One of the hallmark symptoms of an eating disorder is the elimination of certain foods or food groups, commonly referred to as fear foods. These fear foods lie on a spectrum and are highly individualized to the person struggling. A slew of factors influences which foods make the list and there may not always be a significant reason why a food becomes off limits.
One major culprit to the development of fear foods is diet culture. Diet culture is a rigid system of beliefs that normalizes calorie restriction, encourages avoidance of ‘unhealthy’ foods, promotes rigid exercise habits, and emphasizes physical appearance over mental and emotional well-being. We all fall victim to diet culture, but how our brains cope with it varies from person to person. Diet culture hits hardest for individuals struggling with disordered eating.
Over the years, diet culture has become so normalized that its established ways are now considered healthy and wholesome rather than disordered. This complicates eating disorder recovery and makes it difficult for individuals to adopt a more balanced relationship with food. Treatment for overcoming fear foods involves asking clients to do the exact opposite of what most people in society are doing, sometimes including their own families. I’ve been asked countless times by concerned family members why I would want their loved one to consume “unhealthy foods” such as ice cream and Cheetos. My first response is always “Because Cheetos are absolutely delicious” followed by an introduction to the concepts of All Foods Fit and Food Neutrality.
Food Neutrality
Food neutrality is a philosophy of eating that encourages the inclusion of ALL foods as part of a healthy, balanced relationship with food. I emphasize ALL because it truly means that no foods are off limits, other than foods related to allergies and intolerances. This means no longer categorizing foods as good vs bad, healthy vs unhealthy or clean vs dirty. This means allowing yourself the freedom to choose foods based on your true preferences rather than based on its nutritional value. Simply put, food is just food and you’re allowed to eat it without feelings of guilt and shame.
At this point, most clients and their families are looking at me thinking, “Is this dietitian nuts”? And, I get it. I understand people’s reservations about food neutrality. It truly goes against everything we’ve been taught about food and nutrition our entire lives. We’ve been brainwashed to believe that certain foods have the power to completely transform our health and well-being, for better or worse. But I want you to ask yourself, has the nutrition messaging you’ve been taught up until this moment simplified or complicated your relationship with food? For most, it’s only accomplished the latter.
Food Neutrality means that no foods are good or bad and no one food holds more nutritional or moral value over another. Our culture has successfully taken an innate object necessary for human existence and turned it into a moral dilemma. This shows up in our daily lives looking like, “I’m so bad for eating that slice of cake!” or “Ugh, I’m such a failure for gaining weight over the holidays.” Food neutrality is not saying that all foods are nutritionally equal. Food Neutrality is saying that all foods are morally equal. There is no denying that cupcakes are less nutrient dense than a fruit smoothie, but I am not a better or worse person for choosing either one. Both a cupcake and a fruit smoothie can be included when practicing an All Foods Fit philosophy based in food neutrality.
Exposure Therapy for Fear Foods
Exposure and Response Prevention (ERP) therapy is a type of cognitive behavior therapy commonly used in the treatment of Obsessive Compulsive Disorder (OCD). Research shows it is an essential component in helping people overcome their fear foods during eating disorder recovery. The hallmark of ERP is that it does not completely remove the anxiety-inducing experience from one’s life. Instead, it equips the person with tools to appropriately manage their anxiety.
ERP involves a two-step process:
- Exposure: Gradually exposing clients to their feared foods in a safe and supportive environment.
- Response Prevention: Teaching clients to manage their anxiety while replacing their usual maladaptive behaviors with new healthy coping skills.
This process begins with clients creating a Fear Food Hierarchy where they list all their fear foods and rank them from least feared to most feared. This is an important initial step so that ERP starts with foods ranked at low-to moderate anxiety. It’s essential to avoid starting treatment with the highest ranked fear food as this could produce more anxiety than can be managed at this stage of treatment. As the client progresses through treatment, they gradually incorporate higher feared foods.
Tracking your Progress
Tracking progress throughout the exposure process can provide important data for both the client and clinician. For the client, this information can increase dedication by reminding them how far they have come and all the hard work they have endeavored. Maybe the first time they ate a slice of pizza, their anxiety was a 9/10, but two months later, their anxiety is down to a 6/10. This can be motivating for a client to see hard data proving this process is working for them and all their hard work isn’t for nothing. For the clinician, this can help identify areas of treatment that have worked well and those that haven’t so they can fine-tune future exposures.
Things to Remember:
1. Be Patient with Yourself
Recovering from an eating disorder takes time and lots of ups and downs are sure to take place. Your path isn’t going to be perfect and that is ok.
2. Be Consistent
Challenging yourself with fear foods on a consistent basis helps build new neural pathways in your brain. Food exposures are never a one-and-done thing.
3. Be Honest with Yourself
Truly be honest about which foods are difficult for you. Often times clients are afraid to list certain foods due to fear of having to consume them. This will ease anxiety in the moment, but halt your long-term progress. If you’re struggling with a food, speak with your team about it and let them know. They are there to support you.
4. Don't Give Up
I’ll be honest. It’s not always going to be easy. It’s not always going to be fun. But the reward of building a balanced relationship with food where it doesn’t rule your entire life will be absolutely be worth it.
5. Use Your Support System
You don’t have to go through this alone. Your treatment team, family, and friends are there to support you. Ask a close friend to complete an ice cream exposure with you or have your family go out for pizza one night if you feel that would be helpful.
As always, contact me with any questions and comments you have.
Kelly Melanson, Registered Dietitian
