2/23/17

Our Collective Obsession with Weight Loss

The cultural focus on weight engulfs many people's conscious thoughts, the majority of whom do not have an eating disorder. For people whose bodies do not conform to the societal norm, and for many who cannot see their body realistically, there is a plethora of options to attempt to manipulate weight and body. The various industries, including food, diet, supplement and exercise, seek to capitalize on the intense personal need to control weight. 

Not infrequently, patients contact me or see me largely to withstand the onslaught of messages and quick fixes for weight loss. The intense pressure to look a certain way and, just as importantly, to fix problems with one's body that our society insists must exist is relentless. Our minds are bombarded with this message. Personal value seems to hinge on the expectation that we are all seeking to perfect ourselves and our weight. 

And so industries rise to offer solutions. The exercise industry continues to grow exponentially and provide a source of constant guilt and seemingly endless expenditure. The food industry pulls us between diet food and fast food like a ping pong ball. Supplements for weight loss abound. And medicine has gotten into the game from weight loss clinics to the endless stream of new obesity medications to the very lucrative Bariatric surgery centers. 

It's extremely hard to find the voice of reason. No one is saying we are wasting our time focused on body and weight. The message to live a full and productive life is nowhere to be found. 


The broader message I impart to patients who come with these worries is simple. The goal is to put the overall concern about weight into a larger context. Figuring out one's own personal needs and struggles remains paramount. Finding direction in one's life is the goal. If weight becomes the sole focus, life starts to feel like an endless rat race without a point or an end. Acceptance of one's body is difficult but a necessary goal to find out how one actually wants to live. Although this message applies to eating disorder recovery, it has true meaning for everyone in the world we inhabit.

2/16/17

Combatting Eating Disorder Thought Processes

The most powerful component of an eating disorder is the thought process. Unlike most illnesses, the central part of an eating disorder feels as if it takes over our identity. The thoughts become our thoughts. The rules become our rules. The beliefs become our beliefs. 

Deeply buried beneath a system that pushes someone to manipulate food in whatever way the eating disorder determines is the actual person. Those real and true thoughts and feelings are either very compartmentalized from the illness or simply ignored and not part of one's life.  

Recovery initially entails normalizing food because improved nutrition and health are crucial for any steps towards wellness. However, from the start, successful treatment needs to incorporate the concept that the eating disorder thoughts are an alien experience that severely limit personal growth, satisfaction and the true nature of life. 

It is a shock for people to realize how much they have been brainwashed by the illness. Our minds tend to be able to unconsciously accept a belief system, even if it's completely irrational or harmful, and find ways to function within that reality. Breaking through that wall to recognize the system is broken is a mainstay of recovery. 

There are three main ways to accomplish this step. 

The first is the food journal. This simple daily exercise exposes the insidious and constant nature of the eating disorder thoughts. The journal forces one to look many times per day at the painful but powerful eating disorder messages. Similarly, a small bit of perspective from this daily existence encourages the person to question if the food choices and thoughts really make sense. 

Second, the therapy needs to try to separate eating disorder thoughts from personal thoughts. Some clinicians call this distinction the difference between healthy self and eating disorder. Although the terminology may seem artificial, it's critical to start to see the eating disorder as other rather than a necessary part of identity. Once the idea of a healthy self comes into view, those new thoughts consistently question the reality of living completely in an eating disorder world. 

The last step is to use the journal and the healthy self to look more globally at life. As one begins to address a personal philosophy and overall goals, it becomes easier to see how the eating disorder will never allow anything to change in life. Other components of life, relationships, friends, work, must start to matter more and push out the eating disorder thoughts as the primary source of personal identity and accomplishment. As this process starts, it become harder to adhere to the disordered thoughts and philosophy. 


These last two posts explain why eating disorders are psychological illnesses and why clinicians and loved ones need to try to understand the complexity of the illnesses in order to be loving and supportive. Nourishment and health are critical, yet psychological change is the hallmark of full recovery. 

2/9/17

The Psychological Aspect of Eating Disorders

Most people, often including clinicians not knowledgeable about eating disorders, consider the physical symptoms of restricting or binging as the central element of these disorders. The psychological component of the illnesses remains confusing and elusive to most. 

People suffering from eating disorders most often perceive the eating disorder as a powerful barrage of critical and demanding thoughts that dictate daily life. The thoughts typically focus around the need to restrict food and loss weight or to find a way to justify binging no matter what. The thoughts feel so powerful and insistent that they are impossible to ignore. 

Everyone has various thoughts their head, but not everyone knows what it is like to have such powerful thoughts that run counter to one's own logic. In addition, these thoughts don't feel foreign. They feel like one's own true thoughts. 

Imagine for a moment what that last sentence means. The thoughts that serve as the engine of a destructive illness feel like one's own deep and intimate thoughts. The illness itself penetrates to the core of one's own self and literally takes it over, almost as if one has been brainwashed by the illogical, painful thoughts to manipulate food and feel sick. 

After processing this information, it becomes clearer why eating disorders are so confusing to people and why recovery is so hard. The actual symptoms make little sense to people who aren't sick, but recovery to those who don't understand simply means stopping the symptoms. In fact, families and friends usually try to make sense of eating disorders exactly with that philosophy: just eat food.

But the idea that foreign thoughts dominate one's mind and dictate how someone lives their life is anathema to how normal people live. The internal struggle between the desire to live a full life and the eating disorder determined to be thin or use symptoms at all cost leads to a fraught and challenging life. The process of successful recovery demands an enormous amount of energy separating the eating disorder thoughts from oneself  by any means necessary. True recovery means quieting the eating disorder thoughts enough to then be able to focus on life more freely. 


The next post will discuss the most successful ways to separate one's own self from the eating disorder in therapy and in practice.

2/3/17

Focus on Compassion and Love in Recovery

A core tenet of eating disorder therapy is to maintain sharp focus on compassion and love. Eating disorder thought processes are relentlessly harsh, critical, judgmental and downright cruel. However, these thoughts dominate the mind of someone suffering from an eating disorder and feel inescapable. 

As I have written regularly in this blog, the antidote to the thoughts is love and compassion. The instinct for loved ones is to focus on improving eating patterns, weight or physical health. Clearly, eating and health are crucial to recovery, but those comments always directly support the eating disorder. 

Rather than perceive these comments as supportive, as most loved ones imagine, they are interpreted as personal attacks against the eating disorder. Accordingly, the eating disorder thoughts only strengthen when faced with comments about food and weight. The supposed support only seems to propel a further descent into illness. 

The most helpful support that specifically counters the core values of the eating disorder is centered in compassion. Saying things like, "I love you" or "you're really doing an amazing job in recovery" convey a very different meaning. These comments penetrate through the eating disorder messages and connect more profoundly with the essence of the person suffering from the eating disorder. The effect of establishing a secure connection of love and support is what anyone suffering from an illness needs and that is even more valuable in eating disorder recovery. 


Because of the extended time eating disorder recovery takes, loved ones and friends need to keep in mind the need for compassion and love every day. It can be hard to maintain that kind of focus, yet each kind and loving word makes a difference to maintain the path to fully being well.

1/26/17

The Role of the Dietitian in Eating Disorder Treatment

A dietitian is a central part of anyone's recovery and often the most feared and the most misunderstood. People typically expect the sessions to be solely about what to eat and when to eat it. That can be extremely exposing and uncomfortable, if not upsetting or even infuriating for people seeking help. It's easy to see why it's hard for people to follow through with the appointments with this expectation. 

However, there is a big difference between seeing a skilled dietitian specifically trained to treat people with eating disorders and an otherwise good one. 

Expert dietitians who specialize in treating people with eating disorders have very different training. They typically have worked with a therapist or treatment program to learn therapeutic techniques about eating disorder treatment. So these sessions tend to be a cross between a typical dietitian session and therapy. In other words, the appointments are best described as food-centered therapy. 

In addition to setting out a meal plan and an idea of when to eat and what to eat, the treatment involves discussing fears of food, the emotions triggered by eating and the experience of progressing in recovery. 

By centering the food-focused aspect of treatment with the dietitian appointments, therapy sessions can more freely focus on psychological and emotional aspects of recovery. The complementary nature of these two appointments allows for much more direct attention to all components of wellness. Trying to use therapy both for food and therapy often slows recovery and limits progress. 

Assembling a team of a therapist and dietitian who know each other and work together in a similar style can be of enormous help to treatment as well. It's a big step to understand and accept the true nature of why dietitian appointments are essential for recovery. Doing so is representative of a true dedication to recovery.

1/19/17

The Path through Body Image in Recovery

Body image thoughts constitute the most stubborn and tenacious symptom of an eating disorder. For most people, the ultimate goal of the illness is to lose weight and reclaim their body in an idealized form. The result is a wish, a panacea. Life will be wonderful and the world will somehow be good once the magic weight is attained. 

When a fantasy is imbued with an overarching expectation, the desire is doomed to fail. Logically, no weight can fix an entire life. No body shape solves all of one's problems. But the most common implied thought of an eating disorder is just that. 

Two realities ensue from this eating disorder thought. First, no one wants to give up the goal of weight and body because it means giving up the wish for an easy fix to life. Second, negative body image thoughts have little to do with body, as shown in the study from the last post. When a supposed visual about one's body actually reflects all the ills of one's life, there is no negotiating with the power of these thoughts. Moreover, if body image reflects the negative feelings about oneself, those thoughts have no chance of a fix in the eating disorder paradigm. They will remain forever elusive and only cause misery. 

Healing from these critical, negative thoughts means engaging with the actual issues in life. The negative thoughts stem from feelings about life, relationships and emotions. The supposed easy fix of the body image thoughts is to translate the negative emotions about external realities into negative thoughts about body. Then trying to fix one's body stands in for trying to handle the emotions of life, to no avail. 


It is a tough sell to help people face those feelings. The emotions are scary, and the automatic reaction is to turn to the eating disorder for help. Acknowledging and experiencing the feelings is challenging and unpredictable. Each person needs help to manage the intensity and confusion of the emotions and to know things will turn out ok in the end. This process can be very effective. The hard part is helping someone see the value in ignoring the body image thoughts and instead facing the emotions of life.

1/12/17

Connecting with Body in Recovery

People with eating disorders focus relentlessly on body and weight. This focus may be common in today's world, but the level of obsession in these illnesses is significantly more consuming. The thoughts stop reflecting reality and instead become a powerful internal dialogue that goes beyond just the simple wish to lose weight. For instance, how else can an emaciated person still feel she needs to lose weight?

Outside of illness, others often interpret these eating disorder obsessions as they would the normal wish to lose weight. Without considering the overall pressure about body size in our society, it's crucial to realize the stark difference between this common wish and the eating disorder thoughts. 

Often the obsessions about body and weight in an eating disorder actually has little to do with one's body. Research reflects this quite clearly. In one study, patients with and without anorexia were asked to reflect on their own self image during an MRI. The results for people with anorexia, unlike the others tested, showed that in processing their own body, they did not activate the visual center of their brain. In other words, self-image for people with anorexia did not reflect the actual, visual representation of themselves. 

This information is very helpful in recovery. It's easy to extrapolate from this study that recovery needs to involve connecting with one's body again. An eating disorder separates self-image from the body itself. So recovery means learning to feel, process and experience the feelings in your body. This may not be intuitive about eating disorders but is critical to understand the process of getting well. 


Accordingly, inpatient and outpatient programs often include yoga, walks and various other forms of treatment that involve movement. Therapy must regularly recognize how people experience their lives and emotions in their body, not just in their minds. Recovery is not just an intellectual or even an emotional process but also a physical one. Wresting a life back from an eating disorder involves transforming all components of the human existence.