composition and what is natural and healthy for each individual.

5.              Limited Nutrient Diversity: Diets often focus on specific food groups or macronutrients, neglecting the importance of a balanced and varied diet. This lack of diversity can lead to nutrient deficiencies, impacting overall health and well-being. Moreover, rigid dietary rules may hinder the enjoyment of a wide range of foods and limit social connection and wellbeing.

Encouraging a more balanced and mindful approach to eating, focused on nourishment and overall well-being, can be a healthier alternative to the dieting disappointment cycle. Developing a positive relationship with food and addressing the root causes of disordered eating may lead to sustainable changes in the long term. It's essential to consider individual needs, preferences, and health goals while promoting a holistic approach to nutrition.

Reach out to a health professional to seek further support.  A credentialed Eating Disorder Clinician can be a good place to start – these mental health clinicians and dietitians have extra training and experience to support recovery from disordered eating or an eating disorder.

Find a credentialed treatment provider:

https://connected.anzaed.org.au/treatmentproviders/

https://www.insightdietetics.com/

How to find an Eating Disorders Dietitian

How to find an Eating Disorders Dietitian?

When beginning to look for support with your eating disorder or disordered eating, it can be difficult to know where to start. The ANZAED Eating Disorder Credential has been designed to assist with this.

What is the ANZAED Eating Disorder Credential?

The Eating Disorder Credential is a joint partnership between ANZAED (Australia & New Zealand Academy for Eating Disorders) and NEDC (National Eating Disorders Collaboration). The Credential is awarded to dietitians and mental health professionals providing treatment for people with eating disorders that meet minimum standards for the delivery of safe and effective treatment in Australia. Mental health professionals include counsellors, general practitioners, mental health nurses, nurse practitioners, occupational therapists, psychiatrists, psychologists, psychotherapists, and social workers.

The credential recognises the qualifications, knowledge, training and professional development activities undertaken to maintain the credential annually.

Criteria for the credential includes: two years of clinical practice experience, Evidence-informed practice for eating disorders, Supervision relevant to eating disorders (minimum 6 hours per year) and Continuing Professional Development relevant to eating disorders (minimum 15 hours per year).

The Credential is designed to help people experiencing eating disorders to identify and access the right treatment at the right time, increasing the chance of timely intervention and positive treatment outcome.

Find a credentialed treatment provider: https://connected.anzaed.org.au/treatmentproviders/

For more information on the credential, see the Connect ED website: https://connected.anzaed.org.au/what-is-credentialing/

 Where else could I look for help?

The Butterfly Foundation: Find a Professional https://butterfly.org.au/get-support/butterflys-referral-database/

This database is also helpful for searching for other professionals that can be useful in treating eating disorders or body image concerns, including clinical psychologists, psychiatrists, counsellors, paediatricians, mental health nurses, dietitians, peer workers, coaches, dentists, exercise physiologists and social workers.

Dietitians Australia, Find a Dietitian https://member.dietitiansaustralia.org.au/Portal/Portal/Search-Directories/Find-a-Dietitian.aspx

This search tool allows the user to select ‘Eating Disorders’ as the area they are looking for help with. Accredited Practising Dietitians who have a special interest in eating disorders are listed by geographical area.