The Stages of Eating Disorder Treatment

There are three fundamental stages of eating disorder recovery. When starting treatment, patients understandably believe they are coming just to fix their eating symptoms and are often surprised and confused at how personal, emotional and transformative the process turns out to be.

The first stage is normalization of eating. The focus is on creating a new meal plan to follow throughout the day. The changes in daily food are very challenging. First, people expend enormous effort to counter the eating disorder expectations and eat food regularly often when they’re not even hungry. The purpose of this stage is to train one’s body to get used to regular eating, ensure improved health and stabilize any physical and mental symptoms attributable to disordered eating.

The second stage disentangles the eating disorder rules, thoughts and mandates from daily life. Eating disorders often start at a young age and become a significant tool people use to cope with life. Although there are many initial triggers for an eating disorder, over time the behaviors become central to how people function. Disordered eating or thoughts about food become the primary way to manage life’s ups and downs, especially to tamp down emotions. This stage enables people to understand how the eating disorder functions in their life and to learn new ways to travel through their days.

The third stage entails letting go more fully of the eating disorder. Even after significant success in the second stage, people are loath to let go of the sense of accomplishment, relief or comfort the eating disorder provides. Even though eating disorder symptoms often cause physical and emotional suffering, the concomitant benefits are enticing and have been a mainstay of daily life for a long time. Despite the benefits of recovery, letting go of the eating disorder feels like a loss, even the mourning of a central part of life. This stage demands learning how to rely on other people and on oneself more fully. It feels exposing and frightening.

The personal transformation of recovery is most evident in the last stage but traverses all the stages. Eating disorder treatment forces the patient to look inward and search for the purpose and meaning of their lives and to better understand who they really are. With the knowledge of what recovery entails, patients can be more prepared for the road that will take them forward in their lives.

The Moral Panic of Fatphobia

This public radio podcast episode from On the Media points out the underlying features of fatphobia and inherent bias in our culture.

To be clear from the start, none of this information is new, but it is rare to see it covered convincingly in the media. The episode covers three central points.

First, an astute primary care doctor debunks they myth that fat people are at higher risk for illness in general, in this instance COVID. The doctor explains how the overpowering bias of the medical field against fat people leads them to avoid health care, get treatment later in the course of illness and receive less effective care due to doctors who blame the patient for being fat. Initial studies about weight and COVID severity have proven to be poor, and recent evidence corroborates that the risk factor isn’t true, yet the myth continues.

The second point covers a scale intended to override the biased and destructive BMI. This new scale takes weight into account and then measures medical and psychological effects of the person’s health to stage level of illness. A study that aggregates the results of a broad range of research called a meta-analysis proves that the people now classified as “overweight” have equal or better health than people classified as “healthy” weight. This result would shock many if not most people in this country.

The last piece explains an enlightening history about the bias of body shape. I have written frequently here how mass media transformed weight bias into a cultural phenomenon and fueled the epidemic of eating disorders. However, it’s very interesting and upsetting to hear about the many underlying causes for the bias against fat including the inherent racism and the religious morality originally used to create this cultural belief.

The broader conclusion of the podcast is that the fear of fat and glorification of thinness represents a moral panic in our society. The belief is not based on any data, research or facts. And business has capitalized on these fears to create industries which fan the flames of fear for profit.

The human need to feel superior or better can create a deep sense of terror of the other, and that terror needs an object, in this case fat. The podcast compellingly describes how our fear of fat is driven by this panic and nothing else.

It’s deeply relieving to see journalists tackling the topic of fat bias and trying to explain the devastating effects of the unsubstantiated fear in our lives. Let’s hope the medical community can begin to use the concept of “Do no harm” around weight as well.

The Sexist Nature of Eating Disorders in our Society

In recent years, I have written about dieting as the most important risk factor for an eating disorder. Our bodies are genetically designed to respond to undereating in specific ways. For some people, that means restricting food triggers an eating disorder.

I wrote more about the cultural meaning that the majority of people with eating disorders were women in the earlier years of this blog. Psychiatry and mental illness historically created diagnoses that disempowered and pathologized women including hysteria, different personality types, the schizophrenogenic mother and, more recently, eating disorders.

The institutionalization and then corporate strategy to glorify thinness handcuffs women throughout our society. No level of personal and professional success is sufficient for many communities which value thinness first and foremost. Even women who lead full, complex lives, often do so while battling low self-worth driven by the need to lose weight at all costs, disordered eating or often eating disorders.

And so the overarching effect of eating disorders is to disempower women. It’s difficult for them to achieve their most full lives when these added pressures and compulsions of thinness are all consuming.

Rather than protect people from predatory practices around food, dieting and exercise, the culture and even the medical establishment praise these problematic industries as promoting health rather than creating eating disorders. The society creates an environment in which so many women develop an illness and then blames people for being crazy. People who don’t know anything about eating disorders often say, “Why can’t they just eat?” and don’t see how misguided and cruel that question is.

One of the reasons I needed to reiterate how sexist our society is about eating disorders was the recent loss of abortion as a right. As angry and saddening this court ruling has been, I didn’t expect the it to hit so close to my professional home. I heard stories of women in New York who needed abortions in the late 1960’s when it was illegal. They could get an abortion if two psychiatrists would write a letter stating they would commit suicide if they couldn’t get one. They had to manufacture an illness to merit this medical procedure.

The history of women who are either labeled as sick to take away their power or rights is a long one. Psychiatry has been used for many years as a tool to treat women as second class citizens.

The history of abortion in New York reminded me how sexism plays a role in eating disorder diagnosis and treatment. The glorification of thinness, sanctioned food restriction and the societal instinct to subjugate women are all central to the increased incidence and insidious role of eating disorders.

Any thorough treatment of eating disorders needs to take these issues into account. Individual treatment must focus on what will help that person heal and still has to be informed by the inherent sexism in our country.