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.


The Truth about Bariatric Surgery

A caveat to the recent posts about weight is the professional dilemma about Bariatric surgery. These weight loss centers, as they are called, have become a profit bonanza for hospitals. People bereft after years of unsuccessful dieting finally capitulate to the pressure for surgery from friends and doctors. It feels like a last resort, the final decision, and one couched in the misguided concept of improved health. The surgical centers are PR meccas able to reel in even the most ambivalent of patients. Once hooked, these people become true believers. 

They say they are done dieting and know they "haven't been able to use the tools of dieting successfully." The language of personal blame, well honed by diet gurus, allows doctors to recommend surgery and also not take personal responsibility when the surgery fails. 

We will all look back one day in shock and horror that the medical world sanctioned slicing off half or more of a person's stomach for weight loss. These surgeries may very well be the lobotomy of our time. When all data shows dieting to be not only ineffective but also harmful with clear proof it leads to long term weight gain, how can we stand by as the diet industry leads these people to a place of hopelessness and the medical establishment leads them into the operating room? The hypocrisy and craven desire for profit are astounding. 

The central issue is to wrest back the conversation from the extremely powerful diet, food and exercise industries which have completely monopolized the conversation. Sadly, the medical establishment has been led to the same conclusion and now acts as unwitting promoters for diets and surgery. 

The answers to this problem lie with medical education. Unless medical professionals understand the basic facts about food and weight, there will be no counterpoint to the marketplace powers which have capitalized on the fear of fat for enormous gain.


Weight, Part III

A friend recently diagnosed with a serious illness told me a story. She is working hard to maintain weight due to the potential for weight loss from her illness, and she heard someone bemoan her need to lose weight. This friend only wished her biggest problem was losing weight. 

It's a truism that poor health puts all mundane worries into perspective, but this story illustrates something more powerful in light of the recent posts on this blog. Worrying about weight is more than just a mundane concern. It represents something more profound about the empty struggles of modern day life. 

Ruminating about body and weight is now an acceptable way to vocalize and internalize daily problems. We all seem to have accepted that striving for thinness is necessary for overall success, and not achieving it can undermine any other, more meaningful accomplishments or realities. 

The problem with this concern is twofold. First, obsessing about weight and food triggers a deep part of our brains. Food obsession is linked with survival and basic needs of being a biological organism. Watching how food motivates pets is an easy way to prove how ingrained food behavior is in all animals. Once this brain circuit is triggered, it can become all encompassing and have a significant negative impact on daily life. 

The second issue is sanctioned starvation, something I have written about extensively in this blog. The diet industry juggernaut capitalizes on our collective desire for weight loss and paints dieting as a prudent way to live. However, the danger of dieting, always followed by compensatory overeating, is to actually precipitate disordered eating and eating disorders. 

If there is anything my ill friend pointed out, it's that our obsession with weight loss mirrors our loss of values. We must work hard to figure out what to prioritize in a world constantly vying for our attention. The important things in life need to reflect our own selves, not the demands of industry, vanity or culture. Weight obsession is a manufactured reality intended to capture our minds. Our deeper values can't be drowned out by this endless noise.


Weight, Part II

Weight is but one data point to assess medical progress during recovery from an eating disorder. When any person eats regularly for over a year, weight can still fluctuate quite a bit due to several factors such as fluid shifts, hormonal shifts, changing seasons and changes in daily routine. The body attempts to keep weight within a range, but that range is much wider than what many people can accept psychologically. 

Weight reflects part of the natural state of balance the body seeks in order to maintain stability called homeostasis. The human body works to stay in a range of weight to promote health but a specific weight is not important. 

People with eating disorders and many people focused on food and weight believe otherwise. They think they can control weight within a pound or even less, with the advent of scales that measure to the tenth of a pound. The psychological and emotional effort expended to maintain a specific number dominates many people's lives and completely takes over the mind of most people with an eating disorder. 

During eating disorder recovery, one's body often needs to switch into a healing mode which can have a significant effect on weight, albeit temporarily. For instance, many people become constipated as their gastrointestinal system heals which leads to bloating, fluid retention and increased weight. Metabolism can slow down to adjust to periods of starvation in all eating disorders which can result in a temporarily higher weight. Normalizing of fluid maintenance, how the body stores water, often leads to fluid retention and weight gain as well. 

These changes are short-term but cloud the use of weight as a marker of health. 

In addition to weight, there are many other ways to assess improvement in health. Regular food intake is the first and foremost sign of recovery. No matter the other factors, improvement in daily eating is a sign of health. People often experience increased energy, higher stamina, normalization in gastrointestinal function, ability to withstand temperature changes and improved circulation, to name a few. These markers of health take more time to follow and assess but give a much more thorough picture of health and recovery. 

The next post will take these thoughts about weight a step further. What are some reasons for our obsession with weight for people with eating disorders and for our society?


Weight, Part I

Medical management of eating disorders revolves around weight. Every day in residential treatment and at every appointment in outpatient care, getting on the scale is the focal moment for both patient and doctor. 

Weight fluctuations are central to many other illnesses and a good data point for progress or regression. But in treating people with eating disorders, doctors act as if weight is absolutely paramount. 

On the one hand, this seems reasonable. Eating disorder thought processes are almost exclusively about weight and body, so weight normalization appears to be key to recovery. Yet clinicians are often as focused or even more focused on the number on the scale than the person with the illness. Frequently, this dual obsession of patient and clinician sets up an unworkable battle. 

In all other illnesses, a clinician's focus is not on a data point but on health. Eating disorders cause many serious medical problems from anemia to kidney dysfunction to cardiovascular collapse. People routinely die from eating disorders. There are many physical signs and symptoms and clinical facts to address in addition to weight. 

In fact weight is often an elusive and confounding piece of information. Daily weights tend to reflect fluid shifts based on many factors. For instance, even a salty meal can lead to 2-3 pounds of extra fluid weight the next morning for anyone. Actual body mass rarely changes by even two pounds in a week, even for very underweight patients in residential treatment. 

So the question I often consider is why is the clinical world so focused on weight?

The first consideration is that abnormal weights upset clinicians, and weight normalization feels like healing a sick person. Most people with eating disorders whose weight has normalized actually suffer more because their eating disorder thoughts are so dominant. Treatment needs to address the psychological part of these illnesses as well, otherwise recovery is for the clinician's well-being, not the patient's. Focusing exclusively on weight reveals the unfortunate ignorance of many clinicians about recovery. 

The second factor is insurance companies. In order to avoid paying for care, insurance companies have limited the amount of care by assessing practical but very short-sighted data points. Weight is the primary focus. If a patient's weight is normal, then insurance companies limit access to care. Since people frequently change health insurance, these companies bank on providing a stopgap measure to save money. Long-term recovery is not a priority. 

If weight is not the central marker of successful recovery, how can clinicians and patients assess progress? I'll discuss that in the next post.


Clinicians with an Expertise in Eating Disorders

Most mental health clinicians learn how to treat the most common illnesses such as depression and anxiety. Certain psychiatric problems are not addressed in standard training, so finding specifically trained therapists and doctors is important. 

Eating disorders turn out to be among the most specialized example. 

The majority of training for psychiatrists, psychologists and social workers does not address how to treat people with eating disorders except in the most cursory ways. And eating disorders have the most medical complications of any mental illness, a fact which demands an added level of expertise. 

Clinicians need to be able to differentiate between the medical effects of binging, purging and starvation and the psychological effects of an eating disorder itself. They need to learn when to seek not only psychiatric help but medical help and work together closely on a team that attends to chronic medical issues. They need to understand the different levels of care available to patients, not only to choose between them but to understand if these options are even appropriate. 

Even more importantly, clinicians need to be aware that eating disorders cause severe medical problems and have the highest rate of death of all mental illnesses. Leaving one's fate to a minimally trained clinician seems foolhardy. 

It's best for patients to seek clinicians who claim expertise and significant experience treating people with eating disorders and then to ask in more detail about that experience and about possible treatment plans. The answers to those questions can give a lot of information quickly. 

Also finding a primary therapist with experience is likely to open treatment up to a team of clinicians who can start one's path to recovery. Wasting time seeking help from people with limited experience will only extend the time of suffering.


Individualized Eating Disorder Treatment

The standard treatment protocol for someone with a moderate to severe eating disorder is clear. Establish treatment with a team including a therapist, nutritionist and physician. Fully assess the medical and psychological state of the patient. Determine the appropriate level of care: outpatient team, outpatient program, residential program or hospital. Begin treatment. 

This standard approach is considered to be fairly straightforward. Like many other illnesses, the existence of a protocol implies that following the plan will lead to recovery. In the case of eating disorders, this is often not the case. 

The limited data supporting success of this treatment plan leave clinicians with their intuition and experience to make decisions rather than hard information to rely on. The promise that any step in treatment guarantees health and recovery is empty. 

The truth is that each person with an eating disorder needs an individualized treatment plan. The direction of treatment may often follow a standard protocol, but each step forward must be evaluated to see if it is right for the patient. It's not acceptable to confuse a failed treatment direction with low patient motivation. The key is to find a plan that works and not blame the person with the illness if the intervention doesn't help. 

Thus, I usually advise patients to find treatment providers they think they can trust and feel comfortable with. Also be sure this team is willing to collaborate on decision making. Having agency in one's life is essential to feel like recovery is really about wellness and life, not just following someone else's plan. Last, be sure everyone's goal is to create both recovery and a full life. Any other distractions or ulterior motives will only interfere with what recovery is all about.


Why is an Eating Disorder like a Virus?

The nature of an eating disorder is fluid and constantly changeable. Even though the thoughts and symptoms often seem fixed, any change in situation, context or environment will precipitate an immediate adjustment in the eating disorder. In this way it is like a virus in the mind, always ready to adapt to new surroundings, multiply and attack. This ability keeps the eating disorder powerful and enables it to dominate a life. 

For instance, when someone with an eating disorder moves to a new environment, the rules instantly change to suit the situation, mostly in order to maintain strict control over food. A new relationship will lead an eating disorder to find a way to inject itself into a situation. Changes in a food plan precipitate other, often hidden, changes to compensate.  

Paying attention to the subtle response of an eating disorder and fighting to avoid those pitfalls are challenging yet necessary in recovery. 

The ever-changing, insidious quality of an eating disorder demands a consistent, flexible treatment team. The people who comprise that team need to understand each other, be capable of quick response and be very familiar with each other's thought processes about recovery. There can't be a secondary agenda. The team can't isolate from each other and compartmentalize aspects of treatment. Working as a cohesive, directed unit will increase the likelihood of success and also take the responsibility of managing the team out of the patient's hands. 

From a biological perspective, a treatment team needs to mimic the effectiveness of antiviral medications. Viruses are highly adaptable organisms which can mutate in the blink of an eye to a new environment or to new medications. Any success treating viral infections stems from anticipating the likely responses of the virus to new treatment and blocking off all avenues of escape. 

The analogy is very similar for eating disorder treatment. If a clinical team can block off ways the disorder mutates, the person has a real chance of recovery. This level of success may scare some patients who aren't psychological ready for such a big step in recovery, but realizing recovery is possible can have a profound effect on even the sickest patients. 

A patient can identify a team working this well when it appears the clinicians work together fluidly and seamlessly. If a patient needs to manage the team, then there is a problem. If the team members need to spend lot of time getting on the same page, then that is also an issue which detracts from recovery and opens the door for the eating disorder to flourish. 

A treatment team is a crucial part of recovery. But finding any team isn't enough. Cohesive support aimed at cornering an eating disorder can make all the difference in true recovery.


Vocabulary of the Diet Industry: New Information or Corporate Propaganda

The purpose of diet fads is to create a novel way to approach food. If we refashion our daily diet into a prescription for health and well-being and simultaneously eliminate guilt and shame, somehow, some way our lives will magically improve. 

Typically, each successful invention in the diet industry finds new language to help rethink the role food plays in our everyday lives. It's not as if this new vocabulary alters the discussion. Instead, the shift in terminology creates the illusion of a brand new day. 

New views of a healthy diet quickly are coopted by people susceptible to eating disorders. The terminology always hides food restriction or limits under the guise of health and wellness. The insidious nature of the diet industry's mastery of marketing catches those on the brink of an eating disorder at a vulnerable moment. Swayed by the latest fad, many of them will unwittingly use the vocabulary to justify a full blown illness. 

Diet vocabulary is little more than propaganda for big business. The more new language seeps into the general zeitgeist of the culture, the more financially successful the diet. And the casualties left on the roadside are merely the necessary consequence of generating large profits. 

One latest example is the concept of clean eating. Ostensibly, this new language represents eating whole foods with limited processed foods. People can hide behind the overt definition of the term and feel fully vindicated. 

However, the word clean is loaded when applied to food. It implies that following these guidelines is inherently positive and healthy. Any other way of eating must be dirty in comparison so the combination of judgment and health appears foolproof. Feeling clean trumps the fear of judgment around food and becomes the new mantra of eating. 

New diet vocabulary only provides people a way to demonize eating and thereby justify feeling tortured by conflicting, loaded thoughts about food. Diets need to be called out for what they are: propaganda to exploit society's fear and confusion around food. Diet vocabulary is not an answer. It only creates more confusion when we all need to just learn how to eat again.


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.


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. 


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.


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.


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.