This blog is a collection of some stories I was sent. My comments are at the end.
I listened to your podcast this morning about how treatment professionals are failing by making eating more complicated. I wanted to make you aware of an appointment I just had with my psychiatrist. This is the psychiatrist who admitted me to hospital, this is the psychiatrist I have seen for a significant amount of time now, this is a psychiatrist who I have regularly poured out my soul to, and they just said the scariest things I’ve heard thus far in my recovery. I still can’t quite believe what I just experienced is real. Your podcast episode said to let you know when this happens so the following is what i just experienced.
They started by saying it was good I am “maintaining my weight”. I asked if they were also monitoring to see if I gain weight (“too much” or “a normal amount”) to which they replied “oh yes I’m absolutely checking for that.” I asked why and got a response about all the “health problems” associated with being a higher weight; “diabetes, heart disease, hypertension, all sorts of things like that” plus they said “leaner people live longer”. “There’s evidence to suggest that we’re [humans] eating too much these days” they said. “You know they did a study on rats and found that animals that are starved two days a week actually live 30% longer than animals that weren’t.” To clarify, because I could not believe my ears, I asked if they were suggesting that the “5:2” diet was an appropriate thing for them to prescribe to people. My psychiatrist replied “yes, absolutely, if they’re overweight”. I asked them why they thought that treatment for eating disorders should be different for people who live in different sized bodies and my psych said “look, I don’t want to get into an argument”. I said “did you know there’s new research that suggests that “obesity” and those health problems associated have a much more complicated relationship and may not be causative and they replied “well I don’t know where that new research is coming from, but from where I come from we know that people who are leaner, live longer and there is a healthy weight range, above which all sorts of health complications arise.”
At this point I was seriously freaked out. This person whom I had seen for a lengthy period of time had started to look at my body and alter my treatment based on the numbers they were seeing on a page. They were starting to subtly hint at diet advice, and seemed to have lost every piece of knowledge about treating someone with an eating disorder, suggesting that “starving yourself” two days a week was a good idea. This is a professional linked to ED treatment in Australia. They have been the figurehead of my “treatment team” for a seriously long time and I looked to this person for guidance and hope. They have now successfully devastated every piece of faith I thought I had in my team in one 20 min consultation. To have an ED psychiatrist say that they think people these days “eat too much” and that starving yourself two days a week could be a good idea if you’re “overweight”, is absolutely staggering. My faith in the structure that feels like the main pillar of my recovery, is crumbling.
Just wanted to share my experience.
I’m a 24 year old female who has struggled with anorexia and overexercise for 10 years. First, I wanted to say my 10-year-old brother, who does not have anorexia but has watched me struggle, read “Love Fat” in 3 days and said he thought everyone should read it.
Your blog post “Treatment fails eating disorder patients. We can do better” really resonated with me. I can relate to the first and third experiences you mentioned in the post. I took the leap last week and went to what is supposed to be one of the best residential facilities in the United States. However, two weeks prior I moved back in with my family and took your approach to just eat whatever the hell I wanted.
I’m here at the treatment center and super hungry. They probably don’t even feed me half of what I was eating. I’ve politely asked multiple times to have my meal plan increased and the only thing they allowed me was one slightly higher calorie snack and another half cup of cereal or piece of toast at breakfast.
The treatment system is broken. In this center, patients plan meals a week ahead and can’t ask for more food if they are hungry, which reinforces “restriction” brain wiring. This does not allow patients to learn to recognize hunger much less satisfy it, mental or physical.
This morning I approached a nurse to ask for more food, as the dietitian (who has not been supportive of increasing my intake anyway) is out for the weekend and the nurse has authority to increase my food.
The nurse invalidated my concern.
Here’s a snippet of our conversation:
Nurse: “6 times a day of eating isn’t enough for you?”
Me: “no because there is not enough food total.”
Nurse: “are you sure it’s not psych?”
Me: “what do you mean?”
Nurse: “like you think you’re hungry but you’re not actually?”
Me: “I have had anorexia for 10 years. There is no way this meal plan is adequate when my body has so much repair to do. I am worried my brain will go into an energy deficit and start thinking destructive thoughts.”
She then did the broken tape technique and said: “I can assure you your meal plan is adequate for your nutritional needs” “you won’t get malnourished here” over and over. Then acted like she was going to contact another authority to help me and never did. She also asked me if I had been drinking enough water, even though I have documented overhydration issues.
Luckily, my mother is knowledgeable about eating disorder recovery and on the same page as me with using the recovery approach you outline in “Rehabilitate, Rewire, Recover!” She is helping me figure out what to do moving forward. But I want to say that this is a widespread problem and that others are not alone.
Thanks for what you do, there are very few people in this field who know what they are doing. Without your “genuine recovery approach” I’d resign to being sick my whole life.
In your podcast you asked for examples about how treatment providers have failed to facilitate recovery of eating disorder patients. I have a couple of examples, one my own and one a friend.
My own experience was at a public hospital. My weight had stagnated and whilst I was fine with not eating more, my mother said to the dietitian that I needed more food. She had previously managed my anorexia and weight for a couple of years and was well familiar with the amount of food I’d need. The dietitian refused. At a different hospital the same thing happened. I said I was hungry and the dietitian refused to allow me to increase my meal plan.
A worse experience happened to a friend at an intensive day program. My friend had reached weight restoration as per their BMI requirements and was moved from a weight gain meal plan to a weight maintenance meal plan. She was also given a weight range which she was allowed to fluctuate within, from memory she was allowed ~1kg either side of her target weight. This weight range proved to be too narrow for her and with normal fluid shifts she often weighed outside of this. Her treatment team were concerned that she was still gaining weight and instead of simply increasing her weight range, they decided to reduce her meal plan. This resulted in her having half a portion of dinner. When we went around the table and expressed how we felt after dinner, she said that she was still hungry. They sent her home hungry. They were fixing her restriction with deliberate restriction.
I’ve said this before and I will say it again, you just can’t make this shit up. Imagine trying to explain to an alien visiting earth why people in recovery from an illness in which they eat too little are being told to eat less than a normal person would. From a biological perspective it doesn’t add up.
From a psychological perspective it doubly doesn’t add up. Telling a person who is scared of eating too much that they should be scared of eating too much. Telling a person who is distrustful of their body that they should be distrustful of their body.
Why? Why does it happen? Well … you’ll be told that eating disorders are incredibly complicated and there are deep psychological issues that need to be worked on in therapy and above all else patients should not be allowed to “binge” as this will add to their emotional eating problems.
Bollocks. Complete and utter bollocks. This is psychobabble that someone (a whte man made up once and it sounded clever so everyone bought into it. And now we have a treatment system founded on non-science, non-common-sense rubbish. And it is killing people. Literally.
The reason this bollocks exists, is because treatment is still based in psychotherapy and not biology or common sense. The system of how traditional treatment works was founded on the idea that anorexia is a purely psychological illness. Science shows us it is genetic, and biologically based: a biological reaction as a result of eating too little food.
So take that, and add it to a culture that is terrified of weight gain, and still convinced that dieting is the answer despite, again, the science that shows us that dieting behavior contributes greatly to weight gain.
The idea that anorexia is purely psychological is based in fantasy not biology. The idea that unrestricted eating leads to obesity is based in fear not fact. So now, we have systems of treatment that have their roots in fantasy and fear.
Fear of food is the epidemic we have to face, not obesity.