"At Least I'm Better Than I Used to Be!"

Are you just settling for partial recovery?

Saturday's breakfast. But after this, I did have another waffle,
because it really wasn't enough for me.

Daniella, a regular blog follower in her 20s, recently asked me for advice about fullness, about eating enough. So I’m responding to her concerns, addressing in more general terms what might be your fears as well. She writes:

“I have struggled on and off with an eating disorder for 9 years, before finally seeking treatment last August. … Since then, I have come a really long way.

Minus slips here and there, I am no longer actively restricting. I have also moved up from following a pretty strict meal plan to working on intuitive eating. After many years of completely losing touch with and ignoring my hunger signals, they are finally back and I actually listen. I ...no longer wait until I am beyond starving to eat something. Although I am no longer on a meal plan, I pretty much still follow a loose version of the 3 meals and 3 snacks plan…

And now the problem, fullness. I am scared to death of feeling full. ...I am not actually allowing myself to eat enough in one sitting to where I physically feel full. ... (but) I am not actively choosing to stop eating like I used to. (In the past) I would set aside a certain amount of food and only allow myself to eat that, nothing more no matter how hungry I was. But that isn't the case anymore. Stopping when I do just feels natural to me. I don't feel like I am depriving myself at all. I don't leave the meal/snack frustrated or wanting more or even continue to think about food. I think I have just conditioned myself after all of these years to stop eating when I no longer feel hungry, instead of when I feel fullness.

I can recognize that this is still eating disordered ...I also know that the uncomfortableness and anxiety is much more mental then physical. The best way to judge my fullness is really by noticing when I get hungry again next and how soon it is. And I know that this means that I am still not completely in touch with my body.

Any suggestions of how to get passed this? I have allowed myself to stay stuck in this place for a while because of fear and convenience. I've justified where I am by telling myself that I am eating so much better then I used to …”

It seemed like the right amount, but it was a bit too much.

First, kudos to Daniella for the incredible strides she has made in her recovery, and for her honesty and insight into this issue.

So what do I think?

Well, it depends. Not knowing Daniella's (or your) full situation, I need to ask the following:

• Are you now in a healthy weight range, to support normal body temperature, blood pressure and pulse, and menses?
• If not, your frequent eating is still inadequate, necessitating an increased intake.
• Are you limiting your food selection because of this fear of fullness?
• True recovery provides the freedom to consume a wide range of foods.
• Is your pattern of eating interfering with your life?



Feeling full--I had had enough.

• From what Daniella adds, her work-at-home schedule allows for frequent eating to accommodate her need. But her schedule will soon be changing, and she won't have this luxury any more.
• And is getting hungry frequently interfering with your thoughts, your anticipation of getting to eat, your preoccupation with feeding yourself? 
• Then clearly this needs to change.
• "Scared to death" is not a good place to be.

Convinced? Then here are some strategies to move forward.

• Take baby steps. Make a small addition to one or two meals or snacks, and see how it goes. Did any bad come off it? Then it's safe to continue. Any perceivable benefits? Then use these to justify continuing on this course.
• Add foods that are quite safe, to start. First goal is just getting enough. Work on variety later.
• Reality check. What's the worst that can happen by adding, let's say, a fruit, a yogurt, toast, for instance? Nothing. Remember it takes at least 3500 surplus calories over and above your need to gain a single pound.
• Read an old post on this topic which discussed titration—figuring out just how much it takes.

Over time, you will discover just how much your body tends to need for its standard routine, and it won't take so much work.

And remember your goal. Full recovery. 

Which One Really Needs Help? Call the Doctor!

Even Mica was disturbed by this!

I know, I know—I’ve got another 5 days before my expected post is due, but I just can’t wait. I can’t let Laura’s painful experience go unaddressed. If you haven’t read it, please do so now. But brace yourself—you’re gonna get angry.

It’s not unusual for me to hear and read about inappropriate statements and suggestions that medical providers make. Actually, we all can manage to say stupid things—I know I’m no exception.  (Really, no need for those that know me personally to comment on this statement!) But today I heard two doozies—Laura’s tale and a patient’s story.

I don’t know Laura—except, that is, from her blog comments. What I do know about her is that she has made extraordinary progress in her recovery from anorexia. That she can now enjoy pizza! That she gets it—and she follows through with healthy, normal, eating behaviors. That’s she’s worked hard to put all the disordered thoughts aside and use her wise mind to justify doing the right thing. That she, like many others, have needed to use self-talk to move from the myths, the misinformation, about nutrients and foods and weight. Ahh, she’s done so well. I don’t even know her, but I am so proud of the work she’s done, of how far she’s come!

And then someone she respects, her MD, albeit inexperienced with eating disorder, totally sideswipes her. The respectable doctor projects, I suspect, her own mishugaas—about weight control, about carbs, about fats. Our wise Laura knows better—but of course when the white coat-clad MD begins her critique of Laura’s intake it’s simply devastating.

Yes, you can eat the whole panini if you're hungry!

What I read in this comment is not that it triggered her eating disorder; she concludes by stating that this doctor just didn’t work out. (Hooray for Laura! Time to change doctors—or get her to close her mouth and withhold absurd and inaccurate assessments of Laura’s intake!) 

But, I suspect, it’s the profound sense of disappointment in her doctor, and perhaps in our crazy food-and-weight obsessed society, as a whole. Laura appropriately acknowledges that there are absolutely no grounds for this doctor’s comments—she has zero evidence to conclude that Laura is struggling with her weight, or unhappy with her intake or struggling with eating disorder behaviors. 

Perhaps if she had asked more open ended questions—you know, like “How’ve you been feeling about your eating these past weeks?” or “What concerns would you like to address about your recovery?”, she could have prevented this damage. It would make a lot more sense than projecting that there’s a problem, simply because Dr. Dieter has perhaps struggled with her own weight and her eating!

Hats off to you, Laura, for having the sense to air your feelings and get support—and for sharing your reaction with the doctor. Hopefully, she’ll learn from her mistakes. And hopefully, you’ll find an MD that really gets it!

As for the patient story? Nothing too unusual that you haven’t heard before. It’s a case of an MD who looks at a 20-ish patient and tells her that her weight should be about 50 pounds less than it is—which would bring her to a place she has never seen on her growth curve. It would bring her BMI to a percentile lower than ever before, even since grade school! Fortunately, this young woman appeared to have a good sense of self, knowing darn well that this MD’s goal was crazy.

If she is appropriately nourished and growing
along her curve, must we make her weight
an issue?

But what if she took the doctor’s orders to heart and began to fight her body on what was normal? To push activity to an obsessive level and to restrict her intake to a point that was neither healthy nor maintainable? What if she had the genetic predisposition for an eating disorder and all it took was the encouragement of a doctor to set the ball rolling—given her own frustration with her recent weight increase and being told her BMI was in the obese category? This woman was more fit than most people I know and had no health issues. She ate healthily and exercised. And there likely was an underlying medical explanation for her recent unexplained weight gain, yet to be determined.

See the problem? Do they even realize the power of their words?

Do you even realize the power of yours? If you are on the receiving end of poor advice, do share your concerns. Consider another opinion from someone you trust. Or do like Laura did—contact the MD and respond. And if you need to, move on—and reach out for support.

Feel free to share your own horror stories, or simply to express your opinions.

Thanks for reading.

My Mother’s Day Advice.

From the MFA, Boston, MA

I’m not your mother. But the mother in me wants to share some motherly thoughts. Won’t you indulge me in this on my annual holiday? 

Yes, I yearn to do motherly things like feed you—knowing full well that moving past your eating issues and your eating disorders takes way more than my cooking. I fantasize that I can have you all over for a meal and you can eat it and enjoy it without compensation, without unhealthy thoughts and behaviors. That you can see how safe it is to eat. If only it were this simple.

So instead I’m sharing some nurturing guidance, whether you are 20-something or in your 50s.

Indulging at a favorite cafe with my
mom and my son.

Words from your non-mother (when not acting as the Tiger Mom)

• Give yourself permission.
• Be forgiving.
• Treat your body as you would expect your child or your sister should treat herself. Respect its limits—don’t exercise when your body isn’t up for it. And please fuel it.
• Be realistic. Setting the bar too high with unrealistic expectations is a recipe for disaster. You will never be able to healthily sustain such changes.
• Slip. Then pick yourself up.  Yes, it’s unrealistic to believe that slips don’t happen, that they shouldn’t happen, that you should know and do better. So move on. The real test of a slip is your ability to stand back up and move forward. Real progress is having fewer slips that are less severe. Real progress is being able to learn from your slips and work on prevention for next time—without beating yourself up.

• Find a Mom. No, it doesn’t have to be your mom (don’t forget—I said be realistic!) Rather, explore your resources, your supports, and ask for help. Yes, you can do it.

Are you my mother?

• Hope, even if you don’t yet believe, that recovery is possible. Because this old Mom knows that it is.
• Trust that things can and will get better. Gotta love Ingrid Michaelson’s song Gonna Be OK for the inspiration.
• Appreciate what you do have—what’s in place in your life, as well as with your eating. Check out Noa’s Homemade Religion which truly moves me to appreciate.

Enjoy, dear readers! And please let me know you're reading!

Lessons About Eating Disorders

What I Learned at the AED Meeting

I’ve exceeded my 1 week limit between posts, but I’ve got a really good excuse—I’ve spent the past 4 days at the Academy of Eating Disorders (AED) Annual Conference. So I thought I’d share some personal and hopefully meaningful observations about eating, recovery, and miscellaneous thoughts:

• Day one, 4 hours of workshop, and what did they serve at the refreshment break? Coffee, tea and water. Period. And I wanted calories. Food. I was hungry. Half a day learning about a treatment for anorexia and I couldn’t find anything to eat! But it only got better from there—really.



One of several courses eaten at Barley Swine

• I spent a large percentage of my 24 hours each day doing 2 things—learning about eating disorders and planning and arranging to eat—where to go, whom to go with, and what to order, to name a few. And I must say, Austin Texas has some fabulous food! My top picks?  Barley Swine and La Condesa—simply divine!

• Another evening we were 8—two in recovery from anorexia with 3 RDs, 2 therapists and a mom/eating disorder advocate—all eating out together. Can you even imagine? From my perspective it was fabulous. How about a round of applause for those recovering, brave enough to endure such a dinner?
• People appeared better in person than they had on the web. No, I’m not speaking of their physical attributes. But in person, their energy and warmth radiated, adding a whole level of beauty that truly got missed on line. Thoughts were shared and clarified without misunderstanding—it sure helps when you have more than 140 characters to explain yourself!

• Two of the diners are bloggers that I had a somewhat rough start with in the virtual world. Carrie and I, as I recall it, had long ago debated the implications of viewing eating disorders through the lens of biology, much as a conference panel debated labeling eating disorders as brain disorders. While Laura helped shake up my thinking on Family Based Treatment, yet supported my perspective about the important role for dietitians, typically omitted from this therapy.

Carrie, Cate and I before dinner.
(We didn't look any different after dinner, though!)

• Conflict leads to learning and change. If we all stuck with our same ways of doing things we would never grow and develop. We would perhaps feel safe, but would truly stifle our potential, our recovery even.
• Cate and I met for the first time, in spite of feeling I have known her forever. We met through this blog and we have inspired each other to change as well. And you’ll soon hear details about our upcoming book!

Dessert shared with another RD

Meaningful messages from the AED meeting

Connection

Connection helps recovery. A family member, treatment provider, friend, an internet-mentor—even one strong connection can make a difference. And involving your partner shows great promise, based on the research by Cynthia Bulik, PhD and Donald Baucom, PhD. So if you haven’t begun to share with your significant other, or no one knows your struggle, perhaps it’s time to change that.

Hope

“You’re the first person who ever told me I can recover”, I’ve been told far too many times. It is unfortunate. Recovery happens (a bumper sticker, perhaps?), but it doesn’t occur passively. It certainly takes work, your hard work, and a great deal of time. And there are slips, which you must prepare yourself for. Because slips happen (ok, another bumper sticker?) I hope those of you outside the states get the reference to a US bumper sticker—Shit Happens—it would be much funnier if you did!

So if your provider tells you that you can’t recover, then it’s time to find a new provider.

Blame

Blame is useless. Your mother didn’t cause your eating disorder, nor did your ex-boyfriend. Sure, environment can play a role in the development of eating disorders (just as perhaps your genetic predisposition and your personality type may have contributed). But it is most ineffective to focus on “why did I get this condition” or to blame yourself asking “what’s wrong with me, why can’t I change?” We all want answers, but the truth is, what we really need are solutions. And blame is clearly an obstacle to getting there.

Eating disorders are serious

I liked Laura (Collins) Lester-Mensch’s suggestion that we refer to eating disorders as treatable brain disorders. Sounds so serious, no? Even a bit scary—and rightfully so. Eating disorders need to be taken seriously. One in 10 people die from their eating disorder. And delaying treatment only makes the challenge greater for recovery. While we don’t know whether the brain is involved from the start of the eating disorder or as a result of the eating disorder, here’s what remains—the brain is involved, and nourishing it aids in recovery of the disordered thoughts, mood changes and of course, the physical consequences. The brain is not static—it is flexible, plastic, and changeable.

Perhaps viewing eating disorders as treatable brain disorders will allow us to have hope, remove the blame, and inspire us to connect with others without shame to support recovery.

As always, I care to hear your thoughts and reactions to these posts.