Anorexia Recovery: Why is it that treatment seems to serve my eating disorder better than it serves my recovery?

Anorexia Recovery: Why is it that treatment seems to serve my eating disorder better than it serves my recovery? 8


I don’t expect everyone to read this and agree with it. The TL;DR is that I believe that there is a fear that infests many eating disorder treatment approaches and this leads to inadequate intake prescriptions and target weights that do not serve individuals in recovery.  Please read the whole post – and it is a long one – before making up your mind.

 


I was terrified to eat a “normal” sized portion of anything in recovery from Anorexia. But it wasn’t only because I was scared that eating a normal sized portion of food would make me fat. It was not only that I was scared of feeling full either. Due to my stomach being too small I did feel full and bloated easily — but this was not the thing that kept eating smaller then normal portion sizes. Although if you asked me at the time, I may have given this as a justification. Sometimes it is easier to justify eating disorder behaviours with an excuse that seems plausible, or one that someone has offered as a suggestion, than it is to try and explain thoughts and feelings that seem inexplicable at the time.

So what was it? Why was I so terrified and downright adamant I would not eat a normal sized portion of food?

Because it wouldn’t have been enough.

And if I ate the normal, regular sized portion and it wasn’t nearly enough, where would I have gone from there?

I could not eat a whole sandwich. If asked why not, I would answer with “because I am not that hungry.” That was a lie, by the way. The real reason, was because I was ravenous and scared that if I ate the whole sandwich that I would still be ravenous and … then what? I was scared that the normal portion would never satisfy me and where would that leave me?

If I was still hungry I felt like I would have nowhere to go. But layered beneath that was a fear of not being hungry too. I had no idea what not being hungry would feel like having been hungry for years and years. I understand that this sounds totally crazy. But: Anorexia is a mental illness. It is crazy by definition. I’m not not trying to make sense of it as much as to underline the nonsense behind it. If we can understand it is nonsensical, we can forget trying to reason with it and can get on with eating.

I was scared of my hunger. So in that respect, it was easier to eat half a sandwich and still be hungry than it was to eat a whole sandwich and still be hungry. Because at least eating half the sandwich left me somewhere to go. At least if I ate half the sandwich I could tell myself “it’s okay that you still feel hungry because you only ate half of what everyone else did.” I would not have been able to tell myself that had I eaten the whole thing, would I?

The thing is, years of restriction and years of being malnourished and starved leave a body really bloody hungry. Terrifyingly so. So to tell me that a normal portion of food should be a goal for me would crush my soul. Anorexia made me scared of eating. Eating was hard enough on its own. But then add on top of that a layer of fear that I will eat and still be hungry after and still want to eat more. Ouch.

The hard part, is that even if you told me that I could eat more than a normal portion, I still didn’t believe you because Anorexia would say to me. “Other people feel satisfied with the normal portion. This is why it is called a “normal” portion. The fact that you are not satisfied with a normal portion now means that you never will be.”

Putting those eating disorder lies and twists to the side, overall, the message that it is okay for a person with a restrictive eating disorder to eat more — a lot more — than anyone else is generally one which is helpful. Sure, the eating disorder will push back, but that is a test of your confidence in this conviction. Stand firm. It is okay to eat a lot of food.

I think that what this post is really about is the deficit of this sort of information. It is about people being told to stick to meal plans. To not “over eat.” To be afraid of binges. To be afraid of eating. To be afraid of hunger. To be afraid of the very thing that will ultimately get them to full recovery. That is, eating without restriction.

 

“Normal” … whatever.

Some of us with Anorexia do feel very full after eating a small amount. Physically full that is. Mentally full, not so much!

I want to talk about mental hunger rather than physical hunger. If we only eat to physical hunger nobody is going to get weight restored because our stomachs are too small. The mental hunger is there for a reason and it is the mental hunger that causes us to obsess about food. The mental hunger is the body saying that it knows your stomach is full but it wants you to keep eating anyway. The mental hunger counts twofold on the physical hunger in my book for a person with Anorexia because it is the mental hunger that is proof that what we are eating is not adequate. The mental hunger is the brain saying “you are underweight and starving.” That counts.

What is the thinking behind trying to get a person who is malnourished to eat normally as a goal anyway? Personally I could not weight restore on normal portions of food. I had to eat far far more than that to get weight restored. And even if I could weight restore on normal sized portions, where is the harm in going over? Where is the harm in eating too much for a person who is underweight? Of course the eating disorder hates that — but since when was eating disorder recovery about appeasing the eating disorder. Sometimes I feel like this is exactly what traditional treatment for eating disorders is doing, and I think it is also what small portions of food do.

 

“Why is it that treatment seems to serve my eating disorder better than it serves my recovery?”

A question I got in an email this week from an adult who has been in IP twice and been in recovery for years: “Why is it that treatment seems to serve my eating disorder better than it serves my recovery?” “Why was I told not told that it was okay to eat a lot of food?”

Those are very good questions. Don’t you think?

Why is there so much in the world of eating disorder treatment currently that serves the eating disorder rather than serving weight gain and more importantly the mental processes associated with restriction? Why are recovery approaches often so fearful of putting fat on the body?

Yes, I used the “f word.” Fat.

Fat is not a bad word. Fat is a vital component of a human body in the same way that bone and muscle are. So can we please put fat back into eating disorder recovery? I know that eating disorders freak out about that word. I know that. I have freaked out about that word a million times myself. But avoiding it didn’t help. We have to be able to talk about having fat on our bodies in recovery because that is what is required for recovery. Additionally, we don’t need to dictate to the body the proportions of fat to muscle that it can and cannot have. We don’t need to try and control this via overly-balanced meal plans. A “balanced diet” and strict meal plan is  appeasing the eating disorder. When we appease the eating disorder in weight restoration we do not serve the individual because it has the effect of weight restoring them with restriction still present — this results in an individual in a larger body with a still very active eating disorder. No fun.

It also overcomplicates the whole process. The body is not a calculator. The vast majority of us don’t need to dissect intake into micronutrients —  eat the food that you desire and the body will sort it out.

Additionally there is research that points to the poststarvation hyperphagia (mental hunger) that many of us feel in recovery only subsiding once fat-free mass is fully restored, and that fat-free mass only restores after fat mass has begun to reach a critical level as determined by the individual. This explains somewhat the disproportionate fat accumulation that we go through in recovery. It also explains overshoot.  And the part about it being “determined by the individual” relates to that person’s pre-eating disorder metabolism and protein metabolism, and that explains why my overshoot was different from someone else’s. But none of that matters because the body works all this out for you regardless of whether or not you have read and understood the science behind it. And anyhow, we do not know enough about it yet to use any of this to prescribe a person’s recovery intake requirements. Any dietician or health guru who claims to know exactly how your body responds to food and what balance of foods is right for you is making it up. There are too many individual determinants that go into your body and how it operates for it to be possible for a partially-informed outsider to make a guess at what is “right” for you.  And it is futile to even try because we do not need to. The body knows. The body will work it out. Even more simply, if you supply more than adequate amounts of everything to the body, it will have everything that it needs to do it’s job.

In other words, leave all this to your body and it will know what to do with the ratios of your body composition. Leaving this to your body to work out is the safest bet you have because nobody — nutrition degree or otherwise — knows what your body needs more than your body does. The only crux is that you have to make sure that you are eating more than enough and a lot more than your eating disorder wants you to.

All our bodies react to food differently. Some people go into hypermetabolim. Some do not. Some weight restore slowly. Some faster. The human body is an organism and not a machine, therefore we cannot treat it like a calculator. It doesn’t work that every person weight restores on a set number of calories. With this in mind, the safest bet is to aim high.

If a person is given a higher than required intake all that will happen is that they will still weight restore. If they are given a too low intake, on the other hand, there is a huge risk that they won’t weight restore adequately and they will be no further forward this time next year. Overestimating intake requirement can do no harm to the body — it will only give it more fuel to do what it needs to do. Underestimating intake requirement can do a lot of harm to the body and can further damage the mind. Yet time and time again, people are given meal plans and target weights that are too low!

Why not take the pain and the calculations out of it and aim for greater-than-normal eating? If a person has been undereating for 10 years, it stands to reason that they are going to need to do a lot of overeating to get well.

At least I did, anyway. The effects of hypermetabolim in Anorexia recovery are one thing, but aside from that, my body needed a hell of a lot of food to repair and restore.

Additionally, let us take into account the above affect I described of fearing eating a “normal” portion size because I couldn’t bear being mentally hungry after eating and not having anywhere to go. A prescribed meal intake almost always creates an invisible ceiling for those of us trying to negotiate eating in recovery. Anorexia would never allow me to eat up to the “allowed” or “normal” amount and therefore I would always end up under-eating. Oddly enough it was easier for me to get in the mindset of eating large amounts of food than it was to try and eat “normally.” Many people in recovery struggle to eat as much as a meal plan prescribes for this reason — it is more common than it is understood — so why not work that buffer zone into the meal plan and deliver the message that it is okay to eat more than other people are eating?

There is nothing normal about eating disorders. There is nothing normal about eating disorder recovery. We all recover differently, and what worked for me doesn’t work for all. But, one thing that certainly doesn’t work for a lot of us is the traditional recovery model of set meal plans and normal-size eating.  Some of us need to super-size eating — and despite our apparent resistance, that is what many of us want. I think that the main point I am trying to make is that overall intakes (and target weights for that matter) are set too low and that for those of us who want to be given permission to eat a lot of food this is devastating  — to the point that going back to not eating at all is actually easier and less mentally painful than being allowed to eat but not enough.

It’s a bit like … say if you are really hungry, and someone gives you a bag of crisps. You eat one and they then whip it away. It is like a tease, and you would probably wish that they had never offered you the bag in the first place.

Sometimes it is easier to have nothing at all then it is to have too little.

 

Why is it so scary to let people eat a lot of food?

This topic beggers the bigger question: Why are people, emaciated from restrictive eating disorders and wanting to eat and get better, coming out of dietician’s offices with meagre meal plans. I saw a meal plan recently for a person with an incredibly low weight who had been on a “recovery” meal plan for 2 years — of around 2500 calories! And this is the revised version she was given after she went in and asked for an increase. Two years and no weight gain progress and nobody was asking why the fuck she was only supposed to be eating 2500 calories!

I ate more than that for a bedtime snack when I was in recovery.

Maybe I should also tell you, that the second time she asked for an increase her dietician sent her away without one. She told her “not yet, lets slow down a bit and think about increasing it in a couple weeks if you still want to.”

(Sigh)

Some people cite refeeding syndrome as a reason. Not viable for someone who has been steadily eating to a meal plan for a couple of years. I have also been told that people “freak out” if they are given an increase too soon. Maybe true for some individuals. But not for those who are actually asking for more. And I think that it is underestimated as to how many of us in recovery really (secretly) want to eat. Likewise I think it is overestimated how many of us really will lose our shit if we overeat. It happens for sure, but when you get to the bottom of it, the upset is caused by thinking that we have overeaten (done something wrong) more than because we actually didn’t like eating — so the problem lies with where the boundary is set as to what is labeled “overeating.” I have found that once a person understands that overeating is good, they stop freaking out about doing it.

Said differently: the reason that some people with eating disorders get scared when they eat a lot is due to the notion that they have done something wrong or bad in doing so — most of us get an overwhelming and utterly inappropriate guilt reaction to eating. Gratifying such a reaction with “it’s okay, let’s reduce your meal plan and make sure you don’t do that again” only appeases the eating disorder and strengthens the conviction that it is bad to eat a lot of food.

Now, that inappropriate guilt reaction after eating is eating disorder generated. i.e. it happens regardless of eternal messages. Children too young to really understand post-eating guilt get it. However, when it happens, we tend to look externally to help us either confirm or reject the emotion we are having. This is when we start to ask things like “do you think I ate too much?” or even seemingly casual non-question statements such as “Boy, that was a big meal …” to clock the reactions of others. We are testing the waters, so to speak. The last thing we need is to be told we ate too much — especially since eating too much should not be considered possible in restrictive eating disorder recovery!

When you reduce a person’s meal plan or suggest that they “back off eating” because they freaked out after eating a lot of food, you are confirming their fears that they somehow ate “too much.” That is ridiculous. If you do that, you are meeting an inappropriate and irrational fear and confirming it to be true! The appropriate response should be to with confidence tell them that there is no such thing as too much food in recovery and to tell them that they by no means did anything wrong.

I mean, if someone with body dysmorphia is freaking out that their bum is too big, would you sit there and say “hmm, maybe you are right..” or would you tell them “your bum isn’t too big?”

Likewise, when someone with Anorexia is freaking out thinking they ate “too much” they should be simply told “there is no such thing as too much food.”

Another reason — and this one still astounds me — is this notion that “binge eating” in recovery from a restrictive eating disorder is a bad thing. This one bumfuddles me because it’s so wildly out of sync with a very baseline understanding of what the human body’s default response to a period of starvation is. That is: to eat a lot of food. I’ve written about this a lot here. I even made a little video about it here.

 

Maybe my recovery was possible due to the influence of good eaters

Sometimes I wonder if the fact I recovered with zero professional assistance was actually the part that made it happen. I didn’t have a dietician, so nobody to tell me that eating two jars of peanut butter as a snack before bed was wrong. That sort of eating wasn’t wrong, by the way, it was what my body wanted and it got me where I am now.

I had a couple of great eating influences in my life as I recovered. The first, was The Danish Chef, who would think nothing of giving me a 12″ pizza as an aperitif. He would make me sit down and eat things like bratwurst sausages in hot dog buns smothered with Philadelphia cheese and gouda as a “tide-over” while he cooked lunch. The second, my husband, who has always, in the most adorable way possible, coaxed me into eating more. Both these people would take my eating disorder guilt and screw it up into a tiny ball before throwing it on the ground and stamping on it. I once did the “Gosh, that was a lot of food” thing after eating with The Danish Chef and his response was something along the lines of “You fucking idiot, you need to be eating four times that amount. We’re not even started yet.”

Note that neither of these blokes have a nutrition degree. Yet, they were able to lower my fears of eating a lot of food and encourage me to continue eating more.

Intense guilt and regret after eating a lot of food is an inappropriate reaction. It is an eating disorder-generated reaction. It should be dismissed as inappropriate. It should not be pandered to — all this does is appease the eating disorder and strengthen the conviction that eating is bad. Instead, brush it off with confidence and give us the confidence we need to do what we need to do. That is, eat a lot of food.

We are all individuals. We should be treated like individuals. What I see across the board is a blanket of conservative (to put it politely) meal plans for people in recovery — even when the individual is asking for more food.

Let’s take a look at what we know from the Minnesota Starvation Study refeeding period.

The men ate between 5,200 and 10,000 calories a day in the refeeding. And those were men who had been in a very short semi-starvation period. Not years and years of it like a person with an eating disorder may have been!

Yet we still have this odd idea that a person in recovery from an eating disorder should be able to do so on a low food intake. Forget the science — where is the common sense?

Fat Phobia

Much of the problem as I see it has to come down to this. God forbid anyone eat a large amount of food. God forbid anyone eat saturated fat. Never mind that the person in question may be dangerously underweight. We don’t want to take the risk of putting some fat on their bones! Perish the thought!

With this attitude, is it any wonder that people sit “in recovery” for years and years without ever getting there? And remember, I am talking about people who are motivated to recover and are putting their trust in a professional to help them do that. And when said professional sets them a recovery meal plan that is not a touch on the hunger they feel — people, this is cruel!

Repeat after me: Fat is nothing to be scared of. Fat is good. Human bodies need fat.

 

You can eat a lot of food

For many of us it takes us a long time to be able to admit that we want to eat more. So if this is you, and you, like so many others I know, have come away from an appointment disappointed because you wanted to be told that you could eat more and were not: It’s okay, You do not need anyone else’s permission to eat more. If you are hungry and you want to eat more you have to do so. And you can eat more than what is considered “normal” because there is nothing normal about the situation that you are in.

Recovery from a restrictive eating disorder involves eating a lot of food. Don’t let anyone tell you otherwise.

Please follow and like me :):

About Tabitha Farrar

I work as Head of Marketing for a software startup in Boulder. As a recovered Anorexia sufferer, I advocate for proper understanding of eating disorders in my spare time. On that note, I wrote a book about my own journey into eating again called Love Fat.


Leave a comment

Your email address will not be published.

8 thoughts on “Anorexia Recovery: Why is it that treatment seems to serve my eating disorder better than it serves my recovery?

  • Rachael

    Oh my God! Tabitha! This is an amazing post! Don’t get me wrong, my therapist has helped me with coping mechanisms to deal with stress and anxiety, however, it would take a huge load off my mind if someone just told me that it’s OK to eat and eat a lot! So thank you again for giving me the reassurance to eat.
    Although I have gained a considerable amount of weight, I still don’t eat as much as is considered “normal” let alone, what my body requires! I am still under weight and always second guessing myself as to what I should be eating, how much and when to eat! Really, I just need to eat what I want, as much as I want whenever I want!
    The nagging guilt of anorexia is still very strong in me. I can’t go a day without feeling the need to exercise and monitor what I eat. As I have discovered, like you, it really helps to be around people who encourage eating a lot and resting a lot! My husband is wonderful for this and the people I try to surround myself with, are also in this was of approaching food and exercise.
    I think recovery is very much about freedom. Being free of guilt, hunger and restrictions. Freedom from rigid routines and self sabotage. You would know what this is all about. The fact that you now have these freedoms gives me hope and inspires me to keep going!
    I know you have spoken in the past about your concerns for ex-sufferers assisting in the treatment of current sufferers. However, it has been you, your book and your posts that have helped me more than anything during my recovery. The impact of your words is invaluable myself and others like me. Unless you have suffered from an ED, you truly don’t know what it feels like. My doctor thinks I am afraid of getting fat! And I am. But I’m sure once in am weight restored, I couldn’t care less what size I am! The thing that terrifies me the most now is eating and enjoying it! I worry that it will get to a point where I’m told ” OK that’s enough, stop eating so much now!”. If that was to happen, I think I would want to die! Therefore, I just eat enough to appear normal even though my mind is very far from that! Hopefully not for much longer though! Weight restoration is very much up to the individual and we need to be given the reassurance that eating is a good thing!
    I would be so lost without you Tabitha! Thank you!

    • Samantha Windsor

      Hi Racheal
      I can really relate to your post and feel we are prob both at very similar stages of recovery
      Please do send me an email so we can chat.
      I’ve learnt support thorough people who have been or are going thru similar recovery is one of the things that’s really helping me move forward every day

      Hear from u soon hopefully

  • Firecracker

    This is what I believe, and this is what I am living. Your words are alive in the beauty of my restoration. Thank you, Tabitha, for the courage to speak, and for using your own incredible life as a test run. We are hungry, and we must have double cheeseburgers. There can be no other way. So many layers to this, and, ultimately, an entire wealthy industry runs wild hoping I will never leave my cage. Tiger hungry. Tiger on the prowl. There can be no other way.

  • Kimberly Jill

    Thank you so much for this post! I have been in IP, PHP and IOP a few times. I gained the required amount of weight to be discharged, but it never stuck. I always had an issue with the meal plan once out of treatment. I dreaded having to see my nutritionist. I hated the conversations about what I ate, how much of it I ate, and how I felt about it. I hated having to follow such a specific set of rules (which yes, reinforced ED behavior since ED’s LOVE rules). I started lying about what I ate since I was afraid to tell her the meal plan wasn’t working for me. I admit, I did relapse, but then I decided that I wanted to do it on my own. I stopped seeing her and developed my own meal plan. The beauty of it was that it wasn’t really a ‘plan’. I ate what I knew I liked, and I at as much of it as I wanted. I was finally able to keep my weight at a level where my Dr. was pleased. Recently, due to life events, the ED and restrictive behaviors are sneaking back in, so I am fighting like mad to follow my meal (non)plan. I never want to be forced to follow a nutritionists generic, ‘one size fits all’, meal plan ever again.

    • jess

      SAME! I quit going to outpatient after being released from IP and it helped me loads. however, i wouldnt be recovering now if i hadnt been admitted ip in the first place. i hope your life events got sorted out, itll sort itself out! (o^^o) love, jess