At what point do we talk about food morality with undernourished individuals?
The undernourished brain has a different way of thinking than a nourished brain. The way food messaging is interpreted can be very different from what we expect, until the brain becomes better nourished.
I like to use the 8 Principles of Nutrition Rehabilitation in Eating Disorder Support and Care - using the first principle of “Enough”. This means that our first and primary goal is to help individuals to eat enough food in order to meet their biological needs. This is transdiagnostic, and not just for those people engaged in overt restriction.
It isn’t until we get to the principle of “Balance” that we may start discussing in more detail the morality of food. This doesn’t mean that we have ignored all the questions, worries, and concerns that people have along the way, but rather, it means that we can expect their brain to interpret the conversations in a healthier way.
Throughout treatment, there will be many, many, many opportunities to talk about the morality of food. Usually, my go-to approach is by using validation and reflection. This might sound like, “What I am hearing is that your eating disorder has made pizza off-limits. Tell me more about this rule?... “I can imagine that eating pizza might leave you feeling guilty because you have followed the rule of avoidance for so long. Because if you eat it, your eating disorder is left screaming accusations at you. Because it triggers racing thoughts and physical discomfort. Tell me more about what it’s like for you…”
What we want to resist is the “right-ing” reflex in these sensitive conversations. As a caring clinician, of course all that you want is to change the way a person feels about the pizza! You want to help to get them better, and help them to see that pizza is both yummy and normal! What would it be like for you to challenge yourself to ask more questions about their experience with pizza instead of educating them? What would it be like for you to ask a person if they would like to hear your thoughts and understanding of pizza? What would it be like for you to sit with the discomfort that education is not going to change the way a person feels about pizza.
Whenever we feel the need to jump in and offer education, it might be your cue to sit, listen, and offer validation.
We need to connect before we can educate.
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