I feel like I have been writing/complaining about eating disorder professionals promoting restrictive eating for 100 years. I haven’t, but that’s how it feels. How is it not bleedingly obvious that telling a person with an restrictive eating disorder to restrict food is damaging?
Well actually, I can answer my own question there. The reason that treatment providers make this seemingly obvious mistake over and over again, is because due to our cultural belief systems around bodyweight and weight gain, people see a degree of restriction as normal — dare I say, “healthy.” They also see their tendency to view larger bodies as an undesirable thing as normal and justified. Hence, when they say things such as “Okay, I think your weight is good now, you can cut back on your eating a little,” to a person in eating disorder recovery, they don’t even hear the instructions to restrict coming out of their mouths, and they don’t understand the psychological disruption they cause. Implicit bias is a bitch to deal with due to the unconscious nature of it. However if you want to work as a counsel to a specific population, I believe you have a duty to explore any implicit biases you may have that are particularly relevant to that population. Fear of weight gain, fat phobia, good/bad food judgements, thin bias are a few that spring to mind.
I’m writing a book about Fear of Weight Gain because it is that important a topic in eating disorder recovery. Most of the time, when I am talking about rewiring fear of weight gain, I’m addressing people in recovery. However, it is also relevant to address people working with people in recovery, because if their own fear of weight gain goes unaddressed, they are a liability when working with people in recovery from eating disorders. This is because at some point sooner or later, fear of weight gain is going to come out of their mouths when they are addressing their client. It may be directed towards themselves. It may be directed towards the client. It will never go unnoticed by the client. It will always cause confusion, disillusionment, and doubt.
Here are some examples of the stupid Fear of Weight Gain shit that treatment providers say:
- You are now weight restored
- It’s great that you can eat full-fat yoghurt. I have stick to low-fat myself
- I think we can reduce your meal plan now, as you are weight restored
- Your weight is back in the healthy range, so now we need to just maintain rather than gain any more
- Great, well we are at the point where we can start removing some of those extra snacks
- You can cut back a bit now, we don’t want you to go over your target weight too much
- Okay, so now we are at the stage where you need to make healthier food choices, so you don’t continue to gain weight.
- Time to start swapping out full-fat milk for semi-skimmed. Pretty much all people use semi-skimmed or skimmed milk. That’s more normal
The above are all actual statements that have been made my eating disorder treatment providers (dietitians and therapists) that have been emailed to me recently. They all reek of a treatment provider who is 1) afraid of weight gain, and 2) doesn’t trust the body to manage its food intake and weight. This is a huge problem in this industry, because these are the two biggest belief systems that a person with an eating disorder needs to rewire in order to fully recover.
The “you are now weight restored” one really cracks me up. The sheer bullshitty arrogance of that sort of statement. As if that is their (the treatment provider’s) decision, or that they hold the authority on when another person’s body is weight restored. The only thing that has the authority to decide when a person is fully nutritionally rehabilitated is that person’s own body. Anyone else’s opinion is just their opinion, and it is usually an opinion that is filtered through that person’s own fear of weight gain. How can a person with an eating disorder rewire their own distrust of their body when their treatment providers are acting as if their charts and textbooks know more about their body than their body does? The body will tell us when it is nutritionally rehabilitated by decreasing mental hunger. Until that happens, a person is not nutritionally rehabilitated — regardless of what their weight is. The treatment provider’s judgement over what a person’s weight should be and when they should be nutritionally rehabilitated has no place in this discussion at all. The body is the guide.
Did you notice the one in which the treatment provider was referring to their own dietary restriction, “It’s great that you can eat full-fat yoghurt. I have stick to low-fat myself,” and the one about the semi-skimmed milk over full fat? This sort of thing is irksome because it normalizes restriction and implies that most people do it to a degree. While unfortunately that may be true, it is certainly not desirable, nor is it full recovery. Nor is it helpful to a person in recovery to hear from their treatment provider — the very person who is supposed to be helping them recover. They have their own fear of weight gain to contend with, they don’t need yours as well.
If there is truth to the statement that most people use semi-skimmed or skimmed milk over full, all that does is show how fucked up and fearful people are over their weight, and how little we understand our bodies. As if using semi-skimmed milk in your tea or on your breakfast cereal is going to make any iota of difference to anything! It is acting as if the body is that sensitive to fat that an amount as tiny as that could make a difference — that is honestly the last thing a person with an eating disorder needs to hear as they already fear that this is true. IT IS NOT TRUE. If your body is at it’s natural unsuppressed bodyweight, you can vary what you eat quite significantly and your body will stay in that range. Our bodies are intelligent organisms, let’s not insult them with the notion that a teaspoon of extra fat a day can’t be handled.
How about “Great, well we are at the point where we can start removing some of those extra snacks.” Ouch! That stings. As a person who once had an eating disorder and knowing how very hungry I was before, during, and after my initial weight gain in recovery, I know this one would have felt like a slap in the face. Imagine that you are eating your (probably massively inadequate) meal plan, and you are still hungry pretty much all of the time. Then your dietitian goes and tells you that you need to eat less because you have gained weight. How confusing is that? How dismissive is it of your body’s hunger signals? How does this teach you anything other than it is your weight that guides how much you are allowed to eat? <— THAT is an eating disorder thought pattern! It confirms the thought “I only get to eat what I want if I am underweight.” Oh seriously, for fucks sake. The more I think about this shit the angrier I get. How the fuck can you teach someone to trust their body while you are also telling them that they only get to trust their hunger when their weight is low, and as soon as it comes up a bit they are meant to restrict and not trust their hunger. What is the difference between that rational, and what their eating disorder is telling them? Exactly, there isn’t any. Go home and stop making things worse.
Anyone who says anything such as “Great, well we are at the point where we can start removing some of those extra snacks,” needs to be removed from treating people with eating disorders — especially if they don’t understand what is wrong with that statement and how it is damaging. This is precisely why I use the word liability when talking about some treatment professionals ,because many people are so unaware of their own fear of weight gain and restrictive doctrine when it comes to food and eating and bodyweight, that they have no idea the chaos they create when they open their mouths.
If you’re a treatment provider and you know you have said anything similar to the examples I put in those bullet points above: you are a liability. You should not be working with people with eating disorders until you have worked though your own fear of weight gain. Even if you can’t see your own fear of weight gain, and even if you don’t believe you have it, if you have said any of those things I promise you that you do. As soon as you allow your own fear of weight gain to enter into your client sessions, you are a detriment to your client’s recovery.
Fear of Weight Gain is a product of the implicit bias that our culture has that implies that thin is good and fat is not. It is not your fault that you have fear of weight gain, we all do. It is, however, your responsibility to address your implicit bias if you want to work with people with eating disorders. Doing the work to address fear of weight gain can be uncomfortable, ugly, and empowering. Do the work or go work with a different section of the population. Do not inflict your fear of weight gain on your clients who are trying to recover.
I saw the notification coming in that you had written an new blog, saw the title and immediately stopped doing what I was doing (work can wait) to read it! OMG, hitting it on the head as usual!!! I wish they would include this blog post in every training for GPS’s, dietitians and psychologists! … Looking forward to reading your new book too! Please keep doing what you do!
Well said, and true.
Thank you so much for this Tabitha. I am very grateful for your work, which recently helped me turn the corner on my own fear of weight gain. Now I’ve let myself gain weight, and I trust my body. Fear of weight gain is so ingrained in this society, and it is so oppressive. I’m talking about getting out of restriction to everyone I can now!
Thank you for posting your success story. It gives me hope.
Entirely spot on as usual Tabs x
?? Preach it. I’m in my third relapse and I am a completely healthy weight (in the eyes of the professionals!!) yet I still have ED thoughts, chronic extreme hunger which I’ve never experienced and a lot of compulsive movement issues. These issues have been with me for 12 years and each relapse prior to now I have been under the help of professionals who were quick to discharge me once I was “healthy”. I remember being told I was putting on weight too fast…that’s just what a person with an eating disorder wants to hear to get better…not. This time in recovery I have been told over a phone consultation with mental health professionals that I could be at risk of diabetes etc if my night binges continue…once again just what I wanted to hear ? Fear of weight gain is something that should be addressed in the professional field before those professionals talk to sufferers.
Oh..so sorry for those words you had to heard. So sorry. You deserve better care.
Thanks so much xx
Tabitha, thank you so much for writing this piece. As someone who is well into recovery and has worked with several eating disorder “professionals” along the way, I can so much relate to what you say here. It is so confusing to be told by someone with authority that “you shouldn’t gain any more weight” and “you should moderate how much you eat” when you know deep down that true recovery is so much more than this. After dealing with this bullshit for a while, I finally decided to ignore my therapist and do what I knew was right — eat unrestrictedly, rest completely, and, yes, gain more weight. However, I know and fear that others in recovery may struggle to challenge their treatment team’s disordered, anti-weight-gain recommendations and thus stay stuck in quasi-recovery or, worse, suffer from a relapse… It is so great there are voices like yours that are fighting against the current dangerous, unfortunately widespread eating disorder treatment paradigm. Thank you for all that you do!
When I was in treatment, it was compulsory to be weighed every week. We had to look at the number and then discuss it with the professional, and how that correlated with the amount of food we had eaten and were going to eat. Needless to say, it was hell for all participants. Also, the entire week revolved around that one day, and whether anyone wanted to admit it, the results of that day determined how we felt and acted the entire week.The treatment centre just took one set of rules and rituals and replaced them with another.
I understand that people need to be weighed for medical monitoring, but the patient should not need to see the number, nor should it determine what they are allowed to eat (meal plan was just a list of what you were allowed to eat), and for effs sake, whoever is weighing the person needs to keep a poker face!!!
Exactly this. When I was in treatment, we were weighed twice a week and so there was always huge meltdowns from most patients on those days because we saw the weight gain. And once you were further in recovery, they cut it down to being weighed once a week, which had people acting out more because, you’re now weight restored and everyone knows it… We also only ever had semi skimmed milk. Cutting down meal plans and snacks really made me feel invalidated but being weight restored was probably my most difficult time mentally. But hey, you gained weight, you’re better now…
Yep…spot on Tabs..
That is why you, Tabitha have been my one and only Ed coach via your you tube videos & books. I have heard terrible stories of people getting worse in treatment centers etc.. Thank you Thank you for the no BS approach/advice ???
So much wisdom. I am in recovery and now a certified ED RECOVERY COACH. I remember getting so anxious when I was “weight restored!” Restored according to whom? And if restored, why did I feel so emotionally poorly still? As a coach, I hope I am sensitive to my clients of all sizes and shapes. I encourage them to listen to their bodies and their hunger cues. ( once they can identify them). I now eat and exercise pretty intuitively. Some days I eat more some less. The freedom is found in the lack of fear to address my hunger whether it is physical, appetite( the cookie just sounds good) or emotional ( Knowing that I am not hungry when stressed and when the stress subsided I will eat “normally”) what the heck is NORMAL anyways? Fabulous article! Thank you.
I’m interested on your thoughts about restrictive eating that’s not linked to fear of weight gain. I don’t fear gaining weight, being weighed has no emotional impact on me and when I was steadily gaining I was genuinely happy at seeing progress. Saying that I am very restrictive in the amount I eat, weigh portions before cooking and struggle with over exercise. I’m classed as having anorexia nervosa, but I don’t think that diagnosis.
Yes, When I was in treatment, everyone was on the ‘full’ weight gain plan’ until they reached their ‘target weight’. I remember one girl saying that she was still hungry constantly but was not allowed to eat any more then the standard plan because that was ‘enough’. The same plan for everyone regardless of height, build or hunger cues.
Yes Tabitha. This is so extremely true.
I have seen so many people struggle with eating disorders, saying that they finally applied to some sort of clinic to get “recovered”. To “learn” how to eat again. And by that I mean following a meal plan, containing 3-6 meals, and every “meal time” has different options. Like for breakfast you are allowed to choose between yoghurt and berries or 3 slices of bread with peanut butter. It’s so extremely disordered.
It’s horrible to me that in treatment, they teach you a way to eat. As if eating is so complicated it needs guidelines and “rules”.
What really helped me was realizing that before my eating disorder, up until the age of 18, I never followed a certain meal plan. I was too busy with school, friends and work to even think about implementing a certain way of eating into my life. I ate to live, not the other way around. Sometimes I would go to school without breakfast, and be so hungry at a certain point that I could eat a lot. This may sound very disordered and “unhealthy”, but for me, looking back WHEN I had an eating disorder, that pre eating disorder me was extremely healthy around food. My goal always was to go back to that, and “meal plans” didn’t align with that person, at all.
Now, I am NOT saying that it is healthy to skip breakfast and eat a sh*t ton of cookies at 4pm, but the thing is, it is “healthy” when you don’t come from a restrictive place. When you are so extremely busy living your life that you sometimes forget to eat, OR when you just eat because you absolutely adore the food, without being physically hungry (Not that that happens a lot of the time when you are fully renourished).
It’s almost two years since I started full recovery. I did exactly as you said. I ate fully unrestricted and I had zero exercise. I still don’t move intentionally, but I move my way through life since I don’t own a car and work at a restaurant.
I have overshot my pre eating disorder weight massively, I’m not talking about 10lbs. But it’s fine with me now. I’m healthier than I ever was during my ED and honestly, if everyone just followed your words (through your books, blogs and YouTube videos), they would recover. X
Great article. As a therapist and someone with personal (family member) experience this is very relatable. I look forward to the book being published.
Thank you Tabitha for this article. It is so difficult now because the picture of the health is so so so broken in our society. I had been told I am recovered at BMI 19. I had the same weight as preED but I I was 4 years older (still teenage years). So for years I thought I was recovered, I thought those constant thoughts about food are just part othe the postED life….
What a nonsense…I wasn´t recovered. I recovered thanks to your books,articles, podcasts, youtube. And suddendly I see that disordered patterns everywhere…They are sneaky..
Great article Tabitha and very true. Thank you for highlighting it. Looking forward to reading your book.
Yes to all this – I have direct experience of it from my daughter’s old treatment teams. Fortunately we found you and she is making ok progress. I think your post on permission to eat, and my role being to give it, is where we are now.
Thank you for the work, it is needed. x
My favourite one I had a ‘professional’ say to me was “if you don’t feel comfortable at the stage you get to, at least you’re really good at losing weight”
My therapist told me the exact same thing! And I was like “wtf, if I recover I recover, I’m not gonna do that shit again”… Thank god I found resources on my own, I would never have made it otherwise. Tabitha is relly a blessing to this world
Omg me too!!! Each time I freaked out in treatment, instead of reassuring me that I was doing the right thing and urging me to keep going forward, the nurses told me that “I knew what to do to make my weight go down again” and one even told me that “once you cut to half portions, [the weight loss] can go really quick”! This saying just stayed in my head the whole time and of course was there too when I got urges to relapse.
This. This all the way.
When I decided I actually wanted to recover, I went “all in” because it felt right to be following what my body wanted. It’s just….logical. Biological. I hopped from therapist to therapist, dietitian from dietitian. The comments were ridiculous! The number of times people posed the threat of BED if I continued. The people criticizing the amount I ate “well, just don’t eat x much…” I had one say “you’re eating CEREAL?? You should be eating eggs and avocado toast instead” (these are all ED “professionals” by the way).
Unfortunately the overshoot scared me and I relapsed pretty hard with the intention of “doing recovery right” in treatment. The providers were pretty good, but still biased. I faced extreme hunger, even when I was “all done weight-restoring” and voiced my concerns about decreases. I explained that reducing my food intake when still hungry just continues to wire my brain to restrict despite hunger. She said “well we don’t want you to gain too much, get scared of your weight, and relapse.” Shouldn’t they be teaching us body acceptance and not reinforcing an ED mindset??
I tried explaining this to others in the program, and they probably thought I had lost my mind. Few agreed, some teased me. Oh well. I didn’t go there to half-ass recovery. No. This is a full-ass production here.
Currently trying my best to honor all hunger cues. The overshoot is so incredibly hard to deal with. No one recognizes me anymore. I hope that my body settles down to my usual set point (which might not be the healthiest thought, but body acceptance is a process).
Anyways, I’ve recommended Tabitha to many of my friends. Her posts were my comfort and my bible during my “all in” attempt. Although I wish she had some degrees to up her credibility so people don’t think I just believe everything I read on the internet ? I believe her, just others might not
Oh dear, I am so sorry you went through this. It should not be like this 🙁 You tried so hard.
I am sending you lot of hugs, just keep going, do thing you believe in, no matter if other agree or not. I do it. Every day with you 🙂
Driving the fear of weight gain into people who they’ve just told to gain weight? Freaking confusing and unnecessary.
I can absolutely relate to these comments the gain and maintenance language that goes on in treatment – and I have faced it tooo much and not even realised the implicit damage. Agreed, it reinforces a fear to the still semi starving body and brain that if you gain weight then you will just have to reduce food and then sort of feel starving anyway so why bother increasing food to get to that point when it’s inferred you will need to be in a restrictive mindset again. Reading your blog has helped me identify these unhelpful implicit fear reinforces in clinicians I have seen and I am identifying how I have hook line and sinker fallen for it. Thanks for helping me identify this lie.
Ok, so as a parent to a teenager in recovery, what tools apart from weight can I use to understand if we are on the right path ? because if I understand what you are writing, weight is not a function of success and it also brings extra anxiety….
I agree, my teenager is recovering too and I want to use the right language and tools to help her
Thank you for this post!! I have also had really inappropriate things said to me by professionals. I think one of the worst was when my GP said to me “You are so lucky, other people would be jealous if they had a hard time gaining weight”- I was extremely desperate and underweight at the time. She also said that ‘Pizza is unhealthy’ etc. I have also experienced inappropriate comments from the eating disorder treatment team: they were shocked when I gained more than planned in a week and also suggested maybe I should ‘take a break gaining weight’ after I was getting close to the normal bmi range (this was so unhelpful as I was struggling at the time and for sure not weight restored yet…)
I’m supporting my daughter recover from anorexia and we are very early on this path. She has been so brave and fighting hard and is ‘weight restored’ and just been told all these things and having such a hard time since being told she can drop evening snack, since being told she could lose a kilo if wanted to get back to her ‘healthy weight range’ which incidentally is 95% wfh……like even if you’re going to base it on weight not state surely it’s be 100%. Anyway, she is so so so so so so hungry and drops hints that she’d like to honour her hunger and I can see now how mentally tough that must feel to be told by professionals to restrict,,,,what she’s wanted to do all along. I feel so sad after reading this as I’ve been struggling to understand her anger as thought she’d be pleased by what the professionals are saying when in fact I think it’s caused her more fears. BUT MY QUESTION IS…..she loathes her changing body shape so whilst she would probably love ‘permission’ to eat more I know there is going to be backlash as her shape changes. How can I support her with this? We’ve talked through that weight redistributes and rebalances in recovery….based on what we’ve read…..and I’m guessing that this sort of reinforces our societies fat fears. SO how should I be supporting her…..how do we break the fear of fat.
I know this is an old blog but I came here linked from the mom2mom Facebook group about eating disorders. My son is hospitalized for anorexia currently. With his symptoms raging—vomiting after most meals, needing NG tube overnight to account for 2/3 of his daily calories, etc—an attending told me he was weight restored (nope!) and that they could focus on the behaviors rather than weight gain. I said I don’t think so, the outpatient RD gave a much higher goal. She then said “some RDs set goals too high and kids become overweight.” HELL no. Is there even such thing for a 12 yr old yet to go through puberty? (FWIW, the “high” goal was still only 50th percentile BMI!) Luckily we’ve rotated through some other docs since then who are not saying those things. And he actually is doing a bit better right now (with more weight).