Eating Disorder Recovery and the Impossible Magic Cures

Eating disorder treatment involves two central pillars to recovery. The first step is regulating meals with a structured meal plan that can stabilize the digestive system and also calibrate hunger and fullness cues. The second step is to identify emotions and then work on ways to experience, validate and manage those feelings without using the eating disorder.

These two parts of eating disorder treatment don’t, and for the foreseeable future won’t, change.

The complex interplay of the psychological and physiological cues that regulate our eating patterns are largely innate and outside the purview of conscious thought and intent. Eating enough food for survival is an ingrained primal urge we share with all living beings. When we have enough food, the hunger drive is weak enough that we can delude ourselves into thinking we control how we eat. That changes quickly when our bodies are starved.

In the modern world, access to so many foods designed to be addictive combined with the powerful food industry leaves us vulnerable to a system intended to make us associate food with emotion and comfort. The fat phobic culture adds to the lure of food by demonizing being fat and eating “unhealthy” foods, thereby creating a way for children and adolescents to work out their negative feelings through food.

We are pressured to connect food and emotion both through industry and through cultural fat phobia. The result is a high likelihood that people will have disordered thoughts and behaviors around food and, largely based on genetic predisposition or less fortunate circumstances, an eating disorder.

Recovery needs to undo the psychological and behavioral patterns and rewrite the myths about food and weight drilled into people when they’re young. This work is hard and needs repetition but can be successful. People do get better from eating disorders all the time. I have written many posts in this blog that explain the path to get well.

There are also capitalist drives intended to take advantage of people desperate to get help. These industries promise an easy but ultimately unsuccessful fix that only demoralize and even re-traumatize people already suffering with an eating disorder.

Eating disorder treatment programs offer the illusion of a cure but provide a stopgap measure of stability, at best. The services are run primarily by inexperienced clinicians with misleading if not cruel messages that eating disorders are the patient’s fault. In addition, they offer no plan for continued recovery after discharge.

The diet industry benefits from the numerous studies that show that diets don’t work. The business model is that their services never work. People will always come back since the companies know that what they offer is never a cure and often only worsens the eating behaviors. Similarly, GLP-1’s offer a seeming cure for all eating woes. In addition, they are now available to anyone who wants them without medical supervision. There are enough stories online to convince people with eating disorders that these medications will cure them. Despite all the benefits of these new medications, they don’t cure eating disorders.

The path to recovery remains as possible as ever. People do get better. The steps still involve a meal plan, consistent support through a treatment team and resiliency. Many industries know how desperate people are to find a solution to their eating woes, body image thoughts and eating disorders and how susceptible they all are to supposed cures. I advise people to avoid any seemingly miraculous cure. The path towards recovery has not changed.

The Ongoing Need to Eradicate Blame from Eating Disorder Treatment

In recent decades, eating disorder treatment opened up access to care and improved the initial diagnosis by primary care doctors and pediatricians. Awareness has clearly increased, and doctors who see people with an eating disorders have resources for referrals. That’s a great improvement.

What has not changed is the overall mindset and morality about the diagnosis and towards patients, even among health care professionals.

Since the advent of the eating disorder diagnosis in the early 1970’s, clinicians remain perplexed about the cause and persistence of eating disorder behaviors. For people with little familiarity with these illnesses, it’s unthinkable to struggle with restriction, binging or purging, especially after months or years of treatment.

Incredulous as to what motivates people to continue the symptoms, clinicians and laypeople fixate on the myth that people are to blame for their illness. In this line of reasoning, eating disorders expose weakness or a lack of willpower in the individual—still the most used trope in recovery. Any failure to get better is the fault of the patient. Any medical symptom is caused by the eating disorder. The emotional and physical pain wrought by the disorder deserves no compassion and only further blame, insult on top of injury.

Blaming patients for their illness is a convenient way for clinicians to absolve themselves of any responsibility to help people get well. There is no need to think outside the box or consider other possible directions in treatment or to posit new ideas for causes of the illness.

The current business model for treating eating disorders is successful and lucrative. The philosophy is buoyed by a culture used to forging a connection between weight and self-reproach. The population with eating disorders are more likely to opt out of destructive treatment than fight back against an ineffective and often destructive system.

Creative options for care exist, and I have been writing about them in recent months. There is little appetite within the eating disorder field to look outside the current guidelines for treatment and care. Medical diagnoses that may be related to eating disorders don’t get any attention from a psychologically oriented community. The people who don’t get better are labeled chronic without much thought given to improving treatment for them.

In time, I suspect many eating disorders are likely to be seen as medical in nature. Research into the hormonal balance of gastrointestinal and metabolic functioning, a haywire allergy/immune system and misfiring of hunger cues likely will change the landscape of eating disorder treatment.

There will certainly be a psychological component to almost everyone’s eating disorder, but medical knowledge and interventions will help with diagnosis and a higher rate of successful treatment. Blame has no place in eating disorder treatment, and time will prove that to be true. 

Taking a Step Back: the Reality of Eating Disorder Recovery

Reviewing this blog from the past year, I wrote a lot about new avenues in the treatment of eating disorders. The new medications that affect our gastrointestinal system and the confluence of medical syndromes in eating disorder patients that doctors know little about dominated my thoughts.

The purpose of these alternate ideas is to improve treatment success for people with eating disorders. Even with adequate care, too many people still don’t get better. Many do, but the goal is recovery for all.

In that vein, I have started to look elsewhere, not for a new magical cure but for adjunctive treatment options that might increase the success and well being for people seeking help.

However, I do believe I left out the crux of treatment, or at least implied that the hard work is avoidable, if these other therapies are appropriate. The hard work actually remains the centerpiece of any true recovery.

The process of finding a committed, knowledgeable and well-suited treatment team is still paramount.

The struggle to eat one’s meal plan day in day out still is crucial for anyone to get better.

The daily obsessive thinking about body image will still be a very challenging and necessary part of the process of getting well.

And the healing of one’s body as it becomes accustomed to regular nutrition and improved health needs to be a top priority.

No new medication, no alternate diagnosis, no change in metabolism is a magical fix for eating disorder treatment. No matter the initial cause of the eating disorder—be it a general inflammatory syndrome, dysfunction in the gastrointestinal hormonal system, longstanding trauma or any of the myriad causes—recovery takes the same course. A thorough diagnosis and treatment plan may take these other issues into account, but recovery is still a challenging process. There are no shortcuts.

As I enter the new year working to expand treatment options for people with eating disorders, it must be clear that recovery is still a hard, long road. I just want the end of that road to be as successful as possible for everyone.

Accepting the post-GLP World

GLP-1 medications change the entire landscape of how we think about food, weight, our bodies and our health. Even more relevant to this blog, eating disorders are now perceived differently as well.

Any one person’s opinion about the benefits or risks of these medications is conjecture and largely irrelevant, including mine. We are all going through a cultural transformation that extends well beyond health. The tectonic shift in perception about our bodies is more to the point.

Thinness is back in. Any sense of body positivity or a generous understanding of the variability of the human body is out.

The pressure to be thin is stronger than ever, and the cost to do so irrelevant. Since GLP-1’s are available for a few hundred bucks per month, anyone inclined to take them can have them. And if anyone has any personal sense of what is best for one’s health, the current cultural trend demands you take them. What else could be more important?

Also the medical establishment is lying by acting as if we are predominantly taking these drugs to improve our health. Of course, some people do have meaningful health benefits: lowered blood sugar, decreased inflammation, lower alcohol cravings and improved cardiac risk, to name a few.

However, the true customers finding the medications are the healthy people who want to lose weight, pure and simple. That’s where the true profit comes from. That’s what is changing our cultural landscape because GLP-1’s have become the newest addition to medicine-adjacent, “healthy” treatments like Botox, plastic surgery, IV vitamin treatments and now GLP-1’s.

We all need to accept that the collective obsession with thinness landed us here. Experimenting with medications often prescribed by clinicians online who barely know the patent and have little justification to do so except for financial gain is risky business. Our health care system for actual illness has many inherent problems, but the self-care industry is thriving.

People with eating disorders will now include those with little or no treatment who choose instead to take these medications. They may seek help once the medications don’t work well. They may experiment with the drugs to try to manage their eating disorder. They may develop an eating disorder by using the drugs.

No matter how it plays out, GLP-1’s are part of the American zeitgeist and will affect all parts of life and continue to alter how eating disorders exist in our world. The first step is to accept this reality and move forward. I certainly have in ways I incorporate these drugs into my practice, work with people on them and find new ways to help navigate a world dominated by weight loss drugs, for better or for worse.