How to Spot an Eating Disorder...and Apply Biblical Solutions

Dr. Richard K. Thomas, NANC Fellow and President of Mt. Carmel Ministries, just gave me a great idea.

He posted the link to an article written by Dr. Mehmet Oz, entitled "How to Spot an Eating Disorder in Teens", an excellent descriptive summary of eating disorder symptoms. He then suggested that a biblical counselor might go one better by "lay[ing] alongside each of them biblical solutions for lasting change." (Is Dr. Oz the Oprah guy? I don't watch TV but that name sounds familiar).

I said to myself, "Self, that really is an excellent idea for a blog post! So much better than that scathing review of Rx Nation I was planning to write, discussing the evils of Prozac and unmasking the corruption between the FDA Advisory Board and the big drug companies. Yes, this will be a much more edifying experience, indeed."

I am sure that much more could be said from a biblical perspective on each of the characteristics Oz lists, but I will try and give succinct principles and possible approaches the biblical counselor might use. (For the sake of brevity, I will not quote entire verses and passages, but would encourage the counselee to simply look up each reference.) Do read Dr. Oz's article first; quotes from his article are indented below.

Oz lists the following signs (or symptoms) as indicative of a possible eating disorder:

Excessive concern about one body part: If he or she talks about one body part that seems just fine to most other folks around them, it could be a sign of an obsession that may manifest itself in the teen controlling their nutrition in unhealthy ways. While everybody’s perceptions about what’s normal are different, it’s okay to use the ‘reasonable standard’ here—that’s because those with eating disorders tend not to see their bodies in ways that most others do. A preoccupation with appearance or body weight that gets in the way of daily life is a good tip-off that she has crossed from more than just a healthy, teen-like concern about appearance.

This fixation indicates an obvious misunderstanding of God's definition of beauty. She must be reminded that God, who sovereignly created her the way she is for His own purposes, does not judge or rank by outward, physical appearances as humans do (1 Sam. 16:7). His definition of beauty is what she must learn to embrace (Proverbs 31:30; 1 Peter 3:4-5; Acts 9:36).

One of the manifestations of pride is being overly-self critical and self-deprecating. This keeps one's focus inward on self, rather than on pleasing God and living for His glory. The counselee needs to be reminded that she was made in God's image, and by extension, is to be conformed increasingly to the image of Christ (Romans 8:29). To do this, she must learn to renew her mind with the Word of God (Romans 12:2). As she "puts off" the idolatrous preoccupation with her body, she will "put on" the "gentle and quiet spirit" (1 Peter 3:4) of a woman set on following God.

Another passage to discuss with her would be Colossians 3:1-3, which instructs believers to "set your minds on things above, not on earthly things." If her mind is obsessed and preoccupied with her physical flaws, (real or imagined), is it set on "things above"? Finally, she must be taught to shift her focus from self to serving others. This pleases God and will bring her true joy, if her motive is love for Christ.

Unusual eating rituals: This can include rearranging food on the plate, excessive chewing, eating food in a certain order, or having to measure all food consumed. While being smart about healthy food choices is key to maintaining a healthy lifestyle, overly ritualistic behaviors may be a sign that someone is crossing the line between health-conscious and dangerous.

I would first try to learn the counselee's thinking behind the rituals or habits. Just as in counseling a person with an obsession or compulsion, I would want to know: "What are you afraid of?" Once we can learn the counselee's thinking behind the "rituals", we can consider how it differs from biblical truth. For example, if she cuts her peas in half and eats them individually, she may feel that this gives her a measure of "control", which she fears losing. My next question would then be, "How does God's sovereignity fit into this?" Dr. Robert D. Smith writes: "...the person is living by the security of [her] feelings, which [she] cannot make secure. [Her goal must be changed to a biblical goal, and [she] must live by that rather than by her own security checks." ("Christian Counselor's Medical Desk Reference", p. 359).

Rather than going directly into a discussion of Christian liberty in what may be eaten (Mark 7:19; Acts 10:10-15; Tim. 4:4), I would focus on the fears and false beliefs underlying the rituals. When behavior is unbiblical, the behavior is not the problem - the heart is (Matt. 15:18-19; James 1:14-15). What preconditioning factors have contributed to the counselee's current deception and habits/rituals? The biblical view of man provides us the guideline for 'normal' (ie God-honoring) behavior, and change in thinking and behavior is accomplished through the put off/put on principle of Ephesians 4.

Changes in posture: Those who have eating disorders will often try to hide their appearance (the sudden and extreme weight losses) by wearing baggier clothes or hunching over. They do this to cover their tracks, so that adults can’t see these body changes and get a clue about their eating-related behavior changes.

Excessive solo behavior: When someone makes a point of trying to eat alone or taking time right after a meal, it may be a sign that she is really restricting the amount she eats or bingeing and/or purging afterwards. It is important to remember that behaviors do help define eating disorders, but the root of the problems has to do more with the feelings and thoughts that the person has about his or her body.

These two warning signs really go together, because they are different symptoms with a common denominator: calculated deception. The Bible has much to say about lying, deceitfulness, covering over one's sin, and attempting to portray one's self in a false light (which is what eating disordered women do). Psalm 51 speaks directly to the spiritual consequences of "covering one's tracks" - enormous guilt produced by the original behavior is compounded by the shame of concealing it. David will do anything for relief - which ultimately leads him to do the one thing God requires: confess his sin and repent.

Other passages which speak to the seriousness of deceit include many Proverbs and Psalms, including Proverbs 14:8, 20:17 and 26:24. The solution is straight-forward, although not easy: "Therefore each of you must put off falsehood and speak truthfully to your neighbor, for we are all members of one body." (Ephesians 4:25). Women enslaved to anorexic or bulimic behaviors attempt to deceive those around them for two basic reasons: shame (they know the behavior is wrong) and pride (a desire for the admiration of others, while concealing the secret to their slimness.) "I must look better than my sisters," she thinks, which gives way to a form of self-induced legalism ("I can never eat sweets.") When she breaks one of her rules, she gives in to self-indulgence ("I failed, so I might as well give up") and often binges. This "failure" must be hidden from others at all costs. The counselee needs to be taught humble reliance and confession of sin. Once she has learned this and to use the resources God has provided (counseling; accountability), she will be able to rejoice in God's grace and love. In this way, she will be transformed -- and no longer feel the need to "hide".

Increasing self-consciousness: Eating disorders seem to burrow into the brains of their victims, take over their thoughts and grow stronger every day. They build a “fat box,” where every comment, every situation, is filtered through the box and distorted, so that it comes out as a criticism or demand. “You look great today” becomes “You usually look fat.” “You look so healthy” becomes “You’re eating too much.” “I love your hair” becomes “I can’t find anything nice to say about the rest of you.”

"Fear of man" is the biblical term for "self-consciousness". It is the opposite of humility - which has been defined as "thinking of one's self less; not thinking less of one's self." Dr. Oz correctly points out that the eating disorder has "burrowed into the brain" of the counselee (although she is not a "victim"). Therefore, she will have to learn how to "take every thought captive to make it obedient to Christ" (2 Corinthians 10:5). Eating disorders are learned behaviors, which can be unlearned. Wanting to be thin so badly that she is willing to sin (by abusing her body) is idolatry. Putting opinions of others (actual or perceived) above God's priorities (holiness; serving Him) is fear of man. If she allows these comments to affect her to the point where she sins, she fears and respects people more than God (Proverbs 29:25).

The eating-disordered woman may, indeed, have been hurt by other people's sins, but as long as she remains feelings-oriented rather than fact-oriented she will not have the mind of Christ (Romans 15:5). Will she choose to believe what God says - that she was chosen in Christ from the foundation of the world and declared righteous because of His perfect life, death and resurrection on her behalf; or, will she judge her own inherent "righteousness" according to the world's standards? The goal to which we must point her is to seek each day to glorify God with her life - whether she feels like it or not (as Jay Adams is so fond of saying).