7/20/17

The Central Myth of Eating Disorder Thoughts

A refrain of eating disorder treatment is your body knows how to function. Give it enough food and it will take care of itself. The saying begins to be trite the more often one hears it, but the challenge is to recognize how profound it really is. Ultimately, believing this simple message can help someone with an eating disorder discount the majority of what any eating disorder thoughts deem as true. 

Food is a biological necessity for life, as crucial as oxygen, water and sleep. However, of these absolutes, only food is so mutable to allow for someone to attempt to constantly manipulate and adapt their food choices. 

The confusing messages society consistently supports is that one's diet is something to work on and perfect. There's a widely accepted belief that choosing food wisely, if not perfectly, will transform weight and health, if not the course of life itself. Meanwhile, the body will digest, absorb and utilize the energy from food in its own way no matter what one eats. Weight is a data point the body manages for health and wellbeing. And the vagaries of daily life are not related at all to what one decides to have for lunch. 


The best argument to use against exaggerated, if not magical, thoughts about food and diet is that food is a basic necessity of life. Biology dictates what our body needs and how it functions. Our life course and decisions are what we can all try to affect and move through. Expecting food choice to fix life's problems means ignoring one's realities. And our lives need as much attention we can give them.

7/13/17

The Separation of Meaning and Weight

People engaged in recovery from an eating disorder comment on how personal and how philosophical the process is. They marvel at their internal growth and maturation and at how their view of themselves and the world has transformed. 

In the same breath, they often ask why eating disorder recovery needs to be this way. If eating disorders are largely destructive behavioral patterns, why can't behavioral treatment lead to health and wellness?

The answer lies in the fact that ingrained food behaviors tap into our basic human drive for survival. Accordingly, deeply rooted food behaviors function within the oldest and least conscious parts of our brains, parts we share with much more primitive living beings. And so once food behaviors are fixed, changing them becomes overwhelmingly difficult. The patterns exist in the least accessible parts of our psyche. 

As I wrote in the last post, once the survival instinct transitions to diet and weight management, it starts to feel as if maintaining a certain weight is as urgent as our survival. Once that instinct is triggered, changing the association is very challenging. 

The key to creating a meaningful life, one not dominates by the endless search for the perfect diet, exercise plan and weight, lies in the most successful eating disorder treatments. Although the severity of the medical and psychological risk is much greater for people who suffer from these illnesses, the methods used to change profoundly ingrained food behaviors are relevant for both. 

The medical or purely practical approach to treating people with eating disorders is hardly ever successful. Short-term improvement in health belies the course of the eating disorder. Inevitably, the eating disorder thought process hardens when someone is forced to make behavior changes. It may appease clinicians to blame the person for her illness in this situation, but the clear problem remains in the treatment decisions. 

Treatment directed towards a fuller recovery combines refeeding and improved health with a consistent message of creating a meaningful life. Using our conscious brains to introduce and reinforce the need for useful activities, important relationships and intrinsic personal value creates a foundation to combat the eating disorder thoughts.

The psychological process of recovery involves replacing the old eating disorder thoughts about food and weight with a  new philosophy focused on meaning and relationships. As the new philosophy strengthens, the old eating behaviors lose steam and normal food patterns dominate. 

Applied to the general world focused on weight and appearance, the message that dieting doesn't work is too practical. There is no personally meaningful voice or system to replace the incredibly powerful diet, food and exercise industries. It's not a surprise that even those fed up with living their life for weight loss turn to Bariatric surgery for relief rather than a compassionate and kind approach the identity and life. 


The messages competing with the seemingly perfect life of diet and exercise need to find their way into our daily awareness to be effective.

6/16/17

Thinness and the Survival Instinct

The backlash to the dieting culture has been relatively quiet and even meek. There is plenty of evidence that diets don't work and that health is not related to size. But these realistic voices don't make a dent. Slavish focus on weight, food and exercise dominates the mindset of our culture. And at this point, the void that would emerge from eliminating the thin bias is hard to overestimate. We are trained to believe that we need the obsession with weight. Without it, apparently, we would all be lost. 

Believe it or not, a large part of our consciousness centers on survival. This basic instinct has utilized our higher order level of thinking for millennia to outlast and outperform all other species. We tend to think our superior intelligence and problem-solving skills make us evolved beings, but the true element of our station in the world is our ability to survive. Whether it is related to making fire to cook food, ingenious methods to protect ourselves from predators or various means to combat bacteria such as purifying water or antibiotics, our successes rely heavily on the combination of our sophisticated brainpower and our most primitive instincts. 

But now this success has caught up with us. If life for many fortunate people is fairly stable without any imminent risk to health or survival, where can we apply these powerful instincts? Being human means the need to survive remains very present and very strong. Perhaps there's no immediate risk, but this fundamental part of our biological makeup remains intact. 

The combination of strong cultural pressure and social science applied to marketing has brought these instincts full circle. Our need for thinness has changed from a societal norm into a what feels like a biological necessity. Too many people cannot function unless they weigh a certain number or fit into a certain size clothing. The urgency to be thin is increasingly conflated with the survival instinct. For many, life cannot go on normally without thinness. 

Meanwhile, various industries use the vast knowledge about food, metabolism and human suggestibility to create foods, weight loss plans and exercise regimens that encourage a lifestyle largely centered around food and weight. There is a sense of inevitability and virtuosity to the ascetic life focused on diet and exercise. In the end, this ultimate goal of thinness creates nothing more than a small, meaningless life. 


Since we cannot eliminate our survival instinct, we as humans need to find a place to apply it. Allowing industry and culture to shift survival to something as banal as weight isn't creating meaningful lives. Recovery from eating disorders focuses on authenticity and deepening personal relationships as the antidotes. Is this lesson one that can work in a larger context? I'll talk about this more in the next post.

6/8/17

Can Dieting Create Meaning in our Lives

Diet and weight have come to define purpose and success in our lives. The clear data that prove the ineffectiveness of diets and various weight loss regimens never appear to sway the underlying premise of our collective goal. The fundamental concern isn't medical. It's psychological. 

We live in a world where only thinness is normative. The most widely accepted weight scale, BMI, skews heavily towards the lower end of the spectrum and does not take into account the variety of body shapes and makeup. Weight bias pervades all aspects of our culture from media to fashion, business to healthcare. Professionals of all stripes adhere closely to the expectation of thinness. Most people are not at all aware of how weight bias colors their perception every day. 

New movements to counter this insidious fat phobia are more and more prevalent. Body positivity espouses the concept of accepting and appreciating the body you have regardless of size. Health at Every Size, a successful government-sponsored program, has been shown to improve overall health significantly without focusing on weight loss. Yet successful alternatives to weight bias do not affect the central psychological driver for our collective belief. 

Daily life tends to isolate us in our small worlds and to limit our ability to see the overall benefits of our existence. More often than not, those lucky enough to be free of illness or immediate threats to our well-being struggle to find meaning or urgency in our lives. 

The human yearning for purpose has persisted over centuries, and we all struggle to latch onto a tangible meaning for our lives, especially in the modern post-industrial, digital age. One clear salve for the masses is dieting and weight. The daily struggle gives direction for each day. The success or failure of following a diet or losing weight structures an otherwise aimless life. 


So the purpose of dieting is only purportedly to lose weight. The meaning runs deeper and the need for daily structure is even more important than the outcome. That's why people diet or focus on food and weight their entire lives. With this background, what comes next? I'll continue in the next post.

5/25/17

The Magical World of the Perfect Diet

With all this knowledge about biology and weight, it would seem obvious that these facts would change our behavior. However, this knowledge fades into the background amid unsubstantiated, clearly untrue dieting advice. 

It's hard to conceive of why the public would choose a clearly impossible goal of weight loss over a proven path of following the body's own internal signals. Clearly the scientific facts could provide some sense of peace. Yet the drive for thinness remains paramount for the modern adult. 

The meaning of thinness surpasses all success in our culture. Without achieving it, any other achievements are discounted. Even without other meaning in life, thinness itself counts as true success. 

The cultural zeitgeist has elevated thinness to a true measure of a person's value. In these circumstances, scientific knowledge can't be fully accepted. The fantasy that permanent weight loss brought by the perfect combination of diet and exercise must exist, according to this precept.

To conceive of a world without that panacea is analogous to a child believing in a world without Santa Claus. 

In fact, the deeply held belief system around weight leads our population into dangerous territory all the time, heedless of the risk. Children taken to weight loss camps at age eight. Doctors chastising patients about weight without any facts to substantiate their medical recommendations. Communities of adolescents teaching each other how to purge in the school bathroom. Hoards of adults willingly allowing doctors to surgically destroy their gastrointestinal systems. 


As the repercussions grow for various weight loss regimens, the risk to our community also grows. The long term questions about our state of mind and our collective life purpose become clearer. How can we all wake up from this nightmare and define a successful and useful life outside of food and weight? Facts may be necessary but clearly aren't sufficient. The next few posts will address this concern.

5/18/17

The Hard Facts about Weight Loss and Biology

Nothing about homeostasis and weight, as discussed in the last post, is new information. There is more research in recent years to provide evidence for this biological function, but it's not news that the body monitors and manages weight for overall health. 

However, the constant messages from the diet, exercise and food industries completely ignore this reality. These business interests dominate the information available about food and weight and have convinced people, medical practitioners and even government organizations that weight is within our control and a necessary part of overall health. 

Since the cultural norm in recent generations is thinness, it's not hard to convince the public that being thin is preferable. Using weight as a measure for health, longevity and well-being is an easy sell for a population already inclined to believe that thinness is equated with personal value and self-worth. 

In addition, these industries all give clear instructions for attaining said goals. Each new diet regimen purports to be the magic fix for weight loss. Every exercise plan is guaranteed to lead to permanent changes in one's body. Bariatric surgery programs or weight loss centers provide hope for those who fear being destined to their current weight forever. And the food industry rolls out one new food product after another meant to insure health and weight loss. 

What information does the knowledge about homeostasis provide? Can it compare with the prescriptive advice that comes from industry and the media?

Biology only promises that if you eat regularly through the day with typical size portions for meals and snacks and if you follow your hunger and fullness cues, then your body will fall within a reasonable weight range of about 10-15% of your current weight. And if you try to go out of that range, your body will resist weight loss but may gradually allow weight gain. 

Given the choice between the messages of industry and biology, it's clear why the various industries, with their extensive public relations, are much more successful. 

Yet homeostasis is the fundamental basis for how the body manages weight. And all the other messaging about food and weight are patently incorrect. 

So the goal really has to be to learn how to work within the rules that make our bodies function. Philosophies such as intuitive eating or Health at Every Size explain at length what it means to learn how to pay attention to our own internal cues. These approaches aren't easy in today's world, but they are realistic.


Our common goal has to be learning to listen to how our bodies work. Fighting those instincts only leads to misery and endless hours spent on fruitlessly managing an unmanageable task.

5/11/17

Homeostasis: Health and Balance in our Bodies

Homeostasis is a cornerstone of human health. It represents the concept of balance from a biological standpoint. All organs function well when the body can maintain balance and stability of all of its variables. This includes blood levels of electrolytes such as sodium and potassium, ample amount of vitamins and minerals and hydration levels both in the blood and in our cells. The body doesn't require an exact level of these variables but just to be within a normal range. As long as the values remain within that range, our bodies thrive. When the levels go out of range, our bodies will immediately adapt to try to right the system. 

Homeostasis also includes weight. 

Our bodies have intricate signals to monitor weight, nutrition and fat levels. They are a variety of hormones, many of which we still have not even identified, which travel in our bloodstream and alert our organs and brain about our current weight, nutritional status and fat stores. These signals can affect many organ systems and body functions including appetite regulation, metabolism, fat storage versus fat usage and more or less efficient digestion.

Over the course of human existence, the human body has honed these signals for survival. The ultimate goal is to thrive as a species. That means that the paramount objective is to maintain the biological state commensurate with health and longevity. 

It does not mean lose weight or maintain a lower weight, despite our own personal desires. In the end, homeostasis determines our weight. 

Chronic dieting and obsession with thinness challenge our basic biological system. Although many social forces have led to our competing wishes between thinness through dieting or exercise and the desire for ample supplies of processed foods provided by a powerful food industry, our biology trumps all of these pressures. 

The end result is twofold. First we now have a population that has gradually increased in weight for many reasons written about extensively. Second the diet industry has influenced widespread food restriction which triggers a biophysical response to regain weight and stabilize physical health. Ultimately, biological imperative will be victorious over even our best laid plans. Maintaining a weight necessary for survival matters; our desire for thinness doesn't. 


If we accept the biological reality of homeostasis, what direction do we have for eating disorders and disordered eating treatment? I will address this in the next post.