Recovery and Discovery

I was recently referred to a podcast called Finding Our Hunger hosted by Kaila Prins, a woman professionally and personally focused on eating disorder recovery, body positivity and women's wellness in general. Her approach to women's health around body and food is as refreshing as it is profound. Her freedom with herself and the world around her is clear from the opening words of her podcast. 

From the few episodes I listened to, I was struck by the vocabulary and use of terms that were much less clinical and very empowering. One phrase she used to describe the path out of an eating disorder or disordered eating is "recovery and discovery." Although the term is simple and straightforward, the language emphasizes the nature of wellness that steps out of the medical model and into the space of living one's life freely and fully. The pathology of eating disorders, still mostly tied to women's role in our culture, continues the age-old tendency to pigeonhole women's struggles as a sign of illness. The term discovery throws off that mantle for something very different. 

Recovery is a useful term to describe the process of normalizing eating patterns, the experience of hunger and fullness, body image and changing the punitive thoughts of restrictive eating. When applied to the exploratory nature of learning about one's own thoughts and feelings, likes and dislikes and overall identity, the term recovery implies that this search is a journey related to pathology. Instead, the journey of discovery is a path towards living life more fully and rejecting the pressure from society to overvalue body, weight and food over truly meaningful aspects of our humanity. 

I have written extensively about these two parts of treatment but labeled them as different aspects of recovery. A subtle change in terminology can be just enough to differentiate between illness and wellness, between a medial/psychiatric issue and the daily struggle of living life. 

Discovery is truly the end result of effective and successful treatment for an eating disorder or disordered eating. The goal is to find out who you are and to live life. And that is a lifelong process and philosophy. It's the bastion of hope to convince people that full recovery is possible.


A Novel Eating Disorder Revisited: Pathological Obesity

Although most people consider eating disorders to be solely based on eating behaviors and weight, the central problem with these illnesses is psychological. The relentless thoughts about food and weight and the incessant negative, punitive thoughts about oneself are torturous for people with eating disorders. With help to combat those thoughts, changing behaviors and full recovery are both very possible.

The newest and least talked about eating disorder is a result of societal pathologizing of being overweight. Medicine insists that obesity is the cause of endless health problems and in the end an issue with an easy solution: just lose weight. Rather than seeing weight as a complex variable with a plethora of possible causes, doctors approach weight as an easily fixable issue that is at its heart a dire medical concern. 

The public has followed this conclusion and pathologized weight long enough to create a large group of people plagued by constant doubt, shame and self-loathing. Since diets and weight loss plans are almost universally unsuccessful, people attempt to follow prescribed solutions, feel constantly like failures and are obsessed with food and weight instead of trying to live their lives. 

From a psychological perspective, the experience of these constant thoughts are synonymous with an eating disorder. The primary cause of the problem isn't eating or weight. Instead, it is the manifestation of a society excluding, isolating and shaming a population into a submission. In effect, sanctioned prejudice against overweight people has created a psychiatric condition and worsened the growing public health issue of eating disorders. 

The real solution to the problem is to stop pathologizing weight. Overweight people can also be healthy and medically well. The myth that a higher weight is directly linked to poor health is steadily being debunked by research. People deserve to live their lives fully and feel like complete, valued human beings no matter their weight. 

The growing movement of weight acceptance demands that people identify and question the bias towards those who are overweight, a very ignored and tolerated prejudice. Acknowledging the unfair treatment of this population is a big step towards challenging the accepted norms. It is no more acceptable to say one doesn't like fat people as it is to not like people of another race or sexual orientation. 

The best treatment for someone with pathological obesity is to work towards self-acceptance. Rather than believe life isn't worthwhile without weighing a certain number, healing comes with the growing idea that someone has as much inherent value no matter their size. Personal acceptance of that statement needs to accompany a more general belief that bias against someone because of their weight isn't acceptable in any form.


Reviewing the Concept of Full Recovery from an Eating Disorder

This time of year I don't write a post for several weeks, but my thoughts continued to churn about the concept of full recovery from an eating disorder. 

The cultural understanding of eating disorders is a chronic, incurable illness. The struggle to manage the illness may be beneficial, but the concept of full recovery doesn't translate into a world that lacks the general knowledge about these illnesses. 

The medical approach to treatment in the 80's and 90's is the main culprit in the communal hopelessness about recovery. Forced feeding combined with punitive therapy only entrenched people in their eating disorder and made the idea of recovery absurd. The failure of those initial treatments led the larger community to this erroneous belief about eating disorders. Even now the continued use of the medical approach to recovery spreads the notion that no one gets better from an eating disorder. 

The clinical approach from the last two decades presents recovery in a very different light. Refeeding and improved nutrition and health are crucial initial steps into treatment; however, these steps are necessary only for one's mind and body to begin to work again after an extended period of being malnourished. 

The focus of recovery is the transformation of the internal psychological experience of an eating disorder. Understanding the nature of the illness and the daily personal experience immediately helps a sufferer feel understood. Presenting alternate ways to identify and then question these eating disorder thoughts begins the process of freedom from the psychological component of the eating disorder, the part which keeps people so trapped. 

In addition, this mode of treatment centers on compassion for oneself and the struggle in recovery. The eating disorder thoughts are constantly punitive and make the person feel awful about themselves. The end result is isolation which only increases the power of the eating disorder. As I have written many times in this blog, compassion and love are the strongest antidotes to the eating disorder thoughts. 

No matter how many times I write about full recovery, it never seems to be enough. Full recovery is always possible for people with eating disorders and always needs to be the ultimate goal.


Community Influence on Eating Disorders

One aspect of eating disorders I don't write about frequently is the influence of community. Where someone lives and the general expectations and norms for the community have a significant influence on how someone's eating disorder manifests. 

In some communities, a person's value is largely dependent on looking a certain way. Children will learn from parents and peers at a young age that body and looks are paramount for identity and confidence. In the concrete mind of a child or adolescent, these facts transform into black-and-white rules about living. Suddenly, the overvalued ideal of weight and shape become the only important thing in a child's life. This situation opens the door to dieting and obsessive thoughts about food and weight, a significant risk factor for an eating disorder. 

Some communities take this ideal to an extreme. For example, many adolescents or young adults discuss learning how to purge food as a rite of passage. Children openly discuss and teach each other the tricks. In others, Adderall is widely available and shared among all peers as a way to enhance studying and inevitably curb appetite. 

The openness around these dangerous activities among those susceptible to eating disorders is very risky. Some people are at much higher risk for eating disorders based on genetic predisposition and emotional vulnerabilities. However, simply living in these communities increases the risk of an eating disorder based on the accepted and taught practices and overvaluation of weight and food. 

The underlying fix for this distortion is through education, but the difficulty is the means of education that will get through to an age group programmed to feel invincible. Seeing the effects of these destructive behaviors going haywire on peers can have an impact, especially when those peers are only a few years older. Shifting the ever changing sense of what is cool to this impressionable age is just as effective. Focusing on trends for eating locally or body positive movements can energize a new trend quickly in susceptible ages. 

The issue is to raise awareness of these risks in communities where the incidence of eating disorders is high. Doing so can trigger a backlash against the norms and start to change behaviors.


Binge Eating Disorder: A Need for Parity

The societal understanding of Binge Eating Disorder (BED) has had an impact on medical diagnosis and treatment. Binges are seen largely as a clinical term to describe overeating rather than the symptom of eating very quickly an amount of food much larger than a meal in a very short period of time. The distinction is very significant. Even though BED is now one of only three eating disorder diagnoses, most people mistakenly view this illness as justified gluttony. 

The increase in binging in recent decades stems from two changes in our daily lives: sanctioned starvation through dieting and the abundance of addictive, processed foods. Starvation through restricting leads to excessive, uncontrolled hunger in many people. Even once better nourished, the hunger frequently takes months or years to diminish, and regular dieting without cease can mean the intense hunger never goes away. Also many people are susceptible to the addictive qualities of processed foods, namely added sugars and fats, which increase the likelihood of binging. 

In a society searching for a pharmaceutical cure to human limitations, many people seeking help for BED simply want a medication to fix what most people call the "chemical" cause for their illness. The pharmaceutical industry has added to this belief by viewing BED as a new frontier, approving Vyvanse last year despite minimal evidence of long-term benefit. Rather than look for a treatment plan for recovery, people with BED more than any other eating disorder have been primed to only seek a quick fix, as if their symptoms are just a chemical deficit rather than a full-fledged eating disorder. 

The reality is that people with BED need a comprehensive treatment plan including therapy, nutrition counseling and medication just as anyone else with an eating disorder. Distorted views about binging and about the fantasy of a magical cure seem more accepted for BED, but that belief leaves these patients much more hopeless and without reasonable expectations for treatment. It's crucial for patients with BED to be treated as thoroughly as anyone else with an eating disorder.


The Psychiatric Symptoms Caused by an Eating Disorder

People with eating disorders are often diagnosed with comorbid psychiatric illnesses including depression, panic disorder, and obsessive-compulsive disorder in addition to many others. Clinicians do not often attempt to differentiate between the diagnoses and clarify the interplay between them, much to the detriment of the patient. 

It is rare that another diagnosis is the primary diagnosis; usually the eating disorder is the central issue. People with other primary diagnoses may have eating symptoms as a part of their struggle, but a full-fledged eating disorder inevitably takes over a person's life. 

A list of diagnoses, rather than just one, only makes someone feel sicker and untreatable. An explanation of what the diagnoses mean and how they reflect the person's current state and likelihood of successful treatment is a much kinder and more helpful way to approach the path to recovery. 

What is rarely discussed with patients is that starvation and binge/purge cycles themselves can cause psychiatric syndromes. In other words, one effect of chronic eating disorder symptoms is to create a new psychiatric diagnosis hat resolves with normalized eating. 

Starvation and binging are known to lead to depressed mood. Chronic, severe hunger begins to feel like anxiety much of the time, especially because people who are starved lose the ability to identify hunger. In addition, low blood sugar, a common long-term effect of an eating disorder, creates the feeling of a panic attack. Anyone starved over time develops OCD symptoms no matter how susceptible they are to this illness. 

Having a series of psychiatric diagnoses is different from realizing that the eating disorder causes a host of psychiatric symptoms that mimic other diagnoses. This fact also explains why medications tend not to be as helpful in treating psychiatric symptomatology associated with an eating disorder. If starvation or binging causes the symptoms, then medication will be much less effective than food, the only real medication that helps with recovery. 

This idea also brings up the idea that food is a mind-altering substance. It can lead to emotional stability, clarity and mental acuity. Starvation can lead to volatility, confused thoughts and dullness. Eating disorders are illnesses that affect our entire bodies, our minds and emotions included.


The Meaning of Weight in Weight Loss

The concept of weight in medicine and especially in the diet and weight loss industries is very confusing. So much attention is given to the number on the scale and so little to the meaning of that data point in metabolism and health. 

Shifting the focus away from weight and to changes in daily routine around food and activity is much more effective for long-term change. If all importance is placed on the number on the scale, success is marked solely by continued downward changes. Any leeway based fluid shifts, metabolic changes and the many other things that affect weight is nonexistent: it is simply a failure. However, if success relates to consistent lifestyle changes, which also are a better marker of health, the person can embrace the positive, and weight changes will follow as one of several key markers. 

There are three ways to understand weight as a valuable source of data: the current weight, the local weight range and the set point. Each reflects very different information of varying usefulness. Understanding the nuances of body weight also makes clear the limited value of these data for health. 

It's most clear to start with set point, the most longitudinal information, and proceed to the more specific. The set point is a wide range of weight, typically about 15% of total body weight, that anyone can shift within quite naturally. The body is comfortable and not in danger anywhere in this range. Any pressure to go above or below this range leads to a strong metabolic response to attempt to stay within this range. The brain and hormonal system has determined that this range is ideal for health and will therefore protect the range for survival. If enough pressure through starvation or overeating persists, the range can shift down or up over a period of months to years. Then the new range becomes the norm. 

The local weight range is a variation of about 2-5 lbs that the body can vary day to day. This weight change is almost completely due to fluid shifts from retained water or dehydration. Fluid shifts can be significant. One salty meal may increase weight the next day by up to 5 lbs. Monitoring weight too often simply reflects these fluid shifts. Body mass changes rarely constitute more than a pound per week and typically much less. Very fast weight loss on diets is almost exclusively water loss. 

Any specific data point of weight has very little medical value. This number will rest in the current local range and will be up or down based on the current fluid state of one's body. 

Weight data only has value longitudinally. This information over a period of weeks to months will clarify the general set point and range for someone and further history can clarify how long it has been set. Recent eating history and weight change can give a clinician an idea of where the person's weight lies in that range. Longer term history will dictate a plan for lifestyle improvement and how health and then weight may change over time. 

A true shift in the concept of weight loss needs to reflect the limited utility of weight data and take attention off of the number on the scale and instead to sustained lifestyle changes.