Sunday, February 23, 2014

I Had No Idea! Secrets About Eating Disorders

We can't always tell just by looking at someone 
that something isn't right.
There are no excuses for perpetuating misinformation about eating disorders. No justification exists for minimizing eating disorders based on BMI, for generalizing them by age or gender, or for continuing to blame parents for causing them. While the news media may sensationalize and sometimes distort research, social media can fight back to correct misinformation. So read on, and please share!

Today starts a week devoted to spreading the word about eating disorders with the theme “I had no idea!” Thank you NEDA, the National Eating Disorder Association and promoter of Eating Disorder Awareness Week, for inspiring this post.
Random thoughts come to mind when I consider what this theme means to me—and what it might mean to you.  My beliefs and knowledge about eating disorders have evolved over many years, to which I credit the Academy for Eating Disorder listserve, the FBT researchers and Laura Collins and FEAST, blogs like Carrie Arnold’s  and my many, many awesome patients and colleagues. 

What I’ve learned over the decades

Got your period? This doesn’t minimize your diagnosis of anorexia, if you meet the other criteria. And resuming menses after being without a period does not mean you have fully recovered. No, the work is not yet done.

Obese and anorexic? How can that be? You do not need to be below the BMI chart to meet criteria for anorexia. Really. Unfortunately, you are the ones who most often fall through the cracks. And you are continually subjected to messages that your weight is the issue. I am truly sorry for this. Health care professionals need to be educated

Eating disorders are quite common in males, straight and gay. Males get anorexia, and struggle with bulimia and binge eating. Their focus on bulking up their muscle mass may seem like a cultural norm, but may be the sign of an underlying disorder. Check out Roberto Olivardia’s work on men and eating disorders.

Time to look at eating disorders a bit differently.
Over 30 or 40 and struggling with an eating disorder? You are not alone! Eating disorders are not just a teen thing. You can be living with an eating disorder at any age—an eating disorder that never resolved, one that reared it’s head again after previously recovering, or one that developed later in adulthood. Check out Dr. Cynthia Bulik’s work on this population. 

Parents don’t cause eating disorders. And parents shouldn’t be sidelined in the treatment of kids with eating disorders. They play an integral part in recovery, particularly when your poorly nourished brain fights you on eating. Learn more about how families can help from FEAST, from scholarly articles and other from resources.

Barbie didn’t cause your eating disorder. Sure, the media may impact how we see ourselves but eating disorders are much more complicated, involving genetic predisposition, environmental triggers and support for maintaining the disorder. We don’t know exactly what causes eating disorders, but it won’t be long before we understand the genetics. See what research is underway and how you can help the study of eating disorders and genetics.  

People don’t plan to have an eating disorder. It’s not a decision sufferers made. Individuals with anorexia, bulimia and Binge Eating Disorder aren’t simply refusing to change when they maintain their behaviors. Change is complicated—by fear, anxiety, and hard wiring of behaviors. My patient shares some wisdom we can all learn from here

It’s not so easy to just do it as this post describes. In spite of my many years of working with clients with eating disorders, I don’t think I fully grasped how many obstacles to change there can be—that is until Cate. Writing Food to Eat and feeling I was living her struggle with her was beyond enlightening; it heightened my sensitivity to things I had taken for granted—the planning to eat, shopping, cooking, and ultimately eating. 

Let's work to not live by diet rules and restriction, 
but to trust what our bodies both need and enjoy.
Recovery is possible, even for those who have lived with an eating disorder for many decades. But it has to start with the belief that change is possible. Connect with a treatment team-a therapist, an eating disorder dietitian and an MD, and reach out to friends and family for support. I now know that it is not too late to.

Want to help others recover? Share this post to increase awareness of eating disorders, and check out this awesome new eating disorder support by Cate. 

Oh, and please tell me what you think! Thanks for reading.


  1. I like this post. It got me thinking. I am not sure what to do right now. I have been restricting for a long time. Most recently I am taking in under 500 calories a day. I am barely losing weight. If I am barely losing weight at this intake how can I possibly consider taking in more? I just don't understand. If I take in more won't I just blow up? Why, at this intake am I barely losing?

    1. Your body is defending itself against this absurdly low intake--by slowing your metabolism and compromising your health. I know it sounds backwards, but eating more is the only way out--it will increase your metabolic rate and allow you to move from your eating disorder distortions.
      You will not blow up--that I can assure you. You are placing yourself at grave risk maintaining the status quo.If you don't have them already, get in to see a treatment team, including an MD for safety.

    2. thank you for your reply

    3. Yeah, your body's gone into survival mode. It will hang on to the extra fat because fat is stored fuel for the body, and without sufficient food and calorie intake, it has no reason to release it. You must raise your metabolic rate, and you're body's core temperature (I bet you are COLD all the time, right? with cold hands and feet?) to start losing weight and get your body back into balance. See Matt Stone's Diet Recovery 2 and Eat for Heat.

  2. I wonder what you mean when you say "I now know that it is not too late to". Did you used to think it was too late?

    1. The prognosis for recovery is most encouraging earliest in the disease. Generally, it's assumed that the likelihood of recovery isn't great when you've had it for many, many years. But my patient experience leaves me more optimistic. I have had patients (and my co-author) recover in spite of the odds. But it requires the belief that change is possible, and it helps to have relationships with people who can support you along the way. It's certainly not easy, but recovery is possible!

  3. Great post Lori. I am very humbled (blushing on this side of the computer) to think that I helped you understand eating disorders more - especially when I think about how much you have taught me about them!
    And thank you for the link to ASPIRE - our little community is growing :)

  4. As someone in her mid-30's with an eating disorder, I appreciate your mention of my population. It can be lonely as an adult with what seems like a 'teenagers disease' - even though I know it is not the case. It is always helpful to know that there are other women and men out there who experience the same difficulty as me. thanks for the post.

    1. Unfortunately, there are fat too many living with eating disorders that break the stereotype. Share this on FB and other social media to enlighten others; you never know from looking at someone whether or not they are living with and suffering from an eating disorder!

  5. Having a restrictive eating disorder (anorexic or not ) is so hard when you are not super thin. It feels like you are not 'sick' enough, or severe enough to deserve treatment. It also makes it hard for anyone to take your problem seriously, including the sufferer. If we look 'fine' how can we really be convinced we have a life threatening illness?

    1. This speaks to the issue: Hope it helps!

  6. Been in the 'not sick enough' situation. Eating twice a week, in the upper part of normal weight for my height by BMI (which is not meant to diagnose individuals but somehow, the doctors conveniently ignore the fact that it's a tool for statistics...), still menstruating as irregularly as ever. With my rather massive physique, I'd have to be dying of starvation to actually look thin and sick.

    The major step in my recovery was a dance class. I discovered that the body can be used for really cool and beautiful things, that I can actually do them with a bit of practice and there it was, self-esteem, need for decent nutrition to actually perfom somehow...

    Due to some twists of life, I started having issues with eating. Talked to a RD and while she was nice, her general opinion was that it's no biggie, I should eat more greens and all will be set. Anorexia? No need to worry with that pot belly and 100 kilos. Gotta find someone better informed.

    1. I do regret that in spite of the RD credential we are quite varied in our experience. Don't give up, though! Seek out an RD who specializes in eating disorders, perhaps through the many referrals sites for treatment for eating disorders.

  7. Dear Lori,
    Thank you for this. The secrecy is a difficult one. On the one hand it allows me to do many things unjudged by others (people can be very cruel about eating disorders) on the other it's such an obstacle to progress. And I fall into many of those camps. Years of illness, so many people just know me as "tiny", periods at BMIs <13 and a pregnancy at BMI16 (with a very healthy 3.1Kg baby...). Mind you, none of these things help with the "I don't think I'm sick enough" mentally as you describe, so I just cycle from ill to very ill and am always stuck!
    And yes, it's not that I don't realy want to get shot of the anorexia, it's just simply not that simple.
    In fact thank you for all your posts (I have been reading for a long time) - they almost always get a heartfelt nod. I had no idea that dietitians could be so helpful until I read started reading your posts- I really struggled with the NHS dietitian (so used to think of your patients rather jealously!) but having just switched into the private sector I suddenly have someone who "gets it" around the food and who frees up therapy time for other things but who also won't take any nonsense. So fingers crossed I guess.
    Is it ok to ask you a question - amongst many things, one of my huge obstacles to consistent and normal eating and eating enough for weight gain is the fact that I have trigeminal neuralgia, which at times makes chewing almost unbearable. On top of which when it's a long attack (on & off for days-weeks) I give up. On the fortisip, being bothered to make slushy "sick person" food, which I don't like anyway & ending up with a tummy full of liquids feeling sick. And it just prohibits eating normally and makes me feel even more different to everybody else. Milkshakes are out because I'm lactose intolerant (I can do cheese and yoghurt, just no milk). I wonder whether it's one of the worst combinations of illness possible as it just creates a vicious cycle: first it's too painful to eat, then the anorexia won't let me eat as I haven't been eating regularly/enough! Oh, and it's the perfect excuse on occassions when I'm being pushed to eat.
    Thank you again for all your though-provoking and hope-providing posts!

    1. Thanks for commenting, Georgina.
      As for the chewing limitation--I don't really see it as much of an obstacle; your dietitian can guide you on low lactose smoothies, and you can seek out recipes for legume based meals/soups (some recipes are on this site--search lentils, chili),and others. Hope this helps.