Dismantling the Myth that ‘All Foods Fit’ in Eating Disorder Treatment

 

all foods fit

Abstract:

We call for a reevaluation of the long-standing dogmatic nutritional principle that “all foods fit” for all cases of eating disorders (EDs) and its corollary, “there are no bad foods” (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.

Understanding the ‘All Foods Fit’ Approach:

The ‘all foods fit’ philosophy stems from the principles of intuitive eating and aims to remove the stigma around certain foods by emphasizing that no food is inherently good or bad. Promoting food neutrality encourages individuals to listen to their body’s hunger and fullness cues, enjoy a variety of foods, and reduce the psychological burden of food rules and restrictions. In theory, this can help individuals build a healthier relationship with food and their bodies. This approach is particularly useful for chronic dieters with overly restrictive tendencies. 

Our Thoughts:

Our research confronts the oversimplification of the “all foods fit” philosophy. It’s clear that not all foods suit all individuals, and an eating disorder diagnosis doesn’t negate health and nutrition concerns. Recovery from an eating disorder should be more than just about eating chips and cupcakes.

Regrettably, the field has veered off course. The “all foods fit” dogma has morphed into a social marker, a litmus test for inclusion. This has stifled dissenting voices, preventing a much-needed diversity of perspectives in our discourse.

Consider this: a mental health diagnosis became entwined with a well-meaning treatment philosophy, and anyone who did not adhere strictly to this philosophy faced ostracism. The field adopted a stance: “if you do it our way, you are welcome here, but if you deviate, you are doing harm.”

This is the essence of dogma. Science transformed into religiosity, leading to widespread discontent. Many professionals left the field, but some of us remained, challenging the status quo and enduring the criticism. We stayed because we are deeply committed to our patients’ well-being. We stayed and authored this piece in one of the leading eating disorder journals.

Rather than adopting a one-size-fits-all approach, it’s crucial to recognize the individuality of each person’s recovery journey. A more personalized approach, tailored to each individual’s unique needs and challenges, can offer a safer and more effective path to recovery.

If you or someone you know is struggling with disordered eating, there is excellent help available. Take the first step with Nutrition in Recovery.

Dr. David Wiss became a Registered Dietitian Nutritionist (RDN) in 2013 and founded Nutrition in Recovery, a group practice of RDNs specializing in treating eating and substance use disorders. In 2017, David received the “Excellence in Practice” award at the National Food and Nutrition Conference and Expo. The California Academy of Nutrition and Dietetics awarded him the “Emerging Dietetic Leader Award” in 2020. He earned his Ph.D. from UCLA’s Fielding School of Public Health in the Community Health Sciences department (with a minor in Health Psychology) by investigating the links between adverse childhood experiences and various mental health outcomes among socially disadvantaged men. His treatment philosophy is based on a biopsychosocial model which incorporates an understanding of biological mechanisms, psychological underpinnings, and contextual factors that integrate the social determinants of health. Wise Mind Nutrition is an app-based interactive treatment program available for download now - https://wisemindnutrition.com/download.

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