The Long Road of Eating Disorder Recovery

The standard approach to a medical problem is to see a doctor, get a diagnosis, follow through with treatment and get well. This reasonable approach to care for an illness is commonplace but creates miscommunication and confusion around eating disorder treatment and recovery.

If the symptoms of an eating disorder revolve around disordered eating, then recovery should be simple: eat regular meals and snacks and get well. And if the treatment is difficult, then the person just needs to try harder. People erroneously believe that any stumbling blocks must be the fault of the sick person, not a sign of an intractable illness.

This approach to recovery makes sense to someone with limited knowledge about eating disorders. Eating is a staple of every day of life, no less important than sleeping or breathing. But for someone with an eating disorder, meals are fraught with so much stress and anxiety that it feels more like a prison.

Moreover, eating disorder thoughts and behavioral patterns are largely ingrained and unconscious. Even people who are very focused on food but not ill don’t think that much about how or when or what they eat. This may be a controversial concept, but it’s necessary to talk to someone with an eating disorder to understand what it means to think about food and only food all day long. 

The process of changing such ingrained, automatic thoughts and behaviors takes time. Families want people in recovery to get better quickly. There should be a marked change within months, if not weeks, and recovery should be mostly completed within a few months. Sadly, this is not what recovery looks like for almost everyone in treatment.

The process typically takes several years from two to even 7-10 for full recovery. Since the steps are gradual, there is improvement within a few months, but ups and downs are a necessary part of relearning how to think about, approach and eat food in one’s life.

I often hesitate to tell people how long recovery takes, perhaps not to scare them off at the start of a long road. But there is a point where this knowledge is crucial. Committing to the entire process of recovery means embracing this path to living a full and meaningful life, not losing oneself in the minutiae of food, weight and misery forever.


The Secret Life of an Eating Disorder

People with eating disorders become masters of hiding and secrecy. This behavior doesn't represent a pattern of deceit or a change in character. In fact, most people with eating disorders have a strong conscience that judges every step and action and even every thought harshly. 

Instead the shame and compulsive behaviors lead a person to hide their true feelings and constantly put on a show to the world as if everything is fine. And the majority are remarkably successful at portraying themselves as well while suffering greatly with their illness. 

This split between the private and the public self is a common experience for most people. Everyone knows that there is a difference between how they are at work or out of the house as opposed to their personality at home. But for people with eating disorders, this divide is much greater. 

In order to make up for the shame and humiliation of the eating disorder, people tend to overcompensate in the world. They tend to be people pleasers to an extreme and try to help and support others while projecting an image of someone whose life is completely in order. 

But the effect of this outside persona is to reinforce the internal shame of the reality of struggling so much with the eating disorder symptoms. This dichotomy leads to a feeling of being trapped in the illness. 

The juxtaposition between the outside and the inside creates a deep sense of being a fraud. That reality reinforces the need to hide and protect a secret life the eating disorder needs to flourish. The more a person can successfully inhabit these two worlds, the more entrenched an eating disorder becomes. 

Accordingly, successful treatment must open up these secrets as completely as possible. Digging into that private world uncovers the shame and also helps separate the sense of being a fraud from the illness itself. When someone has help and support to uncover the divide between the private and public worlds, the power of the eating disorder diminishes significantly. One immediate goal of treatment is to take away the secrecy and privacy of the illness. Without that power, the path towards recovery opens up.


Finding Hope in the Hardest Moments of Eating Disorder Treatment

Helping people with eating disorders who are also severely hopeless and suicidal doesn't mean just sending them to a hospital. It is important to recognize how serious the suicidal thoughts are while simultaneously seeing that developing trust in treatment is the only way to make progress. 

Many patients with eating disorders are scared to bring up suicidal thoughts to their treatment team. Not infrequently, the team responds by immediately recommending hospitalization or even calling 911. As much as I respect the need to focus on patient safety, everyone is different. Often, overreacting sends a message to the patient not to reveal their deepest and most painful thoughts and feelings. As I have written many times in this blog, secrecy strengthens the eating disorder. 

If the patient is imminently planning on committing suicide, then it is important to consider all options. But if the person has thoughts without any immediate intent, the next step is to try to talk more openly about these thoughts. The hopelessness and suicidal thoughts are almost always a window into the most powerful parts of the eating disorder, and exploring these thoughts can be an important step towards recovery. 

The circular reasoning of an eating disorder leaves patients trapped. It feels impossible to change eating patterns, challenge the thoughts and live a fuller life. The eating disorder thought process is intent on blocking all avenues of escape. After years of being trapped in this maze, it is common for patients to think that ending their life may be the only way out. 

Revealing that level of desperation can be a sign to a clinician that perhaps there is an opening for change. It is important to engage both practically and emotionally with this hopelessness and challenge the false beliefs of the eating disorder. It's hard to face that fear of change, but it is also possible to summon the courage to live life differently and alter deeply ingrained patterns. 

Sharing the intensity of hopelessness is often a sign of impending movement in recovery. Safety is clearly a priority but so is respecting the openness and trust in treatment along with acknowledging that clear, consistent support makes even he most challenging steps possible.


Eating Disorders and Suicidal Thoughts

Eating disorders are relentless mental illnesses. The struggle and suffering that stem from both the physical starvation and the mental torture are exhausting. People who have not had much treatment and don't know what the recovery process looks like can become very hopeless. The severity of the despair can sometimes lead to suicidal thoughts and even suicide. 

Three components of eating disorders increase the risk of hopelessness and suicidal thoughts for people with eating disorders. 

The first risk factor is secrecy. The eating disorder thought process involves a constant need for secrecy. Only in private can someone fully engage in the eating disorder. This urge often leads to lying and hiding in order to create time and space for the illness and the behaviors. Since most people with eating disorders are straightforward and direct, the secrecy creates a sense of hopelessness and despair based on behaviors anathema to their true selves. The idea that the illness leads them to behavior so out of character opens the door to feeling hopeless that life can ever change or be different. 

A deep sense of shame, something I have explored many times in his blog, creates a thought process of feeling intensely negative thoughts about oneself. Years of reinforcing behaviors and thoughts can create a hopeless feeling of being trapped in this shame with no way out. Shame is often a feeling that inundates all other feelings about oneself. Buried in shame, someone with an eating disorder typically feels very hopeless. 

Most people will seek treatment at some point, but the kind of therapy they receive makes a difference as to whether this cycle of hopelessness continues unhindered or comes into question. Seeing a clinician with a profound knowledge of eating disorder thoughts quickly makes a sufferer imagine that the secrecy, shame and hopelessness may very well be unfounded. It makes the idea and process of recovery realistic. On the other hand, a session with a less experienced clinician can only confirm these fears thereby strengthening the hopelessness and suicidal thoughts. 

Suicidality is a common and very serious component of chronic eating disorders. It is the absolute responsibility of the treatment community to provide solace and guidance to find a way out of this desperation towards treatment and recovery.


When to Choose Residential Treatment

One difficult decision in eating disorder treatment is whether or not to go to residential treatment. The factors around patient safety, the course of recovery and the anxiety of the clinician all make the process tricky. 

The number one reason for someone to go into treatment is patient safety. If an eating disorder has led to medical instability, organ damage or significant functional impairment, then the recommendation for inpatient treatment is clearcut. More often than not, any treatment team can come to this conclusion fairly easily. 

Many situations do not present such clear alternatives. When a patient has been in treatment for a period of time without making much progress, the choice of a higher level of care, clinical jargon to mean day treatment or residential treatment, becomes an option on the table. Frequently, the suggestion for more care comes from frustration of the treatment team around the lack of progress rather than a clear indication or need for residential treatment. The idea is that more treatment will kickstart the recovery process and lead to more rapid improvement. However, there is little evidence that this clinical step is successful. 

Another reason clinicians recommend inpatient treatment is the discomfort of the team with the level of a patient's symptom use. Even if that person is functioning and is medically stable, many clinicians struggle with the anxiety of seeing a chronically ill patient. Recommending residential treatment may be a salve to the concern of the clinician, but the key question is whether or not it is beneficial to the patient. 

Instead there are a few questions that would behoove a clinician or team before suggesting inpatient treatment. First, if the patient is at significant medical risk or is minimally functioning, then residential treatment is an option. If someone has not had good experiences with inpatient treatment before, then it is crucial to have specific reasons to consider this option and why it would be different. All clinicians and teams must assess their own fears and anxieties before suggesting inpatient treatment. Last, a team must have clear and reasonable goals for this step in recovery. Unrealistic expectations or even imagining a panacea that sets up the patient for failure are ways to absolve oneself of responsibility, not a benefit to the patient. 

Inpatient treatment is an option for the process of recovery. It must be considered carefully and clearly. The expense in time and energy is significant. This step should never be considered without clear and reasonable intention and assumption of the gravity of the decision.


Facing Eating Disorder Delusions, Part II

Internalizing the idea that the eating disorder creates a false world of beliefs is a significant step in recovery. But delusions, by definition, feel like reality to the person who has them, so questioning that reality is a monumental step forward. 

By and large, people with eating disorder delusions live in a world founded on these beliefs. If these thoughts come under question, one's entire belief system and even the structure of daily life has to be reevaluated. 

It is rare that adults are forced to reassess the way they live their lives. Catastrophic events can force adults to do so, like war or natural disaster or financial ruin. Social changes such as divorce or the loss of a loved one can also make adults rethink their lives. But most adults live in a world of set values and mores. They don't need to question the fundamental rules of the world they live in. 

There comes a point in recovery when people are capable of identifying and questioning the delusions of their eating disorder. They may not always want to question them because it is painful to recognize the lies that have governed their lives; however, they also know that living according to these lies is too destructive to continue. 

For them, facing the delusions is akin to completely reassessing their world and the foundational beliefs of their lives.  This is often the most important step in treatment. It enables people to see a life that is fully recovered and much more full.

As scary as this new world looks, reminding the person that disavowing these long held, false beliefs will create a truer and complete life will enable the person to take large steps in recovery. Above all, emotional support and compassion are the key to facing the delusions and entering a new world.


Eating Disorder/Healthy Self Dialogues

There are many ways to approach the delusional thoughts but only one appears to be consistently effective. In order to use this method, the person already needs to understand that the eating disorder thoughts are delusional and also at least acknowledge that more logical thoughts exist and would encourage recovery. With that foundation, treatment can move forward. 

The core piece of this step in therapy is to create an internal dialogue between the eating disorder thoughts and the healthy thoughts. The ed thoughts have usually felt completely true and also secret for a long time. Exposing them can be emotionally challenging and even scary to admit openly. The healthy thoughts often feel forced and unsure. It takes time for these thoughts to start to seem true and supplant the eating disorder thoughts. 

It is also important that both sets of thoughts come from the person struggling with the eating disorder. It's counterproductive for the healthy thoughts to come from someone else. The purpose of the exercise is to practice and express the healthy thoughts and learn to associate oneself with a new way of thinking. 

An example of the dialogue can start with the idea that one shouldn't have lunch. 

Ed: You don't need lunch today. You're not hungry. 

HS: Food is a part of recovery. Hunger is not the issue. Eating to live is the issue. Following the meal plan is crucial to get well. 

Ed: You're already fat. You don't need food. 

HS: Without food you just end up getting sicker and unable to live your life. 

Ed: But you want to be skinny. That's most important. 

HS: You've done that before. Then you end up in treatment and unable to make friends or do anything. Life is much more than starving. 

Typically the dialogue leads to the conclusion that the eating disorder thoughts only want the person to live for the illness itself. There is no purpose beyond that and it leaves no meaningful life in its wake. 

Although this is a hard part of recovery, it is crucial to help combat longstanding delusional beliefs. Making these changes and doing the consistent work is a big part of the reason people can fully recover.


Facing Eating Disorder Delusions, Part I

Typically delusional thoughts are fixed beliefs about the world that someone is convinced are true but that are clearly false. More often than not, these beliefs are so prominent and so all consuming that they significantly disrupt the person's life and relationships. 

Sometimes the delusions can be circumscribed, for instance focused solely on one person or one event happening in the world. In these circumstances, the delusions only come to light when the specific target is discussed. 

Delusions in an eating disorder are both circumscribed and also internal. The fake beliefs about food and weight only pertain to that person and not others. In addition, the thoughts are shrouded in secrecy and rarely come to light. Unlike almost all other delusions, they only are revealed when questions probe enough to elicit the beliefs. 

Yet these delusions are so powerful that they affect most decisions every single day and profoundly limit how someone lives their life. 

Eating disorder delusions come in two similar patterns. First they can revolve around severe limitations of foods that one can eat or the amount one is allowed to eat. Breaking these laws around food actually feels like doing something absolutely horrific, something illegal that deserves punishment.

The delusions can also revolve around a belief that the person either has never been sick with an eating disorder or has never been very sick despite clear evidence that proves otherwise. Some people with clear organ damage or even at risk of dying still believe they are well. 

It's important to recognize that these are thoughts someone with an eating disorder absolutely believes are true. They are not just passing thoughts. This is often what makes understanding these illnesses so hard. 

Questioning delusions is very difficult. Directly confronting them typically fails immediately and brings any trust in a relationship into question. The way to challenge these fixed thoughts is to essentially build a case against them.

By amassing evidence that shows how these delusions are false, one can begin to bring to light the lack of data to prove these thoughts are true. Even with overwhelming evidence, it can continue to be hard to escape a delusion. It often takes months of questioning the thoughts to weaken them in time.

Gradually, the most important step is to help the person herself begin to question the delusions directly. I'll discuss that more in the next post.


Delusional Eating Disorder Thoughts

The large majority of people with eating disorders seem fairly well and functional on the surface. Although the physical and psychological effects of the illness are rampant, most people can engage in conversation, hold down a job or go to school and maintain stable enough connections in the world. 

The juxtaposition of someone who appears well but actually suffers from a serious disease is confusing for many people. It contributes to the difficulty many have with believing an eating disorder is a life threatening illness. 

To those unaware of the nature of eating disorders, recovery could easily just mean starting to eat normally, as if the symptoms are a choice. That's the primary misunderstanding which explains why it's so hard for laypeople to comprehend the nature of these illnesses. If getting well were a choice, eating disorders wouldn't exist in the first place. 

What lies underneath the seemingly normal facade is a thought process that drives the eating disorder. These thoughts make it a powerful and destructive illness. Distinguishing between clearly delusional eating disorder thoughts and healthy thoughts is extremely confusing for people in recovery. The process of recovery is largely about learning to identify and ignore the eating disorder thoughts. However, disregarding thoughts that have structured daily life for years takes time. 

For the purpose of this blog, I will call these thoughts delusional. Clinically, a delusion is a fixed false belief. In the case of eating disorders, a common delusion is, for example, "I can't be thin enough" or "this crash diet will finally stop the binging" or "I'm really fine even though I feel weak and dizzy" or "I'll just use laxatives one more time." 

The next few posts will explain in more detail what the delusional component of an eating disorder entails and the process of learning how to ignore them and move ahead in recovery.


The Role of Medications to Treat Binge Eating Disorder

Unlike people with other eating disorders, those with Binge Eating Disorder often contact me solely to talk about medications. Sometimes they want to meet to discuss medication options or even, if they live outside of New York, ask to speak on the phone for a few minutes. 

There is a widely accepted view that medications are unlikely to be a significant part of treatment for other eating disorders, but the idea that medications can temper, if not cure, binge eating is pervasive. 

From a clinician's point of view, treating binge eating is similar to treating other eating disorders. The focus on a combination of normalizing eating patterns while zeroing in on the emotional and psychological manifestations of the illness is paramount. There is no evidence that medications help binge eating any more than other eating disorders. 

Seemingly, the media and lay knowledge of eating disorders categorize binge eating as something different. It represents, in our current culture, a flaw or a sign of weakness. As medication has become more central to psychiatric treatment, it is natural to assume there must be medication to fix this core craving or, as some falsely describe it, lack of willpower. 

The reality is that binge eating is one of a variety of biological and psychological adaptations to chronic undereating. We are all programmed to respond to prolonged starvation, i.e. dieting, in different ways. For some people, the starvation mechanism cascades into compulsive starvation and leads to anorexia. For some, the diet ends abruptly and leads to normal eating. For others, it triggers binge eating which can lead to bulimia, binge eating disorder or a variety of compensatory mechanisms to deal with overeating. 

Ultimately, the course of treatment needs to be the same. And a key component of treating binge eating disorder is to take the shame away from binge eating and follow a comprehensive treatment plan rather than a pharmacological magic fix. It's not a flaw but part of an illness.


Weight Bias and Biology

The idea that our bodies know how to function also applies to people who are overweight. They experience overwhelming pressure from society, friends and family to lose weight with the often unspoken message that their weight is a sign of their own weakness and slothfulness. 

The drive for thinness and dieting is usually even more pronounced for those who are overweight. The diet industry plies the public with unsubstantiated miracle fixes for weight loss and happily reaps significant profit on the misery of others. Meanwhile, the government, medical establishment and even close family and friends all support these endeavors as signs of self-care or even self-love. The promulgation of an endless search for the pot of gold at the end of the rainbow all to satisfy the misguided idea that weight is both a manipulatable data point and a sign of virtue is abhorrent. 

The accepted messages about food and weight can easily become personal rebukes of those who are overweight and even open the door to widespread, accepted prejudice. If the person is misled into conflating self-worth and weight, they are susceptible to all types of bias and mistreatment. 

Meanwhile, the human body functions solely on biological terms, irrespective of the current societal norms around weight. As I have written extensively in this blog, weight is not commensurate with health, and there are ample data to prove this point which is summarily ignored by the powerful diet industry. 

All the noise around weight and virtue drowns out the facts. Our bodies know how to manage hunger and food. Given the necessary diet, humans can live and thrive. Weight is but one data point of many that the body works to keep within a range commensurate with health, and the range is largely predetermined by our genetics. Our body size and shape are part of our inherent nature, not signs of personal virtue. 

First and foremost, food and weight are not indicators of our worth as a person. The message of biology trumps all other specious explanations of health and weight. This message needs to be trumpeted and spread to counter the overarching and destructive falsehoods spread by the diet, food and exercise industries.


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.


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.


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.


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.


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.


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.


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. 


The Three Biggest Myths about Weight

Several myths about weight drive an enormous amount of mental anguish in our society. They support the diet, food and exercise industries. They increase the risk of developing an eating disorder. And they cause an enormous amount of suffering and misery. 

Here is a list of the top three with some explanation of the reality. 

1 Diets work but just demand enough willpower. 

Research study after research study has proven, without a doubt, that diets don't work. In fact, extensive research proves that diets inevitably lead to long term weight gain. Sustained periods of malnutrition push the body to release hormones that increase hunger over time and that lead to increased fat storage, all to avoid the risks from extended periods of famine. 

1 Weight loss leads to improved health. 

There is no correlation between weight and health. Despite clear evidence proving this point, doctors will often exhort patients to lose weight without recognizing they are only proponents of a powerful social bias. Health is attainable at any size. 

1 Exercise leads to weight loss. 

Exercise improves long term health significantly but leads to no sustained weight loss. The body compensates for exercise by needing more energy either through increased intake or extracting more calories from food, but long term research has shown no effective change in weight. 

These myths all stem from our collective need to feel like we can lose weight. Since weight has become the paramount sign of success in our culture, people are willing to accept any means of losing weight even if ample evidence proves otherwise. However, the myths don't jibe with basic knowledge of how the body works. The next post will address what actually affects our weight: balance or, in medical terms, homeostasis.