Mrs. Emily Tunstall Loarca Velasquez, RD, RDN

Anorexia nervosa, frequently referred to as anorexia, is a disorder where people severely restrict the types and quantity of food they eat. Those with anorexia have an extreme fear of eating and gaining weight and may repeatedly weigh themselves or engage in harmful behaviors such as excessive exercise or starvation. Those with anorexia often find themselves preoccupied with food, but unable to consume a healthy amount of it. This results in symptoms such as abnormally low BMI, vitamin deficiency, fatigue, fainting, and amenorrhea (lack of menstruation in women). Anorexia may cause bluish discoloration of the hands, brittle and falling out hair, yellowish skin, and lanugo (fine, downy hair). Left untreated, anorexia can lead to organ failure, brain damage, and even death.

Bulimia nervosa, typically called bulimia, is a disorder where people binge (eat large quantities of food) and purge the food that they just consumed by vomiting, laxative abuse, fasting, or excessive exercise. This behavior is usually motivated by a feeling of powerlessness over eating and a fear of weight gain or desire for weight loss. Bulimia can occur in underweight, normal weight, and overweight people. Symptoms of bulimia include acid reflux, intestinal distress, dehydration from purging, amenorrhea, and dental erosion from vomiting. Some people with bulimia have swollen parotid glands (salivary glands near the cheeks) and red scars and marks on the backs of their knuckles. Electrolyte imbalance from bulimia can be particularly severe and may lead to heart attack or stroke.

Binge eating disorder (BED) is the most common eating disorder. People with BED feel that they are unable to control the amount of food they eat and may continue to binge after reaching a point of fullness. BED binges (consuming large amounts of food) are often accompanied by feelings of sadness, guilt, and shame. Symptoms of BED include obesity, acid reflux, weight gain, and dissatisfaction with one's body. People with BED tend to experience cycles of negative emotions and binges. Binges or BED episodes can be provoked by stress, boredom, restrictive dieting, depression, and other triggers.

Other common eating disorders include:

• Pica, eating things that are not food, such as paper, ice, or soil
• Avoidant/Restrictive Food Intake Disorder (ARFID), disinterest in eating and avoidance of food
• Other Specified Feeding or Eating Disorder (OSFED), abnormal eating that does not fall under any disorder

Many people with eating disorders do not consciously develop them, and have difficulty seeking treatment. For this reason, it's important to detect and treat eating disorders as early as possible. Treatment for eating disorders can vary from therapy visits to inpatient treatment, depending on the disorder and its severity. Treatment aims to not only restore physical health and correct negative behaviors, but to also promote psychological well-being and self-confidence.

At the most basic level, nutrition counseling can be simply a talk with a family physician. Doctors receive training in nutrition as part of their education, and they are generally qualified to make recommendations about diet for their patients. Some doctors take a professional interest in nutrition and become experts by taking extra classes or studying nutrition in their practice. In general, however, complex nutrition guidance will be referred to a nutrition specialist, generally a dietitian.

Registered dietitians are nutrition experts that have passed specific higher education, accreditation, and internship requirements. They may work in hospitals, nursing facilities, or private practices to provide nutrition therapy and advise patients about their health and diet. Like dietitians, nutritionists also work to counsel patients about food and health. Some nutritionists have degrees in nutrition or food science, but the title 'nutritionist' is not protected by law. In the United States, anyone is allowed to call themselves a nutritionist, regardless of their education level.

Nutrition counseling can be useful for anyone who is looking to get to a healthy weight, manage a chronic illness through diet, or simply lead a healthier lifestyle. Some examples of issues that benefit from nutrition counseling include:

• Obesity
• Eating disorders
• High cholesterol
• High blood pressure
• Food allergies
• Kidney disease
• Digestive disorders, such as irritable bowel syndrome
• Cancer
• Pregnancy or lactation
• Participation in competitive sports

During a nutrition counseling appointment, the provider -- doctor, nutritionist, or dietitian -- typically will look over a the patient's medical history and talk to them about their current diet, their goals, what kinds of food they like, and any problems that they are currently struggling with in their health or diet. Then the specialist will help the patient set food goals and create a customized plan to help them meet their nutritional needs. Nutrition specialists may also offer classes, workshops, cooking demonstrations, and more. Their role is not to lecture the patient about what one should be eating, but to offer education and resources to make eating healthy foods easier.