Friday, February 18, 2011

Maggie’s 152 lb. Weight Loss—This Time, It’s Not Disordered

Eating Disorder Recovery is More than Achieving a Healthy Weight

At the MFA, Boston, MA
Just this Thursday yet another patient shared her beliefs, her fears about recovery. “If I’m at a normal weight then I won’t need to come in. And everyone will think I’m fine”, she stated. And that was one roadblock to her recovery. Wearing her eating disorder, just like, for a cutter, I suspect, wearing short sleeves, is a way of expressing that there’s a problem. It appears to be a way of passively asking for help, when words fall short. 

Some have been surprised when I described them as still having an eating disorder, complete with thoughts of restriction, denial of hunger, and food and weight preoccupation, in spite of having restored their weight.

A significant drop in weight could be a red flag for an eating disorder, or can be the result of healthy measures, in spite of an eating disorder history. And a normal weight can disguise the pain of your struggling with an eating disorder as well. All of the above apply to Maggie.

You’d think dropping 152 pounds would be a major accomplishment for someone close to 400 pounds. And it is, especially at the age of 67. But the more successful part of this story is the move away from reliance on eating disorder thoughts and behaviors, on both sides of the weight spectrum.

Also at the MFA, Boston
Maggie, at 130 pounds and 5’8” saw herself as a “big fat slob”. A low weight for her height by any medical standards, she was obese by her own. She reports never really feeling good about herself, and by her early 20’s had met criteria for anorexia, plummeting to 117 pounds with restrictive intake and bulimic exercise levels. By that I mean exercising excessively, typically to compensate for eating, in an obsessive way.

Like many I see, a motivation to conceive helped enable her to gain enough for normal menses to resume, and ultimately to carry and deliver a healthy daughter. She managed to maintain a healthy weight, although not a healthy relationship with food and her running shoes. And after some time, triggered by a traumatic event, Maggie’s eating disorder turned to binge eating, with a focus on night eating. (Let me assure you that with support from an eating disorder team, recovery from anorexia does not have to result in binge eating and subsequent obesity! But Maggie had not yet sought help.)

Fast forward to the summer of 2002, when at 388 lbs. Maggie presented to see me. Her goal? To lose weight and recover from her many years living with an unhealthy relationship with food. Basically, to learn how to eat and to listen to her body—something she had never really done.

Maggie still comes to see me, every 4-6 weeks. (She has also worked with a therapist, at my recommendation, but they have finished their work together.) Yes, it’s been a very long road, but her progress has been tremendous. It’s quite impressive that she is down 152 lbs. so far. But more impressive, is that it has been years since she has used behaviors to manage her eating and her weight. 
True, there have been slips where I have had to play the “tiger mom” role, insisting that she increase her food intake, when weight loss was getting a bit too rapid. But she heeded my firm warning, and stayed on course. 

And there were certainly frustrations, like when she went to see her primary care physician recently. In reviewing her history, the doctor asked what her weight had been before we began our work together. And when Maggie, somewhat shamefully, admitted it was 388 lbs., the doctor laughed and told her she had to be wrong, dismissing Maggie as exaggerating her weight loss. Could you imagine! This very same visit, the doctor denied her a referral for a therapeutic water program that I requested, to enable her to move more. Because after so many years, no matter how much weight she lost, her knees weren’t going to fix themselves and allow her to start walking. To her credit, the incredible anger and frustration she felt was verbalized, instead of buried with pastries.

Over these years of working together, Maggie has changed the rules. She allows herself to eat later at night—if she’s hungry, and she chooses foods she truly enjoys—but eats them mindfully. Sometimes I find her counting her carbs, but generally only when she’s concerned about her blood sugars, as she was diagnosed with Type 2 Diabetes several years ago.

Perhaps her next challenge will be learning to manage activity—after she has her knees replaced. And for the record, she also followed my most recent advice—she switched to a lovely new doctor, who gladly issued the prescription for the water exercise program!


  1. Another blogger and I exchanged comments about this very issue last week. We both recognized that we were hesitant to return to a healthy weight because then our family and friends would assume that everything was fixed and that we were completely healthy. Our eating disorders were never about food to begin with, so why would returning to a normal weight indicate recovery? Of course, that's something that only people who understand eating disorders would be able to conceptualize. Although I'm on a healthy road to recovery, the temptation to wear my ED on my sleeve creeps in sometimes.

  2. Thank you so much for sharing this story with us, stories like these really help to shed light on an issue that isn't as easily explained as one might think. What an amazing woman Maggie is to have come so far and found such a strong voice to advocate for herself with her doctor.

    Sometimes I think therapists aren't as forthcoming about just how long it takes to recover from an eating disorder, fearing it will deter their patients from treatment. But it takes more than just a few months or a few years as Maggie experienced, as I have experienced, and as many others have experienced.

    Again, many thanks for your post.

  3. Oh, I like snarkylark's comment! That really sums up what I should have seen as the take home message of your post - that recovery is s-l-o-w (pity that patience and I are such strangers!). Of course I got stuck on those numbers - 117 to 388lbs (eeek).
    As for 'wearing' an ED, I asked my counsellor today if she could 'see' my ED - I'm so paranoid of anyone ever finding out. Thankfully she said that although I am thin I do not 'look' unwell - which was a huge relief. I'm not sure I will ever want anyone outside my treatment team to know about this.

  4. I think the fear that a healthy weight will delegitimize your issues/struggles is pretty common in ED recovery. Over the years I have gotten some very ignorant and dismissive remarks from various medical professionals that basically assumed I was fine if I didn't seem emaciated or *too* underweight to them, without any inquiry into my behavior patterns and mindset at the time. Definitely an example of how beneficial it can be to find a physician with at least some ED experience.

    Great post!

  5. I'm glad this post is striking a chord with readers. Truly it could've been multiple posts, and I can see that it's worth adding more case studies to highlight the points made.

    I'm truly sorry if the numbers were triggering. Does it need a warning? Please let me know! I attempted to put them in context, and it's critical to remember that her weight gain occurred following a trauma, and without support from a team to help her identify and utilize other coping strategies, other than eating. And she had not previously questioned her unhealthy thought pattern and unrealistic goals.

    Just like the male referred to in my BMI post, the weight itself does not have to be the issue, but the thoughts, feelings and even relative change in weight, perhaps.

  6. oh gosh, no Lori - no warning required - I'm sure it's just me :) Your comment after the mention of her weight was an adequate reminder that this was not the point - I just have a thing about numbers. I'm sure it's why I weigh myself so often. But that's my silly problem - I don't imagine anyone else would have interpreted it in such a skewed manner.

  7. Plain Jane-You are not alone, regarding your reaction and focus on numbers! I'm sure you'll hear that's more the norm than the exception. And I know that that will change as you progress in your recovery ; )

  8. Hi Lori-
    I also work with women with eating disorders and related issues and I think the fear of being seen as "fine" is.... huge! But more than that..the eating and the weight and the suffering are a big way women have learned to negotiate for what they need. I know that before somebody decides to hurt themselves with food there is often a thought that sounds like "I'm suffering, so I deserve this".
    It's a difficult theme to bring up but once it's more conscious all of my clients really relate to the way they're using food and weight to justify past or current hurts/insults/feelings of being deprived emotionally.
    Would love to connect with you- great blog and topics. I'm in Harvard, MA out in the country.

    Many Blessings-
    Simple Sacred Solutions To Living Beautifully

  9. I'll be at MEDA day one of the conference, May 20th. Perhaps I'll see you then?

  10. Thank you so much for sharing this inspiring story! It's so comforting to know that there are others out there who share my same struggles and thoughts. What amazing accomplishments Maggie has made! Congratulations!!! :)

    Marissa :)