Navigating food and family: Holidays can be difficult for eating disorder recovery
Posted December 23, 2016
Chapel Hill, N.C. — The holidays can be a source of stress and anxiety for anyone. Whether it’s family tension, presidential election fallout or higher credit card bills, “the most wonderful time of year” is often a time of uneasiness. And those who struggle with an eating disorder face an additional layer of anxiety.
In the U.S., 20 million women and 10 million men suffer from a clinically significant eating disorder. Millions more suffer from an unhealthy relationship with food, exercise or body image. Psychologists, clinicians and researchers from the UNC Center of Excellence for Eating Disorders (CEED) said the holidays can be one of the most difficult times for recovery.
Dr. Stephanie Zerwas, the clinical director of CEED and a practicing clinical psychologist, emphasized that eating disorders do not discriminate — they can affect anyone regardless of gender, age, race or sexual orientation.
She also said that while some people are at a greater genetic risk for developing the disorder, no one is necessarily destined to experience one. Many researchers describe the cause of an eating disorder as genetics “loading the gun” to the disorder and the environment “pulling the trigger.”
Sarah Leck, a Raleigh-native and senior at the University of North Carolina at Chapel Hill, has struggled with an eating disorder since she was 11 years old. She is currently co-chair of Embody Carolina, an organization at UNC that trains students to be eating disorder allies and promotes body positivity on campus and in the Triangle.
Leck said her eating disorder stemmed from environmental stress combined with her genetic predisposition to mental illness. Throughout middle and high school, she struggled with disordered eating and excessive exercise. After graduating a semester early from high school, Leck received inpatient treatment at Veritas Collaborative (CEED) in Durham before attending UNC.
“(Veritas) was my first experience what recovery might look like for me down the road,” she said. “Being thrust into that really intensive recovery environment was helpful, even just to be shown that recovery is possible.”
The traditional family recipes and food-centered social gatherings can trigger someone at risk or recovering.
Sophia Al-banna graduated from UNC with a master’s degree in Public Health and is a registered dietician.
She stressed that there are many different kinds of eating disorders, and those with Anorexia Nervosa or Bulimia Nervosa aren't the only ones affected. The holidays can be especially trying for those with binge eating disorder.
“It would be as if a drug addict were sitting at a table with every single prescription that they love, and they have complete access to it,” she said.
She also mentioned Orthorexia, which is a fear of not eating “healthy,” to the point that it impacts one’s mental well-being and quality of life. The disorder often goes undiagnosed with the word healthy being misunderstood.
Zerwas said the best definition of healthy is the ability to trust your body’s natural hunger cues and allow yourself to be flexible.
“It’s so important to understand that all foods are healthy in moderation.” she said. “And moderation means that at Christmas, you might have more butter than you’re used to.”
As a loved one, the most important thing someone can do is to be educated about eating disorders and compassionate. Every situation is different, and sometimes, support and love are all any ally can offer.
“You can’t force someone to want to recover,” Leck said. “Even if the person isn’t ready, you have to be able to support any sort of positive change.”
For family members, it’s crucial to not add to stress or body negativity. Psychologists said cutting out comments about appearance, about yourself or others creates a healthier environment for all. Even positive comments about someone’s appearance can reinforce disordered eating behavior.
Zerwas explained combining the pressure to eat large quantities of food and the culture’s obsession with new year’s resolutions and losing weight is potentially devastating to the recovery process. It’s important to not add to the stress with “body talk.”
“Whether or not someone in your life has an eating disorder, if you ask questions about someone’s life, that’s always going to be more fulfilling than someone asking about your latest diet or dress size,” Peat said.
As an ally, it is also a good idea to plan events that do not revolve around food.
For those at risk or recovering, clinicians said the most important thing is preparation — planning ahead with your treatment team and knowing how to contact support during the holidays. It’s also important to practice self-care more intently and focus on favorite holiday activities.
Leck said she and many others thrive in recovery with a consistent routine she can stick to it. With holiday events and travels, routines are often thrown off.
“Find out what is going to be served at the holiday meal, and create a meal plan with your team and with your therapist that will work with that,” Peat said.
Peat also said people should recognize what opportunity holiday events bring. People struggling may surprise themselves by how well they do.
“It can be a really empowering situation,” she said. “As much stress as there can be, there’s also a lot of opportunity for making progress."
Zerwas said the most important thing to remember is that recovery is always possible and to not become discouraged.
“Practice kindness with yourself throughout this process,” she said. “Honor where you are in your recovery process.”