Thursday, January 12, 2012

The Hyperbole of Weight Gain—The Problem With Relying On How You Feel.

Do you think she struggles with her size?

“We’ve got a big problem here”, she said, in a most unsettled way. “I’ve gained like 85 pounds”. I’m like a great heifer, no, a large female milking cow—whatever they are called”.  I am F-ing fat, and I can’t fit into my pants, and it’s not good. I’m eating, and now I’m hungry when I wasn’t before, and it feels like I just can’t stop.” Kara was able to sarcastically acknowledge that no, it wasn’t 85 pounds, but certainly 35 or so added pounds gained this one-week period between our sessions.  All while trying to increase her intake, to gain some weight gradually, following a period of weight loss from her already-too-low place.

Hyperbole, and then some, right?  Yet this true story from the past week speaks to a feeling, one that was anything but exaggerated. And I write this to point out how feelings could lead us astray in our attempt to get healthy. Kara’s session was not unlike others I’ve had in my career—in this past few weeks, even—counseling patients struggling with eating disorders and disordered eating.

Following the outburst, I acknowledged that her feeling like she had gained a million (or 35) pounds was real. Yes, it feels different, eating more than her abysmally inadequate diet of past weeks. Her food choices—lots of high fiber whole grains, fruits and vegetables—make it all the more challenging. Their large volume and relatively few calories don’t fit with a need to increase calories. Yet she feels as if she’s eating a lot, too much, in fact.  Oh, and the large coffees throughout the day didn’t help, either.

What’s worse is that once she started to eat more, she got hungrier. As is expected, metabolic rate, and along with it hunger, increases with an increase in food. So while metabolism slows with restriction, it picks back up with refueling. Research confirms it continues to increase (your metabolism, that is) until you hit a healthy weight range. (By the way, it’s also possible to be at a normal weight, eating pitifully little, resulting in a slowed metabolism. Increasing food, in this case, increases metabolic rate and weight may not increase, as calories increase along with metabolic rate.

But even if you know it, it feels scary having your hunger return. “What if it never stops increasing?” “Will I always be hungry, even though I’m trying to eat more?” “Will I ever be able to control my intake once I start eating more again?” The panic mounts.
Don't you just feel like staying this way sometimes?
If you respond to your hunger and honor it, it settles down—if you are eating enough. Sure, you’ll get hungry later—maybe 2 or 3 or 4 hours—and you’ll need to respond to that hunger as well. Otherwise, you may find yourself overeating, having restricted before. Until your signals start working for you, you may simply need to eat on a schedule—eating every few hours.

Back to Kara.

I weighed her. And she did gain weight. But it was only ¼ pound, to be exact. She assumed my scale was broken. I assumed she was serious, since that’s how she sounded. And what concerned me most, was my inability to reason with her in that moment; you can’t reason with someone who is irrational, who is simply responding to her feelings.

 It’s just like trying to reason with a young, underfed child; a malnourished individual is incapable of sensible decision-making and rational thought.

Somehow Kara came to her senses. Perhaps it helped being heard. Maybe the increased eating this week was a boost, allowing her to move from her stuck place, to hear the wisdom of my recommendations. And, finally trusting that rationally, she wasn’t having enough to eat, enough calories, to support her body’s needs.

Perhaps having me acknowledge how difficult, and scary, this whole process is, helped ground her in reality, helped. Rarely do providers describe the negatives of recovery, but I was honest with Kara and acknowledged that it sucks to have to feel.  Being numb—from restricting, binging, disconnecting, really works. It can be quite challenging to start to be present and to feel things you’d rather not be feeling.

Sometimes we really see ourselves
as distorted as this tape measure.
In past years, prior to more intensive treatment, there was no reasoning with her. It’s like a recent 24 year old male patient of mine who couldn’t get past his own food rules, and maintained his vigilance around raw foods, unprocessed foods low in fat, that never provided enough calories for his 6’2” frame. This bright young man was anything but reason-able, rational. That was all lost. It was all about how he felt. At that point, all I could do was recommend a higher level of care, to re-nourish him and restore his brain to allow him to think and act sensibly. Only then can we begin to successfully work together and move forward in recovery.

Last week a patient thanked me for letting her express her darkest, most disordered thoughts. After I listened, I rebutted. She had to hear my counter argument. She needed to see the pros and cons of her feelings—her feeling that she needed to drop some weight, in spite of being in the low end of a healthy weight range, in spite of the consequences on her body, her thinking, and her mood. She accepted my guidance, feeling liberated, and applied it in the days which followed. Because she was healthy enough, like Kara, she was able to come to her senses. Her thoughts helped change her feelings and subsequently her behaviors, and she is turning things around. Nice work!

If you are stuck on how bad your body feels, take a breath, and do a reality check. Is the change as major as it feels? And if so what are the benefits of eating more?  Being numb may feel safe, and change can be overwhelming, but what are the consequences of staying where you’re at, in your unhealthy place? With a supportive team and the right level of care, it’s not too late to move forward.


  1. I can relate to Kara's feelings of having eaten too much and gaining a million pounds at one meal. In my recovery from anorexia, this is something that I struggle with on a daily basis. It's getting better, as I can use my rational brain again. I also physically feel like I am huge sometimes, but then I realize I'm not and that it was more of a mental feeling, than a physical one. I actually still need to gain more weight. This feeling of being too big when I'm actually small is difficult for those around me to understand. Thank you for sharing this post.

  2. Great post. Especially the part about needing to feel heard, and then needing to be rebutted at the end!

    1. I honestly hadn't expected such a reaction. Of course, I'm well aware that we all need to feel heard. I simply wasn't expecting that the rebuttal would be viewed so favorably.

    2. That's when "in the moment" the rebuttal probably wouldn't be been viewed so favorably, but "needed" none the less. Sometimes needs (not equal sign) wants. I know when I share my "deepest darkest ED thoughts" to my treatment team that they're not the correct way of thinking, but it's what I feel and what I believe to be true about myself thus needing that to be heard.

      For me, feeling heard does liberate me to be open to making changes, too. A trust building block for the next step, maybe?

      Then again, sometimes my ED just wants to argue, but usually there's something I haven't said yet that needs to get out there...

  3. After refusing to allow my gp to weigh me the other day because I had put on "a million kilos" I can certainly relate to the way Kara felt! But I can also relate to the need to express all my most disordered thoughts. My RD is great at letting me do this too (must be an RD thing!) - she lets me say all the stupid crap that's building up in my head. And she lets me do it without making me feel like I'm a freak for thinking these things that even I know are distorted.
    Reality checks with those you trust are so important.

    1. So glad that there are so many positive RD experiences out there! And yes, trust is essential as well.

    2. I don't think it's an "RD thing." I think there are a lot of great RDs out there (like you and like mine), but I know there are a lot of less great RDs out there too. I have lots of friends with EDs (met through treatment), and I realize how lucky I am to have the RD I do. She's one of a kind. Sounds like you are too, Lori. Not ever eating disorder RD is like this. I often tell my RD that she's kind of like a "life coach" or a "RD/Therapist." She definitely is the most critical part of my team!

  4. Lori, I think this describes my meeting with my RD nearly every week! And yet most weeks I'm Certain it's a serious gain and that this week is different from the past. I can't seem to match reality to how big my body feels or how much weight I'm positive I've added. I'm body-shaking-terrified to step on the scale every week. Am I driving my RD crazy? I feel bad being such a broken record.
    (ps, thanks for your wonderful blog!)

    1. I would expect that any RD used to working with this clientele isn't driven crazy by such reactions. If anything, it is rewarding to see clients shift in their ability to reality check, be able to sit with their distress from their distorted perspective, and maintain their movement forward.
      Thanks for sharing!

  5. Hi Lori, I love your blog. How do I find someone I can see here in New Jersey who does the kind of work you do? I spent years on Weight Watchers and am now having trouble with overeating. Thanks!

    1. Hi Charity,
      Check out RDs who have a specialty in eating disorders--we tend to be more behaviorally focused. or other eating disorder sights have national referral lists.
      If you don't have success, feel free to get in touch. I do some (although limited) skype sessions which have been working quite well for clients in your situation.
      Thanks for reading!

  6. I weighed myself today after several weeks. While I didn't gain anything during the holidays, I must've done something very wrong, I suspect that SAD is the culprit, after because I gained three kilos. My inner anorexic keeps screaming that I totally don't need to eat at all, it's easy, cool and universal solution to everything... I hope I can resist the call until spring when I can go and do something normal outside. This post was a nice reality check, thanks for that.

  7. I wonder if you are open to chat about some stuff? If so email me at

    Thanks. Interesting site.

  8. My god. That is me right now. Exactly that. Wow.