The Importance of Donuts in Eating Disorder Treatment
Is it OK to give my child donuts?
Should donuts be incorporated into eating disorder treatment?
Why is it so hard for my child to eat a donut?
Today is National Donut Day and it sparked something in me when I saw it on Facebook. ‘Donuts’- they get their own day! They are loved by many. Something to be celebrated! Usually surrounding a fun gathering or occasional or special morning coffee date.
But in my time working with children with eating disorders in Columbus, Ohio, ‘donuts’ have meant something completely different.
I have seen donuts bring tears, screaming, fighting, storming off, name calling, among other things.
In youth with eating disorders, particularly anorexia nervosa, donuts can be what we call a “fear food” or “challenge food”. In eating disorder treatment, a “fear food” is typically a list or a group of foods that elicit fear due to the negative thoughts and feelings about it’s nutritional content. It can be a specific food (donut) or a group of foods (carbs). Sometimes these foods are arranged in a hierarchy, list or grouping to help distinguish less feared from most fear or most difficult to less difficult. In the context of eating disorders, many of the ‘typical’ “fear foods” are foods that are perceived as ‘bad’ in society (diet culture) in that they are perceived to lead to weight gain, have a large amount of calories or sugar or are perceived to be ‘unhealthy’. They can also be foods that induced a fear of over-eating or binge eating based on a child’s past experience with that food.
Fear foods can develop in many ways- sometimes friends or family’s comments or actions around certain foods can lead to the perception that food is ‘bad’ or to be avoided. Think about how we as a society and culture talk about cake at a birthday party- “Oh, I’ve been eating clean all week so I could have this cake”, “I’m gonna be bad today and have this cake”, “OK take it away or I will eat the whole thing!”. This language is so common and so pervasive in our culture, kids are bound to pick up on it. They can interpret that cake is something to be avoided, that it must be compensated for elsewhere in our diet if we have some, and that we are ’bad’ for eating it and won’t be able to control ourselves around it. These things are only true if we are restricting foods and our body is crying out for those nutrients and foods. Fear foods can also come from advertising and media. Think about campaigns focused on obesity- they typically promote raw fruits and vegetables and villainize foods like soda, chips, candy with big X’s or red lines through them- creating the message that these foods are inherently bad and should be avoided and that if you consume them you will gain a lot of weight.
We know from years of research on dieting, eating disorders and intuitive eating, that the healthiest diet and relationship with food is one that includes all foods freely and with a lot of variety.
A healthy diet is one without restrictions or rules (unless there are documented food allergies) and where you can trust your body to guide you to include all the nutrients you need. This means having a wide variety or fruits, vegetables, carbohydrates, proteins and fats. It also means living life freely and fully and being able to have ice cream on a hot summer day and cake at a birthday party and pizza on Friday nights, without having extremely guilt or shame and the desire to “make up for” or compensate for it in some way.
All of this to say, donuts are important to eating disorder treatment and recovery. We know that our children’s anxiety is extremely heightened during eating disorder treatment. They are often being forced to eat larger quantities and more frequently than they have in a long time. As a parent, it is natural and normal to want to do everything you can to comfort your child during this difficult time and want to try to decrease their anxiety. Unfortunately, lowering your child’s anxiety by avoiding fear foods will only turn to make their anxiety higher in the long run. We know that the best treatment for anxiety is ‘facing your fears’ or exposure therapy. Avoidance of your anxiety triggers, only makes anxiety bigger and stronger. In order to overcome anxiety, we have to face it, tolerate whatever distress it brings, and see that we are OK and survived and this helps to reduce our anxiety and know we can handle that thing again.
When it comes to eating disorder recovery, this means facing the fear food, tolerating the distress, eating the food and not compensating for the food, seeing that we are alive, OK and did not gain a bunch of weight, and being able to eat that food again and again until the anxiety is gone or very low. For parents and caregivers, this means continually serving, presenting and helping your child to complete fear foods over and over throughout treatment. Many parents have shared with me, “I wish we would have started fear foods in the beginning”. It can be tempting to serve your child’s ‘safe foods’ (foods they can eat without much distress, typically low calorie foods, lacking appropriate carbohydrates and fats). You are a parent and you just want your child to eat and not be upset-that is normal! And we know it is not what is most helpful for them. You might think, “well at least she’s eating something!”, but I can tell you from experience, sticking to safe foods only prolongs the eating disorder and prolongs treatment.
So my advice to you on National Donut Day is go get those donuts. Serve your child the donut. It will be hard. It might be exhausting and stressful. There could be tears or yelling or name calling. And you can do it. And it is helping your child to get better. It is fueling their brain and their body. It is defeating the eating disorder each time you do it. It is helping your child to be able to live a normal life where they can have donuts with their friends at a sleepover. It is starting a path to food freedom and intuitive eating and a life without stress and anxiety over calories and numbers. It is so, so challenging right now and it is not the easy thing to do to get them the donut. And you can do it with the right support and the right treatment team.