Maintaining a healthy relationship with food over the holiday season
When you think of eating disorders, what comes to mind? Although the media tends to portray stereotypical presentations of eating disorders, the truth is, it’s impossible to tell whether someone struggles with this just by looking at them—just as it’s impossible to tell whether someone has cancer. In this blog, we review what an eating disorder is, how disordered eating habits can show up for people with cancer, and tips to help maintain a healthy relationship with food over the holidays.
It’s important to note that having symptoms of an eating disorder is different than having a diagnosable eating disorder.
An eating disorder is a condition that meets set criteria, used in diagnosis that is outlined in the Diagnostic and Statistical Manual of Mental Disorders, also known as the “DSM-5”. (1) Someone with disordered eating symptoms; however, might meet some of the criteria or have some of the symptoms listed, but not all of them. Whether you have a diagnosed condition or symptoms of disordered eating, both are of real concern and warrant treatment from a qualified healthcare professional.
Below is an example of what someone with an eating disorder may experience, compared to someone with symptoms of disordered eating. In this example, Amelia has a diagnosis of moderate bulimia nervosa, purging type, and Noah has symptoms of disordered eating. Some people who don’t meet all criteria for other eating disorders, fall into a category referred to as “OSFED”, which stands for ‘Other Specified Feeding or Eating Disorder’.
| Amelia: Moderate bulimia nervosa, purging type | Noah: Symptoms of disordered eating |
|---|---|
| Eats a large amount of food within 1 hour and feels out of control, as though she can’t stop eating | Eats a large amount of food within 20 minutes and feels out of control, as though they can’t stop eating |
| Vomits (purges) twice during the binge | Doesn’t vomit afterwards, but feels uncomfortably full |
| Purging has happened 4-7 times a week for the past 3 months | Binge eating happens 1-2 times a month |
| Self-critical thoughts about her body and weight | Self-critical thoughts about their body and weight |
Studies suggest that many patients with cancer experience symptoms of eating disorders,(2) which can greatly impact mental wellbeing and physical functioning. A cancer diagnosis and associated treatment may cause someone to feel less control over what is happening to them, especially when surgery and other treatments may impact their physical appearance or cause discomfort.
Additionally, information about diets and cancer is abundant and pervasive on the internet and social media, and many people don’t know what information is credible versus what is misleading. Both of these factors – feeling a loss of control over our lives and placing rules around what we should eat – can increase the risk of disordered eating dramatically. Often, eating disorders and symptoms of this are not about the food itself, but about regaining a sense of control and relieving stress.
If you can relate to this, please know that you’re not alone. So many others, like you, are trying to find answers and ways to adjust to this new life. It is estimated that at any given time, more than 1.7 million Canadians suffer from an eating disorder.(3) It is possible that these numbers are an underestimate, with many individuals not receiving treatment. Studies also suggest that eating disorders can increase mortality risk by two times or more.(4,5) These conditions cause significant physical strain on the body and lead to an increased risk of suicide.
If you or someone you know is struggling with disordered eating, or feeling a loss of control, consider reaching out to a healthcare provider who can support you. You could consider finding a psychotherapist, nutritionist, naturopathic doctor, or psychologist with a focus on eating disorders, or reach out to your family doctor for a referral to a psychiatrist.
The holidays can be a challenging time for many people, and particularly for those navigating dietary choices. Whenever I work with patients feeling stressed about eating over the holidays, I often start by clarifying what our goals are. Some people want to avoid falling into a restrict-binge cycle (i.e., avoiding or limiting food and then overeating later). Others want to prioritize balanced meals and enjoy holiday treats (and yes, you can do both!). Another goal for someone wanting to prevent cancer recurrence and avoid overeating might be to prioritize intuitive eating. This could look like eating three balanced meals a day, with 5 servings of vegetables, healthy fats and adequate protein, and also enjoying foods that make them feel happy. For example, they might add an After Eight chocolate to their morning yogurt bowl, enjoy peppermint bark after lunch, or make a candy cane protein hot chocolate after dinner.
Whatever your priorities are, here are some tips to help maintain a healthy relationship with food over the holidays. I hope you find something that speaks to you!
Tips for enjoying food over the holiday season
- Remember the holidays are temporary! They make up such a small portion of the year. What you choose to do during this time won’t dictate the rest of your year.
- Identify your support system. Are there people you can go to for help? Are there comforting activities you can maintain? Can you share your goals with someone, so you can support each other?
- Think about what your favourite foods are. Which holiday foods are you most excited about? Are there any that you would feel sad to miss out on?
- Listen to your hunger cues and full cues, or in the simplest terms: eat when you’re hungry, stop when you’re full.
- If you’re a fast eater, try putting your fork down in between bites, enjoy your food and chew slowly.
- Increase mindfulness around meals. Notice how food smells and how it looks before you start eating.
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Decide what your priorities are ahead of time: Do you want to stick as close to your usual daily routine as possible? Do you just want to enjoy your meal? Is the food your top priority, or is it the company of friends and family you want to enjoy the most? Do you want to avoid discomfort (feeling too full, eating foods that trigger cramps or bloating)?
These questions are totally up to you, and there is no “right answer”.
Erica is a licensed naturopathic doctor at The Centre for Health Innovation, where she works with people affected by cancer, digestive concerns and mental health conditions such as anxiety, eating disorders and ADHD. Erica joined the team at The Patterson Institute for Integrative Oncology Research as a research assistant in 2022 and has been practicing naturopathic medicine for over four years. She is also a member of the research committee for the Oncology Association of Naturopathic Physicians and the Psychiatric Association of Naturopathic Physicians.
References
- Association AP. Diagnostic and Statistical Manual of Mental Disorders. Fifth ed. American Psychiatric Publishing; 2013.
- Hossein SA, Bahrami M, Mohamadirizi S, Paknahad Z. Investigation of eating disorders in cancer patients and its relevance with body image. Iran J Nurs Midwifery Res. May-Jun 2015;20(3):327-33.
- Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr. May 1 2019;109(5):1402-1413. doi:10.1093/ajcn/nqy342
- Auger N, Potter BJ, Ukah UV, et al. Anorexia nervosa and the long-term risk of mortality in women. World Psychiatry. Oct 2021;20(3):448-449. doi:10.1002/wps.20904
- Crow SJ, Peterson CB, Swanson SA, et al. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. Dec 2009;166(12):1342-6. doi:10.1176/appi.ajp.2009.09020247
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