So you think you're recovered from an eating disorder? Take this quiz to find out.

1) Recovery is about weight gain. Period.

The simple answer? 

It just might not be going the way you planned. 

False. Now don't let your eating disorder get all excited, saying "See! I told you so!"

Weight restoration is surely a must for those who have fallen from their usual weight or in the case of kids, their weight for age and BMI curves. That is, their expected pattern of gain based on their age and their weight history. For kids, falling off their usual growth curve suggests a problem. It shouldn't be praised or rewarded, but evaluated. (Pediatricians, did you read that?!) But if someone's weight was high due to unhealthy behaviors such as binging, emotional overeating, or general disregard for satiety, and weight dropped with improved eating and coping, weight gain is likely unnecessary.

Simply reaching a healthy range based on the charts also isn't enough. Perhaps your restrictive eating and suppressed weight began as a young teen, and you've lived for years with eating disordered behaviors. Did you rely on cigarette smoking or other substances? Was your appetite suppressed by ADHD meds? As you recover, weight gain may be essential regardless of what the BMI charts say. Focusing on the weight is misguided!

Your weight may be technically in the normal range, but your behaviors may indicate a problem. You know, like restricting, binging, purging, laxative abuse, compulsive exercise.

Weight is just one component of eating disorder recovery.

2) If I get a period (and I'm not a guy) then my body is healthy.

False

Surely losing your period when you're of age and sex to be getting a period is cause for concern. But getting your period is not evidence that all is well and you have recovered. You may get what seems like a period when you're on the pill, or start to get periods back without all the hormones being back to normal. Or maybe like one adult patient I used to see, in spite of her struggle with anorexia, she managed to conceive and deliver 5 children, never missing a cycle. Similarly, weight may be restored to the appropriate place, but it may take several months for menses to resume. For guys, low testosterone level is a more silent red flag that things are amiss; is resolves with adequate eating.

3) If I can take in enough calories, then I've recovered.

False

Can you eat foods you used to enjoy?

Sure, you will need enough calories to get your body bad to normal function--with a healthy heart rate and blood pressure, without major drops in pressure when you go from lying down to sitting or standing; with normal body temperature and energy level; with better sleep and mood. But full recovery means eating a range of foods and nutrients. It requires eating enough carbohydrates and fats-- not just protein. Recovery, true recovery, demands you include foods that seem scary, foods that you used to love, so that you aren't controlled by them. Like eating some pizza or an ice cream if the spirit moves you.  It means eating bread that may be whole wheat, or white, sourdough or french, without relying on ‘sandwich rounds’ or high fiber, low calorie flatbreads, or “Ezekiel” bread. If you’re truly recovered you can eat foods even if you can't justify them for their nutritional value, even if you don't think of them as "good for you".

4) I've stopped using laxatives, vomiting, and I'm eating better. I'm healthy now that I'm exercising every single day. So surely I'm recovered.

False. Replacing one behavior with another-- in this case, having to exercise to allow yourself to eat-- is also not healthy. Be careful that you aren't just swapping one behavior with another-- even a 'socially acceptable' behavior like exercise. If you feel you can't eat if you don't exercise you have work to do!

Ok. So I am doing fine with all that. But I need to be the one preparing the food. I'm still recovered, right?

I know. This is a scary idea. I will
settle for nourishing you
with words.

Not quite. Full recovery includes some flexibility and acceptance of what you can't control.

It means eating meals out without having to look up the calories before hand, and without having to modify the entire meal according to ED (that said, being vocal about your preferences doesn't have to be disordered. While Sally didn’t have an eating disorder in "When Harry Met Sally" this scene is worth viewing for some comic relief. Recovery is being able to eat a meal without watching the food be prepared, fearing the secret addition of ‘toxic’ ingredients.

Recovery acknowledges that people you know diet or overexercise or are losing weight, and it is what it is. (see husband triggering) And that you stay the course with eating and avoiding behaviors because it simply has to be; because you can be a great dieter-- but it didn't serve you very well being in that place before. And because you simply deserve to feel better.

Not as far along as you hoped? 

Then move your frustration to action. If you've just started on this path, hooray for improving your intake and taking steps toward recovery! Perhaps you're finding other ways to cope, so you're freeing yourself from unhealthy disordered behavior. Maybe reading this post helps you realize that more recovery pieces are in place than when you started. Progress! The point of this piece is to raise your awareness to help you keep going and reach fuller recovery. And to shake up some denial that stands in your way.

Yes, there's hope. See some of the links below.

Any changes to your thinking or eating you still need to make? Perhaps the post below will help to motivate.

Please share your thoughts!

And thanks for reading.

http://dropitandeat.blogspot.com/2011/09/beyond-calories-learning-to-embrace.html

http://dropitandeat.blogspot.com/2012/09/lessons-from-my-final-day.html

http://dropitandeat.blogspot.com/2013/05/do-you-believe-recovery-just-isnt.html

http://dropitandeat.blogspot.com/2012/03/normalizing-eating-and-hiking.html

Burning through the calories: where the carbs fit for weight management

Are you hyper focusing on the nutrients that are 'safe' to eat?

Processed foods are bad, toxic even. Breads, even so-called wheat breads, must be avoided. Other starches aren’t great for you either—but those whole grains seem a little better. And forget sugar, because you know all the horror stories about what sugar does.  Best to avoid it all; it’s much safer that way.

That’s what Dave thinks, and he’s not alone. He's an underweight young man, unhealthily thin. Yes, most sources of carbs are a problem for him. In fact, most fats are also a problem for him. He selects only foods he perceives as super-foods—super healthy choices chock full of nutrients; he’s not contaminating his body with any of that other junk. He reads a lot, but never the full research paper, because, I mean, who does? Anyway, if it’s in print, then it must be true, right?

Start to look at the big picture.

No, not correct. Even all the hype about sugar and its negative impact on health pulls from studies showing high intakes—25% of total calories, to be specific. That’s a lot of sugar. And that’s quite different than including a couple of mint Milanos or Lindt chocolates for instance, in the midst of a healthy, balanced diet. But why all the fuss, you ask? Who needs processed carbs anyway?

An RDA for chocolates?

It’s like this. There’s no daily requirement for processed foods—that’s for certain. But creating long lists of foods to avoid creates another set of health issues, both mental and physical. Deprivation, for one, creates rebound overeating, so setting rigid rules about all the foods you can’t eat becomes an issue. Further, avoiding large categories of foods as Dave does leaves fewer fuel sources and nutrients to meet your needs. A diet of vegetables and lean protein and a bit of fruit will likely leave you low energy—carbohydrate stores are our go-to for fuel; yes there’s a reason why Marathoners have a pasta dinner before their event.  Food rules are challenging to adhere to and lead to increased preoccupation with food and eating.

It’s worse if your needs are high, like if you are in the process of restoring weight from a low place. Truly, metabolic rate dramatically increases to well above what others of the same height (but who weren’t restricting and now re-feeding) experience. So the feeling of fatigue may result, and if you’re wondering why your strength is lost, this could be why. Or if you are a growing teen, restricting what you can eat may add to your problems—it’s challenging to meet your needs to restore normal growth when there’s lots you choose not to eat.

Burn, baby burn

Take a step back and try to look at your
assumptions a bit differently.

It's hard to negotiate with irrational thoughts. And the media's messages villainizing most anything that tastes good hardly help. So I’ll turn to my fireplace analogy to help him (and you) see carbs as just another fuel.

Let's say you have a fireplace. You could burn logs of pine or oak or maple. Burning each log type generates heat, turns to ashes in the end, regardless of which you started with.

Should it matter to you which type of log or fuel you use? Well you might have a preference for the scent of pine or maple, let's say. But from a fuel standpoint, it doesn't much matter. That is, as long as the total amount of wood is equivalent. It's just like food and its building blocks. You could burn carbs or protein or fats that you eat and yield energy—our heat equivalent here. And as long as the total amount of fuel or calories is the same, your body hardly cares where the fuel source came from—from a weight standpoint. You may have a preference for the taste of chicken or of nuts, and some foods may be more satiating (think whole grains or balanced meals including protein); and a varied diet will help meet your nutrient needs over time. But if the calories are the same, they will generate about the same amount of energy.

That's sweetened chai tea with real milk to go with our
carb-based snack.

But substitute some twigs and the fire dies down fast. Rice cakes, for instance, just won't sustain the energy. You could swap newspaper for the logs. But you'd need a ton of it to heat your house in winter. Yes, just like if you chose only light products or large volume but low calorie dense foods like broths or salads with little substance to them.

So what can I do now?

Stoke your fire with items that are pleasant. I love the scent of burning pine, personally, and I enjoy a good piece of pastry when I need the fuel. There are times those whole grains are just what I'm yearning, and they'll likely take a bit more time to process, and thus burn, than just white rice. But brown sushi just doesn't seem right.  And favoring protein and eating lots of it simply because you heard it’s good for you is no advantage for long-term weight management.

A healthy body requires getting enough. Not just total calories, but satisfaction, from a wide range of foods and nutrients. Isn’t it time you free yourself from the unnecessary food rules?

Don't wait for an earthquake to shake you into action.

I was talking to a guy from San Francisco this week, and the subject turned to earthquakes. This long-time SF resident and survivor of the big quake of 1989 offered some very practical advice for me to share with my son, a San Francisco newbie, fortunately naïve about the seriousness of going through an earthquake. His focus was not on what to do during the crisis—although that advice is critical as well—but rather what to do before hand. How to be prepared for this challenging situation, because being prepared, as he put it, is the surest way to increase survival.

Imagine that while sitting and discussing such matters my mind moved to you, my dear readers. No, there’s no need to worry about earthquakes for most of you. Rather, the subject of preparedness as a means to ensure survival and minimize damage struck me as most fitting—whether you struggle with an eating disorder or living free of diet rules.

Have a plan, he said. In San Francisco that might mean knowing which are the secure places to hover—the solid doorways and tables to stay under. But before it strikes, he emphasized that it’s critical to have an action plan: to keep cash on hand—because you never know when you’ll need it and ATM machines simply don’t work in these situations. Have a plan for communicating with those you’re close with—because electric doorbells to apartment buildings will fail and telephone lines other than landlines will fail. A transistor radio helps you connect with the world—to reality check what’s going on outside of your own limited space. You’ll need light of course—so batteries and flashlights need to be stashed to access easily.  And of course a supply of non-perishable food as well as water. Decision-making when undernourished will surely be compromised.

Time to come out of hiding and ask for what you need.

You can guess where I’m going with this. Yes, the analogy applies to you who are metaphorically on no greater solid ground. Communication is key to survival, and planning for opening these channels is critical. Can you tell your partner you’re struggling? Can you ask for help shopping and cooking to ensure your health and nourishment? Can you simply say “I need a place to eat dinner tonight?” Can you ask them to keep the pastries off the counter when you are trying to avoid impulse eating? Can you ask for a referral to a therapist or a behaviorally oriented dietician?

Where’s your transistor radio, so to speak, your exposure to the world outside of your own thoughts? Admittedly the cultural media may not be the most fitting reality check for sane thoughts, for diet-free messages, unfortunately. What I mean is that you need exposure outside of your own disorder thoughts—someone that can ground you when you are limited inside your own space. Were you really happier when you were so much thinner? Did staying on that crazy diet truly improve your quality of life? Your mental health? Or are you using magical thinking like the way we recall old boyfriends/relationships, fantasizing about how awesome it all was--when really it was nothing of the sort? Do you think you’ll restrict just for now and then be able to simply normalize your eating? Think again!

Do you have a grounding place to run to—your doctor, therapist, dietician, perhaps even a higher level of care—if your foundation is shaking? Do you have ready to eat food for when resources are tough to come by? A reserve for when, due to all the stress, your ability to organize and think through what’s best to eat may be impaired?

Where will your light come from when the power goes out? Do you recharge with talk therapy, or maybe yoga or meditation? Do you get spiritual support or guidance from wise friends or loved ones?

You may get no warning before the quake, before the shake up to your healthy behaviors and thoughts. So have a plan. Be prepared.

What steps will you take? Please share—we can all use to hear some ideas!

Read more about slips and relapses:

http://dropitandeat.blogspot.com/2011/08/so-you-really-think-i-can-keep-this-up.html

http://dropitandeat.blogspot.com/2011/08/hope-or-despair-only-you-can-decide-but.html

http://dropitandeat.blogspot.com/2011/11/quick-fix-for-your-struggle-with-eating.html

http://dropitandeat.blogspot.com/2010/12/new-years-resolutions.html

I’ve Gained Weight. Now What Am I Gonna Do?

Perspectives for those with bulimia, anorexia and those with no eating disorders at all.

"How much weight have I gained since we started working together?", “I want to know." That was the pressing question.

Ellie has been seeing me for several years, for periods at a time. She presented with severe bulimia, purging 3 times per day, every day, after each of the three times per day she allowed herself to eat. Back then, eating and keeping food in was simply not an option. Over time, her purge frequency decreased and she normalized her food intake, ultimately giving up her bulimia. 

Beyond her initial and modest weight increase, her weight has remained stable within a 2-3 pound range over the past many years. And that initial increase can be attributed to two things—no longer living in a dehydrated state and better nourishment.

To me, the better question for Ellie to ask would have been " how much better off am I since I’ve changed my eating?" In spite of the modest weight increase that she had no interest in, what did Ellie get in return?

When confronted with this question, she appropriately retreats from her disordered thoughts which periodically reemerge and readily acknowledges just how far she has come, how much better she feels. She remembers that there's no way she could've taken care of her newborn grandchildren in the state she was in then, or be trusted driving back and forth to their home. No, the price she paid, the few pounds gained, is nothing given what she's getting in return.

Gaining weight is rarely seen as a positive in our culture. Advertisements fail to praise us for outgrowing our jeans.

But for some, that is exactly what needs to happen. Staying at the weight you were at when you were 12  is hardly appropriate when you are 16, 20, or 40 years old. And even if your weight is objectively 'within the normal range' for the population, it may not be in range for you. It drives me crazy when doctors tell their patients that their weight—a  weight that has never been maintainable without an eating disorder because it's too low—is fine, because they are basing it on the charts for populations. Why the double standard? Because if you've always been a healthy larger size and you've lost weight through unhealthy measures, that 'normal range weight' may be anything but normal. Perhaps given your build, your genetics, your muscle mass, your history of athleticism, your body needs to be at a higher-than-average weight. And fighting it to be at a place you've never been will only contribute to unhealthy ways of eating and thinking. For your mental and physical well-being, weight gain may be just what's needed.

Gaining weight without an eating disorder?

Not long ago—a couple of months, maybe—I noticed that snugness around the middle. No, my jeans hadn't just been dried at high heat for too long. And really it was not in my head. Everything was fitting a bit too tightly. (Yes, even the bras.) Not one to weigh myself with any regularity, I suddenly jumped on the scale. I felt the need to reality check, to verify what I was feeling.

Yup. My weight was up.

Save your rush to judgement, please--it has nothing to do with the cupcakes, the chocolates and my homemade, full fat lavendar ice cream. Ok, let me clarify. No "I told you so's" necessary, because I ate all those foods before. But over the months of summer, the balance wasn't perfect, and so my weight crept up. 

Could it be that I was super active through the end of June, training for my fundraising ride, only to reduce my activity precipitously with the heat wave and awful humidity? Perhaps. Could it be that I've been socializing more, sipping on wine with dinner more nights than previously. Perhaps.  Could I have possibly joined my husband for an after dinner snack—just because it looked good and I thought I'd keep him company—more often than I really needed from a nourishment standpoint? Likely. Like you, I'm not perfect.

But the bigger question is what to do about it. If you were me, would you:

1. exercise a couple of hours each day to make up for the previous reduction in activity?
2. reduce your food intake to compensate for the extra calories consumed?
3. seek the guidance of a Registered Dietitian?

Ok. So I'm the RD so  I'd better come up with a fix.

But if you don't fall into the categories described above--those truly needing to gain weight, or those who've gained appropriately as a result of releasing yourself from disordered behaviors--and you find you've gained some unnecessary weight, here's what I'd suggest. Intuitively, it may seem appropriate to make up for any overeating in the days or weeks which follow. But don't do it! Instead, refocus. Get back to the basics, particularly if you've found yourself slipping into old patterns. Have you forgotten the basics? For starters,

Sit. No eating as you walk around the kitchen emptying the dishwasher. No eating standing at the fridge. And no, don't sit at the fridge; seat yourself at a kitchen or dining room table.

Separate. Eating and distractions,  (other than your family which you can't get rid of) should be separate activities. TV watching, texting, reading--these should be separate from eating. (Unless, I'll add, you are struggling to get food in and find that being less mindful is actually helpful--which it often is!)

Eat with your senses. Are you seeing your food and acknowledging what you're eating? Are you experiencing the textures of what you're eating? Are you tasting your food? Doing so will allow you to slow the pace and to feel more satisfied with what you're eating. You'll enjoy the food so much more!

Choose what you enjoy. Are you giving yourself permission to eat what you like, or holding on to rules about what's allowed vs forbidden, in your mind?

Tune in to  your hunger. Don't wait  until you are at the extremes of hunger--if you're starving you are more likely to struggle to eat as described above, and overeat.

Re-explore fullness. Are you eating until you are stuffed? Might a modest adjustment in portions be appropriate? That said, if you start with smaller portions, do give yourself permission to eat again later--after about an hour--regardless of what you you ate before.

Don't panic! And don't take radical steps to 'fix' the problem. Restrictive eating, denying your body's signals and needs, does nothing positive in the long run. It will only perpetuate an unhealthy cycle and make you feel like c!*P!

Breathe. It won't take long to get yourself back on track. But be realistic--if your eating was off course for some time it will certainly take some time for you to be back to your former, healthy self. Radical dietary changes can have radically negative consequences, so do be patient and appreciate the modest improvements as they happen.