“It’s hard to eat consciously when food porn is constantly slipped on us”: an interview with psychologist Svetlana Bronnikova

Svetlana Bronnikova is actively studying eating disorders, runs a medical center and maintains a blog. She has years of practice behind her, thanks to which she managed to write the bestseller "Intuitive Eating".

We talked with Svetlana about how people get sick anorexia, bulimia and other ailments, and also asked her to talk about what intuitive eating is and how to maintain a healthy weight without diets and food restrictions.

About what causes RPP

- Eating disorders (ED) - is it only a psychological problem?

- No, now we are saying that eating disorders are genetic-metabolic psychological disorders in which the perception of one's own body is impaired.

In many families where there are adolescents with anorexia nervosa, one can find features of a similar disease in their parents. This suggests that a certain number of people in the population are born vulnerable to eating disorders. This does not mean that they will definitely get sick. But they are more prone to it.

In addition, we see that the metabolism of those with an eating disorder is different from that of normal people. For example, the metabolic processes of patients with anorexia nervosa pull their weight to the lowest point. Throughout their lives, they have to make efforts not to lose kilograms, while most other people always have the dynamics of a smooth (normally small) weight gain.

- But a person without a genetic predisposition can also get RPP?

- Yes, sure. Genetic predisposition alone is not enough: it is not a prerequisite. For example, we see that our young patients often find themselves in a toxic environment where their mom and dad are extremely concerned about weight and “proper” nutrition.

From an early age, they begin to restrict the child’s diet and differentiate foods into “bad” and “good”, “healthy” and “unhealthy”. This easily leads to adolescence he develops bulimia nervosa or binge eating disorder.

About whether it is possible to recover from RPP

— Are there many people with RPP in the world?

“There are more of them than you might think. Official statistics for decades show: about 1% of the population develops anorexia nervosa, about 1.5-2% - bulimia nervosa, about 2.5-3% suffer from binge eating. And these are only those who reach the specialist.

And there are still many people who have not been diagnosed. It also has to do with accessibility. psychotherapeutic help, and with its cost, and with the continuing fear of a psychologist, psychiatrist and psychotherapist (who are all confused).

This is also due to the fact that RPPs are polymorphic. Flowing from one to another, they do not always meet clear diagnostic criteria. So, most often, experts observe the presence of symptoms from various disorders: one or two from anorexia, one or two for bulimia... But in order to make a diagnosis, you need a complex of at least five signs.

About 60% of eating disorders cannot be described by any single diagnosis.

Therefore, there are more people with eating disorders than official statistics show. It affects less than 10% of the population. But, according to other studies, the symptoms of eating disorders and dissatisfaction with your body 7–8 women out of 10 have it, as well as 4–5 men out of 10.

- And how many years can treatment for RPP take?

- We do not use the word "treatment", we say "recovery". A person who has never had an eating disorder or worked in this field has the illusion that any disorder can eventually be cured. But it's not.

The truth is that people who are recovering from eating disorders will have to pay attention to this area at all times. It will not work to live without thinking about food and weight at all - the way those who have never encountered this live.

However, full recovery does not mean 100% absence of symptoms. It implies only the absence of pronounced signs, such as excessive workout, induction of vomiting, constant restriction of oneself in food. Full recovery also provides for a sufficient level of psychological comfort, which allows you to direct attention not only to the body, but also to other areas of life.

This process depends on how much time is needed to correct biological parameters. If we take into therapy a person with a normal body mass index, he will recover faster than someone with a low stat. The second will first need to reach a certain weight and only then try to function normally again - study, work, lead a social life.

I dread stories of miraculous healings. I have not seen an effective recovery last less than a year.

 What is the difference between RPPs

- Is there any gradation of eating disorders? For example, is it better to be an overeater than anorexic?

- If we talk about the severity, then the most serious threat to our body is underweight. Since the body mass index of 17.5 and below entails a number of devastating consequences.

Not only in the form of hair loss or dry skin - those symptoms that can be considered more cosmetic. First of all, hormonal and reproductive health suffers. With a low BMI, most women miss their periods, and they artificially enter a period of menopause, which is physiologically unusual for them.

This means a huge risk to bone health. Osteopenia appears osteoporosis - diseases that occur in older people, when calcium begins to catastrophically leach out of the body.

Very serious consequences also await the gastrointestinal tract. And with anorexia nervosa, and with systematic malnutrition, and with bulimia nervosa, we see chronic gastritis, gastroduodenitis and all kinds of disorders of the gastrointestinal tract, which require attention even after a person recovered.

Anorexia and bulimia affect literally all organs and systems. Even on the teeth. Since people with bulimia nervosa constantly vomit, stomach acid eats away at them. teeth so that sometimes you have to change the entire jaw completely.

- And if we talk about overeating, how do its types differ: emotional, compulsive, paroxysmal?

— In Russian, where scientific concepts related to eating disorders have not yet settled down, there is a big terminological confusion. People constantly confuse emotional, compulsive, and binge eating. Although in fact there are absolutely clear criteria here:

• Compulsive overeating - this is overeating of any genesis, of any origin, when we absorb food without a feeling of hunger and as if against our will. This is a story from the series “didn’t want to, but overate.” And this manifestation is characteristic of all forms of eating disorders. Both patients with anorexia nervosa after prolonged restrictions and patients with bulimia nervosa compulsively overeat, subsequently causing vomiting.
• Binge eating is a separate form of compulsive eating. It implies the consumption of a very large amount of food - 2,500, 3,000 or more kilocalories in one sitting. During an attack, such people experience a loss of a sense of control: “I understand that I overeat, but I can’t stop.”
• Emotional eating is a variant that isn't really about food, but about emotional regulation: "I eat to deal with my feelings." By the way, not always negative. People overeat not only when they are sad, but also when they are happy - they note something, celebrate.

You also write about orthorexia, a disorder in which people refuse certain foods. If we take vegetarianism or veganism, do all the followers of these movements have it?

Not all vegans and vegetarians have an eating disorder. Yes, there is a high percentage of people with eating disorders in this population. But that doesn't mean that they are all orthorexes.

The question of motivation is important here. The population of Buddhist monks is 100% vegan. They are guided by the belief that no living being should be hurt. However, you will not find people with orthorexia among them. Moreover, many of the Buddhist monks are obese - they gain weight due to restrictive nutrition and low amounts of protein.

There are people who came to vegetarianism and veganism for ethical reasons: "I don't want to eat meat so as not to make it bad." And there are those who chose this path for orthorexic reasons: “I don’t want to eat meat, because it makes bad to me". People with symptoms of eating disorders, like everyone else, are looking for a theory, a framework that would justify them and explain their behavior. In my opinion, this is where the border lies.

On whether RPP existed before

— Why has RPP recently taken on the character of an epidemic?

— I don't think so. I would say that, like many other problems, RPP just became visible. Even 7 years ago, when my book about intuitive eating was published, there were no specialists, no activists, no discussions on this topic in the public field. It was as if the problem didn't exist. Although people fell ill in exactly the same amount.

It was only later that a whole series of publications appeared: interviews in which famous personalities talked about their struggle with eating disorders, fiction and non-fiction books, documentaries and programs.

People with eating disorders have become visible. They began to make themselves known. What happened in English is called awareness - an increase awareness regarding the problem. And the nature of the epidemic, which you mentioned, has been acquired since the 1970s.

- With the development of the fashion industry and the emergence of models like Twiggy?

“I would really like Twiggy to be left alone. She is not to blame for anything. When we claim that because of her standards have changed in the modeling business, we say as usual: the truth, but not the whole truth.

Because at that moment, in general, a culture of thinness appeared. She marketed the dietary approach as the only one possible. As if only by limiting food, you can be healthy and weigh as much as physiologically intended. This mechanism, as it turned out, sells so well that... I do not believe that in the near future the industry will abandon it.

After all, we understand that dietary and the fitness industry is the richest segment of the market. He earns a whopping $90 million a year, and that's just American statistics!

So skinny culture is primarily a marketing strategy that sells people the idea that beauty, health, and longevity can only be achieved through dietary restrictions.

But all this is fraught with great suffering.

Let's remember, for example, the reboot of Sex and the City, which was recently released on HBO. The series, of course, is simple, but extremely relevant for my generation. There, as if in a catalog, all the problems faced by women 50+ are sorted out. After all, today they are no longer grandmothers, but people who continue to lead an active lifestyle.

However, for many viewers, the restart caused resistance. Yes, the heroines of the series are very well-groomed, not overweight, but - God! - they have wrinkles! "Take away!" We don't want to look at the natural aging process. We are so accustomed to the beautiful that we have forgotten how to see the real - the body is aging, postpartum, with cosmetic flaws like stretch marks and folds.

I would like to predict a reality in which in 15-20 years the attitude towards the body will change. But so far this is not the case.

- And if we take a more distant historical period - conditionally the Middle Ages or the Stone Age, did those people also suffer from eating disorders?

“Eating disorders have existed throughout human history, no matter what beauty standards were or how affordable food was.

There is an evolutionary theory of the origin of anorexia nervosa. If this genetic mutation, which for some reason lingered in the population, which means that it was important for survival. It is assumed that people suffering from this disorder saved the tribe during hunger strikes.

After all, usually a person who wants to eat is depressed, irritable, tired. However, for those who suffer from anorexia nervosa, the opposite is true: hunger activates them. Most likely, it was they who encouraged the unfortunate, frozen tribe to get up and look for a new food base.

I often hear: “They have seen enough of their skinny models - and they refuse to eat!” It is a myth. There have always been RPPs.

Here is an example: detailed biographies of Catherine of Siena, an Italian Catholic who lived in Middle Ages. According to these texts, she suffered from anorexia nervosa. Her spiritual father urged her to eat more. But Catherine replied that she was unable to swallow a single bite.

At the same time, she was unusually active physically: she preached, cared for cholera patients, could walk 45-48 kilometers between villages every day, eating only one apple. But at the age of about 30, she died of exhaustion. Just as those who do not treat this disease die today.

We also know that the Scottish Queen Mary Stuart went through a period of anorexia nervosa right after she moved to France. There she was to marry the French dauphin at the palace of Catherine de Medici.

Despite the big physical activity - riding, dancing at balls, Maria ate very little, because of which she lost a lot of weight. But a few months later, the disease receded and Stewart was able to recover. There are many such historical examples.

How to get rid of food restrictions

— Is there a utopian possibility to save humanity from eating disorders forever? What needs to be done for this? Teach everyone about intuitive eating?

“We, as consumers, live in a huge conflict of interest without even realizing it. All those huge chocolate bars, giant packages of chips called family packs…

Let's face it: this isn't a family pack, it's an overeating package. You buy such a package of chips when you are wildly tired, when everything is tired, when you just want to sit down and watch the series, crunching snacks.

It’s hard to eat mindfully when we’re constantly being fed food porn, where liquid chocolate is poured onto a beautiful shiny bar…

Therefore, on the one hand, we are victims of the food industry, which wants to sell us as much as possible. On the other hand, the dietary and fitness segment is fighting for us. But what we do not suspect is that they united a long time ago.

It works like this: first I buy low-calorie foods that I do not get enough of and which sooner or later lead to overeating. Then, during the next breakdown, I run to the store for ice cream with triple chocolate and a huge bag of chips.

After that, I feel guilty and stomp to buy a diet meal plan and a gym membership. As a result, the weight is only gaining, the level of dissatisfaction with my body is growing, and all these industries are incredibly profiting from me as a user.

Making it so that all people on earth eat intuitively is a good idea, but its implementation is possible only where endless advertising of something incredibly tasty is not poured into the ears and eyes. By the way, according to research, some people are more sensitive to these triggers.

— How then to be?

- In order to return to a harmonious diet, you need to remove restrictions on products. The problem of any modern city dweller is not that he overeats, but that he systematically malnourishedand then overeat.

But for some reason, only overeating falls into the area of ​​attention and concern, and many consider undereating to be the norm. If you knew how many medically obese people we see who are not eating enough.

This is because there is a culture of body and fat shaming that puts food in shame. Remember this famous Internet meme: if you look like a fit girl, you can post a photo on Instagram in pajamas eating pizza from a box, and you will be called sincere and real? And if a plump woman does the same... You understand what I mean.

In order to return to mindfulness, we need to start with a complete, non-restrictive three meals a day, which will have the necessary proteins, fats, carbohydrates.

“But wouldn’t it be like another diet?” Now I will make myself a plan for three meals a day, including proteins, fats, carbohydrates. I will follow him. And if it doesn't work out, I'll feel guilty. It is not very clear what “eating mindfully” means.

— You are describing the behavior of a person suffering from symptoms of eating disorders. Such people tend to develop very strict dietary rules that cannot be followed all the time, and if they deviate from these rules, they punish themselves by tightening them.

Conscious eating is a harmonious diet, when about 70-80% of the time you have a plan, and 20-30% of the time you can deviate from it and understand that there is nothing wrong with it.

For example, many people have a problem with not eating breakfast. You should try to incorporate this meal into your daily routine, but if it does not work out from time to time, you should not make a tragedy because of it. If you don’t have time to eat a full meal in the morning, put a banana in your bag and have a bite them on the way.

We strive for perfectionism so much that we eventually lose the ability to take any small steps to improve the quality of life.

Following the principle of "either perfect or not," you are more likely to upset your eating behavior than come to a good, harmonious diet.

The same applies to bans on any products. For example, some people think, "I'm going to try to give up sugar so I don't overeat." No. People who don't overeat enjoy desserts. This so-called food for joy, which is consumed not for the sake of nutritional value, but for the sake of pleasure: chips - because you want to crunch, sweets - because you want something sweet. "Food for Joy" is an additional option that does not form the basis of the diet.

- But what about people with diabetes or other diseases who are limited to a diet? Can they adhere to the principles of intuitive eating?

- The international clinical guidelines for diabetes categorically state: a complete ban on simple carbohydrates is not indicated.

But, unfortunately, many nutritionists, endocrinologists and gynecologists broadcast a restrictive police approach: “Let's take this food from you and see if you survive or not.”

If the patient is overweight insulin resistance, polycystic ovary syndrome, infertility, acne, most doctors prohibit sugar. This is a completely ineffective strategy. A better question would be, "What can you add to your diet to make it more complete?"

The Lancet published a massive multi-million dollar study on nutritional deficiencies leading to earlier deaths. According to him, people from large modern cities do not eat enough whole grains, fruits and nuts.

According to modern data, there is not a single person in the world who does not suffer from fiber deficiency.

Here is the answer. To improve the quality of life, you need to add whole grain bread, fruits and nuts to your diet.

I am convinced that diet is a religion. And religious ascesis - refusal of sugar, milk, gluten free - in the name of beauty and longevity, it will first lead to breakdowns, and ultimately to the fact that a person will develop a malnutrition.

Can your overweight patients who switch to intuitive eating lose weight? Do they sometimes turn to this approach to lose weight?

— Yes, many lose weight on intuitive eating. And yes, some come for weight loss. But do something for weight loss is a failed strategy.

You, perhaps, will lose weight for the next six months or a year, but then you will gain it back, and even in excess. At the same time, you will break your metabolism on your knee, and next time it will be more difficult to go this way. Even if people were on diets all their lives, at some point their weight would reach a certain level (plateau) and would not fall below. Therefore, it is much more practical to direct efforts towards accepting your body as it is already now.

How to love yourself and others

- “Accept your body”, “love yourself” - how is it? What exactly needs to be done for this?

- A Russian person is far from the status of “love yourself”. For most of the people I work with, the number one priority is to stop bullying yourself.

Don't try to shift from brake to gas. It is worth trying to find at least some neutral state where we are not destroy ourselves for every piece, for every fold on the body, for the fact that a dress of some size did not fit or did not fit properly. This would already be a big advancement in the line of conditional "self-love" that everyone talks about but no one understands what it looks like.

It's also helpful to keep in mind that worrying about weight is not about weight.

If you are no longer satisfied with your body, it means that some area of ​​\u200b\u200blife causes you such tension and you are so afraid to look into it that you prefer to count calories.

Why? Because we have the illusion that the body can be controlled, that "I can handle the weight." And when we start to “take care of ourselves”, the area that causes anxiety - relationships, career, personal self-development - instantly turns off and stops itching. Hungry a person wants to eat, he does not care about the meaning of life.

All this happens because we do not have the courage to go to a therapist and say: “You know, I’m terrified that I’m 35 years old, I don’t like my job, but I’m afraid to leave it.” Or: “I don’t have children and a partner, and I don’t know how to build a relationship.” We are terribly afraid that there are no answers to really exciting questions. And to the question "What should I do with my body?" there is always an answer. Here it is - slipped by the diet industry: "Let's lose weight!"

Journalist Naomi Wolf book The Beauty Myth wrote that a patriarchal culture needed diets to keep women from revolutionizing. Even though this is a rather radical statement, I think there is a lot of truth in it. The diet is so debilitating, it takes a person’s attention to itself so much that political, social protests and the search for the meaning of life there is simply no energy left.

Another practical tip about “love yourself” is to enjoy what you can enjoy: beautiful clothes, delicious food. Not within the framework of the approach when absolutely everything is allowed, but with the thought “Does this give me pleasure right now?”.

- In the new book "Isolation and Eating Disorders" you say that we are a generation of unloved children. What is it connected with?

- There is generational theory, according to which my parents are from the generation of baby boomers. These are people who were born immediately after the war. All over the world, not only in Russia, their main psychological characteristic is that they are extremely emotionally bankrupt. These people are cold, narcissistic, preoccupied with themselves, absolutely not investing in emotional intimacy with their children.

The next generation is mine, Generation X. We attach great importance to relationships with children. The pendulum swung the other way. The phenomenon of the “child-king” has appeared, when the whole family serves the needs and wishes child development. Mom takes them to extra classes, dad earns money for these classes, the nanny takes them to school.

But, despite the fact that the trend has changed, I cannot say that our generation (due to its emotional deficiency) knows how to build relationships with children and love them. We rather go on the material path. "I want to give my child everything" means "I want to give him the best education, the best teachers, the best vacations, the best classes, the best camps."

In motherhood, I am 18 years old, I have two children. And during this time, I increasingly come to the conclusion that the most significant need of a child is to be sure that I will always accept, understand and support him. And this is what we all really miss.

None of my patients can boast of being loved and accepted, that they were told: “You can do it, we will think of something, this problem will not seem so serious tomorrow morning.”

In my favorite children's book about the Kid and Carlson, there is an episode where the Kid comes home after a very bad day at school. He got into a fight, got a bump, met a puppy on the street who reminded him that he didn't have a dog. In general, a seven-year-old boy is absolutely unhappy.

His mother bakes in the kitchen buns. She looks at him, understands everything, but says nothing. Doesn't require you to tell me what happened. Does not rush to comfort him. She pours him cocoa, puts a bun and puts him on her knees. And at that moment, in the small world of a seven-year-old child, everything becomes good.

We all really lack this, sometimes even silent support. Because most of us grew up as objects of constant parental anxiety: “If you don’t study, you won’t go to college, if you become a janitor, you won’t have money.” We imperialize this voice, we we grow him inside himself.

And most adults don't need any extra mom, grandma, or dad to scold them. We're pretty good at this on our own. And when I say we need to stop beating ourselves up, that's what I mean.

So we need to shut up our inner criticizing parent?

- Yes, and start talking to yourself in a comforting voice: “Everything will be fine, you can handle it! You are 40 years old! You've done all these 40 years! What reason do you have to think that you can't handle it now? Yes, the problem is terrible, yes, you are desperate, yes, you are very tired. But how can you now take care of yourselfso that you have the strength to move on? This inner conviction - "I can handle it" - is very lacking. This is practical self love.

- Maybe you have some guesses about how our generation - those who are 18-25 years old - will love their children? Will there be other practices of care, acceptance and expression of love?

- You asked a very interesting question, because each next generation does something new with children. It builds relationships with them based on the mistakes that the previous generation of parents made.

It seems to me that the generation of the current 20-year-olds will have children later and in a much more conscious state, without automatism. And it's wonderful!

Loving a child is not as easy as it seems. Because in order to love him, you must first want him to be born. And if you become pregnant only so that your mother falls behind with the question “And when are the grandchildren?”, It will be more difficult.

It seems to me that your generation is able to have children when it is ready for them, and is also able to engage in direct play interaction with them. I think you will treat the children in a much more significant way as equals.

Surely you will also make some serious mistakes in education, but I am very interested in what will come of this approach. Because it seems to me that conscious parenting raises conscious children.