Clinicians, you do not help us recover from Anorexia when you set low target weights and food intakes! 4


This is the first of a series of blogs aimed at eating disorder professionals. This series was inspired by the members of the recovery Slack group.


 “Pampering” as a restoration component of many IP systems is particularly troubling. I have actually had IP treatments where ‘goal weight’ has been ‘negotiable’ and in a downward stance…not helpful when in our most inner beings and sense of what is ‘right’ for our personal wellness and recovery…we intrinsically ‘know’ this is not right…often too low for true physical and mental recovery.  I find it crucial for IP systems to acknowledge that weight restoration is merely the ‘tip of the iceberg’ when it comes to anorexia and ED recovery.” – Anon, adult in recovery from Anorexia

This “pampering” when it comes to weight gain as described above is a frequent topic of conversation when I talk to my clients about past treatment experiences. Of course, we are all resistant to gaining weight. That’s part and parcel of the disorder. But, that doesn’t mean that deep down we know we need to gain weight. Our resistance to doing so doesn’t mean that we don’t feel let down when you give us a target weight that we know is too low. That makes us feel like what is the point in trying to eat more or start recovery at all, because to achieve the target weight you have set us we are going to have to spend a lifetime dieting. Likewise with daily caloric intakes. People who are malnourished need to eat a lot more food than the general population. Yet many of the meal plans I see prescribe less food in a day your average person eats

 

Stop prescribing restrictive diets to people in recovery from restrictive eating disorders

Don’t give people with Anorexia caloric ceilings. Don’t discourage binge eating. Binge eating is a natural response to a period of starvation and when it is discouraged you are actually encouraging us to over-ride our innate desire to eat a lot. That’s what Anorexia does — we don’t need you to do it too.

Yes, sadly many of you set target weights for people in recovery from Anorexia that mean we will have to gain some weight but always be dieting in order to stay at your target weight. Do you understand how painful this is? Do you understand how ludicrous this is? You are putting people in recovery from a restrictive eating disorder on a restrictive eating plan for life. That is cruel. Stop it.

We don’t need you to pamper our resistance to gaining weight. We don’t need you to collude with our disorder and set a low target weight. This doesn’t equal freedom for us. Anything short of full remission is purgatory and when you set low target weights or low daily caloric intakes you are setting us up to forever be trapped in a half-life. Sure, we may be physically less out of danger of death, but that alone is not enough to live a free and happy life. Remission is more than weight gain. The mental freedom from the disorder that makes life worth living and recovery worth fighting for comes only when we can eat unrestricted. If allowing someone to eat unrestricted makes you uncomfortable then you are in the wrong field of work.

 

Stop trying to control weight gain

Most clinicians pamper the ED which feels safe but that not the aim here. We need just support in the process and reassurance. I just get told to keep to a set number which is in my opinion rations. So if I agree to go in IP I don’t think it will help. – Anon, adult with anorexia

Rather than giving people the illusion that they can control their weight gain, support than in knowing that their body will take care of them so long as they eat unrestricted. Controlling weight gain = restriction and rationing. It also illustrates your own fears. If you are happy in your own body and trust your body to operate as it needs to without your interference, you will know that it does just that. You will know that if you don’t diet and restrict your body finds set point weight range and equilibrium is found. Do not project your own fears and insecurities onto your clients.

We don’t need to control the way in which we gain weight. The body knows what it is doing. Some people gain fast, some people gain slow. If supported to eat without restriction a person will end up at the weight that their body is designed to be. Gain fast or gain slow you will end up in the same place. The idea that we should control weight gain by restriction is ridiculous. Anorexia lives in restriction, but that’s not all … restriction gives the brain signals that food is not abundant, which makes the mental hunger stronger. When we gain weight while restricting we are doing only that: gaining weight. In order to reach remission we have to gain weight and change the neural pathways of restriction, hence the irony of “helping” someone by thinking they can control their rate of weight gain with restriction.

 

Do not replace ED rules with your own

Not to replace ED rules with ‘their’ rules eg drinks only 250ml, at set time, in set mug and in one place I was IP at set temperature – Anon, adult with Anorexia

As illustrated above, many clinicians and treatment centres try to treat people with Anorexia by making up arbitrary food rules. Oh the irony. You are trying to treat an eating disorder which is often high in OCD behaviors with prescriptive eating schedules, types of food, quantity of food, eating times, and even down to the temperature of the food!

For adults with Anorexia I think that the biggest insult here is being treated like naughty schoolchildren. In terms of recovery progress this is another example of how to keep someone alive in a living hell. I have plenty of clients who come out of treatment centres with more rules then they went in with.

Treat every person as an individual. Show us that freedom to eat what we want when we want is there for us. What motivation do you think you are giving us when you illustrate recovery as meal plans and measured-out cereal for life?

 

Stop making recovery more complicated than it is

Recovery from Anorexia is a process of eating a lot of food, gaining weight, and stopping all OCD-ED behaviors. This is simple. It is not easy, but it is simple. Therapy is not needed to eat food (but it is helpful for some people). Humans did really well eating food before scales were invented, therefore measuring is not required to eat food. Prescriptive meal plans are not required to eat food. “Exchanges” are not required to eat food.

Does that mean we don’t need you? NO! We need your support because we are terrified of eating in the way that our mental hunger wants us to. We really really need you. But we need you to be helpful, not to pamper the illness, not to put us on diets.

 

What do we need from you?

Support to eat unrestricted.

Encouragement to eat the foods we are most scared of.

Trust in our own bodies to sort this out if we provide the fuel.

We need to look at you and believe that recovery is worth fighting for.

We need to see freedom.

What we don’t need from you is another voice telling us to be sacred of eating.

 

 

 

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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.


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4 thoughts on “Clinicians, you do not help us recover from Anorexia when you set low target weights and food intakes!

  • RangerKwii

    “Yet many of the meal plans I see prescribe less food in a day your average person eats.”

    So shockingly true. I toyed with the idea of starting to refeed by adding a few calories. 1600 one day, 1800 the next. But that amount just seemed like such a small drop in the bucket, it was almost a tease. I felt like–I guess I’d just rather keep ED happy than try to torture myself with this tiny amount of “maintenance” or “slow weight gain” calories. Thanks for this article and for all your writing on this subject!

  • Tina

    Thanks for writing this piece. My daughter was admitted 3 times to an inpatient unit and she did not make progress until she was at a weight much higher than the original goal weight. Her original goal weight was already higher than her BMI but her body needed to go even higher. The body truly does know what it needs to do. Recovery is a process and I am looking forward to the day she can stop living the “half life”.

  • Lisa

    Tabitha, I have an issue with a piece of this philosophy. The use of language is VERY powerful. The use of the WORD Binge eating from the multiple meanings of the word AND the illness is my concern.
    So I’m quite familiar with the science of hunger in relationship to famine and starvation. The biological response IS to seek out food stores and eat much more than one needs in the moment to prepare the body for the next famine.
    The problem with the language of Binge eating is that some people suffer from a life threatening biological response that doesn’t NOT turn off. It does NOT balance out. It is a horrific state can be life threatening both in its physical and mental consequences.
    My thought is that we as caregivers AND professionals buy into the fear of becoming Binge eating disorder when the bodies require and ask for MORE than a weight gaining meal plan.
    This IS what should NEVER be referred to as BINGEING.
    IT INFERS SOMETHING ITS NOT.
    Breaking ed rules IS a crucial part of recovery. Understanding that a sufferer can and should eat freely outside of a meal plan with validation that is NOT in fact bingeing but practicing living life without acting off off ed thoughts.
    I think the use of the word bingeing actual thwarts efforts to achieve this goal.

  • Juliet Weston-Simons

    The whole target weight and meal plan thing happens as a outpatient too. I remember being given a meal plan as I started outpatient thinking “well that’s not going to be enough is it, I’m starving here!”. I found myself saving the calories on the plan for the end of the day so I felt like I could eat a lot, just what I wanted to do. So the measly meal plan actually created ED behaviours I didn’t have before! I knew deep down this wasn’t what my body needed but needed someone to say it was ok to eat however much I needed as I was scared of doing this because I saw it as violating my plan. Years of semi-recovery could have been avoided. Thanks for your fantastic posts and information/revelation!