MR Round Table: We Spoke to a Specialist About Food Anxiety
A follow up to our previous e-mail conversation on our thoughts about food.
Leandra Medine: At Man Repeller, we really try to have the hard conversations that we believe women are thinking but might be too afraid to talk about. That fear is rooted in shame and we’re trying to defeat shame by exhausting communication. I wrote about my fertility issues, we’ve spoken about anxiety attacks and recently, we had a conversation about food. It was about how much time we spend thinking about food and whether or not the relationships we have with food are healthy. That conversation left a lot of question marks unaccommodated. What we saw was an enormous amount of empathy. It made us realize that there’s a sort of epidemic plaguing our society and we probably need to do something about it if we can. Neither myself nor Amelia are specialists, though, so we are very grateful that you were able to speak with us.
Dr. Allegra Broft, a psychiatrist in the Eating Disorders Research Unit at the Columbia University Medical Center: It’s a huge topic that you’re tackling. I work up at the Columbia Eating Research Group and I have a small private practice as well, so I deal with the most extreme types of problems. That gives me a good vantage point across the topic’s spectrum, though I deal a little less with the subtler struggles. However, I do think many, many women in America are entrapped by some version of overthinking food and overthinking shape and weight issues.
Leandra: What do you think that’s a result of?
Dr. Broft: It’s hard to speak in generalizations. When talking to eating disorder patients, one of the things they’ll often say is, “I hate it when I, as an eating disorder patient, am being put into a box as though I am just an eating disorder.” But we have some models that we use to think of where these disorders come from, and I think that they apply across a wide variety of smaller struggles.
One is the “cognitive-behavioral” model of eating problems. Whatever the problem is — whether it’s a restrictive eating problem (i.e., thinking about dieting all the time) or if it’s a binge-eating problem — much of that fixation with food, for many, has at some point involved some sort of shape and weight pre-occupation.
And where does that come from? Well that’s the “black box,” for most folks. These are the underlying issues that initiated or perpetuate weight or food preoccupation, which are not necessarily the same from person to person, and are sometimes hard to easily identify.
What are some themes of that “black box”? Things like a self-esteem issue, an identity problem: “Who am I in the world?” Someone could be biologically depressed and feel that focusing on shape and weight helps them escape. These are all put forward in a cognitive behavioral model for formal eating disorders, and I think can apply across the spectrum as well.
Leandra: There’s this very unique gray area of women who don’t necessarily identify themselves as having an eating disorder, but do identify themselves as having unusual eating habits. Are we actually disordered?
Dr. Broft: Even as a professional, I’m not sure if I can always make te call. How do we think of a disorder, whether it’s an eating problem or an anxiety problem? It’s where there’s a psychological experience that ends up taking over the way that you would otherwise function. Your social life becomes impaired; in the case of food it’s, “I don’t want to go out because I feel uncomfortable in my clothes,” or, “I can’t work in the way I’d like to because I’m ruminating about food all the time.” That’s usually where we draw the line, diagnostically.
And of course that becomes a gray zone, because some of us may worry about it a little bit. Maybe it interferes with our work for five or ten minutes, but is that enough to be considered full dysfunction? I’m not going to pretend to say I always know exactly where the line is with that.
Amelia Diamond: I’m sure that this exists in a multitude of industries, but you see it all the time in fashion and hear about it in dance: talking about our bodies in a messed up way is total day-to-day banter. “I’m too fat for skinny jeans,” is code for, “Where should we have dinner?”
Leandra: Dr. Broft, just before you arrived — I’m taking estrogen supplements right now so I’m extremely bloated — I lifted my shirt to show Amelia that I don’t fit into my pants.
Amelia: She did. And the biggest compliment in fashion is, “You look so thin.” When I leave New York City and do the, “Ugh, I’m so fat today” monologue, they’re like, “Why are you talking about this?” And I’m just like, “This is normal conversation in my world.”
Dr. Broft: That’s a really good point. I think a lot of women are going there by default. It’s almost engrained. You’re doing such a wonderful thing by speaking about it now and asking, “Do we really have to go there?”
When I talk to patients across the spectrum, I ask, “What is the utility of labeling yourself in this way?” Or, “Your pants don’t fit today, is that really so bad?” The implication is that there is something terrible about it. So, it’s not the statement per se, but it’s where you go with it in your mind and what you think it means about yourself.
Amelia: Sort of like a habit?
Dr. Broft: It’s really interesting that you use that word. I do think of it that way. I get jazzed about the word “habit” because in our clinical research team, we’re thinking about habit in regards to neuroscience. We’re thinking about to what extent are these full-blown eating disorders mediated by the neural-circuitry that deeply engrains habits in our brains.
One of the things that cognitive therapy teaches us is the notion of automatic thought. That’s basically the idea that we all learn certain scripts or ways of thinking at a very young age. The example that we often talk about in cognitive therapy is when we first learn to tie our shoes. We don’t know how to do it in the beginning. We do it very slowly at first and have to give so much thought to that action. Once we master it, of course, we never think about tying our shoes again. It becomes an automatic script in our mind.
We have a way of doing this in other parts of our life, like in the way we think about ourselves and our bodies and food. At some point there was probably a slow process where we were learning to think certain foods are good and certain foods are bad. And now that’s all become so engrained that we don’t even think twice about it.
From a cognitive therapy perspective, we have this subset of automatic thoughts and cognitive distortions that we kick into gear and automatically think: my pants not fitting is a sign that life is terrible, or I am a slob. So yes, I think “habit” is a good word.
Amelia: Part of what we discussed in our food conversation is how to actually talk about these things, and what’s okay to say. I read a book once where the author, who had an eating disorder, explained how hard it is for people to write about this topic because it’s so easy to trigger readers who have eating disorders. She wrote that girls in school can learn how to practice disordered eating by reading about it in school text books. So how do you teach it? How do you write about it? How do you talk about it?
Dr. Broft: It’s true. And I don’t know what to say about that issue. It’s like doing this interview: how do we walk the line? Hopefully, we get some messages across that are really helpful about how we approach our bodies and ourselves in a healthy way.
In the field, in general, we do shy away from suggesting reading to patients for exactly the reasons you’re talking about. I don’t have the answer as far as exactly how that line is established because there is lot of danger.
Amelia: Do you think there’s danger in speaking about it in the way that we did publicly, talking about our anxieties and thoughts?
Leandra: And trying to figure out whether or not there is such thing as a healthy relationship with food.
Dr. Broft: I think that…as with any opening up of this discussion, there’s always the potential of other people expressing their own anxieties, and their own ideas may feed people in a not-so helpful way. Or maybe it helps other people realize a problem that they didn’t acknowledge before.
Amelia: What surprised us was that a lot of these comments said, “Me too.”
Leandra: Which is why I’m really curious about whether or not there is such thing as a healthy relationship with food. Are there women who don’t spend any time thinking about it? Who are like, “It must be so exhausting to live in your head.” I’m not sure.
Do you find that a lot of people in your field become specialists because they’ve experienced the plight themselves?
Dr. Broft: Actually, one of the larger eating disorder recovery centers in the country, Monte Nido, is run by somebody who is very open about the fact that she struggled.
Some patients say there’s nothing like talking to somebody who previously struggled with this as well in terms of really connecting and empathizing. On the other hand, that can become complicated. If the therapist has really worked through her issues and can manage the complicated element of having struggled to be objective with others and bring a recovered attitude towards treatment, that’s one thing. But it can be complicated and triggering for women or people who have struggled.
Amelia: You’ve referred to women a lot. I know men can have eating disorders, but it is primarily female problem, right?
Dr. Broft: Statistically, of all those who struggle with anorexia or bulimia, the breakdown is 90% women, 10% men.
Leandra: If we could help positively affect the construction of the psyche of a girl who is just entering the phase of her life where she is becoming influenced by the thought of food and what her body looks like, what do you think is the type of advice that we should be giving her?
Dr. Broft: It’s something like: if you start turning to a diet to control your shape and weight as a solution to feeling good in the world, stop yourself from going there.
Leandra: Meaning…don’t react to a symptom and assume that this symptom is the problem?
Dr: Broft: Yes, something like that. It’s such a good question. It’s obviously to the core. A New York Times article was recently published addressing “design thinking.” The author wanted to lose weight to the point that it preoccupied her thoughts. The idea of this “design” perspective is to try to first find empathy toward a problem or within yourself, and then to take the perspective of, “If I want this, what is it that I’m really trying to solve?” She was fixated on her weight, but design thinking made her ask: What do I really need? Why do I really want to lose 25 pounds? She wanted more social connection, she wanted a sense of community and to have more energy. She was then able to tackle those issues directly.
I think that speaks to some element of what a lot of women are looking for: they want to look better, they want to feel more socially or romantically confident. So he started peeling it back and thought, “If that’s what I’m looking for, do I really want to put all the focus on weight? I want to think about how I can amp up my social connections. Do I need to get myself out there more?”
Leandra: That’s very self-aware.
Dr. Broft: I think that’s the idea: What is the real problem here? If you’re focused on weight, that can’t be “it.”
Amelia: I don’t have anywhere near the body of like, Kayla Itsines — a fitness celebrity on Instagram — but I’m not going to lie: I’d like to. What if you’re like me, i.e., not overweight, feeling fine most of the time, but want to lose some weight. When does that become a problem?
Dr. Broft: Well, why are any of us trying to look like anyone besides ourselves? You have to ask yourself, “Am I happy about the way I am?” If the answer is yes, then screw it. Of course, talking to a neutral source is one way of reality-testing yourself along those lines.
Amelia: In other words, if you’re concerned, consult a professional.
Dr. Broft: Yes, that’s always a message that I believe in delivering.
Leandra: I think the other thing, though, in asking if you like how you look, is trying to strip away how much you value yourself and if it’s contingent on you comparing yourself to other people. Are you historically comparative? That’s something that happens to me with my anxiety. When I’m not comparing myself to, for example, another female entrepreneur who’s done X, Y, and Z better than I have, I feel much better about what I’ve built. But when I am, I feel like I’m not doing anything constructive. When I’m comparing my current self to my former self — looking at Man Repeller as a business I’ve built myself independent of anything else — I feel very proud.
Dr. Broft: Which model works better?
Leandra: Obviously the one where I feel proud, as long as it doesn’t affect my humility!
Dr. Broft: I think it’s a really good example. That’s really what you want to think about. What is the purpose of comparison? It just doesn’t serve most of us well.
Leandra: Yeah, it’s like malignant motivation.
Dr. Broft: A lot of us are used to needing that — looking toward those external sources that whip us into shape to move forward, so I think that’s a brain tendency that a lot of us have and yet, what does it do? It leaves us feeling shameful or guilty or inferior. So it doesn’t work very well, even though some of us have learned to drive a lot of motivation from it.
Leandra: It’s so baked into our culture, right? To compare ourselves to others in order to become better as ourselves. But all that stuff is within us, we just have to work to break down the negative tendencies and with healthy self-awareness, keep trying to cultivate these new ones.
To learn more about eating disorders and healthy eating practices, Dr. Broft recommends “The Rules of ‘Normal’ Eating” by Karen R. Koenig, “Intuitive Eating” by Evelyn Tribole and Elyse Resch, “Overcoming Binge Eating” by Christopher G. Fairburn. For more information, visit the Columbia Center for Eating Disorders, as well as a blog on eating disorders maintained by Dr. Broft’s team.
Photographed by Krista Anna Lewis