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.