Understanding, Working With
and Preventing Eating Issues

We have written this section with a range of health professionals in mind, including GPs, guidance counsellors, dentists, dieticians, chemists, nutritionists, community agencies, psychologists, therapists, gym staff, social workers, public health nurses and others who might encounter or work with people who have eating issues. What follows is not intended as an exhaustive examination of the nature and treatment of eating issues. Rather, it suggests some ideas and themes concerning compassionate and holistic ways of understanding and working with eating and body image issues.

Some Key Points

• Eating issues and eating disorders are complex issues that defy simplistic responses such as “just eat normally”, “you’ve got nothing to worry about at your weight”
• Identifying symptoms (or diagnosing) will not tell you anything about a person’s experiences
• Be careful not to assume that an absence of a clinical problem indicates that everything is ok
• Equally, the achievement of a ‘normal’ weight does not necessarily indicate health and wellbeing
• Language is very powerful and it is unhelpful to label people using terms such as ‘anorexic’, ‘bulimic’, ‘eating disordered’, ‘obese’, ‘sufferer’, ‘victim’
• Be careful not to assign moral value to weight gain or weight loss for anyone (e.g., “that’s good that you’ve gained/lost weight”)
• It is useful to view eating issues as contextualised problems i.e., as existing in cultures where body size and shape are overlaid with numerous moral meanings
• Stereotypes about who is affected by eating issues are unhelpful. Anyone can be affected including men, lower socio economic groups, Maori and Pacific peoples, lesbians and older women.
• In your work never advocate dieting or weight loss targets

Working With Someone With an Eating Issue

When you are concerned about someone with an eating difficulty:

• Keep the focus on some of the ways eating difficulties affect people’s lives e.g., social isolation, guilt, mood swings, secrecy, preoccupations with food and weight.
• Treat all eating difficulties seriously.
• Examine your own attitudes and understandings about body image and size so that you do not convey any prejudices or exacerbate existing issues
• Be sensitive in the ways you approach someone with your concerns
• Always remember that the eating issue is the problem, not the client.
• Clients struggling with an eating issue may appear ‘non-compliant’. This ‘non-compliance’ is a symptom of an eating issue not the client
• Recovery from eating issues can be as complex as the issue itself.
• Maintain your own professional supervision to work through any frustrations
• Have realistic and flexible expectations about the change process and how you evaluate progress
• Seek professional support and referral for the client where appropriate.
• Name your concerns to your client, about specific behaviours e.g., “I’m concerned about your wellbeing because I’ve noticed that you have been working out while you have an injury,” “I’m concerned about you because I’ve noticed the loss of enamel on your teeth”.
• Communicate to your client that you take any eating issues seriously and support them in doing so as well.
• If you have serious concerns about your client’s health (e.g., noticing rapid weight loss) immediately refer to an appropriate eating issue agency.
• More developed eating issues (particularly anorexia and bulimia) have physiological consequences that can impact on a client’s ability to access and respond to help and support
• Educate yourself about the warning signs of anorexia and bulimia and appropriate referral pathways
• Collaborate with your client in discussions and decisions about the best course of action
• One size does not fit all when working with eating issues. There are a wide range of approaches and strategies for change. Inform yourself about them.
• Dieting is an inappropriate recommendation for anyone, regardless of weight
• It is essential to maintain appropriate confidentiality.
• If you need to tell a third party about your concerns do so in a respectful and sensitive manner and keep your client fully informed

Creating Environmental Change in Your Workplace

If we understand that eating issues arise in cultural contexts in which there are restrictive ideals and moral values ascribed to body size and shape then as health professionals the challenge is to create body safe environments. Our schools, gyms, workplaces often inadvertently reproduce toxic messages about bodies. EDEN understands body safe environments to be places that promote body trust and satisfaction, size acceptance and diversity.

Some things to consider are

The physical environment

• Is the seating appropriate for all body sizes?
• Does waiting room reading material contain stereotypical images and dieting advice?
• Are there posters on the walls with images of idealised bodies?
• Does resource material contain weight loss advice?
• Is there sufficient time and flexibility around meal and activity breaks?

Policy & Procedures

• Are there clear referral pathways when an eating issue is identified?
• Does harassment policy include harassment on the basis of weight and size?
• Do your recruitment practices contain any overt or covert weight discrimination?
• Do you have a commitment (or where appropriate, policy) in your work to promote health at every size rather than weight loss at any cost?
• Is this commitment reflected consistently in for example, marketing messages, names of classes, choices of products on display, health advice, and interactions with clients/patients?
• Do you have policy for instances where there is suspicion that a customer might be requesting/purchasing products (e.g., laxatives, diuretics, herbal weight loss pills etc) for inappropriate use?

Comments & Conversations

• Do you participate in dieting and body evaluating conversations or link weight with unrelated health issues (e.g., “you’re so slim you could be a model”, “wow, she’s put on weight!”, “I’ve lost 5 kilos on that diet”, “I’ll have to go for a run after this piece of cake”, “you can have a naughty treat if you are good for the whole day”, “if you resolve your emotional issues, the weight will drop off”, “you will live longer if you lose weight”)
• If your work necessitates taking weight measurements, do you do this in a sensitive manner e.g., refrain from commenting (either positively or negatively), check out if the client/patient wishes to know their weight, ensure patient confidentiality.

Education & Prevention

• Are there opportunities for training in your work place on, the nature and incidence of eating issues, the referral and support of people with eating issues, addressing personal values and attitudes around weight and size?
• Does your eating issues education/intervention focus on ‘signs & symptoms’ or is it integrated into a contextual approach? The latter ensures that any individual change is supported holistically and environmentally.
• Do prevention efforts include the entire continuum of weight issues e.g., drawing links between fat phobia and eating issues.
• Do you use sensationalist material in your educational resources (e.g., images of skeletal women, extreme examples of fatness)?
• Does your approach focus on and work towards enhancing wellbeing and developing body trust rather than narrowly focusing on weight as the sole determinant of health?

If you or your workplace would like to explore the implementation of policies, practices and values that promote body satisfaction then please contact EDEN to discuss your needs.