In Response to Bridal Hunger Games

Preventing the Damage After the Wedding

It's hard to know what disturbs me most about the NY Times article Bridal Hunger Games printed yesterday. Was it the hopelessness of women who don't fit into their ideal image of what a bride should look like—willing to take dietary change to extreme measures to achieve short term “success”? Or my fright at the willingness of MDs and nurses, helping health professionals, whose “first do no harm” mantra has clearly been dismissed? 


Or maybe it's the NY Times itself for creating a piece that seems more like an advertisement for unhealthy weight loss schemes, rather than a balanced report on the pitiful state of our culture and the consequences of being lured into quick weight loss schemes?

Pressure on women for their “big day” abounds, and it's been addressed before on this blog http://dropitandeat.blogspot.com/2011/09/wedding-diet-guaranteed-to-change-your.html. But let's take another look, from the perspective of the newlywed in her post-honeymoon period.

It's now October or November, some months past the glorious wedding day. And as quickly as it was lost using a  starvation strategy—NG tube or HCG, or self-imposed restrictive dieting—her weight has been climbing. Those lovely wedding photos are images of the past, as she is now left with a rapidly gaining yet non-pregnant body. With  her deprivation diet, she began to crave foods like never before. Her thoughts about food and eating were all consuming (pun not intended) and her rigid pattern of restricting has turned into rebound binge eating. 


The more she withholds the calories her body needs, the more she feels stuck in the cycle of overeating and over thinking. Her thoughts become more black and white, as she feels that once she starts, there's no stopping her. She feels hopeless and depressed. And she certainly doesn't want her disgusting body, as she sees it, to be touched. This is hardly the fairytale she envisioned.

In fairness, this certainly might have gone somewhat differently. Perhaps her predisposition to developing an eating disorder, combined with the trigger of dietary restriction and stress leads her to continue her weight loss. Now her periods become irregular and soon ultimately stop. Her libido drops and her irritability worsens, along with depression. She spends way too much time thinking about food and eating and exercise now, and becomes more withdrawn, avoiding social encounters. Hardly wedded bliss.

In either case, there is hope. Food intake can be normalized and health, both mental and physical, can be restored. But the best thing would have been prevention—avoidance of these crazy, unhealthy diets which can cause this whole scenario to snowball. So if you're lured into believing that you'll be happier dropping weight for your wedding day, please think again!

But back to the article and all my issues.

Where the Medical Community Goes Wrong

Ok, so apparently the nurse tells the patients about the FDA risks about the procedure. Great. But action speaks louder than words. If a provider wearing a lab coat tells you he/she does this all the time and promotes it as a solution to your problem, don't you think it's fine to do? Won't you allow your unhealthy, irrational thoughts to buy into the “treatment”, forgetting the risks? 


Who ARE these providers, willing to inject patients with a hormone while supporting extreme starvation of 500 calories per day, a deficit of at least 1000-1500 calories daily for most moderately active women of average height? Or those willing to subject healthy women to a feeding vehicle reserved for the severely ill unable to consume enough food orally—cancer patients, anorexics, to name a few—simply to make a buck? And the nerve to call it “nutritionally balanced” when it is devoid of carbohydrate, and induces ketosis and self-starvation! 

And yes, the quoted Dr. Shikora gets it right—but regrettably fails to acknowledge that discomfort is the least of the problem; he acknowledges with what I suspect is a bit of sarcasm that having a tube shoved down your nose is “not always comfortable and pleasant”—perhaps because he hears more complaints of discomfort following the gastric bypass surgery he is well-known for performing.

And while Dr. Aronne wisely suggests that waiting until there's little time left for change (resulting in taking extreme measures) is not the best strategy, I'm still left questioning this assumption:  that brides need to lose weight for their wedding! Perhaps if the focus were not on losing weight for a dress or for a day's appearance, I'd be okay. If weight had been climbing as the soon-to-be-bride had become sedentary or had turned to stress eating to manage at her new job, I could certainly see room for change. Addressing her unhealthy behaviors to help her gain control of her emotional overeating, to strategize about alternative coping measures, or to learn to distinguish hunger from other eating triggers—these I could support. 


Helping the soon-to-be-bride feel better, I certainly endorse. But that's not what the article encouraged. Maybe it's me, but this seemed like a sensational article about how to lose weight rapidly, without appropriately highlighting the very serious consequences.

So if you're feeling hopeless about your weight, don't be lured by promises of quick fixes—wedding, or no wedding. Consider the consequences of your actions both on your thinking and your general well being, not just on your weight now but in the future. 


And if you're ready to make changes, be sure they are reasonable to live with—not just for a week or two, but for life. No eating plan that severely restricts calories or omits whole food categories fits this description! 

Shame on these doctors who promote such weight loss programs. And shame on the NY Times for such an unbalanced perspective of the costs of such measures. You could easily buy a new dress at Kleinfeld's for the future cost of an eating disorder program, and the cost of your time at the therapist, doctor and dietitians' sessions to undo the damage from these diets. 


Fitting into your grandmother's dress, or society's expectation of your wedding day appearance, is no justification for messing with your head, and your body.

Recovery Happens. But Not Without Your Help.

Statistically, she was likely to fail. She had a long-standing eating disorder, and was well entrenched in her 31 year of thoughts and behaviors. She lacked motivation to change, and continued to live in a toxic environment, from a recovery standpoint. And quite frankly, her eating disorder worked for her. 

Yes, you read that correctly. While unhealthy and quite dangerous, ED helped Cathy on many levels. It was her drug of choice, so to speak. It numbed her, allowed her to live invisibly, and allowed her to have no expectations for herself.  If you only knew the details of Cathy’s life, you wouldn’t be judging her for her choice.

That is, if it were a choice. She was not the first generation of her family to live with an eating disorder. Genetics? Environmental? A combination? There’s no quick answer, but likely a combination of factors result in developing an eating disorder, and in maintaining it.

Cathy’s began at the age of 16. Yet she first presented to me at the age of 37. Her only experience with ED treatment was at her 3 hospitalizations, the last one just prior to seeing me, a stay prompted by her suicidality. Hardly enthused about recovery—never mind being there, she presented to my office only to please her therapist (with the consequence of losing her if she failed to show).

This was no quick fix, and in truth, the battle isn’t fully won—yet. She’s had great support from her therapist, moving forward not just in her relationship with food, but her ability to begin to advocate for herself. It hasn’t been easy—for either of us—but it is so satisfying to read her unprompted words below. So I just had to share. Cathy would never frame her amazing recovery as her accomplishment. But there’s still time to work on that in therapy! Hope you feel inspired by Cathy’s shift, occurring over a 3 year period.

"I've been so sick - literally laying in bed for most of the week).  I managed the hell day yesterday of consuming only liquids and endured the copious amounts of Gatorade and Miralax (prepping for the colonoscopy).  You were right, the test was fine - knocked out cold for both tests - but it was the prep that was not so. 

How in the world did I use this whole laxative thing before???  It's just awful and I actually hate it!  I can't believe I would use laxatives!!!  I am never, ever going to use them again - and this only reminded me of why I wouldn't want to use them again!  Also, let's talk about barely eating --- how in the world did I manage that one too????  I couldn't tell you how damn hungry I was all yesterday!  

Am I that far removed from ed that I am soooo out of practice by barely eating anything?  I was dragging, unenergetic, blah blah blah.  I was unable to finish the last 2 glasses of the Gatorade blend (so I cheated) but they didn't say anything about it today (thought I was going to get spoken to!)  I was so close to throwing up the end of that Gatorade, I absolutely wanted to throw up my stomach hurt so much from that, so it was a fight (even putting my hands in front of my mouth) not to puke it up.  I decided it's better if I skip some than throw up all I had. 

I wanted to share these thoughts with you, and why?  Because I was just reminded of how lousy I feel when I'm ingesting laxative pills, and barely eating anything.  It sucks!  And I guess it reminded me that also that after days of being sick, then topped off with yesterday's recipe of clear liquids and Gatorade, I just want to feel well!  

Maybe this is me saying I am liking feeling healthy.  I am hoping tomorrow morning this sickness will be gone, and I'll be able to fill my tummy with coffee and wheat toast - and even a morning snack!  I want energy back!  I guess I appreciate better health more than I thought."

Fasting

I didn’t eat, or drink for 25 hours, from 5:45 Friday night to 6:45 PM Saturday.  No, I haven’t lost my mind or my sensibility. And there’s no need to worry about me. I did it because it is my family’s tradition to fast, a complete fast, on this religious holiday, the Day of Atonement, which occurs once a year. And the experience raised some thoughts I’d like to share.

The purpose of this fast day is, in part to atone for one’s wrongdoing. But in general, it is intended to be a reflective, contemplative day, full of soul searching.

So here’s what I learned.

The act of fasting, or restricting my intake so severely, leads to anything but meaningful reflection and soul searching. Yes, it prevents us from doing other prohibited activities, including working and having sex (yes, that’s prohibited too). But meaningful contemplation? Clarity of thought and insights into our relationships and behavior?  What were those Rabbis thinking?!

It started harmlessly enough. I missed my evening snack, and in the morning I could only imagine the scent of dark roast coffee, freshly ground and brewed, as I do every morning in my French press (Melior), in addition to my breakfast, I might add. But I was fine. And then I sat through the temple services. As the morning hours passed and 1 PM was approaching, I noticed that it took me longer to read, and to comprehend the written passages.

And by 3:00 all I could think to do was to nap. And so I did. For almost 2 hours. No introspection. No making amends with friends and family. Just sleep. Quite the meaningful fast day!

As for my overall food consumption, let’s just say there was little thought or restraint to my “break-fast” meal that evening. Bagels, cream cheese spreads, smoked fish, cream cheese brownies, rich, whole-fat blintze soufflé, salad with nuts and goat cheese and of course walnut oil and dried fruit (yes, I made that one). And more brownies. Ah, and the coffee. Oh, and I had some bread with honey before going to my friend’s home for this meal (okay, so I broke the fast a bit early).

Many if not most of you, regardless of your size, have at times restricted your eating. And many of you still do. So I ask you to consider the following. Does the restricting ultimately work? Ok, I will agree, that in the short term, restrictive eating meets some needs. If it didn’t, you wouldn’t maintain the behavior. But the benefit is very short-lived. And not without consequence.

From a weight management standpoint, I’m certain it is ultimately most ineffective. As I experienced, I ate more both before the fast and after than I would usually consume. And my activity was impacted as well. I couldn’t even think of walking my dog. And I spent more hours sleeping than I ever would in a 24-hour period. And let’s say I were on a diet in which I intended to restrict types or amounts of various foods. The result? I would likely feel denied and deprived, and when I finally had a weak moment I would likely binge or overeat on the “forbidden” foods. Sound familiar?

But if the main goal, consciously or not, was avoidance—of feelings, of engaging in all life has to offer, in dealing with thoughts too challenging to contemplate—then restricting clearly works. But not without a price. It has a very short-lived benefit, and ultimately fails to fix the situations you might seek to avoid.

Perhaps the best part of this fast? It reminded me of how much better I feel when I eat to meet my needs. I appreciated that my mind and my body so depend on nourishment throughout the day. 


As for control, which many of you yearn for? My eating and your eating is far more in control when we can have delayed gratification and not eat impulsively. And when we can think clearly.

Susan recently broke up with her boyfriend of 3 years because of her eating disorder, her bulimia. She had been living with him and he had no idea of her daily, yes daily struggle with food and purging. But after working together for many months, together with her therapy work, Susan came to a realization. Several months had now passed since she had relied on purging. And she was eating regularly, and more adequately, with fewer restriction, although “healthier” foods still seemed safer. And she was feeling more grounded, more in touch with her feelings—and her self. And so Susan began to realize that she wasn’t happy in her relationship and hadn’t been for years. So she ended it. And moved into a new place of her own.

If it weren’t for her steps toward recovery Susan would not have been able to shift direction for better, to find her voice, to state her needs, to be true to herself, to have control over her life. So there’s control, let’s say over how little you choose to eat, and there’s control, over things that really matter.

Now I think I’ll need to revisit those cream cheese brownies, which I was in no position to truly savor on Saturday night.


As always, I'd love to hear your thoughts!