Is it an Eating Disorder or Disordered Eating? with Michelle Pillepich

our inner picture of our outer self healthy behaviors. I had a much bigger role at all health than the actual number on the scales. Internal dialogue can be so powerful and often it's super negative and critical in a way that we wouldn't talk to other people that we care about. When you start to share your story, that gives other people the courage to share theirs. I know you would be proud now of how far you have come in your relationship to food, exercise, and to yourself.

I felt freedom, I've gained relationships. I've found my true sense of self worth. There's one thing I need you to take away. You're going to be okay, welcome to outweigh this is an intro that you know if you're listening to this podcast. We don't always do an intro, but if you hear us do one, it's because we had an afterthought and we want you to know it. Or we actually might need to put a trigger warning, and I want you to hear me now and receive

this trigger warning and take it seriously. You're your own person. You can make your own decision what you're going to listen to. But this is an episode I would have maybe listened to to try to figure out what else I could do to help my body lose weight or do whatever it is I want to do. So my encouragement to you would be we're gonna try to talk about everything on Outweigh episodes. We don't want to censor

and edit our content. We think that this is a very serious matter, and I would just encourage you mentally, if you're not in a place to really hear this episode and take it as help instead of part of your toolbook that you use to fuel you're eating disorder or disordered eating patterns. Then I would encourage you to press pause now and say this episode for when you're in a better place. Yeah, Hey, fam, I definitely piggybacking

on what Amy said. This episode is so important. We're joined by an amazing eating disorder registered dietitian, and I think what you'll hear her say, but I want to just say it right now before you even move forward, is what is your intention in listening to this episode? So what is your intention? Ask yourself right now, and if it's coming from a place of I want to

best support my body, then go for it. And if anything is coming up, as you know in your gut of I want to take advantage of what might be said here to further along and live in secrecy and have more tools to get away with what I've been getting away with, then perhaps pause this episode and don't don't take a listen. Lisa and I care about y'all, and that's why we feel it's important to share that with you before certain episodes that could be triggering. So

there you go, that's our trigger warning. We hope you're enjoying all the guests and experts that we're having on and Michelle is amazing, and after you hear this, you'll realize why we'll definitely be having her back on Welcome back to Outweigh Today we have on eating disorder registered dietitian Michelle Pillow Pitch. You can find her on Instagram

at Michelle two Els Pillow Pitch Nutrition. We'll drop that in the show notes because it's a little bit of a hard one and we're going to be learning all about how to discern if you have an eating disorder or disordered eating. So welcome, Michelle. We're so excited to have you. Thank you, thanks for having me. I'm excited to be here. So let's jump right in to the good stuff and help our listeners learn how to discern if it's disordered eating orn't eating disorder. What can we

be on the lookout for. Yeah, it's a great question, and I think that there's a lot of crossover. So a lot of the disordered eating symptoms and traits like maybe counting calories or over exercise or things that are super common in our society are also present in eating disorders. What is the distinction is, I would say the intensity of both the symptoms, so maybe they happen more frequently, as well as the distress caused by food or the

thought of weight gain. So, for example, if somebody has let's say anorexia, nerrosa, they would be really anxious to the point of like almost panic about eating foods that might cause weight gain. It's this real fear of a larger body size and with anoxia. Ing on that topic, the weight can also be a diagnosable factor, and I do like to really really emphasize that low weight is not necessary to have an eating disorder. Plenty of people

have eating disorders, even anorexia, without being underweight. But if someone is underweight to the point of being medically unstable, having lab values that are off, feeling faint and dizzy, very often not being able to stand up too fast, those things can be signs that your weight is also a part of the diagnosis. That is part of that criteria for anorexia, and then for other disorders like bulimia or binge eating disorder, the frequency of behaviors is also

part of that diagnosis. So the d s M five, for anyone who doesn't know, is the Diagnostic and Statistical Manual of Mental Disorders. I think that's the exact title. So that's like the Dictionary of Mental Illnesses. And so there are criteria for all these disorders, and for bulimia and binge eating disorder, the binges and the purges are occurring for I think it's once a week for at least three months to classify a diagnosis. If it's happening once a week and it hasn't been three months yet,

that doesn't mean oh, don't get help yet. You know, anything that is disrupting your life is of course deserving of help. But that frequency is also kind of a key. So can we actually get just a quick definition of anorexia and bulimia and I guess binge eating disorder? Are those the three main eating disorders that you work with? Yeah, I would say those are the main ones. And then I mean orthorexia is a really big one. I think

you guys have touched on it before. I don't think it's in the d S, m um, it would be considered eating disorder otherwise like unspecified something like that. But that's another main one. So anorexia is primarily a restrictive eating disorder, so limiting food intake to an inappropriate level based on your age and height and your calorie needs. Also that intense fear of weight gain and weight changes and body image. It can also have an aspect of

body dysmorphia. And not seeing your body as it accurately appears, and low weight is part of that diagnosis. There's also something that is very unfortunately called a typical anorexia, which would be a restrictive eating disorder without low weight. And I would say probably every eating disorder professional is fighting against that name because obviously, like, that's not a typical that's just a human who is not at a severely low weight. So with the anorext it's primarily the restriction.

Bulimia involves purjey, so that would be compensating after a binge. And I also like to define binge because a lot of people think, oh, I'm binging because I ate a bunch of Halloween candy and Halloween is on my mind. What classifies a binge is having a quantity of food that is larger than what is typically needed or what you would have in like a normal average meal to meet your needs in a distinct period of time, and having this feeling of being out of control, like you

can't stop even if you wanted to. So that kind of compulsive and out of control feeling is also really characteristic of a binge. If it's Thanksgiving dinner and you eat a lot of extra pie because you only have it once a year and you just love it. Like, that's not necessarily a binge, you know. We can also choose to eat past fullness because it's enjoyable and we want to and those are completely normal things that like mentally distressing feeling of being out of control is really

characteristic of a binge. Um, so that is kind of binge eating, just order having those frequent once a week episodes at least of binge eating eating those larger quantities of food. And then bulimia is primarily the purging, so having a purging episode every time there is a binge, and anorexia can also have binge purge as a form of compensation for eating. So there's so much overlap. People

don't often fit into just one little box. Can you also speak to what a purge might look like, because for some people, they're probably thinking in their heads that automatically means throwing up, but that could mean going to the gym for five hours exactly. Yes. Um, that's a really good point. So purging is really any form of

compensation for food eaten. So it could be making yourself vomit, it could be purging getting rid of those calories and from over exercise, so exercising much more than your body kneeds or wants. It could be taking laxatives after meals, or diuretics and using that type of medication. It could be even like sitting in a sauna for a ton of time, all sorts of things. So primarily I would say the vomiting, the exercise, the laxatives, and diuretics are

the main things. Um And yes, those are all forms of purge, which I would say could be kind of interchangeable with compensation. For the purpose of someone identifying and just for people listening right now that may feel shame around anything she just said, specifically laxatives or sitting in a sauna for long periods of time, Lisa can speak to her experience. But I've done every single thing you just mentioned, so there is no shame and we need

to be talking about it. Because I didn't even realize my sauna sessions were harmful. But in college I would go sitting there after I'd already done tons of work out at the gym, and I would put saran wrap around my stomach and sweat it all out in the sauna for like forty five minutes and then I would The pleasure I would get from unwrapping the suran wrap is such a mental thinging But also I was completely miserable, but didn't really know that that what I was doing

was wrong. But I still hit it from everybody. And I remember one time my roommate found a bunch of suran wrap in my trash can, and I was mortified. I just ignored it. But I mean, I still remember that clear as day, and that was twenty years ago. I remember on Season one about way you talked about the suran wrap and the sauna, And there's actually been a resurgence of that trend at a popular wellness I'm

putting in quotes. I don't know anything about it. I'm not like mocking it, but like a wellness spot in New York City where a lot of models are doing this and and and it became very popular and it's really important. Not everybody, I'm sure that does the suran rap has a disordered relationship to food or an eating disorder, but you know when you're doing it excessively compensatory lee

and so forth. So there's a line. And you know, this year, I think it was this year has been a weird year, but it was this year I wrote about my use of laxatives, and it was something I never spoke of out because even I've I've shared so much about my disordered eating journey, laxatives like that made me feel so disgusting and shameful. And I'm just gonna say it again here because it's so not okay. How you know, easy it is? But I pooped in my pants once as a college student. I can't blame gonna

say this on that way. But the body is not supposed to do that. Like I was destroying my inside and that didn't stop me. By the way, that was just a moment of Wow, I'm doing something serious. I you know, maybe put a pause on it for a moment, But not okay at all. And what's even more not okay is any shame you may feel around something that you've done in the past. So that's why I told

that very embarrassing story. So the one thing I just want to ask Michelle, is you know, with laxatives for me, it's very open about her story with binging and purging. I took laxatives, but it wasn't you know, three times a week for six months, so I was in that gray area. Again. If I'm not a clinical eating disor order,

what am I? That doesn't make it okay? So what would you say to somebody who is using or participating in compensatory behaviors such as the shana or over exercising, or laxatives or diuretics, but not at the frequency that makes it, you know, bulimia, get help. I always say it's important for anyone to get help, to reach out to talk to a therapist, dietitian, someone close to you before that if that feels like too big of a step, because sure, maybe you didn't have a clinical eating disorder,

but clearly that behavior was disrupting your life. You know that's not something that we want anyone to be doing. So I always always, always say, I probably say this a thousand times a day, what is your intention? The intention matters? I ask every single client that whenever they say is it's good, is it's bad? So if you're taking laxatives once because you're really backed up, you went

on a trip, whatever, like okay, normal. If you are taking it because you ate something that you feel guilty about, or because you want to lose weight and it's clearly too many peelate your body. That's disordered intention that deserves help and attention. So I would say, reach out and

the shame is something so important to talk about. I'm so glad that you guys are both sharing your stories because I mentioned at least earlier, I used to work in a residential treatment center and new clients when I was meeting them for the first time, would always say, Oh, I don't think I need to be here. I really don't need to be here. I'm just doing it because

my parents told me to blah blah blah whoever. And I always told people if we accepted clients based on who thinks they need to be here, I'd be out of the job. We would never have anyone nobody thinks they need help. But if you are resonating with any of these intentions in any of these stories, then you deserve help, and it's really important to reduce that stigma and to be able to reach out and get it.

I'm just gonna throw something else in the laxative conversation, because again, trying to recognize whether or not you need help, maybe you're not taking laxatives like that, say laxative on the box, but you're drinking smooth Move tea every day or every night before bed, because I certainly was doing that. That is an easy way to disguise it because it's this organic herbal tea and it's like, oh, I just

kind of need to go to the bathroom. And I would drink that publicly and openly in front of my family and be like, oh, I gotta make a smooth move, and that was more acceptable than I'm gonna go pop my laxative pills. So that is a warning. Look at that behavior as well, anything you're using to disguise. Yeah, that's actually how it started for me. At my college roommate.

You know, we went to a health food store. Again, a health food store, so I assumed anything I'm buying from a health food store is good for me, and it's tea tea is good for me. And you know this is before Instagram with you know, now we see these laxative teas all over, So that was really important point. Amy, Thanks for bringing that up. You talked about lab values in anorexia, and I think that's something that a lot of people don't understand. When we talk about anorexia, we see, oh,

they're just a thin person. You know, they're fine. What is going on health wise for somebody with anorexia? A lot of things can be going on, and it's also so individual, so in terms of lab values, they can be off in any sort of thing, like a lot of nutrient deficiencies, because of course you're not eating a lot. But I will say that it's actually fairly uncommon to

have lab values that are really off. And that's another reason why so many clients come to me and say, I don't really need this, I'm fine, My labs are fine, and our bodies I know, Lisa, you know this as a dietician. Our bodies are so complex and work so hard to keep everything in balance, and I just always tell people it's normal till it's not. So maybe they're fine now, but if you continue down this path, it's

not going to be fine. Bone health is really big, so even before things show up as off, I would say bones can be deteriorating osteopenia and osteoporosis. So using bone strength is very common in young people who suffer from anorexia, so that is of course not something we want. Hormones and your menstrual cycle can be affected. And again I always want to give a disclaimer that it doesn't always happen, and so some people are super sensitive and

if they lose two pounds, they lose their period. Some people I personally have worked with clients who have had a twenty thirty year long battle with anorexia never lost their period, had children, and been severely underweight the whole time. So if you still have your period, that doesn't necessarily mean I don't have a problem. But if you lose your period, that's definitely a sign that something is off. I like what you said, it's normal until it's not.

That's a really good reminder, and I would think, and again, we've spoken about this and we shared our stories on the first four episodes of Our WAGH. But I was once told when I was much younger, by a mentor to me that every time I threw up, it was a slow suicide. And so can you just speak to the harm that we're doing to our bodies all to fit into some whatever box of what we think we

should look like. Describe what that really means, because I feel like that can sound really drastic to someone that's like, what stop like slow suicide? Don't even but it's it's so true. Yeah, no, it is. There are so many things that are harmful and people only think about I shouldn't say only, but tend to think about the external and well, I don't look thin enough where my teeth

aren't ritting out of my head. But yeah, especially like with purging, the integrity of your esophagus and digestive system is being damaged. I don't want to be like a horror story here kind of scaring people, but I think it's important to know what's possible that it can get to a point where you can't stop the sort of opposite flow of your digestion and there is involuntary regurgitation

that happens. Even just your digestive health being off poor neutral and absorption as your intestines are being damaged, really your whole digestive system being totally ruined. I've seen people end up with a colostomy bag from an eating disorder

and other complications of it. You know, it's kind of interesting that, like gut health is so trendy, but at the same time, people are doing these behaviors to change their body that really impact your digestion, your bone health, you know, being able to so easily break a bone

at a very young age having fractures. Heart health is also really really dangerous, and I tell people when you're not eating enough, someone who has a restrictive eating disorder, your body, if it doesn't have enough carbohydrate to use for energy, then it goes to breaking down fat and muscle. And people think, oh, yeah, I'm going to use up all my fat, but also protein and muscle, and your

heart is a muscle, and your heart can deteriorate. Your heart can stop from purging too much from refeating syndrome. If you restrict too far and then reintroduced food when your body is not ready for it or too quickly, that can cause electrolyte imbalances. It's really dangerous for heart rhythms. So it's a serious thing. I think a common statistics thrown around is the anorexia is the deadliest mental illness,

and people don't really realize that. So, yeah, that's actually a great pivot because eating disorders so much right now on the internet is to blame quote unquote diet culture. And obviously, you know there is this pursuit of thinness ingrained in all of us. But one thing that I think is kind of getting lost in the mix, is that eating disorders in the nature that we're discussing them today are not just because of diet culture. Right, What are some of the factors that could go into causing

and eating disorder? So many and it's never just one thing. So you know, if someone is listening and has a child or parent or best friend with an eating disorder, nothing is your fault or any one person's fault. They are biopsychosocial disorders. So there's a biological component. It is ingrained in our biology of our body. There is a genetic component. I actually researched that for my master's degree. It was really interesting and psychological. So there is a

mental health component. These are mental disorders, so there's that whole piece, often probably always co occurring with anxiety, depression, any type of other psychiatric diagnosis, and social So yes, there is the diet culture piece, the people you're around, the sports you're in, the cultures and activities that can also influence things. And it has to be that perfect storm.

So you know, one person might be in competitive dance or something that is a community in which eating disorders are prominent, and maybe they don't have the genes that predispose them to the eating disorder, and they're fine. But somebody else does have that genetic makeup and that psychiatric makeup and they do develop an eating disorder. So it's really complex, certainly. And so for somebody listening that resonated with either the arexia the bolimia, somebody might be listening

and they're they're nervous. What is the first step that they should take, because I think that's where a lot of people actually get stuck. Yeah, the first step is I would say tell someone eating disorders thrive in secrecy, So putting it out there to whoever you're comfortable with, Well, then get the ball rolling with somebody holding you accountable, helping you get help, helping you make the phone call to a therapist or a dietitian or your doctor or

whatever you need to do. That is the first step that you feel comfortable with. But just sharing is really important, and I think especially for the eating disorders that are so shameful, I'm so glad that you guys brought up the shame piece because anorexia tends to be this like glorified eating disorder. Oh, everyone wants to be thin, and nobody wants to talk about their binge eating, And that is kind of an over generalization, but that's what I

see the most. So if you're binging, telling someone is probably the last thing in the world you want to do. And that's why it's the most important, because these are also relational disorders. You know. Eating disorders can cause lying and stealing and hiding things, and so putting it out in the open is what's going to squash it. The more people who know, the more you are saying out loud that you're wanting to beat this thing, the more

capable you will be of beating it. Oh, I'm so glad you brought up that piece, and some people listening may have, Like you said in the beginning, you may not fall into one category. I certainly have dabbled in all of them, not so much anorexia, but I was restricting, which then led to my binging, and then I purged, and then I have suffered from orthorexia, which I didn't even know was a thing until recently. But I had that for way longer than before I ever heard of it.

But I always kind of in my head secretly wished I just struggled with anorexia, because that would have been easier to talk about and more I hate to use this word acceptable, but it seemed more like that would be something where people like, oh, okay, yeah, I get that too again, talk about all the other things you have going on, and even now I would maybe put orthorexy in that category of like people don't really know what it is, so I can be like, yeah, yeah, orthorexia,

you know I have that, and that's just wanting to eat so healthy, and then people are like, oh, yeah, okay, I can get on board with that disorder. But they all need attention and they all need help. That's the purpose of this and your work too. Of course, just thank you for being a part of this conversation of getting it all out there. All of them need attention, and not one of them should be glamorized more than

the other or more acceptable to talk about. We should be talking about every single thing so that other people can strip the shame and we can all start healing together. Yeah. I think we definitely need to have Michelle on again because there's so many different details that we could have dove into, but for this one, I just wanted to cover how to tell if you have disordered eating versus eating disorder, and I think you you provided us so

much valuable information. So you can find Michelle again at Michelle Pillow Pitch Nutrition. We will put that on the show note and we'll also put the website so if you are in the New York region, perhaps you can book a session to work with Michelle directly. Thanks for being here, Michelle, awesome. Thank you guys so much.