Walking the tightrope

September 11, 2017

Self-Paced Course: Non-Diet Academy


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A Certified Eating Disorders Registered Dietitian (CEDRD) with a master's degree in dietetics & nutrition. My passion is helping you find peace with food - and within yourself.

Meet Katy

Eating disorders frequently occur alongside other medical conditions, leaving the person to “walk the tightrope” of managing their medical issues in conjunction with recovering from the eating disorder.

Easier said than done.

Some common co-occuring medical issues that we see in our clients: Diabetes, pre-diabetes, PCOS, hypertension, hypercholesterolemia, bariatric surgery, IBS, ulcerative colitis, Crohn’s disease, arthritis/joint pain, autoimmune dx, thyroid dysfunction, heart disease, liver disease, osteopenia/osteoporosis, kidney disease.  (This list is obviously not comprehensive; it’s just some examples to demonstrate my point).  

Many of these conditions come with dietary recommendations.  For a person with an eating disorder, these dietary changes can actually provoke the eating disorder, and ultimately make things worse with their overall health.

Here’s an example:

A person goes to their doctor because they haven’t been feeling well.  Turns out their blood pressure is high.  So the doctor tells them to follow the DASH diet (low sodium) and to lose weight (because everything in the medical world seems to be about weight loss these days – sigh).

The person is freaked out to hear that they have high blood pressure, and goes straight to shame about “How could I have done this to myself?”  As if it is their own personal failing – because that’s what our society (and doctors) often tell people.

So in an attempt to be the “good patient” and follow doctor’s orders, the person starts avoiding sodium and cutting calories to lose weight.  Their eating disorder looooves this.  A license to restrict and to be seen as “good” and “in control” and “healthy.”

But then it backfires, because later on their eating disorder has them bingeing on the very foods that they are supposed to be avoiding.

The person goes in for their follow-up visit with the doctor feeling like a total failure.  Rather than losing weight, they had gained weight, and the doctor isn’t shy about pointing this out.

What the doctor doesn’t understand is that the eating disorder was actually part of the problem, and that putting the person on a diet was exacerbating the issue.

The food behaviors associated with the ED were causing the person to binge, and this was part of the high blood pressure.  However, genetics also played a big role.  They had a strong family history of high blood pressure.

By failing to understand the eating disorder and its role in the person’s overall health, the doctor actually prescribed a diet that was harmful to the individual.

THIS is the tightrope we walk.  

When a person has both an eating disorder AND other medical conditions, the recommendations for one sometimes conflict with the other.  Ideally, for eating disorder recovery we try to help the person eat intuitively.  This isn’t always possible with medical issues – such as diabetes.

What’s a person to do?

Well, first of all, keep in mind that the eating disorder is also a medical (and psychiatric) condition.  Therefore, it needs to be put on the list of things to be treated.  You can’t compartmentalize a person’s health.  We must treat the whole person.

Triage – with the help of a treatment team of your doctors, and your eating disorder therapist and dietitian, they will help you sort through your priorities and how to juggle it all.

Don’t go through this alone.  It’s messy.  It’s confusing.  It’s hard.


This Thursday I will be giving a webinar for the International Association of Eating Disorders Professionals (iaedp).  If you want to tune in the cost is $15.  Sign up here.

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