all things considered

Practising Remission after 44 Years of ED

[amazonia-love]

When Love Comes To Town

You guys ever have that moment when you hear something and, all of a sudden, finally understand a concept you have never really grasped before? It happened to me recently at a TBT-S (Temperament Based Treatment, with Supports) workshop for carers of kids with ED run by Drs Laura Hill, Stephanie Knatz Peck and (I forgot the other name – doh).  Dr Hill was talking about why CW purging is so compelling. As she talked, I suddenly had complete clarity about my own history with purging. I suffered with AN/BP for nine years from before I was a teenager to age 20; I don’t have to describe the struggle. I know that you who have it, or have had it, or have cared for someone who has it, understand already. It is hell, isn’t it? No matter how many times I promised myself I would “stop”, no matter how many times I begged the God of my childhood to forgive me and to help me not do this to myself any more, I was unable to break the habit. I would suppress my intake for as long as I could and then bust out into a spree; or it would just happen over and over again every day for weeks – no rhyme nor reason – and no way out that I knew.   I had breaks of being behaviour free – but they were few and far between. Plus, I lost my ability to function well at those moments. The behaviours worsened when I was involved in a relationship of any kind with a boy. They became the way I managed distress about expectations; on one hand, the expectations of the religion in which I was raised, and which was all consuming, about physical behaviour between “the opposite sexes”; on the other, the expectations of boys and men about physical behaviour. And somewhere in the middle of those, me myself, and my absolute hatred of being “groped” competing with an all-consuming craving for being “loved”.  I would find myself in a relationship (which was  really just one big struggle to feel validated while repeatedly peeling some guy’s fingers off my body?) and enjoy the euphoria that came with feeling wanted, and with being held, and being touched in a non-sexual manner. Trouble is, non-sexual touch was never enough for most guys; cue the usual battle, hands from no-go zones, while trying to avoid rejection.

My  craving, above all, was to be wanted.

I remember sitting in a car with a guy friend once and telling him that I just wanted someone to want to marry me. He just about died on the spot. I didn’t understand why he was so nervous. But he misunderstood the words. I wasn’t saying I wanted him (or anyone else) to marry me, just that I wanted to be WANTED. Poor guy probably shat himself.

Given that I was raised in a misogynistic religion, where women were seen as temptresses, leading men to sin, and sex outside of marriage was about the worst thing anyone could do, it was natural that I struggled with overwhelming guilt. Hell, when I was a pre-teen, I used to tickle my own arms as a means of soothing myself. I know now that it was stimming, and it is not a big deal. Back then I felt as guilty as hell because I believed it was “masturbation”, which was right up there with some of the worst things as mentioned. I had no concept of  physical pleasure being “allowed” or that I was ok to bring it to myself.  To complicate things further, I had been sexually abused as a small child by a family member. My response in that situation had been to “freeze” (my default fear response), and later to shame myself for it having happened, a pattern that would play out many times in my later years. The worst part of that experience was losing the innate response to say no and resist, and not ever having that response validated or reinforced by someone else. It was only as an adult that I began the difficult task of validating my own responses to that situation.

Add to this the rhetoric in my family religion around “gluttony”. Hoo boy. Can of worms anyone? Gluttony was a “huge” sin, and as a child I listened to many bible-based talks (given by the same men in suits that roundly condemned all things sexual) condemning “desires of the flesh”…. Overindulgence in food and sexual pleasure – an incredibly damning combination. Add in my father’s eating disordered behaviours and personality, and his incessant discussions about fat people – linking body size to weakness and lack of discipline, greed and “not really being spiritual people” as he himself struggled against his own hunger and deep sense of self-loathing, and his rigid control over the clothing his daughters wore, and his constant attempts to supress any signs of blooming sexuality in our actions or dress.

It was a shitstorm that enabled my ED to flourish. The only way of managing my anxiety  was, of course, practicing ED behaviours;  either severe restriction (usually fasting on vegetable juices, something our family had done since I was 9), or reactive eating followed by purging.

And then love came to town. Someone wanted to marry me. A manboy of 20, same age as me. He had the same urges as all the other boys, of course, but it was a little more permissable in the context of “getting married”. Sex was all good in a married state (until misogyny and patriarchy reared their ugly heads, along with our complete ignorance about adulting, and my trauma history came home to roost). And, because the religious constraints around “going too far” were in place, I was getting all of the physical affection I had been craving, without being pressured overly much for more.

I “confessed” to him about the purging. He “confessed” a “great sin” of his own. And, naively and hopefully, we promised that that was the end of those behaviours. Which, of course, it wasn’t. But we thought it would be. I did stop purging. Only had a couple of lapses after that. It was like switching off a light. One moment the purge was there, and the next it was gone.  (What I didn’t know was that I was not “cured” of ED, and that it was still running the show behind the scenes, and that it would overwhelm me in the future any time I faced an anxiety-inducing situation.)

In my mind I had always tied it up with “being in love”. I used to jokingly say that I had “traded addictions”. Turns out, I was partially right. Partially.

Back to Dr Hill. In her discussion about purging, she mentioned  the huge rush of a nine-amino acid peptide, vasopressin, at that moment, which has a euphoric, heady, calming effect (it also affects fluid balance in the body). Vasopressin is one of the reasons that purging is so compelling. I registered with a shock that I had taken a photo of a newspaper article that mentioned vasopressin, and that it was still stored in my phone. I  flicked through my gallery until I found this.

                                   And there it was.

Dr Hill’s words completed and validated my understanding of how I had been able to stop purging at the time. I replaced one source of vasopressin with another, and added in high levels of oxytocin (which has been used to some success in treating AN) to boot. I knew back then the purging was problematic. But I didn’t have a name for it until a few years later. And, the fact that I had been able to stop the behaviour fooled me into thinking that I had been cured at that moment. As more became known about ED, I used to  believe that I had “had” an ED in my younger years; I used to believe purging was an addiction; and I used to think that my eating was an addiction as well, and that all I had to do was to get the same control over it that I had gained over purging. Which I endeavoured to do for most of my adult life, and came closest to perfecting, between the ages of 46-52,  before realising that I had a very long term relationship indeed with ED, and that my seeming “perfect control” was classically typical AN.  

ED and anxiety are bosom buddies. All too often we focus on the behaviours, or on our current weight, or on the foods we are eating, or on how are clothes might fit. Practising remission isn’t about “what “ we do or how much we weigh, but hinges on whether or not we are using ED modalities to manage our anxiety. Stopping purging was great. But I STILL had an active ED. If I map out my life from that moment, there is a clear pattern. I resorted to getting into, or staying in, an overall calorie deficit whenever things got stressful. And until I interrupted THAT pattern, I was unable to practise remission. 

Deal to the anxiety; and you deal to the ED.

[amazonia-love]

The Long Walk Home

Sometimes I hear people express frustration at how long their recovery is taking. Especially those who have had ED for a long time. They see other people who have “recovered” in a few months or a year, perhaps a little longer, and who have now returned to their former way of life, often a very active life. How is it that some people breeze through recovery and others take a long time?  Full recovery doesn't happen in a few months. It takes a long time. Weight restoration to a socially normative weight, one that doesn't raise any flags with people around you, accompanied by a return to a high level of physical activity and lots of social media posts about how good recovery is, doesn’t necessarily equate to complete recovery. Been there, done that, have blog posts and images to prove it. There is a difference between doing what is needed to reduce harm, and allowing yourself the time and space to learn new, deeply embedded, sustainable non-ED responses. When I first recovered (in my early 20s)  it only took me a few months. I stopped using ED behaviours, and went back to a weight that other people saw as normal. I looked the image of someone who was “healthy”. But I wasn't. I still used activity (playing sports, dancing, skiing, walking, hiking, working in a physically arduous role) as a means of keeping my anxiety low. And while I baked wonderful cakes and cookies, and cooked amazing meals, in my private moments I often delayed and avoided eating. The ED neural wiring was still the main driver of my everyday life, and it was my default any time I came under stress. I was in a partially remitted state at times. But NEVER practising remission as my default method of living. 

Of course, I didn't know that was how ED worked back then. And the reasons for avoiding delay were being “busy”, having “so much to do”, needing to “help someone out”, and just loving being active. Activity for me was insidious, for sure. Notice I don’t say “exercise”. Physical activity is not always cloaked as exercise; neither is being “very busy”; neither is “just being a hard physical worker”. Remember that “levels of the neuropeptide, NPY levels increase for all of us if we are semi-starved, but for those with a genetic predisposition for an eating disorder, the result is increased activity. In fact, the drive to be active decreases as an eating disordered individual re-feeds.  That drive to be active can return at any time. And it can mask a relapse if the person is eating in public, talking the talk about being recovered, and at a weight that doesn't ring alarm bells. And it can mask a relapse where we are in the forefront of a group, being held up as an example of how recovery “looks”, and when we are able to explain how recovery works on a number of levels. ED is a tricksy fucker, no two ways about it. It is all too easy to be a leader and talk the talk when we are not quite walking the talk. And it is a part of the ED temperament that we might become that person.  For me to get to the point where I could be sure my activity was not being driven by ED neurobiology I had to make the decision to keep my activity levels deliberately low, and my focus inward. 

And now, I am coming up to 6 years of practising remission. Even so, I still struggle with the old patterns. I have been able to see more and more clearly how the anxiolytic effects of restriction helped me function in every area of my life. I feel like a person who has had a brain injury, and who is learning to do everything again, right from scratch. Somewhere I read that remission can take as long as 79 months .... and that makes a lot of sense to me. 

This is the reason for me taking a back seat and not blogging as much. I have been rebuilding myself, piece by piece, sometimes in a painfully slow manner. Although earlier on in my recovery I turned into a bit of a keyboard warrior - which is ALSO another way of being active without anyone noticing that ED is in the house. I reached a point where I needed to stand that urge down and focus on myself, and my recovery, exclusively.  Learning to practise remission effectively takes time.  Our brains may need time to make the changes to the prefrontal cortex that we missed out on because of ED - the brain freezes and keeps people stuck at the age at which they started to starve, and in patterns they forge around the same time. What this means is that because I am no longer functioning with the same ED-specific biochemistry,  I am still sometimes uncertain and unsteady in many situations. The only way I can describe it is that I have been learning to walk again, in a landscape that looks very different from what it was when I was restricting. 

I think it is common to feel this way. 

I walked in a tropical rainforest one weekend, and saw these "strangler figs"; they slowly take over a healthy tree and consume it, so that in the end only the fig itself survives, and the original tree is no longer in existence. This is how I feel - that the substance of me, the "original tree" is coming back into sight as I take the vines off from around myself, but also that it is a slow and tortuous process along the way.   This is how it starts - the vines are ED, and the tree is the person it afflicts. We don't even register that we have been surrounded and are being strangled by this disorder. 

Then it moves to this ... the middle left side shows the original tree through the vines. Notice that the vines have become stronger, and thicker, and have almost completely obscured the original trunk. What you can’t see is that the vines are consuming that original trunk and using it to sustain themselves.  We lose so much more than weight when we have ED. We end up with a parasitical network of neural wiring that drives us to behave in a certain way. Refeeding to a stable weight is just one part of the recovery process. And it is not enough. 

And finally, where we end up before recovery - on a metaphysical level as well as physiological. And also, for many, the very bones and flesh that form and cover our skeleton. The original tree no longer exists, and instead there is a hollow network of vines that stand in its place.

There is no way of rebuilding the trunk by planting a tree inside that network of parasitical vines. No way. And there is no way of getting to practice full remission while we are keeping on using activity as a means of managing ED anxiety; even if we are posting images of our meals on FB and Insta. Even if we do amazing selfie posts with ED related tags. Even if we lead a group and others look to us for advice. Rewiring our neural responses simply doesn’t happen quickly. Unless we recognise it, we can end up still stuck in an almost invisible ED framework, looking as though we are thriving, but still in the stranglehold of ED. 

[amazonia-love]

My Belly - being utilised to help dispel weight bias and stigma. PROUD MOMENT. 

[amazonia-love]

Amygdala Matters ...

Click here to see Anxiety VIDEO #2 ... This is the second of .... MANY :) ENJOY X

Amazing artwork from an unknown source.

[amazonia-love]

Eating Disorders and Anxiety - Why Anxiety matters

The first in a series of videos made with the help (mastermindship) of my amazing niece Amy who has had a journey into the depths of anxiety parallel to my own. She also has the bombdiggetty skills at editing and filming, and I am grateful to her for sharing her skills and arohanui with me. Dealing with my anxiety has been the key to me managing my life in such a gentle way ,and finding beauty and peace of mind that I didn’t really know existed. Enjoy.

[amazonia-love]

What needs adjusting - societal understanding of what recovery "looks like", or recovering bodies so as to meet societal preferences?

This is the dress I wore to the funeral director the day after my dad died, not long after my diagnosis with AN. I was never intended to be that size, and I had fought all my adult life to stay there. Recovery is not linear or simple, but it IS freedom beyond my previous understanding.

S.Lindley Ashline of http://diversestockphotos.com/ took this divine photo, and many others ....in an effort to change the way we see and understand ED recovery.

[amazonia-love]

The “O” Word

We need to talk – urgently – about the “O” word. Investigative journalists need to report on this issue in a way that employs critical thinking, not in a one-sided, and inaccurate manner.

 By O, I mean obesity. Why now? This morning, Channel 9 Australia featured a news article indicating that a group of doctors are asking the government to impose what was elegantly described (no click bait here) as a “fat tax” – with the Dr being interviewed using “O” as a euphemism for the word obesity – saying that she doesn’t like mentioning it to her patients; it also aired another story about a Brisbane based surgeon who has suggested that children as young as 11 should be having part of their stomach either amputated, or squeezed (euphemistically called Bariatric surgery) to force their bodies to become smaller[1]. At no stage did the journalists presenting these news items attempt to counter or question the validity of the opinions on offer – altho columnist Miranda Devine later suggested that it would be good “to see more carrot and less stick” than the extreme measures suggested.

 I saw these two news articles while preparing to review some presentations from a conference held in Sydney this week – At Home With Eating Disorders (ED’s), for parents and carers and people involved in all facets of ED treatment, dealing with children and young people who are at a real risk of dying because of their disorder. What kind of risk are we looking at? ED’s have a standardised mortality rate that is 12 times higher than the annual death rate from ALL causes in females aged 15 to 24 (NEDC, 2010b)[2].  And children even younger are also at risk, being affected directly by the hyperbolic and sensationalistic news articles such as those mentioned.

 To put it bluntly, children are far more likely to die from ED than from being fat.  However, if they don’t develop ED, their health risks still rise, when you factor in the metabolic damage done by repeated attempts at dieting to induce weight loss[3].

 Brisbane GP Leanne Barron, who treats kids with eating disorders, said: "I have seen a five-year-old who has lost 3kg in one school year because she is so frightened of taking 'unhealthy' food and of not being able to eat the quantity of 'approved' foods in her lunch box.

"Fanaticism by the broader community has led to classroom weighing, lunchbox nazi-checks by teachers and schools vying to have the 'healthiest tuckshop' while in their playgrounds underweight children and teenagers shiver through the heat of Queensland summers, unable to maintain a healthy body temperature." [4].

One reason the push to impose surgery on those children deemed obese is that - according to the surgeon - “diet and exercise plans are not working”. But wait, we “all know” that that is all anyone needs to do to have a “healthy body” – surely (read the comments and see how many people assert that exact sentiment) and that only lazy, uneducated, uncaring parents could possibly allow their kids to have a body weight higher than that which is deemed acceptable.  Apparently, that is not the case.

NEWSFLASH . . .  obesity is not simply the sum of “not enough exercise and too much food” (or all the variants of that basic equation.[5]

NEWSFLASH . . .  it is possible to be fat and healthy. It is possible to be obese and healthy.

NEWSFLASH . . . people at a higher weight than is currently deemed “healthy” have lowered mortality rates across the board. [6],[7]

NEWSFLASH . . . dieting is a direct pathway to obesity. Many of the fat people being maligned today are the dieters of yesterday[8],[9], [10]

 None of these studies are new – but they appear to be unknown among journalists commenting on the topic. Certainly it appears that most of our journos are suffering from implicit weight-bias, and are woefully under-informed.

 Our society has been on a diet, starting with the low-fat protocols introduced by Ancel Keys over 50 years ago[11] - and weight and heart-health risks have increased exponentially across that time. That was perhaps our first, or most significant footstep on what Dulloo[12] terms a “pathway to obesity”, and we are still walking that path – never having achieved the end goal of smaller bodies across the population, regardless of which iteration of calorie restriction we have tried. One of the primary reasons that people become increasingly obese is that they have repeated attempts at weight loss by low calorie dieting and or exercise. We know that this is neither healthy nor sustainable behaviour[13].

 Can journalists please stop talking about weight loss as being being a “fix” for obesity, and instead focus their effort on incisive efforts that draw on evidence-based research with regard to improving health? And while you are at it, could you delve into the “health at every size” paradigm and offer advice that is aimed at improving health and quality of life, instead of focusing on how people look in a bathing suit?

     [1] https://www.facebook.com/iwakeupwithtoday/?fref=nf

[2] https://www.eatingdisorders.org.au/key-research-a-statistics

[3] https://www.ncbi.nlm.nih.gov/pubmed/25614199

[4] http://www.couriermail.com.au/lifestyle/parenting/pressures-to-diet-weighing-on-kids/news-story/2cf48973d3f1ff74af7b5b91dbd2e982

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858344/

[6] http://ajcn.nutrition.org/content/97/6/1195.full

[7] http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486350

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3759019/

[9] https://www.edinstitute.org/paper/2015/6/13/gaining-weight-despite-calorie-restriction

[10] http://amazonia-love.tumblr.com/post/160461367208/is-ed-weight-loss-maintenance

[11] http://www.bmj.com/content/353/bmj.i1246

[12] https://www.ncbi.nlm.nih.gov/pubmed/25614198

[13] http://onlinelibrary.wiley.com/doi/10.1002/oby.21538/abstract

[amazonia-love]

Is ED Weight-Loss Maintenance?

So. Apparently, one of the next weapons in the “war against obesity[1]” is to be something gleaned from studying those who have anorexia nervosa (AN), and those who have successfully maintained weight loss over time because:

… individuals with AN and successful weight loss maintainers manifest the metabolic profiles opposing further weight loss and promoting weight re-gain. However, both groups over-ride these powerful biological drives and maintain a reduced weight.

. . . it is worth exploring whether there may be trait-level factors (e.g., personality traits) or other similarities (e.g., exercise patterns) between successful weight loss maintainers and individuals with AN, which if substantiated, might indicate that both groups share a proclivity to forming habits and may have some innate ability to tolerate the physiological and psychological effects of starvation and/or reduced caloric intake. [2]  

         No shit, Sherlock. People with AN definitely have that innate ability. Eating Disorders (EDs), of which AN is just one, have the highest mortality rate[3] of any other mental health disorder. That innate ability is so powerful that, by the terms used in this exploratory paper . . .  you could call people with AN the most successful weight-loss maintainers in the world.

           Hell, it is so powerful that some of them can hold off eating until they die.

           And – they do die. In droves.

           The authors fail to address another group of people who are also extremely successful at tolerating “the physiological and psychological effects of starvation and/or reduced caloric intake”. This group is almost invisible in terms of this ability. Because their ability to sustain being in a state of sub-clinical starvation does not lead to a sustained reduction in body weight, the group is vilified because their bodies fail to produce the criteria necessary to be declared “successful”.

           It is worth noting here that there is no evidence proffered in the article, beyond the rote-like repetition of an old trope: “successful and sustained weight loss is critical to reduce the morbidity and mortality associated with obesity”, to identify where that “reduced weight” should sit – what number on a scale it needs to reach for it to be deemed successful (see Fig 1)[4], or just how it reduces such associated morbidity.

           It is also worth noting that the authors have made the rookie mistake of correlating body weight with calorie intake (not to mention the even rookier mistake of automatically correlating weight loss with health – but that’s another blog post). I.E they identified two types of people who purportedly maintain a reduced (from what, to where?) body weight and make the glaring assumption that maintaining calorie restriction is automatically correlated with a lower (again – than what?) body weight. Given that 80% of body weight is heritable[5], [6] they would be better acknowledging that calorie intake is simply not a reliable predictor of body weight and body weight is simply NOT a reliable predictor of health. 

(Fig 1) 

           Glaring also is their omission of people who restrict calories without being successful at weight-loss maintenance. I need to be clear that this blog post is size/weight neutral. My intention is not to ascribe any value to a particular body size or weight, or to imply that “all fat people are on diets”. I am specifically referring to the reality as self-reported by people who present as fat and who speak about their experiences of trying to lose weight via calorie restriction. And I am not referring to people whose genetic set-point puts them into the obese or overweight category – although of course they are also likely to experience stigma and oppression because of their bodies.

          There is an enormous community (pun not intended) of people capable of “overid(ing)these powerful biological drives”, of the “conscious exertion of rigorous self-control”, who eat primarily “a diet low in fat and calories, and a restricted variety of foods”, have  “significantly lower resting energy expenditure, lower levels of leptin and thyroid hormone, and higher levels of ghrelin”, for whom “food restriction has become habitual and therefore requires less effortful self- control” and whose lifetime habit of restrictive eating already bears out “the hypothesis that food restriction becomes less effortful and more habitual with time”.

           Trouble is, the community I am referencing suffers from what the authors of that article identify as a “problem needing fixing.  Or, to put it another way – despite their remarkable willpower and discipline in maintaining a state of calorie restriction, their bodies do not achieve the desired outcome – a body weight that falls within arbitrarily defined parameters of weight/size/shape. To put it another way … some bodies respond to attempts to lose weight by GAINING, and gaining and gaining and gaining because of a series of complex metabolic changes that affect the way the body compartmentalizes the energy intake, “being caught in a biobehavioral bind in that successful weight loss dieting (which increases weight suppression) may forestall but not prevent a return toward their past highest weights”.[7]

         It is no secret that there is a connection between prolonged dieting – i.e. calorie restriction – and an incremental increase in body weight, and in particular a pronounced and exaggerated increase in fat mass, as the body attempts to restore fat free mass to previous levels.

The increasing prevalence of dieting among normal-weight individuals, and the weight cycling that occurs through repeated dieting; both of which have the potential to provide a pathway to obesity in otherwise normal-weight individuals, and thus of concern in terms of public health. [8]

          It is also no secret that dieting in adolescence is a trigger for EDs[9], or that it is a predictor of obesity in adulthood. It is also a predictor of being trapped in perpetual, and increasingly unsuccessful attempts to reduce weight by dieting, often gaining weight in a calorie deficit[10].

           What is perhaps less well known, is that ED’s commonly go unnoticed in people of average or above average size – including those termed morbidly obese[11]. To exclude the reality that people termed overweight through to morbidly obese often undereat, many subsisting on an intake that is sub-clinical or clinical starvation, in an article such as that one under discussion, is to exclude the experience of those whose bodies do not fit the standard criteria of someone with ED.

           Worse still, by failing to acknowledge that the research they suggest – which makes the unspoken and wildly erroneous assumptions that fat people are unable to restrain their eating, or that they simply “eat too much”, or that fat bodies should be forced to become smaller – in short that fat people may be able to benefit (aka not be fat any more) from having “a little bit of anorexia”, they are increasing the stigma and weight bias that keeps fat people trapped in ED along with their smaller counterparts, while suffering the same ill-effects - not of being fat – but of chronic undereating in relation to their actual energy needs, and being invisible to many health practitioners concerned with treating ED.            

        If a fat person with ED, or with a history of chronic undereating sees a Dr, it is unlikely that they will be screened for ED. 99% of the time they will be offered uninvited weight loss advice, either directly, or indirectly. The article under discussion proposes that in the future they might be pressured to behave like a person with anorexia. The reality is that many fat people have already been doing so for much of their adult life, if not since childhood[12].

 Part of the solution or part of the problem?

             The presence of an article like this in a journal dedicated to Eating Disorders is of major concern. As mentioned, the unspoken assumptions fail to acknowledge that people of all sizes get EDs, or that it is possible to be a very successful calorie-restricter, without being a successful weight-loss maintainer. They also repeat the overly simplistic and erroneous notion that weight-loss automatically correlates to improved health, while failing to acknowledge that long-term calorie restriction, and repeated patterns of loss and gain, not only damage health but also contribute to increasing weight gain. 

           In effect, the authors are proposing that fat people, who may have spent many years restricting calories, cutting out food groups, exercising intensively to no avail should be exposed to yet another iteration of the same type of treatment because of outdated, erroneous and simplistic concepts such as …. *fat people are unhealthy*, *restricting calories leads to sustainable weight loss*, *weight loss makes people healthier* - I am sure you know the drill.

           What possible use is there in promoting behaviours that cause incremental damage[13] the longer they continue, that contribute to the very *condition* they are intended to *treat*, that see people applying the same ineffective measures that have not achieved the intended ends, that contribute to stigma that is not based on biological science but on weight-bias, and that reinforce erroneous messages about health and its relation to body size?  

           Many of the “obese” people they are seeking to *treat* will have been engaging in the very behaviours that are being promoted as healthful, with the result that they have become increasingly obese.

           What value is there in applying treatment to a state-of-being[14] that has in itself been caused, or contributed to, by that very treatment, or an iteration thereof, and causing incremental metabolic damage among the way?

           And what harm is being done by the failure to acknowledge that many people of size have already experienced severe negative health outcomes by following the advice of medical personnel to “lose weight”, and that with research such as that suggested, they will be further exposed to harm because of iatrogenic measures based on bias and not biological science?

           What will it take for the proponents of calorie-restriction to admit (and to change their practice accordingly) that one of the primary reasons that people gain weight is because of attempting to lose weight by means of calorie restriction?

          Can we at least see research that reflects the fact that weight loss by calorie restriction is not a panacea for all ills, and in fact that it can cause or contribute to many health issues, and that – regardless of body weight or size – people need care that focuses on helping them to “gain health”, rather than simply being told to “lose weight”?  

    [1] Not a war I support in any way. It is fattist, stigmatizing, elitist, ableist, healthist bullshit at best. Leave fat people the hell alone and stop taking out weight-biased crap on people who deserve better.

[2]Gianini LM, Walsh BT, Steinglass J, and Mayer L. Long-term weight loss maintenance in obesity: Possible insights from anorexia nervosa? Int J Eat Disord. 2017;50:341–342. https://doi.org/10.1002/eat.22685

[3] https://www.nationaleatingdisorders.org/mortality-and-eating-disorders

[4] (April 28th, 2017) https://www.facebook.com/marilynwann

[5] http://www.ijpmbs.com/uploadfile/2015/0412/20150412034517510.pdf

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275599/

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3759019/

[8] A G Dulloo, J Jacquet, J L Miles-Chan, and Y Schutz(2017) Passive and active roles of fat-free mass in the control of energy intake and body composition regulation, European Journal of Clinical Nutrition 71, 353–357; doi:10.1038/ejcn.2016.256; published online 14 December 2016

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720870/

[10] https://www.edinstitute.org/paper/2015/6/13/gaining-weight-despite-calorie-restriction

[11] http://www.ravishly.com/eating-disorder-community-has-fat-phobia-problem

[12] https://theestablishment.co/what-happens-when-one-fat-patient-sees-a-doctor-eddd6cd4a252

[13] https://www.edinstitute.org/blog/2011/9/17/is-it-too-late-for-me-to-recover-from-restricted-eating-behaviors-ages-26-52

[14] I use “state of being” because it is inaccurate and stigmatizing to use medical labels to what should be a neutral factor.

[amazonia-love]

[amazonia-love]

It is so easy to confuse "being at a socially rewarded weight" with "being free of ED behaviours".

[bigfatscience]

She sometimes asks me, ‘Mummy, what will happen to me if I eat too much food?” and I hear the echo in her voice of my own years of terror of the same thing. I tell her what I now know to be true, that all she needs to do is listen to her body and it will tell her how much she needs to eat – and that if she is hungry, she is probably growing. I want to tell her it will be ok, and that gaining body fat is not the end of the world, and that health and happiness are not dependent on being tiny – but it is too much and too soon. So after I answer her I hug her, and hold her close, and she buries her face in my now very ample breasts and hugs me even tighter, purring like a contented cat, and I hope my newfound self love and acceptance can pass through my skin to hers and inoculate her against the negative messages she is sure to encounter for the rest of her life.

Lessons From My Momma’s Knee, by Tumblr user  @amazonia-love (via bigfatscience)

[amazonia-love]

In Case You Still Think ED is About Your Body ...

What has helped me most of all in coming to a state of peace with myself and my body is recognising that the anxiety of ED creates a much bigger awareness of self as part of the overall anxiety issue. So we fixate on our appearance, or weight, or face and we imbue the anxious responses we get when we look at ourselves with so much more power than they actually have.

Another way of saying that is that the real issue is anxiety, and that roams around looking for things to fixate on, and that validate the anxiety and keep it in a never ending loop. For me it went like this for most of my life since adolescence: 1. see self in mirror; 2. notice (some supposed flaw); 3. feel panicky because (weight, ugly, whatever); 4. keep obsessing; 5. meanwhile breathing has become more shallow, body has tensed up, amygdala sending out threat messages that fire up the sympathetic nervous system into a fight, fight, freeze, faint response; 6. I identify that threat response as being CAUSED by whatever I have noticed in my body or face; 7. I decide to take action to do something to lessen the anxiety, i.e. restriction, exercise, which gives me a false reassurance that I am back in control, but in reality I am fooling myself.

To add to this, our system is usually on high alert for perceived threats BEFORE this process happens, esp if we are refeeding. So we are looking for evidence, continually, to support and validate that heightened sense of threat. And, in most instances, that evidence is body, weight, size and face focused.

As well, as Gwyneth Olwyn has long pointed out, our amygdala responds to threats PRE-THOUGHT - or, it reacts before we have the chance to operate in a cognitive manner - which is why you usually read about the amygdalic response being what happens when we see a snake out of the corner of our eye and jumping before we even realise that that is what we are looking at.

When I post something positive about my appearance now, I am not saying that I look better to myself than I used to, but rather that the huge threat response that used to be activated when I looked at myself has now stood down, and that I owe that change to all the mindfulness and attempts at changing my thinking.

This is not, and never has been, about your appearance. It is about the way that anxiety operates, and what is is - for the moment - focusing on when you are in an anxious state, or what can trigger you being in an anxious state.

Focus on managing the anxiety, and recognise that the thoughts in themselves are quite neutral - they are simply you misidentifying the source of your anxiety, and THAT is where you can gain mastery - by saying over and over and over again .... "this is just anxiety. I am thinking disordered thoughts that have no basis in reality. I am focusing on my appearance because that is a pattern I have been in for (however long)." And then put all of the anxiety management skills into action, breathing, mindfulness, distraction etc - not attaching to the thoughts but recognising them for what they are - the product of an anxious mind and body, and FALSE.

[amazonia-love]

Weight Gain & Kid in Recovery?

OMG, I Was So Busy Helping My Kid Recover From ED, that I GOT FAT.

So, this has happened, and you are freaking out? Relax; let it go.

Your wonderful body is doing what is right for you - it is increasing the size of the body fat organ (which is a powerful part of the endocrine system) in response to your very real stress and distress. It is a protective mechanism, and indicates that the stress you are experiencing is a threat against your body and mind. Body fat levels rise in the presence of many things other than increased calories - lack of sleep, exhaustion - even exposure to artificial light - and without a doubt you have been getting less rest and calm, mindful relaxation time since she/he has been in recovery. You are on edge, and you can't let your guard down because of the massive responsibility you are dealing with. And your body is responding to that in the best way it can - protecting you. If you have been eating more high calorie food, the resulting insulin spikes will be knocking down rising cortisol levels - because insulin is the antagonist to cortisol. You don't WANT high cortisol, and yet, because you are trying to keep your child alive, that is what you have been getting. Food and insulin, in the absence of a specifically diagnosed disease, are your body’s way of trying to manage the raging stress hormones coursing through your body. You are safe

 15 pounds does not put you at risk - we KNOW that the people whose bodies come into categories often described as*verweight and *bese (not going to give them page space) have better health outcomes across the board.  

Right now you don't need to be beating up on yourself because you have gained weight. Right now you need compassion, mindfulness, self-care at a very high level, more sleep, time-outs for you and you alone, and time in the fresh air where you can just let go. You would probably benefit from some therapy as well - not to help you lose weight, but to help you manage the distress you are suffering, and have been suffering for a long time, because of the grip this deadly disorder has on your beloved child.

Eat, breathe, rest repeat

Your kids live in a world where they are terrified of body fat, and weight gain, and almost any kind of food. All the hype about healthy eating and obesity has them too scared to eat a damn thing. And they DIE as a result. If we want them to get out of that world we need to do the same ourselves. And that means we need to change the way we see our bodies, and understand body fat for what it is - not an enemy or monster, but one part of a miraculous organism that keeps us alive the best way it can.

You are doing such a massive thing, supporting your child through the most dangerous time in their entire life; don't let uninformed societal attitudes rob you of the beauty of your own actions. You are saving your child’s life, and in turn, your body is doing what it can to help you.

Modelling radical self acceptance and kick-arse self-care

 If anyone challenges you about your weight gain, or says that you need to lose weight, look them in the eye and say: "My child almost starved to death because their fear of eating and weight gain stopped them eating. If I starve myself, while urging them to eat, I will put them at even more risk. My weight gain is normal, given the circumstances. There is very little clinical evidence supporting your suggestion that I need to lose weight; and I don't accept the prevailing view that I must be thin to be healthy, simply because the social media pushes that message on a daily basis."

Lets face it - if the worst that happens is that we need to go up a couple of dress sizes and stay there so that our kids will get the message that it is safe to eat, and thus continue living - what's the big deal?

If helping to support your child stay in remission - keeping them alive - means that you stay overweight for the rest of your life, take the deal. This disorder challenges every one of our priorities. But you know what? Our kids are alive, and our bodies are bounteous, as are theirs. Why not rejoice, and acknowledge their power and celebrate the fertile organisms that we are.

By doing so you can flick the bird to all that societal fattist bullshit, and help your child get out of the hell that is ED.

[amazonia-love]

Lessons From My Momma’s Knee

I am a mother to an eight-year-old girl who is already worried about getting ‘too fat’ and if she is ‘pretty enough’.

 This was not always the case. Until two years ago I was a fulltime fitness freak, dance instructor, with an undiagnosed, very long-term eating disorder. I ran boot camps, body transformation seminars, and participated in transformation contests. I have been in recovery for a year. It will take some work to undo the damage my body image beliefs I modeled to her over the last few years. I am getting there.  But she is struggling at the sight of with my necessary weight gain, and, for now, sedentary way of life, especially the pain and swelling from damaged caused during my latest brush with anorexia nervosa. I have gone from epitomizing what a healthy woman of my age ‘should’ look like and to being a semi-invalid in a slow and painful recovery.  

  A few months back, my husband came home from a 10 day trip away with our daughter, telling me her new anthem was All About That Bass by Meghan Trainor – a body positive song if he ever heard one (he is my co-conspirator in un-indoctrinating our girl).  He played it on his ipad, and she sang and danced along with joy. It felt great.

 That is, until the song finished.

 She turned to her father and asked “Daddy, do you like Mummy’s booty?” (referring to the line that says: “My Mama she told me don’t worry about your size. She says, “Boys like a little more booty to hold at night.”).

 I laughed, and so did he. And he said: “yes, I do, very much.” And we mentally high fived each other because here we were, doing it, helping her grow up free of the enslavement to body image issues and self-loathing that have marred my life thus far.

 But I felt uneasy even so. Something didn’t sit right with me even as I laughed. The sense of unease nagged at me until I sat down and googled the lyrics.

 On the surface the song is a wonderful body-love anthem. It dismisses the need to be a ‘size two’ and celebrates ownership of a decent amount of ‘booty’ - a curvy body and a generously sized butt. It is a strong woman stating her own satisfaction with her body.  So what’s the problem?

 Here’s the kicker – the first thing my daughter honed in on related to how a man, her father in this case, might see my body.  And, yes, I want her to know that even though I no longer live in that athletic and toned body she is used to seeing me in, he still sees me as sexually and visually attractive. It is good for her to know that he feels that way.

However, she didn’t ask ME how I felt about my body. How I felt about my ‘booty’. And she still hasn’t.  It was  only important to her to find out how Daddy felt. And that concerns me.

 How her Daddy saw my body was of primary importance to her, and she has repeated the question in many ways since.  This priority  is reinforced in almost every fashion magazine and endless movies and tv shows.  I don’t buy such magazines, and I am careful with what she sees on a screen. But we are not hermits. I can’t stop her seeing such things altogether.  And this is not a sole example. I have seen it time and again both with her, and her young female friends. She is conscious, at age 7, that what other people, particularly males, think of her body and face is of paramount importance.  And, lets face it, her biggest role model to date – ME – was until very recently consumed (literally as it turns out) with the need to get my body to what I perceived as a socially acceptable shape and size, and to keep it there, complete with obsessive eating and rigid exercise schedules.  

 Don’t get me wrong – the song is a bloody WONDERFUL body image anthem. I love it. I feel good listening to it and dancing to it. But I don’t feel good hearing my 7 year old daughter express anxiety about how other people might see my body, or her body after hearing it. I don’t like that she honed on only on that aspect. I am not ‘doom and glooming it’ either. It is bloody marvelous that she is free to ask, and that we are open to such a discussion. After all, how we live will to a great extent be a template for her future life.  But, like I said, I have a lot of work to do.  

 A little further along the song says “But I can shake it, shake it Like I'm supposed to do, cause I got that boom boom that all the boys chase, all the right junk in all the right places …”

 Again, the message is subtle, but clear. It is really important to have a body that boys will like, that does what it is supposed to do, and that has curves where they are supposed to be.  As an adult, I can critique the words, and fit them to my newfound body acceptance goals. I literally don’t give a crap about how any one else feels about my body. It is not up for judgment. The beauty pageant has been closed down and the venue is boarded up. I am happy that my husband likes my ‘booty’, but if he didn’t, that is not going to change my opinion. It is what it is – and my response to it is no longer conditional upon the views of anyone else (as a side note, while I am writing this, I am feeling particularly ‘pumped’ – this is a huge change for me, and is very empowering).

 The next time my husband played the song,  and our daughter raised a similar question, I was more prepared. I said very calmly, but in a voice with surprisingly steely undertones “I am happy that Daddy loves my booty – because I am madly in love with him, but it is much more important that I love it. If he didn’t love it, I would still feel the same about myself. It is up to me to say whether my body is ok, and not up to anyone else.” Voicing that thought was like trying on a different style of clothing than I am used to for the very first time. I was surprised with how well it suited me, and how well it fits.  It is the first of a collection of new ‘basics’ in my self-esteem wardrobe.  

 I was voicing a reality that has been a long time coming. I am 53, and I have had an eating disorder for 44 years. And I have ALWAYS worried about what other people might think of my body (and my extension, me); until this year past; so I am new at this; as new to it as is my daughter.  And while my ED is neurobiological in nature, and therefore not ‘caused’ by any one factor in my life, the pressure to look the way I believed I ‘should look’ has been an enduring trigger all those years.  I have lived  a life of looking at my body through the eyes of others for a very long time, so it is a real culture shock to simply see myself through my own. And, it is a real joy. Freedom tastes better than socially acceptable ever felt.

 She is being raised in a world where supermodels pose for selfies in underwear or naked, and then post tips on how to look your best should you ever decide to do so yourself.  Their breasts and buttocks are thrust into our line of sight as if commodities for sale or hire. Their appearance is their coin of value, their trade-able asset. The females on her favorite TV shows are, almost without exception, thin, tall and conventionally pretty or beautiful, even the cartoons.  Music videos and clips abound with the same basic imagery – scantily clad women and girls gyrating around in front of men (who are generally wearing way more clothing), while advertisements for diet aids and ‘health foods’ have one common message – in order to be healthy, attractive, popular, and happy you need to have a body and face that other people, particularly men, will find attractive.  

 Disney princesses wait for someone to come along to ‘fix’ their problems and save them (altho this stereotype is being challenged more and more, thank GOODNESS), and headlines such as ‘George Clooney marries lawyer’ dominate (kudos to the Business Woman Media for turning this on its ear), and women who are raped are still interrogated about what they did to cause it.  Large social events are always accompanied by a post mortem of the way in which women attending or participating presented themselves, with points out of ten given to the best and worst.  And throughout all of this, we are bombarded with messages about that almost exclusively equate body size with health and fitness, as if these can be assessed accurately solely by external appearance or dress size.   On one hand we are trained from birth to present ourselves in a way that others will find attractive, while at the same time learning that women will be held accountable for their appearance for almost their entire lives.  The most powerful and influential women in the world are publicly pilloried for the way they look on any given day, or their choice of clothing. A bad haircut or an unflattering dress can subvert the message of a political or commercial decision like nothing else. The twittersphere is full of reductionist commentary that whittles the value of a woman down to this narrow and demeaning criterion.

 The message is deafening in its completeness. It is imperative that other people find you attractive or perceive you as being healthy and socially acceptable as judged by your appearance. We are pressured live our lives in the view of others, and all too rarely encouraged to interrogate our own self perceptions.

 So. What am I doing to challenge these perceptions in my tiny daughter’s mind, to undo the mischief much of my own disordered thinking has wrought?  

 So far, my husband and I have agreed on a strategy to give preference to TV shows and movies that do not perpetuate these myths. Not so easily found. Even those with a female hero will portray her as slim, and pretty, and attractive to boys, and usually popular as a result. They go hand in hand don’t you know? We are also sustaining an ongoing, light dialogue that challenges the messages she is receiving, and questioning them. When she tells me she is worried about whether a boy will like her or not, I say that I hear her, but then gently ask her if she I wonder if it is also important to think about whether HE is the kind of boy SHE likes to be around.  That thought had never occurred to her before, and it has generated some lively discussions. I asked her during one what sort of boy did she find it pleasant to hang out with, and she had to really think about it.  She made a list there and then, and I could hear the wheels turning that she was discovering a hitherto unknown power. Until that moment, her focus had been on getting THEM to like HER.

 As I said, this is a work in progress.

 We have enrolled her, at her request, in surfing lessons. We live close to Surfers Paradise in Australia, and are surrounded by beaches. She loves the lessons. No one notices or comments on how pretty she looks, or how thin her stomach is, but the instructors high five her for staying on her board, and learning new skills. She comes home with her hair in a tangle and a huge appetite, and she is full of pride in her new found competencies.  And as a couple, her dad and I are working on not focusing only on her appearance when complimenting her. We ask her how SHE feels about her doings, and seek her opinions and commentary on whatever she is involved in. We want her to see herself as the main player in her own life, rather than as a subsidiary in the lives and opinions of others.  Today she was taken into a rip by one of the instructors, who then relied on HER telling HIM what to do with the surfboard to get out of it. She did so, and they made their way to the top of a huge wave and cruised triumphantly back into shore at great speed, her smile a testament to how well she had handled the challenge while the big burly instructor followed her directions; a feeling I hope she replicates many times over in the future.

 As well, my burgeoning awareness of how I have been shaped by this over awareness of the perceptions of others is helping me shift my own focus.  This has meant that when her hands reach out to touch my new-found curves where once was bone and muscle, I don’t flinch. Instead I pull her closer and hug her and express my love of self, and of her, and how it feels to be together.  When she comments about my big butt, I agree with her, and say, in truth ‘yeah, it is’ and then move on from there because we have a life to live and more important things to do than to discuss or even think about for one more minute how much adipose tissue my 53 year old butt may have.

 She is still uncertain about whether she is ok with me being fatter than she has ever seen me. I remember watching The Biggest Loser with her only a couple of years ago, and it burns in me to think that I allowed my impressionable little girl to witness other people being pilloried and abused and punished because of their body fat levels. It makes me nauseous to think that she was being trained to look at people only from the outside, and to judge them – to see complete strangers and their bodies as problematic and unattractive, and automatically unhealthy.  So, I can’t expect her to be automatically comfortable with me now being overweight. And I accept that. She may grow up and retain the same sense of discomfort that she has now, when contemplating bodies with any visible body fat. I hope not. I really hope not.

 But, again, I am consciously not pushing any such agenda.  I have however stood down from my own fat phobic stance and am embracing a more holistic view of health that concentrates on ‘state’ not weight.

 She sometimes asks me, ‘Mummy, what will happen to me if I eat too much food?” and I hear the echo in her voice of my own years of terror of the same thing. I tell her what I now know to be true, that all she needs to do is listen to her body and it will tell her how much she needs to eat – and that if she is hungry, she is probably growing. I want to tell her it will be ok, and that gaining body fat is not the end of the world, and that health and happiness are not dependent on being tiny – but it is too much and too soon. So after I answer her I hug her, and hold her close, and she buries her face in my now very ample breasts and hugs me even tighter, purring like a contented cat, and I hope my newfound self love and acceptance can pass through my skin to hers and inoculate her against the negative messages she is sure to encounter for the rest of her life.  

 The best way for me to protect her from the societal messages that may trigger her into disordered eating is to live my own truth at all times. And that means taking back and keeping the right to accept myself despite anyone else’s view. It is lovely that my husband ‘likes my booty’, but it is even more important that my self-acceptance is not conditional upon his acceptance and approval, or anyone else’s for that matter. My booty is up for grabs only if I feel inclined to make it so. And if I am okay with my own body, then what else needs to be said?

[sourwolfsam]

Gryffindors are bright mornings, leaves dripping in gold. They’re the trailblazers, unafraid of the road ahead. They’re laughing so loud your stomach hurts, the knowledge that your friends are right behind you wherever you go. They’re ice skating with someone you love, clinging on to them for dear life. They’re make-believe games with quests and dragons and swords pointing at the sky. They’re rosy cheeks, winter winds and freezing hands. They’re the adrenaline when a plane takes off, the drop at the top of a rollercoaster. They’re delighted screams and freedom, the wind through your hair. They’re panting, pillow fights, feathers bursting into the air. They’re finger painting and festivals and burning sunsets. They’re the burn in your lung after chasing something you’ll never be able to catch. 

Hufflepuffs are honey and flowers and the soft autumn sun. They’re knitted jumpers and scarves and soft tan boots. They’re fresh air and nature, the sound of birds singing. They’re rolling down a hill in the spring, grass stains on your knees, daisy chains in your hair. They’re waving at someone across a crowded room, bright smiles and laughter. They’re coming home after a long day and seeing your family. They’re playing fetch with your dog, your cat weaving between your feet. They’re fluffy socks and song birds and kraft notebooks with hand drawn patterns. They’re throw cushions on a bed, a tiny cottage surrounded by wilderness. They’re the ground beneath your feet, the air that you breathe. They’re the light you chase when you thought you’d never see the morning. 

Ravenclaws are leather bound books and overstocked libraries. They’re waking up at two am to google that thing that’s bugging you. They’re journals with half the words crossed out, scribbles and ink stains and missing pages. They’re stretching when you’ve been hunched over all day, rolling off the edge of a bed, burrowing in blankets. They’re torch light and held breaths and reverent whispers. They’re the entire night sky and everything beyond it; the embodiment of the universe. They’re desperate searches and hidden castles and ghost stories by firelight. They’re the mystery of a dark corridor, the force of a whirlwind. They’re the excitement of discovery, the rustle of crunched up paper. They’re the last whisper before you fall asleep. 

Slytherins are foggy hillsides and picturesque landscapes. They’re hand written love notes and subtle glances across a classroom. They’re black boots, long coats, buttons done up to the top. They’re tipping your head back to breathe the air, kicking up stones on a deserted path. They’re mirrored lakes, everything below the surface. They’re the confidence to get something right, the feel of magic in your fingertips. They’re holding your breath underwater, pretending to be a mermaid when you swim. They’re finding that one song that makes you want to create a storm. They’re the chill in the breeze, the force in the tide. They’re enchanted forests and lingering glances and long drives. They’re the lightning and the thunder and everything in between. 

[amazonia-love]

Dear Therapist

Dear therapist, I have an eating disorder because my brain responds in a very specific way to a calorie deficit. This gives rise to increasingly disordered thinking, and even greater restriction, and drives me to exercise, or move, more and more the higher the deficit gets. The worst thing about this disorder is that my brain really LOVES how it feels when I am restricting. I feel invincible,beautiful, energetic and as if nothing can touch me. At the same time I am numb, frozen, and unable to connect in a meaningful way with family and friends that love me. I can't see the danger I face even tho it looks as though I hate myself. And my relationships will break down as a result of the disconnect that is taking place in my increasingly malnourished brain. As well, my amygdala - the primal brain - misidentifies food, calories and weight gain (all of these in any combination) as a threat. And so I struggle to eat as a result. I am terrified, because of the anxiety generated by the amygdala. I will interpret my terror as a fear of food, weight gain and calories. I will interpret my terror as being caused by people in my life, particularly family. While it may be true that I have familial stress, this is NOT the reason I am terrified. What I need help with is managing my disordered thoughts, and in particular the fear of eating and weight gain. One huge factor in those thoughts is the way that significant people in my life deal with and respond to weight gain. If you are a restrictive eater, and you keep your weight down by dieting and exercise then you will not be helpful to me unless you know how to manage your own situation without letting it bleed into therapy. And unless you know how to read the research around body weight, fat, obesity and food intake, it is possible that your words and attitudes will perpetuate my disordered thinking and behaviour. Please don't focus on my disordered thoughts and behaviour as if they are the causal factors. I am in a state of of starvation and by brain is fucking well emaciated, given that it consists of around 80% fat. I am behaving this way because my cognitive functions are increasingly compromised. You CANNOT THERAPY ME OUT OF A STATE OF STARVATION. You CANNOT CHANGE MY BEHAVIOUR AND THOUGHTS IF MY BRAIN IS STILL DAMAGED BY RESTRICTION. You CANNOT MEND MY PRIMARY RELATIONSHIPS IF YOU FIRST DON'T HELP ME TO MANAGE MY ANXIETY AROUND REFEEDING - AND SUPPORT ME THROUGH THE TERROR I HAVE ABOUT GAINING WEIGHT. I need you to HELP ME FIND A WAY TO PROTECT MYSELF AGAINST THE FATTIST ATTITUDES IN OUR SOCIETY, AND TO SURVIVE PEER PRESSURE TO STAY IN A STATE OF STARVATION. Once I am in a state of energy balance, and my physical brain is partially restored, then would be the appropriate time to see if there are any underlying issues with my family or past. Right now I need you to focus on the most important thing, which is my refeeding. I cannot make changes to my neural pathways if I am still starving. I appreciate your efforts but I would really like it if you focus on the areas that most need your help. I cannot be emotionally and psychologically healthy while I am starving myself to death, or still in a compromised state due to a cumulative energy deficit. Please support my efforts, understand what my body has to go through without judging me for gaining weight, and stay by my side as I save my own life by learning to eat without fear.

[amazonia-love]

When Weight Goals Reinforce ED

When Weight Goals Reinforce ED

 You know the scenario. Your child is under the care of an ED treatment team, and you are doing your part at home; pushing the food, reassuring, caring, protecting. Every week she gets weighed, and you are all pushing toward a magical number that they call WR, weight restored. This is the weight that her therapist, dietitian, Dr and you think is her ideal.

 However, as she gets closer to that number, she starts unraveling. The ED behaviours are back in full force. She refuses to eat certain things, misses meals, stops eating bread. The dietitian says “why not drop your calories a little, seeing as how you are so close to gaol?”; the therapist says “there is no need to force yourself to eat so much food”; and the Dr says “we don’t want you gaining too much anyway”.

 Next thing, she is in a full-blown relapse, and won’t eat at all, and she is admitted to a treatment facility, and you tear your hair out in despair, because this thing keeps going full circle. This is her 9th admission.

 Or, he has been refeeding and resting as per instruction, and is compliant with his treatment. But the minute he reaches that WR point, he starts exercising again, and cutting carbs, adding protein, determined to maintain at that exact number. Next thing you know he has lost 20lb and can’t understand why he has relapsed.

 Will it ever end? How do you interrupt this cycle and create a new one?

 The Nature of the Beast

 The trouble is, ED is primarily an anxiety disorder. And that anxiety latches onto things, like shit to a blanket, any chance it gets. So when the primary focus of ED treatment is to get to a specific weight goal, the ED brain will fixate on that goal, and a whole raft of fresh anxiety will build up around it. Such as, the fear of going over that weight goal; the fear of getting close to that weight goal. As she comes closer and closer to the weight, the anxiety will ramp up to an even higher intensity.

 The ED brain will make that goal weight a thing of terror; it will fixate rigidly on that number, and ruminate around it; it will use anything it can to manipulate that number on the scale so the treatment will cease and it can just go back to being ED’d again. And it will use it as a bargaining and negotiation tool – aiming for 85%, 90%, 95%. Saying yes to those is missing the point. Hitting that goal weight does not mean your child is recovered. Changed behaviours that support remission and not restriction, accompanied by anxiety management techniques that do not create and maintain a calorie deficit are far more reliable indicators that they are moving toward a true remission. Restriction is anxiolytic. So as long as they are using it to manage their anxiety, there is a long way to go to remission.

 What we need to understand about anxiety is that it itself is the primary issue, and that it in turn causes disordered thinking and all manner of physiological and emotional responses. For those that are lost in the ED maze, each of these thoughts, feelings, physical sensations and symptoms become a series of foci, things to play what Gwyneth Olwyn describes as “whack a mole” with – without ever attending to the underlying anxiety itself. The anxiety is generated by the amygdala, and then the cognitive brain interprets and makes sense of the resulting sensations  - Gwyneth terms these “post-hoc rationalisations”. Without getting a handle on the anxiety that underpins the condition, the sufferer is condemned to the hell of thoughts that rush from “how fat I am”, to “this food is dangerous”, to “if I get to X weight my world will end,” and “I HAVE to stay at size 6 or smaller or I am going to die”, and trying to appease these thoughts with restrictive behaviours.

 What adds to the anxiety is the fear generated by anyone involved in the treatment. The attitudes of the treatment team, along with their implicit beliefs and biases, and their own relationship with food and their body are critical; weight bias is rife across every section of the medical world, and it can and does affect the patients under their care as mentioned above.

 The parent’s experience with weight related issues can feed their own anxiety, and these will be relayed to the child without a word needing to be said. And honestly, who of us as a mother has not attempted to control our own weight, maybe still is as the child is in recovery, for so many reasons? Who of us as a father has never been fearful of being seen to be ‘fat’?  Given that ED is heritable, it is possible that we ourselves have ED, and are still battling with the effing thing. And even if we don’t, it would be a rare thing to see a parent who is totally happy with their own body; we live in a fatphobic world, and the pressure to have children whose bodies fit the ‘ideal’ is tremendous.

 What parent is not fearful about the negative experiences their child may face if they are perceived to be overweight?

 Remission is not a matter of arriving at a certain weight. It is not static, and it is not an end point. It is a practice. It is an entire way of life. Weight is an important aspect, but not by any means the primary or sole criterion.  Complete remission can only be achieved when the person is restriction free; when they are no longer using restriction as a means of managing anxiety; when their body weight is maintained on at least the minimums that are age, gender and activity-level appropriate. Remission means that all signs and symptoms of the ED are no longer present and active.

 If your child is restricting via calorie intake and/or exercise, then no matter what weight he or she is at, they are NOT in remission. Don’t get me wrong, they may be practicing harm reduction, and that is so much safer than starvation, but they are still very vulnerable; they are at constant risk of relapse, because being in a calorie deficit is the number one trigger for ED.  You can change this by changing the focus, and leading the treatment team to change theirs as well.

 Do not allow your child to experience repeated relapses because their treatment team is prescribing and perpetuating calorie restriction in some way.  Insist that they follow best-evidence based practice and focus on the most critical elements.

 Don’t Move The Goalposts: Get Off The Field

 Because remission relates to the cessation of ED behaviours, which of course will affect their weight, changing the primary recovery goal can help someone more successfully negotiate the expected physical and emotional changes without constant relapse.

 Take away the goal weight altogether, and focus on the behaviours. Focus on getting over the fear of any food. Ask the therapist to be more aware of their own weight bias, and to not allow this to intrude in their treatment practice. Change the treatment team if you see that weight is the primary focus, and find one that is more interested in helping your child learn to manage anxiety without starving themselves. Ask them to help you mange your anxiety as well.

 If weighing needs to be done, do it blind. Don’t let the child know what it is. Say, and mean it, that “it is not as important as you being able to eat freely”.

 Challenge your own weight bias. Ask yourself where it came from and if you want to keep focusing solely on weight as a symbol of health, wellness, and value as a person. Educate yourself on the way that we as consumers, and particularly our young people, are manipulated into seeing bodies a certain way.

 Educate yourself on the calorie level that a growing body needs in order to lead a full life, rather than how low a calorie intake is needed so as to keep their body at an artificially low weight.

 Tell your child, and mean it, that “your weight is not the most important thing – you being well and happy is”.  Tell them that you don’t want to look at food only as in how it relates to weight, but you want it to be a symbol of love, and life, and connection – a celebration of all those things when you are together.

 Create a vision board where you and the child create your vision of what remission looks like – and make it weight-neutral and fat-bias free. Make it about all the other things that life has to offer them; your freedom will inspire them to leave the cage as well.

 If you want your child to have the best chance at remission from this tortuous disorder, practice remission right alongside them. And demand that anyone involved in treating them does precisely the same.