Eating Disorder Recovery during the Holiday Season

The holiday season can be very hard for people in recovery from an eating disorder. They feel pressured to appear more well than they are and to put on a veneer or comfort and calm when the holiday meals elicit anything but that feeling.

Recovery and progress cannot move forward any faster because of a holiday, and the most important decision in anticipation of these days is to stay grounded in what works in recovery.

Practically, the person in recovery needs to follow their meal plan and expectations of the treatment team as a top priority. Often, this plan will mean eating at times others don’t eat or types of food other people may not be eating.

It’s also critical for people to explain to families that the plan for recovery is more important than any family tradition. The goal is not to make this specific holiday better but to pave the way for real recovery in the future.

Moments of seeming normalcy that only hide the severity of the illness perpetuate the lie that things are getting better. Transparency, even if it reveals the difficulties of recovery, is much more honest and promotes progress towards wellness.

Families can focus primarily on compassion and support. The holidays shine a spotlight on togetherness and food, both things people in recovery struggle with. The food is clearly difficult and the time together makes it much harder to hide the eating disorder. This feels very exposing for people fighting to get well. When families show love and support, the environment encourages openness and decreases the urge to hide.

Last, I encourage families to try to celebrate the gains in recovery and recognize how hard the process is. The changes someone makes in a year time might seem small, yet the work and progress lay the groundwork for more and more health and for breadth in one’s life.

The Veneer of Success Hides the Suffering of an Eating Disorder

Many people with eating disorders appear to live relatively normal lives. To the uneducated or ill-informed observer, the limitations of the eating disorder don’t diminish someone’s life considerably.

Except for the most ill, people with eating disorders can maintain careers, relationships, friendships and family. Part of what can be so confusing to many is that the only issue between health and illness is simply eating food regularly through the day.

Although eating appears to be straightforward, nothing is harder for someone with an eating disorder.

The experience of those who are sick is diametrically opposed to how the bystander views the illness. The sick feel as if their entire life has been hijacked. They are able to cobble together a life out of sheer force while constantly battling thoughts and behaviors around food which dominate their internal world. They live in a constant state of self-loathing, rumination about food and misery. Any accomplishments pale in comparison to the suffering.

The behavioral and medical components of the eating disorder are just ramifications of the powerful psychological and emotional toll of the illness.

All the success does not represent the true difficulty of surviving with a chronic eating disorder. In fact, people often feel as if they lose any sense of who they are and instead function as a puppet controlled by the eating disorder thoughts.

Compassion for someone with an eating disorder begins with understanding how powerful the eating disorder is and how hard it is to function with it every day. The more someone understands the daily struggle with the illness, the stronger they feel to fight against the thoughts and behaviors.

In addition, support involves helping someone remember who they are deep down beneath the eating disorder. Since they often lose connection with their true selves, any real relationship in the world helps them remember that there is a real person underneath the illness.

Concrete accomplishments don’t represent steps towards recovery. Escaping the relentless thoughts of an eating disorder entails daily, grueling work, and any help connecting with the deep, meaningful relationships in recovery helps a person keep fighting to get well every day.

The Truth about Full Recovery from an Eating Disorder

The notion of full recovery from an eating disorder remains controversial in the media and lay world. Eating disorders may be very specific diagnostic entities to clinicians; however, the terms are used more broadly by the public. Similarly, many if not most people see eating disorders as a way of life rather than an illness with an actual cure.

Two phenomena lead to this fallacy: clear evidence of people with chronic eating disorders and the cultural acceptance of food and weight obsession. These two realities help propagate the myth that no one can get better from an eating disorder.

The truth is that some people have chronic eating disorders they need to manage throughout their lives. Sometimes the eating disorder is disabling and extremely limiting and in other circumstances people can manage larger lives while also dealing with a chronic illness.

A significant percentage of people do fully recover, including people with all different kinds of eating disorders. These people tend to have certain similar experiences that increase the likelihood of recovery.

First, people have a higher chance of getting better the earlier they enter into effective treatment. The longer someone is ill, the more ingrained the eating disorder thoughts and patterns become. This is especially the case when the eating disorder persists in early years of adulthood and becomes a key component of adjusting to life in the world.

Second, the more fulfilling a person’s life is despite the eating disorder, the higher the success of treatment. People need to have things that matter more than the eating disorder. This enables them to deal with the persistent discomfort of eating normally because there is something else to eat for.

Third, people need to be able to believe the thoughts that counter the most basic argument of the eating disorder. These thoughts include fear of gaining weight, the need for regular nutrition and that there are other ways to handle stress and emotion. When the eating disorder is the sole way someone handles life, recovery looks much more daunting.

Last, the more support someone has in life enables recovery to proceed more smoothly. Support isn’t absolutely necessary but makes a difference so the person feels less alone.

Completely recovery is a very common end result of treatment. An eating disorder is not a life sentence despite the general belief otherwise. Getting treatment early and fully committing to the work of getting better really can pay off.

Societal Risks of Bariatric Surgery, Part II

Fat has become the evil we avoid at all costs. In our collective world of fantasy, one of only good fortune, endless riches, eternally youth, fat is the source of the evil we avoid. The dream is that remaining thin and perfecting our diet and exercise plan will allow us to revel in what was once unattainable: immortality.

Society has tacitly agreed that fat is culprit of all our woes. Accordingly, we must avoid eating fat (except fats deemed healthy) and we all just avoid fat people. As bias against race, gender and religion decreases on all fronts, bias against fat people is on the rise. They are seen as lazy, ignorant and lacking in all willpower. They represent everything distasteful in the world and must be avoided at all costs. They deserve what they have brought upon themselves.

The diet industry rests largely upon the theory of self-advocacy. With any specific diet, a person will successfully lose weight for good and transform their lives. The data proves that 98% of diets fail, so why would any new diet be more successful than the last? Since diets work by supposedly empowering people, those who fail are to blame. Certainly the diet can not be the failure.

The exercise industry is the same way. New exercise plans promise a life transformation including weight loss, new confidence and personal transformation. Lack of success is always a personal failure. The exercise program cannot be held accountable for false promises.

The medical establishment reinforces the concept of fat as the source of all illness. As doctors arrogantly explain the dubious relationship between weight and health, they offer no solutions mostly because there are no reasonable solutions to be found. Diets don’t work. Weight loss medications won’t work. Doctors easily shirk off any responsibility by blaming the patient.

Inevitably, the demoralized patient believes they are to blame for their weight and that their weight will shorten their lives considerably. The only path left is Bariatric surgery. Medicine pushes these patients towards surgery, and the centers have become large money makers for hospitals struggling to survive financially.

Perhaps Bariatric surgery is barbaric. It’s a last ditch effort to transform a person’s body and life by cutting away most of their stomach and decreasing their physical ability to eat food. The result is forced prolonged starvation: anatomical anorexia. The only way to lose weight is to create an eating disorder by any means.

If thinness is the only key to success in this world and the promises mentioned above, is it any wonder droves of people have signed up for surgery?

Watching people gradually find a way to eat again around the surgery, I have wondered what the long term results will show. I see so many patients eventually eat more regularly or overeat again after their bodies adjust to the surgery.

And how will we reassess the long term effects on so many people undergoing this procedure as they age? Surgery isn’t a permanent solution but only delays our inevitable need to face the judgment and bias around weight. It is a scary view of what the fantasy of thinness has wrought in our world.

Societal Risks of Bariatric Surgery, Part I

The medical establishment posits that Bariatric surgery is the newest and most effective way to combat issues with weight in our society. As previously explained in this blog, our bodies have adapted to the environment created by the food industry, namely processed foods meant to appeal to our most powerful tastes and that also wreak havoc on our metabolism. Rather than face the public health crisis caused by the food industry, surgery, which is now covered by insurance, is the solution of the moment.

The increase in average weight in the country is linked to worsening health. However, this link is questioned by many authorities. Movements like Health at Every Size present substantial evidence that proves otherwise. The power of the food industry has convinced society and doctors that people are to be blamed for their weight which causes poor health and that these people need help to fix their weight problem. There are medications meant to counteract this scourge which have limited benefit, but surgery is the increasingly common recommendation as a quick fix.

Bariatric surgery is essentially anatomical anorexia. Gastric sleeve surgery, the newest iteration, surgically separates 80-90% of one’s stomach leaving a very small, crescent shaped stomach. The result is the physical inability to manage no more than a few bites at every meal, at least for the first 6-12 months after surgery. The Bariatric surgical centers focus solely on weight loss. Their success is measured by the number of patients who lose a certain percentage of body weight over the first year or two. Long-term results, let alone overall health, are secondary.

But surgery essentially leads to drastic food restriction over a long period of time. By any other definition, this looks like anorexia. Any starvation, however it is imposed, can lead to very strong hunger that triggers overeating or binging. Also, restriction over a period of time leads to malnutrition no matter the weight of the person. The surgical programs don’t consider overall nutrition or the health consequences of such prolonged limited eating. Instead, they focus on improved blood sugar and blood pressure, metrics that increase insurance coverage. What benefit is there to swap one set of medical issues for another?

Based on how easy it is to sway medical opinion—the continued manipulation by the pharmaceutical industry is the clearest example, it’s not surprising that other more powerful forces have convinced medicine to take this approach to treat larger patients. But how is it that thousands of fat people blame themselves so much that they endure risky surgery time and again? Why is it that no one is questioning this barbaric practice? I’ll address this in the next post.

The Fallacy of Willpower in Eating Disorders

Clinicians regular conflate eating disorder recovery and willpower. For people with anorexia, they say that willpower is the essential ingredient to be able to follow a meal plan. For bulimia, therapists describe willpower as the main way to avoid binges. For binge eating disorder or compulsive overeating, willpower is the only way to stop eating.

All research into treatment shows that this therapeutic approach is ineffective, yet the theory is pervasive in the clinical community, to the detriment of all those seeking help.

The focus on willpower as a part of eating disorder recovery, despite its clear ineffectiveness, is due to three issues.

First, therapists struggle to manage the helplessness and powerlessness they often feel when treating people with eating disorders. Therapy may include insightful sessions, a clear understanding of the cause of the eating disorder and a definite plan moving forward. Even still, the person may make no or marginal progress. Without any clear culprit, the therapist can easily blame willpower—the patient—for the failure to move forward, absolve themselves of responsibility and avoid more frustration.

Second, the concept of willpower camouflages a therapist’s lack of knowledge or experience treating people with eating disorders. Willpower reflects an aspect of therapy called motivational interviewing first adapted for people with substance abuse issues. Although there is some benefit utilizing this treatment approach for eating disorders, the therapy does not take into account the greatest difference between the two: food. However, it’s a convenient way to explain why someone is not progressing in treatment and instead blame the patient for her illness. It behooves patient and therapist to get a second opinion or try a different course when a clinician is unclear how to proceed rather than attribute a stall in progress to a largely irrelevant treatment modality.

Third, the therapist is unwittingly reinforcing the eating disorder mindset when focusing on willpower. Since this approach is wholly ineffective, it only makes the patients feel more inadequate and more helpless. Rather than trying to find a new way the circumvent the illness, the therapist expresses frustration in the most facile way: leading the patient back to the helpless state of the illness.

When a patient encounters a team focusing on willpower as a core part of treatment, the patient ought to both confront the team about this approach and, more importantly, seek new help. Using willpower as a fulcrum to leverage recovery inevitably fails and only reinforces the illness. Better treatment exists elsewhere.

Eating Disorders vs. the Collective Focus on Weight and Food

The cultural views of weight and being fat factor heavily in the clinical approach to treating people with eating disorders. Those with anorexia are often lauded for their weight even when the illness severely limits their lives. Fat people are shamed so much they develop body distortions or eating disorders through endless dieting and even Bariatric surgery. Bulimia is sometimes seen as a necessary evil to manage weight. 

The lens through which many people understand eating disorders is itself distorted by the vilification of fat and glorification of thinness. 

In order to make more sense of eating disorders, the distinction between what these illnesses are and the societal distortions about body size and shape is critical. 

Eating disorders are characterized by abnormal eating behaviors: chronic starvation, binging, purging, excessive exercise, laxative abuse. However, the true nature of an eating disorder is psychological. Obsessive thoughts about weight, food and self-loathing dominate the minds of people with eating disorders. These thoughts make it almost impossible to live a full life. Even those who objectively seem to be living talk in secret of how much mental energy they use for the eating disorder. Their lives are not theirs to live. 

Society’s views about weight reinforce much of these eating disorder thoughts. The endless praise for thinness, pervasiveness of dieting and marketing for diets and exercise all confirm that the underlying basis for the eating disorder appears to be valid. It seems as if everyone is focused on weight and food. 

When people hear about or discuss eating disorders, the difference between our collective focus on food and weight doesn’t seem much different from an eating disorder on the surface. 

People without eating disorders may engage in these thoughts and behaviors, but their lives go on. They can let go of these thoughts, stop a diet or exercising and think nothing of it. Someone with an eating disorder cannot make these changes without the illness consuming their lives. 

Changing the obsession with food and weight is not a short-term solution because the obsession is too ingrained in our national ethos. It’s critical to recognize that eating disorders are true illnesses, many levels more severe and all-consuming than simply altering one’s daily diet. Comparing eating disorders and the general focus on food and weight completely misunderstands how severe and destructive eating disorders really are.