(Transcript for this podcast is available if you scroll down! Thanks toMarie for transcribing it!)

In this podcast Tabitha talks to the fabulous Carrie Arnold about the problems associated with setting target weight too long:

Topics covered:

– Body diversity

– What happens in patients minds when target weight are set too low

– Anorexia in larger bodies

– Overshoot vs. recovery weight

About Carrie Arnold

Carrie Arnold is an award winning blogger, freelance science writer, and author living in Virginia. She writes on a variety of topics from microbiology to evolution. Carrie is in recovery from anorexia, and is very active in the eating disorder community as an advocate for better research and treatments.

Carrie’s Webiste

Decoding Anorexia

The Eating Disorder Recovery Podcast

Recovery Stories: Allow for Body Diversity when Setting Target Weights

Tabitha and Carrie Arnold

Hello there, welcome to this weeks podcast, in this podcast you're going to hear a 
pretty short conversation that I had with Carrie Arnold.. Carrie has been on this 
podcast before, I'll link to our previous conversation. We had a talk about eating 
disorders and OCD. Last year now, quite a long time ago. So she's been on the podcast 
before, Carrie is a freelance writer and she's in Virginia. She's in recovery from an 
eating disorder. 

Today we are going to talk about, the topic of the moment, target weights and a couple
 of reasons why setting target weights too low can really have pretty troublesome 
effects on the person in recovery.

Here's Carrie

C: The first target weight that I got, right when I was first diagnosed and I had
 already lost a huge amount of weight. They gave me a target weight that was only 4 
or 5 pounds more than I currently weighed. I remember being on the one hand happy 
because it was not that I had any intention of even gaining that little amount of
 weight but I just remember thinking like....What the hell?!! you know, these people..
.I don't think I would have been able to trust them.

T: Right. Wasn't there any kind of thoughts around, Oh if they're saying that 
I should only be this weight that's so much less than I was previously, then I was 
right to lose weight?

C: Yeah, and I remember there were a couple of incidences, the first treatment centre 
asked me what I wanted my target weight to be.

T: OK (laughs) did you say what it is now?!

C: Basically. And when I was at Renfrew in the fall of 2001, they measured me at 5'4.5. 
So my target weight, I shit you not was 122.5lbs. Down to the half pound and I just 
remember being like, you do realise that a bottle of water drank is going to either 
put me over or under. When your target weight depends on a glass of water before your 
weigh in, then there's something wrong.

T: Oh my gosh, but even that's then the message that humans have to be that accurate 
about their weight.

C: Yes. We survived for millions of years without scales. Like, I don't think we need 
to be that accurate.

T: No and I think humans and any one person has a range that varies from day to day 
anyway. So then it just kind of colludes with this idea that we have to be completely 
exact and calculating about every thing that we eat. And that it even makes a difference
 and therefore about the weight as well. So, in your treatment  history, you've had
 target weights been basically set at just about what your underweight is, you've 
had scrutinized accuracy down to the half pound.

C: And I've also ended up with a really good treatment team that's like, they took
 a look at my weight history and everything and kind of, all those were full of
 crap and my nutritionist started by saying, well we're going to get you up to at
 least this amount and then we're going to re-evaluate and see how things are going. 
She said, we'll know when we're getting closer because the rate of gain will slow down 
dramatically because your metabolism will really kick in. Eventually you will 
start being less obsessed with food and everything. It's probably, it's definitely 
going to be higher than you weighed in the past. She said, I'm not going to lie and 
tell you a lower weight range to get you in the door..because a lot of the time people
 give a lower range because they're afraid of scaring you. But she said she had a 
lot of faith in her patients. She said, I want you to trust me and I can't do  that if
 I tell you one thing and know that it's not right.

T: Right, I like this person.

C: Yeah and she said, she's had to tell overweight patients that were anorexic and had
 lost their period that they needed to gain weight. She said that was a hard sell! But 
she's not afraid of doing that at all. So, that really helped. I think my weight even 
went higher than they might have anticipated but they got my old growth charts and then
 they were like no that was exactly what we would have expected you to have weighed.

T: Right, that's your you.

C: Yes and looking at my family they're Eastern European. They're short and stocky. 
They're not tall and thin. No one is. I'm just a little under 5'5 and I'm the tallest 
female on either side of my family. That's just, tall is never going to happen either!

T: Yes, it's in your genetic, it's you. Can you remember that conversation and when
 she told you that your weight is likely going to end up being higher than say you
 wanted it to be or whatever. Do you remember did you either go 'Oh god I don't want
 to work with this person' or did you go 'Oh OK'

C: It was a bit of both honestly. It was, at that point I had probably been sick for 
10 years but probably more like 15 look back. It was terror and anxiety but I think it
 was also relief that someone was giving it to me straight and that I had been fighting
 for so long to keep my weight artificially down because I didn't think it should be 
that high. That it was sort of relief that someone was giving it to me straight and
 that maybe I had been given permission to stop fighting my own biology.

T: Right and so that had been I guess until then. Were you ever in the situation 
where you reached the target weight that someone had set, a low target weight that
 someone had given you and they had said, 'OK you're done, bye' 

C: No, because I never really stayed with anyone long enough to kind of get to that
 point. I had a doctor that I had at one point where I gained over my target weight 
and I was seeing a decent team at the time and they hadn't told me not to  keep gaining
 anything and I'd gone off to grad school and I went to my first appointment at the new
 eating disorder clinic and the doctor made some comment like 'we certainly don't want 
you to gain any more weight' and it turns out that what ended up being my target range
 was 10 or 20 pounds over that. So that's the comment that's really stuck with me the 
longest. And it's been the hardest to shake.

T: Understandably

C: Yes it was said in that 'we certainly don't want you to gain any more' I went to a 
doctor at a relapse and explained that I had an eating disorder and she looked me up 
and down and said 'well that's certainly not a problem any more' and I'm like fuck you.

T: Those kind of things sting and they stay. Did you notice improvements when you 
allowed yourself to stop fighting your natural body weight

C: I don't think I had ever allowed myself to stay there long enough to really notice 
the sustained improvement. It was like I'd gotten there long enough to noticed the 
increased craziness and then I immediately started restricting again.

T: Yes, because it gets worse before it gets better.

C: Yeah and I didn't really, it wasn't until later that I really had the support to
 force me to stay there and get through it and realise that the world wasn't ending 
because I weighed more than a BMI chart said I should, or I thought I should, or society
 thought I should. It was helpful when the team didn't brush off my concerns either. 
Sometimes it would be 'well that's just the eating disorder talking' and that drove me 
absolutely bonkers. Because yes, of course there were times when I was completely in 
anorexic mode and freaking out and no that's not an appropriate time to have a 
conversation but by expressing my discomfort with this weight gain and in my new body
 it's not necessarily the eating disorder talking. So having a team that could really
 validate how hard it was and address the cultural issues around body weight, not so 
much as the causes of this disorder but as barriers in getting better.

T: Yes, so they were probably working with you not just at you.

C: Yes, yes. I've noticed when I first got to my healthy weight I thought that I was 
the only person with anorexia that would ever weigh this much. That I was some weird 
freak of nature because you see most of the before and after pictures and the people
 in the recovery community and a lot of them are very thin. And there's nothing wrong
 with that, I know there are plenty of people with that as there natural body shape. 
But when I'm looking at that and looking at myself it was like there was this big 
disconnect. I'm not even that particularly large. I'm still well within average weight 
for women of my age and so I'm not trying to say I know what it's like to be someone 
who's a lot larger and has an eating disorder but it was looking at myself compared to 
a lot of these images is, I thought I was the heaviest person who ever had anorexia 
ever in the history of all humankind amen! And you know, realising now is that there 
are a lot more people out there who's bodies don't conform to the traditional narrative
 either of people with anorexia being inherently thin even in recovery and also the
 broader cultural narratives around what a 'good body' is. I am far from the only person
 and there are a lot of people out there, they just might not be talking about their
 history or we might not be looking at them as having an eating disorder because the 
don't fit those criteria that we are used and it's not that weird at all.

T: I think that will help a lot of people who are there right now.

C: The only other thing is, I know a lot of people when they talk about overshooting 
target weight and on the one hand I do think that does happen to a lot of people, but 
I also think that at least 90% of the time we hear target weights are set too low and 
that you're thinking you overshot but really it was the target weight that was too low
 not that your current is too high. It's that idea that it's your weight that's the 
problem not the actual target setting. That took a long time for me to really mentally
 get my head around.

T: Overshoot can definitely be troublesome because then people can be like, I hope
 I'm in overshoot, and it's going to go back down.

C: For me too, then I'd start restricting because it was like, well if it's overshoot 
it will come back down and it wasn't coming back down and then I was like, well I'll 
make it come back down.

T: Right and then even the term overshoot implies that you went over something and that
 you got it wrong, which I don't particularly like. It could be that you got it just 
right actually

C: Exactly.

T: Big thank you for Carrie for coming and talking to me about target weights. Probably
 a difficult subject for a lot of people, it's also I guess a scary subject for a lot of
 people. It's an important subject, it's important because I think treatment providers
 need to understand what happens when you set a persons target weight too low. With 
most people, what happens is they get to that weight and if that weight is too low the 
anorexia response is not turned off and so they still have that anorexia response still
 going on that fear of weight gain and fear of eating and all of the obsessions that go
 with it but they are just in a larger body. And that's  hell and that's not OK. It's 
not a nice place to put somebody. If somebody is allowed, if their body is allowed to 
get to the weight that it should naturally be at then the anorexia response should start
 to turn off and then everything gets easier for that person. But when the target
 weight is set too low then they never get to that point and then there's the things
 that Carrie talked around just the effects of hearing a target weight that's too low
 has on the individual in recovery. If that target weight is a couple of pounds more 
than your underweight weight that's scary. If that target weight is higher and accurate.
 That's scary too. Because our bodies don't work like that. Our bodies are organisms
their not machines. Their weight varies. The same persons body weight will vary
 throughout the day let alone be an exact .5 of a lb. Oh my god shouldn't laugh, it's 
so fucked up. Anorexia is this response that makes most of us hyper aware, super 
obsessed especially around numbers and we get really kind of worked up around it and 
it all has to be absolutely accurate and then you go into a treatment setting and the 
treatment providers are telling you that the numbers have to be absolutely accurate and
 you have to eat your body weight up to .5 of a lb to be the right weight. How is that 
helpful? That is like taking somebody who has contamination OCD and giving them a s
crubbing brush and telling them that they have to make their bathroom cleaner or
 something. That is so messed up.

OK, you might have a story that you want to share as well. If you do, get in touch. 
I'm all about sharing recovery stories good and bad. You can get in touch by email.
 My email is: info@tabithafarrar.com or twitter: @love_fat_ 

Cheers, until next time. Cheerio.


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