Friday, May 29, 2015

The truth about the rumors about me.

Yes, I'm direct.
Today I heard reference to me and how I practice, shared by a patient, spoken by a therapist. "She's extreme", the therapist reportedly said, referring, no doubt to my reaction to my new patient's eating disorder behaviors and her severely restrictive intake. I bypassed the "let's just wait and see" approach after a mere couple of visits, after noting the wac-a-mole pattern to her "recovery". Stop the laxatives, increase the purging, increase the food, double the exercise. And there weren't the necessary supports at home to help implement change and ensure her safety and her progress. 

It's not the first time strong descriptives have been used about me and my management of eating disorders. I've been called  "tough" and "not easy". It's a wonder anyone would choose to come to see me. I sound so scary, no?

So let me fess up. It's all true. 

My stand against eating disorder behaviors is extreme-- extremely intolerant. Not of the patient, but of the disordered behaviors. Purging and laxative abuse and severe calorie restriction has extreme consequences. Yes, eating disorders can and will kill, regardless of BMI. And in my view, there's no other stand to take than an extreme one, a zero tolerance for allowing the eating disorder to suck away the life of you or your loved one. 

A dietitian who tells it like it is and sets limits
isn't all that bad.

That doesn't mean my recommendations are extreme, although one's eating disorder may believe otherwise. 

Being told to stop exercising, yes stop exercising, when you consume too few calories to prevent damage from exercise can feel extreme.But so is the muscle wasting that results from starvation when your body tries to produce the fuel to sustain your workout or sport. And, the consequential reduction in bone density, the osteopenia and osteoporosis and resulting fractures. And the impact on hormone production, and mood, and energy level. Yes, the impact of eating disorders is extreme. 

When indicated, I will shake things up. I'll recommend moving from rigidity around foods and nutrients, but I'll guide patients on moving forward. I'll expect patients to be medically stable and low risk before supporting exercise. And if additional support is needed, I'll direct patients to a higher level of care when necessary.

Do families and those with eating disorders really want a provider who simply says what they'd like to hear? Someone who agrees that there's no need for a higher level of care if you don't want to go? Someone who speaks words the eating disorder prefers, shares messages that keeps the anxiety low, and placates those parents in denial about the eating disorder reality--even when things aren't going well? Colluding with the eating disorder is not therapeutic support and patients and their families deserve better.  So call me tough. 

It's my hope, though, that tough isn't equated with uncompassionate or insensitive. Because if that's the rumor something has to change. As I've written before, there needs to be support and compassion, and a sense that you and your disorder are well understood to begin to trust that recovery is possible.

Yes, I'd love to hear your thoughts! Thanks for reading. See more below:


  1. You are extreme because you told someone to stop exercising?

    1. Actually, because I was expressing my concern and belief that a higher level of care was needed.

  2. To be honest it's not the first time I've heard this about you. And after being your client for a couple of years now, I would tell someone just the same thing. When I was told to go back to a nutritionist and was told you were tough, I knew you were just who I needed to be seeing. My unhealthy voice may have thought otherwise after the first session with you and quite possibly every one after. But if I really want to make recovery work this time "tough" is what I need. I know you know what you are talking about and I have all my trust in you. You are not here to just make me fat. If I wanted to have a RD that sugar coated the truth then it wouldn't be you. When I first met with you, you told me you highly advised that I didn't workout at all. It was very hard to hear that, but you explained to me what I was doing to my body. And that scared me. You gave me your opinion and backed it with facts. It was then my choice. And when things seemed to get worse you fought hard, worked with what I was willing to do to keep out of a higher level of care. Until the time came when you said you no longer felt comfortable supporting the idea of not getting more help. The rest of my team wanted it for awhile and when you said that I knew you, they, everyone was right. None of you toughness has done me any harm, if anything has helped me greatly. So keep saying it how it is, if someone wants real recovery, they should be looking for an RD like you to help fight with them.

  3. Lori, I have nothing but respect & admiration for you AND your communication/treatment style! I have had the privilege of working with you for many years. Just today, you asked me why I kept seeing you. This is why---you force me to evaluate what I want/value in life especially when all my thoughts seem eating disordered and twisted. You push me when all I want is to retreat. In short, NEVER CHANGE! ~MN

  4. I think its really interesting that a therapist said that you are extreme - what did s/he want you to do differently? Stand by while your patient self destructs? Maybe the therapist is extreme! Besides, if you were "too easy" there'd be rumors about you then as well.
    Tough and mean are different. You are not lacking in compassion. You just don't take any of our behaviors or other bull lightly and if you did our eating disorders would just up the ante anyway. The eating disorder lies to us - you are the filter that catches all of the lies and tells them back to us in order to reveal truths. Sometimes my ED tries to trick you (I swear, its not me, I can barely stand half of what comes out of my mouth) and the healthy part of me is practically holding my breath hoping you will be "tough" enough to see it; because what will happen to me if you don't? Your lack of tolerance regarding unsafe behavior is exactly why we come to you.

  5. @leavinged36, mooshie and anonymous:
    Your honest responses are greatly appreciated. I know in my heart that the approach I take with my patients is in their best interest. I expect patients to give me push back, but I expect better from other health care providers. Yet your thoughtful words encourage me to continue to do what I do, as I do it.