Can someone with a history of disordered eating safely count calories or macronutrients (macros) again?

Counting Calories or Macros After a History of Disordered Eating

Individuals with a history of disordered eating should generally avoid counting calories or tracking macronutrients as these practices can trigger or exacerbate eating disorder symptoms and impede recovery. 1, 2, 3

Understanding the Risks

Calorie and macro tracking present significant risks for those with a history of disordered eating:

• Research shows that using calorie tracking apps is associated with higher levels of thinness and muscularity-oriented disordered eating behaviors 3
• Individuals who use calorie trackers demonstrate higher levels of eating concern and dietary restraint 4
• Calorie counting is adversely associated with eating disorder severity among vulnerable populations 5
• Exposure to calorie information (such as on menus) can be detrimental to eating disorder recovery and increase feelings of isolation 2

Assessment of Risk Factors

Before considering any form of dietary monitoring, healthcare providers should evaluate:

• Current recovery status and time since active eating disorder symptoms
• Presence of ongoing eating disorder thoughts or behaviors
• Motivations for wanting to track calories/macros (weight/shape concerns vs. health)
• Current relationship with food and body image
• Available support systems

Clinical Decision Algorithm

1. High-Risk Indicators (any of these suggest avoiding calorie/macro counting):

   • Active eating disorder or less than 2 years in recovery
   • Weight/shape as primary motivation for tracking
   • History of obsessive behaviors around food or exercise
   • Current preoccupation with food, weight, or body image
   • Tendency toward all-or-nothing thinking about food

2. Alternative Approaches to Consider:

   • Intuitive eating practices that focus on hunger/fullness cues 5
   • Meal planning without calorie/macro specifics
   • General portion awareness without precise measurement
   • Focus on food quality and variety rather than quantity
   • Regular eating patterns (3 meals, 2-3 snacks) without calorie targets

Professional Support Recommendations

If nutritional monitoring is medically necessary (e.g., for diabetes management):

• Work with a multidisciplinary team including a dietitian experienced in eating disorders 1
• Implement monitoring under close professional supervision
• Focus on minimum necessary tracking (e.g., carbohydrate counting only for diabetes)
• Establish clear boundaries and warning signs for problematic behaviors
• Regularly assess impact on mental health and eating behaviors

Special Considerations

For Medical Conditions Requiring Nutritional Monitoring:

• Diabetes management should prioritize flexible approaches that minimize rigid tracking 1
• Weight management interventions should screen for disordered eating and avoid rigid meal plans 1
• Bariatric surgery patients with history of disordered eating require specialized support 1

For Research Participation:

• Individuals with eating disorders or disordered eating should be excluded from feeding trials and studies involving calorie counting 1

Warning Signs to Monitor

If someone with a history of disordered eating does attempt calorie/macro tracking, watch for:

• Food preoccupation
• Anxiety around food choices
• All-or-nothing thinking about food
• Return of compensatory behaviors
• Social isolation around meals
• Emotional distress related to tracking

The evidence strongly suggests that the risks of calorie and macro counting for those with a history of disordered eating typically outweigh any potential benefits, and alternative approaches to nutrition that promote a healthy relationship with food should be prioritized.