Atypical Anorexia: The Invisible Eating Disorder

Atypical Anorexia: The Invisible Eating Disorder

Extreme food restrictions, abnormal eating behaviors, intense fear of gaining weight, but maintaining a normal or above-normal weight – could it really be an eating disorder?  

Atypical Anorexia (AN) is an eating disorder included in (OSFED) Other Specific Feeding and Eating Disorder category.  Its features are similar to typical anorexia without meeting low weight criteria, and those with AN are often living in a larger body or may have been living in a larger body and lost a significant amount of weight and received positive comments from family, friends, and physicians only to keep encouraging them to keep up what they are doing.  

Was their weight loss it due to a change in lifestyle?  Or surgery, cancer, depression, grief, or and eating disorder? 

It’s important to look behind someones weight loss, don’t just assume it is healthy. 

They may exhibit:  

extreme fear of being fat

adding up all the numbers of the foods they eat, 

forcing exercise to burn a certain amount of calories

cutting out foods and food groups, 

avoiding social events with food,

anxiety over meeting a friend for lunch

deciding if they can eat dinner or not

body dysmorphia

distress over body image. 

Those suffering from AN often do not show physical signs of suffering, therefore it is important to look beyond their weight.  Eating disorders in someone living in a larger or normal size body can be a deadly psychiatric illness with physical and psychological complications.  It may be accompanied by low blood pressure, amenorrhea (loss of menses), depression, OCD, self-harm, or suicidal thoughts.  

AN in not a lesser diagnosis than anorexia, it is just a different manifestation. Many individuals who have atypical anorexia may not even realize that they are struggling with a severe and deadly eating disorder, simply due to the weight stigma that surrounds this disease.  A person may think, “I am not sick enough to have an eating disorder”, because they may be within a normal or above weight range. There is a 3:1 ratio of females to males with the diagnosis of AN.  

All eating disorders can be debilitating for an individual who is struggling. If you or a loved one may be dealing with an eating disorder, be sure to reach out to someone and talk about your struggles. 

A treatment team consisting of an eating disorder dietitian and therapist will focus on evidence based treatment, Cognitive Behavioral Therapy, Exposure Based Therapy, Nutrition Rehabilitation and normalizing eating behavior.  

Don’t let any type of eating disorder keep you from achieving health and happiness. 

Suzanne Iovanni, RDN, CSSD, CLT

Let’s Talk Diets and Hormones

Let’s Talk Diets and Hormones

The weight loss industry knows we have caught on to them, especially commercial weight loss programs such as Weight Watchers and Jenny Craig, often thought of as your mother’s and grandma’s diet which they have become lifelong members with- why is that? Because they do NOT work!  And gone are the days of fat free foods and 100 calorie pack snacks, those just leave us feeling hangry (hungry and angry).


Restrictive diets in effort to lose weight and quick, results in increased cravings and urges  for food.  90-95% of people who lose weight on diets, regain the weight back  and many result with weight higher than they started at!  We have the before diet, after diet, then there is the after, after diet!   And it is not because you failed!  Restrictive diet’s cause you to gain weight in the end!  


Diets cause many biological and health damage including; teaching the body to retain more fat, slows rate of weight loss with each attempt of dieting, lowers metabolism, and increases binges and cravings.


Dieting also provides psychological and emotional damage; eating disorders,  increased stress, social anxiety.  Dieting gradually erodes confidence and self-trust.  


Since the diet industry knows that millennials have caught on, they are coming at us from a different angle. They are reinventing themselves as Wellness. They are coming at us from a sneaky way to continue the dieting rollercoaster, but presenting it as health and wellness (and sustaining the multi billion $$ diet industry). These are in the form of clean eating, cleanses, Whole30, detoxes, Paleo, Ketogenic Diet, Intermittent Fasting.  Again, giving you more food rules and pushing you further away from intuitive eating, which really hones in on your hunger and satiety cues.  Resulting in not eating when we are hungry and then eating past satiety.  


I admit it is so hard to go against the grain and start trusting your body to tell you what, when, and how much to eat.  Especially when you are constantly inundated with social media posts regarding diets.  The only thing you should detox are the social media accounts that make you feel not good enough!  It’s time to retrain our minds on nourishing our bodies for physical and mental satisfaction as well as balancing our appetite and weight regulating hormones after dieting has disrupted the balance.  Diets that consistently have us taking in too few calories than we expend through our resting metabolic rate (RMR) and activity, result in our bodies responding by increasing or decreasing certain appetite stimulating and satiety hormones.  Let’s take a look at hormones that effect our appetites and weight – Leptin, Ghrelin, Cortisol, and Insulin. 


Leptin is the ‘master’ hormone that regulates weight and is produced by fat cells.  It tells us when we have enough food and can burn energy.  It also influences our fertility and immunity.  Its primary goal is energy balance and it influences how much we eat, expend, and store.  Weight loss decreases leptin, then the brain tries to gain weight back.  We can have leptin resistance!  This is when the brain isn’t listening.  No drop in appetite, no increased metabolism.  Your brain can even think you’re starving, because it doesn’t think that there’s not enough leptin. So it makes you even hungrier!

So the vicious cycle starts:

  1. increased body fat = more leptin
  2. too much body fat = leptin signal disrupted
  3. brain thinks you are starving, so you eat more
  4. and it repeats

Ghrelin is the ‘hunger’ hormone, which is produced in the stomach and tells the brain to eat!  It’s primary role is to increase appetite, increase food intake, and store fat. Ghrelin rises during dieting and increases hunger.  The more restrictive you eat, the higher the ghrelin. Yikes!! So, how do we decrease ghrelin? Avoid restrictive dieting, ensure adequate sleep, increase muscle mass, and  increase protein intake throughout the day 

Cortisol is increased with STRESS!  I know, we all have stress in our lives, but, if we have chronic high stress resulting in high cortisol levels for long periods of time, this can result in high blood pressure, weight gain, fatigue, disrupted sleep, impaired memory (brain fog), and suppress immunity.


Insulin is the ‘storage’ hormone. High spikes in insulin from peaks of blood sugar tells our body to store fat. The goal is to control blood sugar peaks to prevent high spikes in insulin. Which results in decreased cravings, increased energy, and better mood : )


The end goal with all my clients is Intuitive Eating.  Intuitive – using or based on what one feels to be true even without conscious reasoning; instinctive.  BUT, for many, we need to reverse the damage that restrictive dieting has done to their metabolism, hormones, mental thoughts regarding food, and depleted energy levels.  So, how do we get these hormones regulated?!  First off, ensuring you are not eating BELOW your RMR!  Then begin eating balance meals based on macronutrients – PFC (protein, fat, carbs) and make sure you are ‘pairing’ your foods to contain all 3. To begin regulating your hormones, you need to trust nutrient dense foods and forgo the fear of calories.  Remember, limiting calories ultimately increases cravings by increasing ghrelin, resulting in overeating in the later part of the day, and then the guilt sets in.  One should never feel guilty or bad about eating!

Here are the 5 Keys to Health to focus on to help regulate your hormones;

1.  REST (Lack of sleep leads to more ghrelin, less leptin, and disrupted glucose and insulin metabolism)

2.  NUTRITION (eating PFC throughout the day)

3. MOVEMENT (find ways to enjoy movement throughout the day)

4. MINDFULNESS  (calmly accept your feeling’s and thoughts and aware of eating)

5. SELF CARE – decrease stress!


The health and fitness world can be a confusing place.  A Registered Dietitian can help cut out the noise and guide you to the best eating and lifestyle strategies that are individualized to you and your personal goals. Visits with a Registered Dietitian are often covered by your medical insurance.


~ Suzanne

Building Better Nutrition


An Athletes Secret – Binge Eating Disorder

An Athletes Secret – Binge Eating Disorder

Binge Eating Disorder – A compulsive drive to eat and continue eating well beyond feeling full and consuming ~3,000 – 6,000 calories in one sitting, usually alone.  Binge eating disorder is the most common eating disorder in the U.S., effecting 8 million Americans, yet it is the least talked about.  There is alot of misconception and stigma when it comes to binge eating;  it is not a true eating disorder, no willpower,  lack of control, or that you have to be living in a larger body.  

Eating disorders do not discriminate.  Athletes are especially at a high risk for developing eating disorders due to the natural pressure they face in their sport.  Middle school, high school, collegiate, weekend warriors, or professional athletes are all at a high risk of developing an eating disorder which gentics and environment plays a role.  Athletes in asthetic sports are at an even higher risk; ballet, long distance running, wrestling, swimming, gymnastics. 

At a high level of training, athletes often follow a strict diet.  Any type of restrictive eating, even unintentional, can backfire and increase the urge to binge.  A binge is much different than overeating or emotional eating.  Having a large bowl of ice cream after a tough day is an example of emotional eating, while consuming a half gallon of ice cream then moving on to a box of cookies can be an example of a binge.  Binge eating disorders are reoccuring and on average lasts at least once per week for 3 months of consuming an excessively large amount of food in a short period of time and is characterized by experiencing a lack of control and significant distress among binge eating.  While overeating is a challenge for many Americans, recurrent binge eating is much less common and much more severe.  Atletes with binge eating disorder are at a high risk for injury, poor recovery, poor performance, and psychological problems.  

It is often difficult to identify an athlete with binge eating disorder, as their weight is often  at a healthy weight.  But, they may start to socially isolate themselves from food events, skip meals, or overtrain to compensate for their binge.  Family members and roommates may notice large amounts of food disappearing or empty containers pushed to the bottom of the trash.  Remember, people with binge eating disorder are ashamed and feel they have no self control.  Coaches who are in frequent contact with athletes may notice signs of an eating disorder as well. 

5Warning Signs:

 1.  Eating too little in front of others.

2.  Training to hard and excessive.

3.  Increased focus on weight, shape, size, and appearance.

4.  Stress fractures and overuse injuries.

5.  Missing large quatities of food.

It is important to have a discussion with an athlete who is showing signs of an eating disorder such as binge eating.  It is imperative an athlete receive the treatment they need for support and recovery.   If you know an athlete exhibiting any of these signs, it is best to seek help from a Registered Dietitian who specializes in sports nutrition and eating disorders to help the athlete build better relationships with food and their bodies.  

Thanksgiving with an Eating Disorder

Thanksgiving with an Eating Disorder

Thanksgiving, a time to give thanks for all you have and enjoy the day eating delious food with loved ones. Sounds good, right? This holiday can act as a huge trigger and bring alot of anxiety to those suffering with an eating disorder. The entire day is allegedly built upon the foundation of food. The expectation is to eat, A LOT! 

For the many struggling with eating disorders, this day can be very overwhelming; eating off schedule, eating risk foods, food prepared by others, worrying about what and how much they eat before the holiday even started.  Then add the stress of being “watched” by family members.  And of course there is always diet or weight talk by some relative!  “I’ve gained 20lb this year, starting new with my diet after the holidays”, “I’ve been eating so good all week so I can indulge today”, “I’m starting my 3 day cleanse tomorrow”, “You look so skinny have you been eating”?  There always seems to be some kind of conversation regarding weight, diet, and exercise.  I’ve heard it in my family as well, and I quickly give the evil eye and change the subject.  Nope, sorry, I will not allow this conversation in front of my chidren or be the topic of conversation on a day I am looking to relax and be thankful for all we have.  In fact, I will not engage in fat talk or the latest diet trends anytime!

Take the focus off the food, calories, and weight.  Enjoy being with family and friends and take pleasure in honoring your hunger with nourishing foods as you should any day of the year.  

Tips to Survive Thanksgiving for those with eating disorders or disordered eating:

1.  Steer Clear of  Negative Body Talk!  Don’t allow others to make comments about how bad or good they’re being, how they need to work off the food tomorrow, or how they worked out this am to stuff themselves.  When others start using negative body talk, shift the conversation!   Let’s talk about what we are grateful for.

2.  Don’t Restrict!  Restricting before a holiday meal is a sure way to lead to a binge.  Eat a balanced breakfast and premeal snack.  People talk about Thanksgiving dinner like it’s the last meal.  But, there are no rules stating you have to eat yourself to the brim.  Eat as if it is any other day.  

3. Honor Your Hunger and Fullness.  Allow yourself to eat when feeling hungry and listen to your body when it say’s you have had enough.  You do not need to eat it all today, as you can have some again tomorrow.

4.  Partner Up!  Have someone to lean on that truley understands what you are going through.  Either someone physically there or someone you can call or text.  Step away and use your coping strategies.

5.  Affirmations!  Put an end to the  negative thoughts and replace with positive affirmations, “Food is not the enemy, it is nuturing and healing”, “I am strong, fierce, and brave”, “I am worthy of love from myself”.

6.  Forget The All or Nothing Mindset.  Depriving yourself of special holiday foods or feeling guilty over a food choice is not helpful.  Listen and be in tune with what your body wants and needs.

7.  Remember the Reason for the Season.  Although it seems Thanksgiving is all about food, try to remember what it is really about.  Focus on what you are grateful for and honor your journey to recovery by eating foods you want, listening to your body’s cues, keeping your support system close by, and avoid engaging in “fat talk”. 

Remember, the food you eat and your size does NOT define you or your worth.  Enjoy the day and have a happy and healthy Thanksgiving!  – Suzanne Iovanni, Building Better Nutrition

Orthorexia:  When Healthy Eating Makes You Sick

Orthorexia: When Healthy Eating Makes You Sick

A preoccupation with healthy eating can lead to a form of dysfunctional eating called orthorexia. It is on the rise and the athletic population is at a higher risk. The condition starts as an innocent attempt to improve nutrition and/or performance.  Yet, it often leads to elimination of too many foods or food groups, labeling food as good or bad, clean, pure, or correct.

Can healthy eating really be a problem and turn against you?  If it becomes an unhealthy obsession that impacts one’s social life, self-esteem, and anxiety, then yes, it can be a problem!  ‘Ortho’ means correct and ‘rexia’ means desire.  In other words, a desire to be correct.

In our current food-obsessed culture, it can be a slippery slope with healthy eating.  All sorts of people (non-nutrition experts) are pushing fad diets, cleanses, fasts, sugar-free, flour-free, gluten-free, dairy-free, vegan, you’ve heard it all, right?  When someone needs to follow a restricted diet due to health or multiple food allergies, they are followed by a registered dietitian to ensure adequate nutrition intake.  But, when you log on to social media and keep seeing posts or articles from non-nutrition experts putting the fear of food on you and making you feel bad for eating a processed food, or asking you to spends lots of money on a special supplement or drink (which is processed by the way), don’t listen, just delete.  

Many of my clients suffer from orthorexia, although they may look happy on the outside, they are hurting on the inside.  I met with a teen yesterday, whom  I’ve been working with for the past few years.  Although he continues to struggle with some anxiety and negative thoughts around food, he is recovering from orthorexia.  He is a bright, athletic, popular teen and he stated to me that he would have full blown panic attacks if asked to eat a homemade cookie.   He was at his lowest point when his orthorexia was high, he socially isolated himself from friends, avoided doing things he loved if it involved eating away from home.  He did not enjoy holidays due to the high anxiety he would have from eating non-pure foods or foods prepared from someone else.  I am happy to say he has worked very hard and has been persistent at fighting this disorder!  

Recovery from orthorexia does not mean you can not eat healthy, nourishing foods.  You will still heat healthy, but the difference will be your understanding of what healthy eating is.  You will realize that food will not make you a better person and you will not base your self-esteem on the quality of your diet.   

If you find yourself tying one fad diet to the next, or find yourself with an unhealthy obsession with healthy eating, please seek help by a registered dietitian who specializes in disordered eating.  Orthorexia is a serious disordered eating pattern that can have mental and physical health consequences.  You may know alot about food and food science, but the information you receive may not always be accurate as the information may come from non-reputable sources.  When following social media, look for nutrition advice from qualified nutritionists.  




What is Intuitive Eating?

What is Intuitive Eating?

Forget the rules, restrictions, and control!  Intuitive eating is an approach developed to help people heal from the side effects of dieting.  We are born as intuitive eaters, it isn’t until rules and restrictions (DIETS) are set around food that we lose our inner intuitive eater.  Diets often result in repercussions – labeling food as good and bad, restriction leading to binging, feelings of failure if you eat a “bad” food. An intuitive eater honors their hunger, respects fullness, and enjoys the pleasure of eating.  Listen – really listen.  Focus on the diverse, delicious, nutritious foods you CAN have, rather than what a diet tells you, you can’t have!  When you eat nutrient dense whole foods, focus on how well you feel and realize you deserve to feel like the best version of yourself! Be kind and nurture yourself.  Eat well to feel well and this will inspire you to exercise and motivate you to sleep soundly.  It’s a journey to get back to intuitive eating and it starts with rejecting diet mentality and make peace with food by allowing unconditional permission to enjoy and eat all kinds of food. The 10 Principles of Intuitive Eating

  1. Reject Diet Mentality
  2. Honor Your Hunger
  3. Make Peace with Food
  4. Challenge the Food Police
  5. Respect Your Fullness
  6. Discover the Satisfaction Factor
  7. Honor Your Feelings without Using Food
  8. Respect Your Body
  9. Exercise – Focus on How You Feel
  10. Honor Your Health

Let’s build BETTER NUTRITION not perfect nutrition.

Reference:  Intuitive Eating by E. Tribole and E. Resch.

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