Revisting Serving Sizes in ED patients

Do you remember back when we discussed portion distortion (http://anorexiarecovery1.blogspot.ca/2013/03/portion-distortion.html) and talked about how with ED patients, this tends to get a little funky? ED patients have found to have difficulty estimating how much food is on the plate at any given meal. What does this mean? That ED patients somehow see portions as actually being bigger than they really are. This contributes to how difficult recovery can be, as the patient must rely on his/her judgment in order to eat enough. Clearly, this presents a problem if the patient sees that they are eating more food than what is really on the plate. This is why many patients have a treatment team to help them, or measure their food for accuracy.

Let's consider another study that showed the same results: http://www.ncbi.nlm.nih.gov/pubmed/23276722. This study found that ED patients overestimated how much food was on the plate, and also labelled some meals as being 'large' whereas subjects without ED labelled them as 'small' or 'average/medium'. But WAIT?! What exactly IS a serving size? Not many of us actually measure our our food. This is because we usually have an instinct as to how much is enough for us - in other words, we 'know' how much to eat without meausring. This is not always the case with patients with ED. For the sake of information, let us review what a 'typical' serving size is. One serving of cheese (50g) is about the size of 2 9-volt batteries, while one serving of peanut butter is about the size of a golf ball (30 mL). A piece of meat is about the size of a palm of your habd (75g), and a serving of cooked veggies (125mL) is about the size of an ice-cream scoop or tennis ball. Now, think about your own food. Is this actually the size you eat? Probably not. To be honest, I actually have more than this! But nevertheless, this is what the servings 'look like'. But how many people actually count how many servings of the food groups they eat a day? Not many.

What is the point? Perhaps we are getting too focussed on food group servings that we forget the bigger picture: moderation is essential. If you eat the amount of cheese equal to three batteries instead of two, will you become unhealthy? Likely not. If you have an extra half-cup of vegetables, will you become a superhero? No. It is the LIFESTYLE as a whole that matters. Intake should equal output, and this should be from a variety of foods. This includes desserts as well.

While patients with ED may have a bit of portion distortion, it is not hopeless. I am getting better at realizing how much food I need, although I still have ways to go before I master this. But it is better than a year ago when I first started recovery. My mind is now more open to trying new things as well. In a way, my mind and body have adjusted to my new life without ED, and this is making me a whole lot happier! I still have times when I DO underestimate or even overestimate portions, but that is okay. Recovery is a work in progress. But as I continue, I need to remember one thing: in the long run, portions won't kill me. It is the pattern of over or under eating that will. As long as I eat everything in moderation (meaning, not too much OR too little), I will be healthy. Sure, patients with ED may have trouble getting their serving sizes right. But many other people do. This does not mean that they cannot be healthy. It simply means that maybe they need a little help or direction in realizing how much is enough.

Understanding that 'ENOUGH' means not too much or too little is important. In fact, if you ever come across the correct, medical/scientific definition of malnutrition, it is 'eating more than OR less than what is suitable to meet the demands of one's metabolism and homestasis'. What does this mean? We need to stop worrying so much about the little things that don't matter and start realizing that one's entire lifestyle is more important than a day's meals. For some, this may mean stopping to eat when they are full so that they do not mindlessly graze on food. For others (like some patients with ED), this can mean revisiting their portions and understanding how much food they should be eating. For the rest of us, this can mean eating the way we already eat because we have found a comfortable and healthy balance. To be honest, there is no one powerful almight golden rule of nutrition that states how to have a pefectly healthy life. Except for moderation, laughs, happiness, love, hope, faith, support, knowledge, care, kindness, smiles, perseverance, and good health. A recipe for success.

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