Friday, March 29, 2013

Here’s to a Speedy Recovery? Not So Fast!

Alan came in yesterday and he put it right out there. “I was really disappointed with our visit last month.”, he shared. “I expected to lose more that the 6 pounds given all the work I had done”. More than a pound per week achieved through his modest dietary changes and his move from a sedentary activity level wasn’t enough. Sure he was feeling better—sleeping better, less heartburn, more energy—but still the weight loss wasn’t enough.

Thinking this portion should satisfy? Maybe not!
I wish I could say this was an atypical occurrence. Rather, many a patient, and a parent, present painfully honest about their dissatisfaction. Not with me, I’ll add, but with themselves, their child, their spouse. Really, they struggle to make sense of the reality of changing behaviors with their vision of what should be.
And if you’re like them, it’s not your fault for struggling with this. Ever watch The Biggest Loser? Those who get thrown off the show for not losing fast enough lost 7 or so pounds—in only one week! How about those Jenny Craig and other diet program ads—the ones with those alluring before and after photos with the oh-so-tiny-print revealing for legal reasons, that “results are not typical”? (For the record, losing rapidly will ultimately result in rapid weight increase, preoccupation with food and weight and a host of other consequences).

Perhaps you’re dealing with an eating disorder. These past 2 weeks I’ve watched as my patient’s insurance company repeatedly rejected her pleas for treatment. Alison long struggled with anorexia and bulimia and after much work on the part of her providers (myself included) had agreed to enter a program. I thought that was the hard part. But then the tables turned and she became the one who had to fight for coverage for appropriate care; in the eyes of the insurer, 15 or 20 years entrenched in her eating disorder should surely be remedied in a couple of weeks in a program! Even her providers at the treatment center—no doubt influenced by the regulations and coverage struggles they’ve come to accept—seemed to take that stand, despite her recent slip when left on her own.

You just might encounter some obstacles.
Your difficulties in recovery may be influenced by your unrealistic expectations of the process of recovery or of changing behavior. Like Alan, you may take a “why bother?” approach and throw caution to the wind, sabotaging your progress because you sense you’ve already failed.

Sarah’s parents recently emailed me concerning their anorexic teenage daughter whom I’ve been working with. “She’s been making a point of going out more for dinners and she’d stopped keeping a food record”. Potentially cause for alarm? Maybe. But in Sarah’s case it was anything but. She had make remarkable progress with weight restoration over the preceding months and had been forthcoming about her difficulties—when they occurred. The dinners out? Now that she was more comfortable eating in restaurants and having others prepare her food she was stepping out; it was not an attempt to avoid parental mealtime supervision. And the lack of record keeping? Sarah was working on moving toward more intuitive eating at this point, and we had agreed to move from the daily food logs and exchange list accountability. I am not faulting involved parents in the least. But sometimes change is a good thing, as in Sarah’s case.

Some families expect recovery to be like ER treatment—you come in in a crisis, you get emergency treatment, like surgery or a new medication and you’re discharged to home and fixed. Unfortunately, eating disorder recovery is nothing like this.
So what to do when you live in a world filled with outrageous messages and your unrealistic timeframe for change is far from attainable? Focus on the immediate benefits of the positive changes you’re making, versus dwelling on the disappointments and frustrations. Consider not just the shoulds, as in “I know I’m supposed to be eating better, so that’s good” or “I know that this will help me down the road to prevent heart disease”. 

Don't expect to feel so positive all the time!
Consider the benefits many of my patients shared this week:
  • my energy level is so much better
  • I’m thinking more clearly
  • I’m less preoccupied with what, when, how much to eat and I’ve stopped counting calories!
  • my worst fears haven’t come true, in spite of my resistance to making the changes
  • it’s getting easier to do the tasks I initially struggled with
  • I’m seeing the impact of my role modeling on my young kids
  • I was able to have a scoop of ice cream and trust that it would be there if I wanted more later!
  • I baked and ate what I baked for the first time in years! (from Food to Eat, I’ll add!)

I also saw improved blood sugars in diabetics—with less than Biggest Loser amounts of weight loss, and I heard from both patients and families about improved mood and decreased irritability.

I realize that the positives, like those described above, may also occur side by side some negative experiences. For those starting to eat more as instructed, the physical sensations can be challenging. And anxiety, for many, is a real challenge and may need to be tackled with support from your therapist and MD. I don’t want to paint an unrealistic rosy picture, suggesting that all you need to do is adjust your thinking!

We’d all like a speedy recovery, as the expression goes. But in order to move there, we just might need to adjust our expectations.

Remember Patience?

Your thoughts?


  1. It is hard when recovery is not as clearly defined as numbers on a scale... and it is hard when our body's natural healthy weight isn't what we'd hoped ( thanks to a culture that idolizes one body type and one body type only). And quite honestly at first it sucks. But when we take a step of faith and decide to start listening to our bodies anyway, baby steps start to take us farther than we ever thought was possible. Not only do we start to see that we feel healthier physically, we also start to see our souls and minds become healthy. And eventually, we start to look around and realize that we not only overcame a disordered relationship with food, we also developed a healthy relationship with food, our bodies, and ourselves. But what really makes it all worth it is when you get to the point where you are able to help others get to where you are! So if you are still not sure if you are ready to take the leap and commit to forming a healthy relationship with food, remember that it will be hellish for a little while, but it will eventually take you out of the equally dreadful place you are struck in. It's not easy, but it's oh so worth it!

  2. It's definitely hard when we have a high expectation that we do not meet. However, I think it's important to focus on the positives we do attain such as the increased energy levels and the numbers going in the right direction on the scale.

    Whilst it can demotivate you when you don't hit your expected goal, it can also motivate you to come back and lose even more weight next time.

    I think it all comes down to perspective, and how you as an individual see things :)