“I was always the chubby kid in class and I’m big-made. Initially I was at a girls’ school. I was not pressured in any way, and I’m sporty so I was naturally driven to be more masculine. But then, I transferred to an international school and things got interesting. I am 5’8’’ and have broad shoulders, so many people said I look like a man, which is not true. But overall, I do look masculine, I think. But it’s not a problem. I did martial arts, rowing, and physically-demanding sports, so I understand. Up until 19, my relationship with food was ok. I would eat whatever and a lot of it. My dad would call me a fat cow, which I ignored until I hit 19. I had a bad breakup, had to stop sports, and fell into depression. I wanted to get that ‘glow-up’ revenge from my ex, and when I got my first proper phone, I discovered a fitness app that allowed me to count calories.
I started skipping meals, and working out way too much. I would walk from Borella to Ethul Kotte sometimes and spend the whole day on juice. I had body dysmorphia. Anybody would look pretty to me, while I’d look like garbage. I started losing hair, falling sick, and didn’t get my period. I was losing myself, my friends, and my social life, because if I went out, I knew I’d eat. I’d cup my hands around my waist, and my hands needed to touch each other and my waist needed to go in completely. When it was unbearable, I would run to the fridge and inhale everything there. I started watching modelling shows and that triggered me more.
Going vegan in 2020 helped me improve my relationship with food, but I still have severe body dysmorphia. I don’t see myself as pretty. I workout a lot and I cut calories. But, it's better than before. It comes and goes. Nobody knows that I have an eating disorder except maybe two people. Even if I told anybody, I’d probably be invalidated. They’d say ‘you don’t need a doctor, just eat’, so I’m working on myself. My mom is a workaholic who either eats very little or forgets to eat. So they wouldn’t go to doctors about food. But things have definitely improved I feel.”
The call ends and there is deafening silence. A brave soul, battling an eating disorder, had spoken with so much honesty, laying bare critical issues prevalent in our families, schools, mental health awareness, and relationships. In commemoration of World Eating Disorders Action Day, 2 June 2021, Brunch peered head-on into the stark world of eating disorders.
[caption id="attachment_140669" align="alignright" width="281"]
“Imagine the patient being stuck in a rut and being unable to see anything outside of it. So the deeper the rut, the harder it is to get them out of it” Sigrid de Silva [/caption]
Sigrid de Silva: Senior Dietitian, Nutrition Consultant, Lifestyle and Wellness Expert, Author
What are the most common eating disorders that you have encountered in Sri Lanka?
Anorexia Nervosa, a severe restriction of food that leads to starvation and malnutrition, even death. Bulimia, which has several combinations and can present as binge-eating, compulsive overeating, or binge-eating followed by purging. Orthorexia, while not so common in Sri Lanka, is spreading across the globe and may be prevalent here. It starts with individuals being obsessed about eating healthy food only (usually beginning with going all-organic) and then continues until they have cut off so many food types that they have barely anything left.
What is nutrition therapy in the context of eating disorders?
Ideally, the treatment needs a team that consists of a psychologist/therapist specialising in that area, a physician to study any physiological issues that may have occurred depending on the severity and duration of the issue, and a dietician/nutritionist. Proceeding with a client needs to be extremely cautious because if you push too hard, you could destroy any progress that may have been achieved. The first session needs to consist of listening, followed by gradual steps to reinforce positive progress. The importance of having a balanced nutrition for our survival needs to be communicated to the client/patient.
What is the impact of social media on eating disorders?
The impact is immense. The internet as a whole can provide certain sources which may encourage an individual to abuse their relationship with food. With extensive access to information, and inadequate regulation of what content is being watched, especially in children and teenagers, the risk increases. Parents, caregivers, and friends can watch out for telltale signs such as weight loss, solitude-seeking tendencies and changes in eating habits. In addition, one should not seek treatment for conditions such as IBS, which restricts food intake, through the internet. If you need a dietary change, please consult a professional.
How is healthy eating reintroduced to those in treatment?
After a few sessions and due consideration of lab reports and positive progress, using the help of a psychologist and making careful suggestions according to the preferences of the patient is recommended. This varies from case to case. However, pushing too much too soon is ill-conceived. One should also look out for deceptive behaviours, which is a common action among those in treatment, which is why lab reports to check liver function and scales to study body weight are important.
[caption id="attachment_140667" align="alignleft" width="289"]
“Individuals suffering from eating disorders gain a sense of control and higher self-esteem through the control of food intake. The perception that they have of their bodies is distorted” Ammarah Ashraf [/caption]
Ammarah Ashraf: Clinical Psychologist (MPhil), Shanthi Maargam/Wellness Counsellor; Global Press Journal and Lecturer
What’s the psychology behind eating disorders?
Individuals suffering from eating disorders gain a sense of control and higher self-esteem through the control of food intake. The perception that they have of their bodies is distorted. They would consider an underweight person to be beautiful, while seeing themselves as “fat” when they aren’t. They have reduced sensitivity to hunger pangs, and other symptoms stemming from food abuse. Their cognition consists of feelings of inadequacy, impulsiveness, perfectionism, low self-esteem, and poor coping mechanisms. Their preoccupation with food is obsessive and usually stems from childhood trauma, presenting clinically, between 15-35 years. Emotionally, they have an intense, uncontrollable fear of weight gain, and depressive and self-harm feelings.
What are the risk factors?
Adolescent females have an increased risk of developing eating disorders prompted by physical, hormonal, and mental changes. Genetic factors, authoritarian parenting, childhood or sexual abuse are the main risk factors. Children who are picky eaters or experiencing gastrointestinal issues are at a higher risk. Children and adolescents with anxiety disorders, social phobias, or who are victims of bullying, may develop eating disorders to gain control, soothe themselves, and battle self-esteem issues. Parents who are over-controlling, or demand high-achievers, or who restrict and criticise a child’s diet, can contribute to this.
Are there cultural factors specific to Sri Lanka that can exacerbate eating disorders?
Girls are expected to fit into a certain “appearance” so that they can get married. Parents are often pressuring children to do exceptionally well in school, starting from the Grade Five scholarship exams. Parents also compare their child to other children, resulting in poor self-esteem. Increasing numbers of child sexual abuse, witnessing domestic vioence are also factors. In Sri Lanka, psychosomatic issues like IBS (Irritable Bowel Syndrome) can be ignored; patients are told “it's all in your head”. Add to this that the causality of these conditions are idiopathic and they are chronic conditions, patients can be at risk.
What is the role of social media in eating disorders?
Social media activates inadequacy and constant self-comparison in all of us. It initiates unrealistic levels of perfectionism and competition, often resulting in insecurities. If an individual is unable to handle their emotions healthily, eating disorders can occur. The various celebrity diets and weight loss plans/apps can have a psychological impact too.
Are there support systems in place to help those afflicted?
Free psychological services such as Shanthi Maargam are available. There are a number of hotlines available. It is mandatory that people reach out to any such source if they feel that they have a negative relationship with food or are under stress due to untreated gastrointestinal or psychosomatic issues. Both the public and private sector offer support, but there is a general lack of awareness that needs to be remedied.
[caption id="attachment_140668" align="alignright" width="288"]
“I had people question my food consumption during gatherings, where if I served too little they’d assume I was pretending. If I served more, they’d judge me for over-eating” Dominique Croos Sedra[/caption]
Dominique Croos Sedra: Freelance Beautician
What has been your experience with body positivity and feeling judged for your weight/body structure?
Women are expected to fit into a certain beauty standard – men are too, but it is more severe for women. In the beauty industry, I see a woman of size six or eight wear spandex. It doesn’t make sense. This unrealistic ideology of having a perfect body definitely contributes to eating disorders. Body positivity to me, is accepting my body. I was thin until I hit puberty, and I was shamed for gaining weight. It hit me suddenly that I shouldn’t care about what others think of my body as long as I like it. My body has gotten me so far in life, so I should appreciate it.
How can one nurture body positivity?
I recommend taking pictures of your body daily and looking at it more often. Don’t hide your body, and unfollow models or anybody who makes you feel poorly about your physique. Ignore those who diminish the way you look or tell you to go on a diet. I had people question my food consumption during gatherings where if I served too little they’d assume I was pretending. If I served more, they’d judge me for over-eating. Damned if you do, damned if you don’t – so ignore everyone and be you.
Food is a basic human necessity, but not one that should be feared. Anything you eat, you can burn and metabolise with a healthy nutrition plan and workout regime. Eating disorders are not pitchfork-bearing demons; they are merely an end result of unresolved conflict, poor relationships, and the lack of mental health awareness.
We all have a role to play in normalising different body types and only promoting fitness and good health as opposed to “toned and thin”, “thigh gaps”, or “washboard abs”. As long as we shy away from talking out the perceived taboo, and as long as we ogle at a plate full of food, eating disorders will continue to claim lives.
[caption id="attachment_140669" align="alignright" width="281"]
“Imagine the patient being stuck in a rut and being unable to see anything outside of it. So the deeper the rut, the harder it is to get them out of it” Sigrid de Silva [/caption]
Sigrid de Silva: Senior Dietitian, Nutrition Consultant, Lifestyle and Wellness Expert, Author
What are the most common eating disorders that you have encountered in Sri Lanka?
Anorexia Nervosa, a severe restriction of food that leads to starvation and malnutrition, even death. Bulimia, which has several combinations and can present as binge-eating, compulsive overeating, or binge-eating followed by purging. Orthorexia, while not so common in Sri Lanka, is spreading across the globe and may be prevalent here. It starts with individuals being obsessed about eating healthy food only (usually beginning with going all-organic) and then continues until they have cut off so many food types that they have barely anything left.
What is nutrition therapy in the context of eating disorders?
Ideally, the treatment needs a team that consists of a psychologist/therapist specialising in that area, a physician to study any physiological issues that may have occurred depending on the severity and duration of the issue, and a dietician/nutritionist. Proceeding with a client needs to be extremely cautious because if you push too hard, you could destroy any progress that may have been achieved. The first session needs to consist of listening, followed by gradual steps to reinforce positive progress. The importance of having a balanced nutrition for our survival needs to be communicated to the client/patient.
What is the impact of social media on eating disorders?
The impact is immense. The internet as a whole can provide certain sources which may encourage an individual to abuse their relationship with food. With extensive access to information, and inadequate regulation of what content is being watched, especially in children and teenagers, the risk increases. Parents, caregivers, and friends can watch out for telltale signs such as weight loss, solitude-seeking tendencies and changes in eating habits. In addition, one should not seek treatment for conditions such as IBS, which restricts food intake, through the internet. If you need a dietary change, please consult a professional.
How is healthy eating reintroduced to those in treatment?
After a few sessions and due consideration of lab reports and positive progress, using the help of a psychologist and making careful suggestions according to the preferences of the patient is recommended. This varies from case to case. However, pushing too much too soon is ill-conceived. One should also look out for deceptive behaviours, which is a common action among those in treatment, which is why lab reports to check liver function and scales to study body weight are important.
[caption id="attachment_140667" align="alignleft" width="289"]
“Individuals suffering from eating disorders gain a sense of control and higher self-esteem through the control of food intake. The perception that they have of their bodies is distorted” Ammarah Ashraf [/caption]
Ammarah Ashraf: Clinical Psychologist (MPhil), Shanthi Maargam/Wellness Counsellor; Global Press Journal and Lecturer
What’s the psychology behind eating disorders?
Individuals suffering from eating disorders gain a sense of control and higher self-esteem through the control of food intake. The perception that they have of their bodies is distorted. They would consider an underweight person to be beautiful, while seeing themselves as “fat” when they aren’t. They have reduced sensitivity to hunger pangs, and other symptoms stemming from food abuse. Their cognition consists of feelings of inadequacy, impulsiveness, perfectionism, low self-esteem, and poor coping mechanisms. Their preoccupation with food is obsessive and usually stems from childhood trauma, presenting clinically, between 15-35 years. Emotionally, they have an intense, uncontrollable fear of weight gain, and depressive and self-harm feelings.
What are the risk factors?
Adolescent females have an increased risk of developing eating disorders prompted by physical, hormonal, and mental changes. Genetic factors, authoritarian parenting, childhood or sexual abuse are the main risk factors. Children who are picky eaters or experiencing gastrointestinal issues are at a higher risk. Children and adolescents with anxiety disorders, social phobias, or who are victims of bullying, may develop eating disorders to gain control, soothe themselves, and battle self-esteem issues. Parents who are over-controlling, or demand high-achievers, or who restrict and criticise a child’s diet, can contribute to this.
Are there cultural factors specific to Sri Lanka that can exacerbate eating disorders?
Girls are expected to fit into a certain “appearance” so that they can get married. Parents are often pressuring children to do exceptionally well in school, starting from the Grade Five scholarship exams. Parents also compare their child to other children, resulting in poor self-esteem. Increasing numbers of child sexual abuse, witnessing domestic vioence are also factors. In Sri Lanka, psychosomatic issues like IBS (Irritable Bowel Syndrome) can be ignored; patients are told “it's all in your head”. Add to this that the causality of these conditions are idiopathic and they are chronic conditions, patients can be at risk.
What is the role of social media in eating disorders?
Social media activates inadequacy and constant self-comparison in all of us. It initiates unrealistic levels of perfectionism and competition, often resulting in insecurities. If an individual is unable to handle their emotions healthily, eating disorders can occur. The various celebrity diets and weight loss plans/apps can have a psychological impact too.
Are there support systems in place to help those afflicted?
Free psychological services such as Shanthi Maargam are available. There are a number of hotlines available. It is mandatory that people reach out to any such source if they feel that they have a negative relationship with food or are under stress due to untreated gastrointestinal or psychosomatic issues. Both the public and private sector offer support, but there is a general lack of awareness that needs to be remedied.
[caption id="attachment_140668" align="alignright" width="288"]
“I had people question my food consumption during gatherings, where if I served too little they’d assume I was pretending. If I served more, they’d judge me for over-eating” Dominique Croos Sedra[/caption]
Dominique Croos Sedra: Freelance Beautician
What has been your experience with body positivity and feeling judged for your weight/body structure?
Women are expected to fit into a certain beauty standard – men are too, but it is more severe for women. In the beauty industry, I see a woman of size six or eight wear spandex. It doesn’t make sense. This unrealistic ideology of having a perfect body definitely contributes to eating disorders. Body positivity to me, is accepting my body. I was thin until I hit puberty, and I was shamed for gaining weight. It hit me suddenly that I shouldn’t care about what others think of my body as long as I like it. My body has gotten me so far in life, so I should appreciate it.
How can one nurture body positivity?
I recommend taking pictures of your body daily and looking at it more often. Don’t hide your body, and unfollow models or anybody who makes you feel poorly about your physique. Ignore those who diminish the way you look or tell you to go on a diet. I had people question my food consumption during gatherings where if I served too little they’d assume I was pretending. If I served more, they’d judge me for over-eating. Damned if you do, damned if you don’t – so ignore everyone and be you.
Food is a basic human necessity, but not one that should be feared. Anything you eat, you can burn and metabolise with a healthy nutrition plan and workout regime. Eating disorders are not pitchfork-bearing demons; they are merely an end result of unresolved conflict, poor relationships, and the lack of mental health awareness.
We all have a role to play in normalising different body types and only promoting fitness and good health as opposed to “toned and thin”, “thigh gaps”, or “washboard abs”. As long as we shy away from talking out the perceived taboo, and as long as we ogle at a plate full of food, eating disorders will continue to claim lives.