#eating disorder awareness

Letter to Younger Self/ Person. (The Costs of Conforming to Societies’ “Ideal Body”)

Dear…

I’m so sorry you’re struggling with body image right now.

Sometimes being human & having a body can suck. 

And, I really wanted to tell you a few things I wish I knew when I first struggled with body image. 

1. It’s okay. There’s nothing you need to do/ or can do to “fix” your body. Your body is NOT the problem. 

          a) it’s how you are made to feel about your body that is the problem.

          b) No matter what you do to “fix” or change your body you won’t feel better because your body is not the issue. 

i) Think of a day where you had the best day at school perhaps. You probably felt really good in yourself that day & if you looked in the mirror that day you would have “liked what you saw”.

ii) Now, think of a really bad day. Maybe you fell out with your friends. Looking in that same mirror, you didn’t feel so good. NOTHING, in your body changed between the two reflections. But how YOU FELT ABOUT YOURSELF was different. That’s basically body image. It has nothing to do with your body. & so my darling changing your body is never the answer. 

AND what’s more it comes at so, so many costs. Costs my darling, I wish more than anything to spare you from. 

Here are some of the costs associated with trying to look like the “associated ideal appearance” 

1. It’s an illusion. The biggest lie you have even been sold. 

    a) Even if it is possible to reach, it NEVER lasts because of nature. We age, we get sick, we go through changes in lifecycles (puberty, pregnancy, menopause so many more). Bodies are supposed to change, age & not stay the same. 

BUT, 

 i) even if it is possible, getting there can be a dangerous pursuit. 

ii) it can lead you down a path of yo-yo dieting, disordered eating at best & at worst my path a miserable life of an eating disorder. Or dangerous disfiguring surgeries. 

iii) Your body image gets worse and worse because there’s “more” to “fix”, “more” to conform to, it’s never enough.  Your relationship with yourself, your body and food gets completely fractured. 

The psychological costs are astronomical. 

– Once you start you might feel good. (I’m not going to deny this) but that doesn’t last long, because here’s the thing, if you change something about your body & it’s not where your body is meant to be naturally, it WILL fight like hell to get to where it wants to be. Where it feels safe, where it can do all the amazing things that make you special. Your body doesn’t care about the fake “ideal”, it cares about you. 

BUT, hard truth, when your body goes back to  its own happy sweet spot you will NOT feel happy. You will feel like something is wrong, like a failure & then you’ll want to “fix” it again & so it goes on and on. You never really feel happy with your body.  But you see, if you’re following you don’t need to fix anything. Your body is and will never be the problem. 

What makes you special and the reason we love you, has NOTHING/ zilch/ nudda not one iota to do with the body you live in. Your earth suit. We love you for all the things that make you, you. 

Another cost, specifically of dieting; food is something that if diets didn’t exist- then it’s fun, it’s away to socialize, share memories with friends and family or fuel your body to allow it to do all the amazing things you do!

    a) But diets introduce morality to food. There’s NO morality, food just is. It cannot be “bad” or “good”. But, dieting corrupts your brain & teaches you to believe foods can be “bad” or need to be “earned” or avoided. NOT TRUE. ALL FOOD IS EQUAL. ALL FOOD HAS VALUE. 

     i) Dieting confuses your brain. It makes something that is simple become harder than quantum physics, introduces maths when there’s NO need. 

ii) the more you diet, if you “trip up” you feel you failed & few bad about yourself. You can’t win. It all results in you feeling worse about yourself. When you zone out.. none of these things are to be fixed or in our control to begin with. But they all lead  you to feel crappy.

Trying to “achieve” the “ideal” appearance:

Takes you away from what really matters, it draws your attention away from things you actually care about. It’s makes your life smaller. 

It isolates you and that can make you lonely. 

It makes you boring. (Participating in, talking about diets, plastic surgery, etc is really boring) 

It makes you less “you”, less authentic. 

It takes you away from your true values. 

It also robs you of the opportunity to really get to know yourself and discover all the wonderful possibilities life has to offer.  

And while you think you need to shrink yourself to fit in, the opposite is true. You have the right to take up space, unapologetically. To be bold, to create your own path in life, and to enjoy the freedom that comes with it.

The more you try to “fix” the more you fixate on the “problem”. The problem that’s not even there. But it magnifies and you see it get bigger. This makes you feel more negative about yourself. You obsess over it and this only makes you feel worse. 

This striving for the ideal- lends itself to you beginning to compare yourself to others. 

     A) You have NO idea what anyone else around you, on Instagram, TikTok, tv, at school is doing to “achieve” this “ideal”. They might be very unhappy, living with dangerous ED’s, disabilities you don’t know about, you don’t know. But when you compare yourself to them you feel “bad” not “good  enough”  because you don’t look like that. 

Again zone out. 

i) Most pictures you see on TV, instagram or ticktock aren’t real. They’re made up/ curated. If you saw the person in “normal” day to day no make up/ filters etc they wouldn’t likely look like that all the time.

ii) let’s come back to the “ideal” according to who. Every single person on this planet is different which is really cool if you think about it. What you like in someone/ or are attracted to might be very different to the “ideal” and that is very cool. You can be who you want, like who you want.

Now, this is not specific to you, but important to EVERYONE. Conforming to ideals makes it hard for everyone to have and exist in a body. 

Because,

It perpetuates the narrative that -ANYONE- outside of this “ideal” is a “problem” & needs to be fixed. This in turn fuels:

               -Racism

              – Ableism 

              – Fatphobia

              – Homophobia 

              -Transphobia

       ** we don’t want to continue this! ***

You see, NO one needs “fixing” to be good enough. 

When you think of your favourite person,

What’s the first thing you think of?  What is it about them you like?

I bet it has nothing to do with how they look. 

Now, I bet if the same person told you they “hated” their body/ how they looked,

You  would remind them of how much you love them and all the reasons why.

You my darling, are perfect as you are. You are loved for who you are and always will be. And deserve to take up space in the world, to be seen and heard.

EDAW, Infertility, Pregnancy Loss

** I’m going to discuss eating disorders, infertility & pregnancy loss & so feel free to skip this post if you think this might be unhelpful for you. Reader discretion advised. ****

Standing perusing the new born baby clothes in a department store to pick a gift for my expectant friend. I feel my eyes welling up and a lump in my throat. This week would be the week my husband and I would have been expecting to welcome our own rainbow baby. Instead I’m choosing a gift for our friend’s baby, and the enormity of our grief hits me like a freight train once more. In the middle of a busy store. No warning.

My husband takes the present from me and hugs me.

I say to myself; “ It’s just a piece of clothing, ridiculous. Pull yourself together, I shouldn’t react like this”. I was not prepared for moments like this. I was done with this, right? moved on?

This moment felt so permanent, so raw. I wiped the tears from my face. Paid for the onesie and the next day went to visit my friends and pass on the gift.

No one talks about how many emotions one can feel all in the space of a few minutes when you have experienced either pregnancy loss, infertility and are surrounded by either pregnant friends or those with children. You can feel immensely happy for someone and consumed by sadness at the same time and a deep sense of no longer belonging in circles. So much confusion.

Pregnancy loss, miscarriage, ectopic and infertility are all difficult words to speak. People avoid the subject, skirt around the topic or mutter under their voices as if it’s a dirty word. Some people avoid you completely too. I’m sorry if this is your experience, you’re not alone, despite how it feels.

It’s Eating Disorder Awareness week. This weighs heavy on me, one of the topics I rarely see discussed in the ED community/ space is exactly this subject. Infertility, pregnancy loss or navigating pregnancy/postpartum in recovery. The latter I do not feel equipped to discuss because, I have not been there.

However, I have lived through the wrath of infertility and pregnancy loss with an eating disorder. Both, I believe should be spoken about more openly/freely in the space because eating disorders, infertility and loss all have isolation & grief in common. Sadly we are also not immune to these problems. There’s enough shame already and I feel called to open the discussion.

On top of the isolation these issues bring, & speaking from my own experience, they perpetuate the common hallmarks of guilt, shame, loneliness & body dissatisfaction eating disorders feed off. Another difficult and common denominator of these, is that society shies away from & stigmatises them. There’s not a safe space to openly discuss the experience of an eating disorder let alone the often complex complications such as infertility or loss that can be more common amongst our population. Considering 1 in 4 pregnancies end in miscarriage, that’s a lot of people even outside the ED community that are affected by loss and emotional distress.

Throughout the entire process I experienced intense body loathing. Every cycle failure this intensified. Every pregnancy announcement around me I felt more and more disconnected from myself and my peers.

This, I imagine for a person without an eating disorder is also a common experience. However for someone with an eating disorder, familiar with, the all encompassing viscous eating disorder voice, it was incapacitating. Infertility treatment in itself was incredibly hard, my body changed over night, my hormones reaped havoc with my mood, appetite.

The lack of control. Your body is not your own. Things change in an instant. One minute you’re pregnant, then you are not. The feelings of shortcomings were unbearable. “Why can’t you do this” “It’s your fault”, “you’re a failure” “You’re so broken” We’re all things I repeatedly said to myself.

Infertility, pregnancy loss are not a form of grief readily recognised or accepted by society. I found myself not knowing “what the process was”. How I “should” be. If I was “allowed” to feel what I felt.

Infertility, treatment, pregnancy losses all stirred up feelings of alienation from my body. It didn’t feel like a safe place to reside. I believe this is a common experience with many who go through this, however, personally with the history of an eating disorder it allowed a space to slip into a familiar self-deprecating/punishing state.

For me, a family, being a mum was a strong motivator for my eating disorder recovery. You hear the term “ remember your why” banded about in the recovery space a lot.

For me, the post-pregnancy loss, this term especially, alienated me from my own community for a time. I didn’t feel I belonged in any community and I’d temporarily lost my ‘why’, until, like always happens with recovery, I found new reasons to recover. But for a while, body positivity spaces, neutrality spaces really infuriated me. I needed to know this was okay, but there’s no one who talks about this! I’ve never seen it anyway. It’s ok to feel whatever you feel, there is no right or wrong. What you feel is worthy of compassion. COMPASSION is what I lacked for myself. Compassion is what society lacks at times. And so you need to learn to be compassionate to yourself and to find where it’s safe for you to get the support you need. For me it’s been talking to my husband and my therapist. A lot. It’s been in writing.

Connection is the other thing that humans need. Yet, experiences like this, where you not only feel disconnected from yourself but also with everyone around you, finding a way to remain connected is imperative to healing. Whether it’s online communities, podcasts, blogs, friends, family, therapy or whatever.

Eating disorders are complex entities. Whilst I can only speak from my own experience, I know there are certain themes many of us share. Numbing painful emotions can be one thing an eating disorder promises, at the expense of losing any emotion. However, in a body that no longer feels home and with such grief it’s hardly surprising many of us believe the false promises. Again connection, having people that remind us of our values and show us compassion is so helpful.

I wish, we lived in a society that recognised this grief and there was a space to acknowledge a persons loss and pain. No one should have to suffer the self loathing and loss in silence. Expecting these feelings as a given, and allowing room for them how we heal. Creating a safe space for discussions and environments for healing.

Your grief is real and you are worthy of help and support.

The way your experience affects your body matters, you matter.

Thinking of anyone experiencing complex body related grief especially during this EDAW.

These are my own experiences and opinions and whilst I want to make my posts relevant to as many people as possible it is impossible to do this in a single post.

Navigating Work and Recovering From an Eating Disorder.

Might work be an area that requires your attention in ED recovery?

If I was to ask you what one of your most challenging situations in recovery has been, I expect a lot of you will answer, navigating recovery and work.

What is it about work that makes it difficult to remain in recovery or on course with your goals?

Taking time off from our jobs/ school or college may not be possible for everyone in ED recovery. It wasn’t for me personally. There are times, where I know not being at work would have been really beneficial to recovery. Taking time out is beyond the scope of this blog and very individual.

I want to share some reflections regarding the relationship my work has had in my own eating disorder with the hope this may help you.

Considering many of us spend more than half our adult lives at work, it may be we need to put extra “work” in to maintaining our health in our place of work. Finding a way that means the two are not in conflict is vital. Both living with an eating disorder and recovering can be very stressful, managing this with the stressors of work can compound this further. It’s exhausting.

Ideally a person who is in the early phases of recovery wouldn’t be worrying about their career when the main goal at this time is to stay alive, yet because of a plethora of reasons, such as financial worries, stigma, access to care this is the reality for many. Many jobs lack the flexibility that is so needed to make progress in recovery.

Recently, I moved city and role in a new hospital.

Before we moved I told myself , “this was going to be an amazing fresh start in terms of recovery”. Before I go any further, I still have this view but I’ve had to shift my expectations and time line.

I came here with the mindset; people here don’t know my past which means I can start a complete fresh, ‘I will eat with people, eat all the foods I’ve not been able to in previous jobs and I will break away from the ED disorder identity’.

** To be clear, I ’m not ashamed of my background or struggles and if asked I will elaborate, however I want to recover, and not being tied to this ED persona is important to me.

My goal is to not be seen as the person who is ‘weird’ around food, or left out of social engagements that involve eating. I’ve missed out on this for years and my goal is to heal this relationship. Making connection with others, is recovery to me. To get to that, this for me means taking smaller steps.

Okay, so fast forward 6 weeks into my new job. I’ve felt completely perplexed by why my intentions hadn’t come into full fruition.

Let’s break this down, why might be harder than anticipated?

1. Firstly, let’s bin the notion you can ‘out run’ an eating disorder. I believed for years I could move and leave my ED behind. Time after time I proved this wasn’t a thing. I moved half way across the globe and my eating disorder followed. And so, let me save you the wasted time: YOU CANNOT OUT RUN AN EATING DISORDER.

2. People spend a lot of time at work. Sometimes people are afraid to share their struggles for fears of; discrimination, stigma or bullying. I was and to a certain extent still am.

3. Work can be a trigger for many. I’m not for a second saying certain occupations cause an eating disorder, however I strongly believe in those of us with the vulnerability to developing an ED, certain jobs may perpetuate them. Having this knowledge may be an asset in preventing and helping people to recover, for both employees and your employer. For instance certain occupations attract particular personality traits. Working in fitness, fashion, catering may draw specific trait’s. Working in the food industry may both be motivated by an ED or exacerbate. Certain careers like professional sports, fashion, entertainment and healthcare reportedly have higher incidences of people with eating disorders. Doctors’s may be at risk through; perfectionism, hard working, people pleasers and combine that with a culture where it’s praised if people forgo breaks, being vulnerable and speaking out against struggle is seen as a weakness. The stress of looking after others, exams, career progression, missing social events, It’s a perfect storm for those of us with the ED vulnerability.

4. Neural pathways take time to develop and naturally take time to deconstruct and rebuild new pathways. If your ED mindset and behaviours are entangled with your job, then it doesn’t take a rocket scientist to get why it takes time to resolve. (Though it’s taken me until now to realise this for myself).

5. Culture and societal pressures, “diet culture, weight loss, fad diets” are almost seen as a way of workplace bonding. People can fear being ostracised by speaking against this or simply excluded if they try to protect themselves from these otherwise seemingly innocuous conversations.

6. In the same theme as above fearing social engagements that involve eating with others can feel like it’s thwarting making connection’s and perpetuate this spiral.

7. Work place canteens may serve as a barrier to some people, the lack of options coupled with social anxieties may add a layer of stress.

8. Time pressure, work related stress may exacerbate eating disorder thoughts and behaviours especially when eating disorders have been the maladaptive coping strategies for stress.

9. Work may reinforce self esteem issues. If a person’s eating disorder is entwined with poor self esteem, a person who feels negatively about themselves at work or has poor confidence it’s unsurprising this may manifest in their eating disorder’s.

10. Imposter syndrome may be both perpetuated by an eating disorder and in some ways recovery. This is a big one for me, as I battle the eating disorder it can cause a imbalance of energy. I become anxious my focus on recovery is thwarting my career progression. I feel added stress and pressure, which can become a trigger in itself. However if I am not focusing on recovery, my work performance slips at the cost of my obsession with food and numbers. My anxiety can make me worry about losing out on promotions or career progression. Yet despite having to expend this energy, it will never impact upon my work in the same detriment that living with an eating disorder can. Being patient and kind to yourself here, I feel is the key. Forgiving for what is.

Now we can see some of the ways our eating disorder might be entwined in our work schedule, we have given ourselves insight and a place to focus our recovery goals.

I personally feel like identifying this, is a milestone in my own recovery, but I also feel frustrated by the fact it’s something I have to consciously focus on. It’s another hurdle when so much I want to be able to say; I’m free. Free to focus on anything but recovery from anorexia. However, I also fully embrace this is part of my healing journey.

Though I don’t claim to have this figured out, these are some of the tools I’m using to help me navigate this part of my recovery:

1. Make realistic goals. I am very much a black and white, or all or nothing thinker. Recognising my thought processes around recovering in the workplace has served as a catalyst to make changes. It’s not a failure if you can’t challenge everything all at once.

2. Be honest with yourself and importantly your support team. Make use of help anywhere you can get it.

3. Set yourself goals and debrief if they need tweaking. For example my initial goals were to eat with people every day when I started here. When that wasn’t working I needed to go back to basics and work out what was serving as the barrier. If eating with others is something that causes you a lot of anxiety, perhaps starting with smaller challenges first and building up to this might be a good one. I’ve been working on challenges like; making eating regularly non negotiable, practising eating different foods and buying the occasional meal or snack from the canteen. Something I have never been able to do until now. As I’ve become more comfortable in doing this I’ve then aimed to eat with others on occasion. I might not be in a place to buy foods and eat with others everyday yet, but that’s okay! I’ve often brought my lunch in and then gone and sat with my new peers outside or in the canteen. My point here is, you don’t have to achieve everything at once, take a step back from striving for perfect. Perfection is an illusion. Start with what feels achievable right now. I was focusing on the end goal rather than where I am right now.

4. Perhaps find a colleague you feel comfortable with, someone you can eat with (they don’t have to know about your eating disorder). I used to eat with a colleague in my old job, because she had a “fuck it mentality’ around food she was a great role model ( and she didn’t know how much she was helping me)

5. If it’s an option, sharing your struggles with a co-worker or employer. This is very personal and not for all. However having people around who know about your ED may allow other ways you can be supported: making time for breaks or allowing you to attend appointments etc.

6. Boundaries, boundaries and boundaries. Whatever boundaries you need to protect your recovery, whether it’s removing yourself from triggering comments, or carving specific times in your day that align with recovery. Boundaries are like a recovery superpower.

How can you, as someone without an eating disorder help a co-worker?

It’s highly likely you work with someone struggling with their relationship with food and body. You may never know someone is struggling ( kind of the nature of an eating disorder).

But you can be a real ally in someone’s recovery by:

1. Being mindful of how you talk about food and bodies around others. Don’t be that person who encourages the cheap diet talk. Keep the diet talk out.

2. Don’t comment on others eating habits, an innocent comment such as “ I wish I could eat that, or is that all you’re having or you’re going to eat all that” might just be the comment that serves as a barrier to a person eating.

3. If someone turns down an invitation to join you in social eating, don’t stop inviting them on other occasions. When someone feels excluded or isn’t given the opportunity to participate it may perpetuate the cycle that they cannot join in or they have to keep isolated. Eating disorders are extremely isolating.

4. Be kind. Don’t judge someone.

5. If you think someone you work with may be suffering from an eating disorder, share your concern with them in a non judgemental manner ( this may depend on your relationship). They may not open up to you, but you may have given them encouragement to talk to someone they’re comfortable with. It’s not your responsibility to make someone recover ( no one can do that) and so often a person won’t need advice but a supportive ear.

6. Educate yourself about eating disorders, some of the most harmful comments come from ignorance rather than a place of malice.

7. Be a role model, show people it’s ok to show vulnerability, to talk. You’re vulnerability may be the gift a person needs to feel safe.

8. If you are an employer, you can make your workplace a safer, more inclusive environment. Providing mental health training, awareness to make the workplace inclusive and reject stigma surrounding mental health.

I expect if asked, a lot of you would join me in saying one of the biggest threats to you recovery is work. Right?

With that, it makes sense a lot of our recovery energy needs to be focused on creating balance where the two are not in conflict. Perhaps talking with your support team can help you create a more symbiotic relationship.

What else would help you at work?

Trigger Warnings…

Trigger Warnings

What are trigger warnings and do they work?

These are often at the beginning of an article or social media post, either labelled as; trigger warning “TW’, or content warning ‘CW’. Triggers have many different definitions. The discussion regarding their use is not straightforward or easy.

I’m keen to start a discussion about how we perceive them, use them or alternatives that we could implement.

This is a heavily nuanced subject and I do not claim to have all of the answers, in fact my experience and knowledge is finite.

However I wanted to explore this topic further after an Instagram post I shared about them sparked a few interesting DM’s. https://www.instagram.com/p/CUYQe2Mhae4/?utm_medium=copy_link

Before I get into my own views, lets discuss the origins of where “trigger warnings” for content originated.

Trigger warnings originate from trauma, PTSD content. They were specifically attached to protect people with a history of PTSD/ trauma from experiencing the negative effects of reliving the traumatic exposure and secondary response. “Being triggered” in any other setting is different to this. People with PTSD often cannot regulate their response to the trigger.

I do not have experience with PTSD and so I’m not equipped to be able to talk about all of the nuances associated with this. I can however talk about the use of “TW” outside of trauma & PTSD and the potential harm they cause.

Multiple studies have demonstrated TW used in any other context at best do not work and at worst can cause harm. Yet almost every post I come across in the eating disorder community comes with a “TW”. It’s almost as if a trigger warning absolves a person from any responsibility of what they are posting.

If you are consuming, participating and engaging with particular content on social media you have a level of personal responsibility.

What do I mean by this?

It is your choice to visit certain pages, hashtags and communities. You have the same choice to avoid or unfollow content that does not help you.

Additionally you have a degree of responsibility regarding content you share. If you feel it may be harmful, caveating it with a TW is not solving a problem. Before I share anything, I consider a few things; does this post have the possibility to harm, does it serve the community I want to be an ally to and how would I have perceived this when I was unwell?

There is also a big difference between being “triggered” and discomfort.

Unlike people with PTSD, most of us with eating disorders whether you like it or not can choose to be triggered by something.

People with PTSD find it difficult to self regulate/soothe when they come across a trigger and reminder of the traumatic event. It can have many physical, somatic effects such as dissociation, soiling, hyperventilation and these are not in their immediate control. Therefore trigger warnings applied to topics/scenes depicting graphic violence/ sexual assault may help. There’s also debate that avoidance of such can do harm to some people’s recovery but again I am not equipped to go into the nuances regarding these.

I know when I was deep in anorexia, I would seek content with “TW’s, my eating disorder wanted me to be triggered. A trigger warning did not deter my unwell brain. If anything they helped keep me stuck in the cycle. I chose to be triggered by them. Why?

Eating disorders by nature a incredibly competitive. When the eating disorder voice is the dominant voice it will go looking for anything that validates it and makes it “more successful”. I could have controlled my response to them, I could have avoided them all together, but I chose not too.

Trigger warnings do not prevent this. They are the problem.

Now I’m solid in recovery, if I see an post with ‘TW” I can view content without allowing myself to become “activated”. I will often choose not to open such posts depending on how I am feeling in myself. I take responsibility in what I engage with. This is self regulation. But let me lay this out there…the “TW’s” on content I used to seek when I was ill with anorexia would reinforce intrusive thoughts. Labelling content with a “TW” would often lead me to engage in things I wouldn’t other wise. It’s like when someone says “don’t think about the colour red” all you can think about is the colour red. TW’s don’t tell you to avoid the content but they may increase the intrusive thoughts too. There’s increasing literature to show that “TW’s” do not work and can result in increased anxiety (I’ll share some links below).

As I have referred to already there is a difference between “being triggered” and feeling uncomfortable (feeling our feelings). I can feel uncomfortable about something but still remain within my parasympathetic nervous system and not enter the fight or flight mode invoked by the sympathetic nervous system. Commonly posts will elicit feelings of grief because I resonate with them to a time when I was unwell. These feelings are healthy and transitory- they do not keep me stuck in a state of “activation or triggered into a trauma state”.

Again I’m not knowledgeable in all of the nuances regarding this. I wanted to start the discussion about how blanketly these warnings are being used and whether they are causing more harm than intended.

I’m not saying there is no role for TW’s, I am encouraging you to reflect on why you use them, is it truly to prepare an individual or to remove responsibility from what you share or engage with?

Do trigger warnings help you are they as useful as we think? Do they cause you more intrusive thoughts? I’d love to hear your opinions, either via the comments or email me.

A few published studies:

Lived Experience..in ED Recovery.

Lived experience is one of the most valuable assets to recovery.

You can read about eating disorders in as many text books as you like and on some level you will understand them. Cognitively you may get it, but unless you’ve walked in the path it’s difficult to “really get it”

When you have lived that experience, You get it on a whole other level. People in recovery “get it’ on a level that reaches them to their core.

This makes people with lived experience such important allies in a person’s recovery journey and can be crucial alongside treatment.

I will never be able to express the gratitude I feel for my therapist, I know she saved my life, literally. Therapy was huge in my starting recovery and breaking free from the ED. But the most transformative part in my own recovery has been through connecting with those who have lived it.

At all stages of my recovery lived experience has been influential and important in my own growth.

Reading blogs, listening to podcasts/vlogs and following pro-recovery accounts on social media has really assisted me in the process.

There’s a deep level of trust that develops, knowing that others who have fully recovered, or are in a strong place in recovery helps us to feel connected, validated and most importantly gives us HOPE.

I reflect on the times I listened to people like Jessica Flint, Tabitha Farrar, Mia Findley and Millie Thomas sharing their stories, their wisdom and experience and aspiring to reach many of the milestones in recovery. Believing through sheer faith in their stories that recovery IS POSSIBLE for everyone. Even in some of my darkest moments in the throes of the ED or difficult moments in recovery, trusting what those who have lived and come through the other side has felt comforting and at most motivating.

Connecting with others in recovery seemed terrifying to me when I first started. If I had have been offered group therapy or any form of treatment that meant connecting to others, I would have ran a mile. In fact, I did. I was so ashamed of my eating disorder and terrified my “sordid secret” would become common knowledge. But through listening to others, joining platforms or groups a lot of this shame began to disappear, because there was nothing in this community that was judged, hadn’t been felt, said or done before. I started to see I was NOT ALONE, that there were millions of us who have experienced eating disorders.

A common theme I began to understand was the level of shame we all suffered. The more I read stories, listened and talked the more the shame began to dissipate.

Things I felt I could never share with another living person, suddenly felt like no big deal in the recovery community. The nuances that we believe are so shameful and not to be brought out into the light of day, are everyday struggles we share and is part of non-judgemental wonderful conversations. They say shame is fuelled by secrecy, I believe this is so true.

Following other’s journeys enabled me to find my own voice. I refuse to be ashamed of something that has made me who I am and helping me to connect with my true self.

I used to say I wanted to recover to the person I was before the eating disorder. I no longer wish this, because recovery has made me someone else, someone bigger than I was ( pun intended), but the level of growth that comes from choosing to recover & surviving an eating disorder is such that I wouldn’t trade it for the world. I’m becoming more connected with myself with every recovery orientated decision and becoming aligned with who I want to be. I’m grateful to those who were brave enough to share their experiences, that motivated my own recovery and helped me keep faith.

People recovering from eating disorders have to do this in a world that still challenges many of the beliefs we have to unlearn and to be able to recover in this society is so hard. For some this society can be incredibly cruel and the more people who share their struggle, experience the better this will be one day, especially for those who cannot find their voice. Lived experience is becoming a much bigger part of recovery, with the ever increasing resources available, recovery coaches becoming mainstream and peer mentorships, this can only be a good thing alongside traditional recovery. These people have experienced the struggles, the up’s downs and navigated their way out and are so valuable in helping others do the same, with compassion and sensitivity that is as authentic as it can get.

I’ll share some resources that have been so imperative to my own recovery below.

  1. https://www.recoverywarriors.com/ From blogs, to podcasts and online community platforms such as the “Courage Club” this has been huge in my recovery. Jessica Flint is fully recovered from her eating disorder and has now founded a recovery community that has reached thousands of people in recovery. This has introduced me to some of the most incredible people I’ve ever met.
  2. https://www.instagram.com/lindseyhallwrites/?hl=en Lindsey Hall has herself recovered from anorexia and she shares incredible insights
  3. https://tabithafarrar.com/ Tabitha is a recovery coach, who has fully recovered from her eating disorder. She’s very direct in what she believes recovery is, but she has shared some amazing blogs, podcasts and now mostly posts video content on youtube. I followed her avidly when I first started recovery. She posts about things from “extreme hunger, weight gain, and neural rewiring”
  4. https://www.instagram.com/millietnz/?hl=en & https://podcasts.apple.com/au/podcast/end-eating-disorders/id1534539219 End Eating disorder recovery Podcast.
  5. https://www.beyondbodycoach.com/ Mia Findley- is an Australia based recovery coach, who has fully recovered. She posts videos and podcasts with her experiences.
  6. http://maintenancephase.com/ This is a great podcast that promotes HAES, diversity and is anti-diet
  7. https://www.instagram.com/drheatherirobundamd/?hl=en

Recovery Super Powers

Protecting your recovery can be like developing a super power. It’s also incredibly important when we are surrounded by potential triggers every where.

If we are in recovery from an eating disorder, we need to learn to reject diet culture, which is really difficult when it infiltrates every part of our society.

I recently came across a blog, where the author was promoting a weight loss regimen, whilst sharing their own ED Recovery.

 That tells me two things, firstly it is not something helpful to my recovery, secondly the writer very likely still holds a lot of internalised implicit biases around weight and fear of weight gain and unlikely recovered.

 The intention of this post is to highlight the importance of being aware of  the content you chose to follow and your motives behind it.

People have the right to write/ talk about whatever they like. However, it can be really damaging to a person who is trying to heal from an eating disorder to follow accounts like that. You have a choice regarding the content you chose to follow or not.

My thoughts are and they may be unpopular, YOU CANNOT recover from a restrictive eating disorder whilst still actively attempting to pursue a smaller body. Believe me you cannot. It took me long enough to come to terms with this. You might get the idea of “I could go on x diet, lose this much and I would be ok”. Take it from me you will not. It is a relapse waiting to happen. That is how my last real relapse happened. All it really tells you, if you get those thoughts there’s still work to be done on neural re-wiring. It gets easier. I get these thought from time to time, “If I could just lose X amount I will be happy” this is my eating disorder voice and one that I know cannot be trusted. A size, or shape will never change how I value myself, I am so much more than a measurement but this is not what my eating disorder believes, it will make me buy into the notion that my worth is solely based on a number. This is not happiness.

I cannot diet ever. ever. ever. Choosing to go on a diet when you have a history of an eating disorder is like saying a person who has recovered from substance or alcohol abuse can have the occasional drink. You would not say this. Dieting is our drug. We cannot safely dabble.

In recovery the focus should be on challenging our fear of weight gain, body image, learning about the health at every size movement. Dieting becomes less appealing. I’m not saying you won’t get those thoughts. However your brain will learn that you don’t place all of your value on a number and it’s not something we’re interested in. If the concept of Health at Every Size (HAES) is new to you, I encourage you to explore some of the resources I’ve shared at the bottom. However, a very brief summary of HAES; the basic premise supports people in implementing health practices for the purpose of overall well being rather than the focus on weight control. There are some key values to HAES, it encourages people to eat intuitively, accepting of body diversity shape and sizes and that health is about much more than weight. This is a very simplified explanation.

I do not believe a person can endorse weight loss and be fully recovered themselves, because the aim of eating disorder recovery is to unlearn your fear of weight gain, to rewire implicit fat bias/ fat phobia. Therefore by promoting weight-loss on an eating disorder recovery site is an oxymoron. It does not have a place in recovery. I personally do not follow accounts whereby the premise is promoting weight loss or any form of diet culture based content.

If you are trying to recover from dieting, disordered eating or an eating disorder it is your responsibility to not allow this to trigger you. Therefore avoiding unhelpful information such as “losing weight” in eating disorder recovery might be the easiest way.

My last real relapse came from thinking “I can safely diet”

How I deal with these thoughts now; I challenge myself with the following questions:

Why do you want to diet, what are you actually trying to do? What are you lacking in an area. (It’s usually self care and self compassion for me).

Why do you feel the need to change your body- can you learn to accept your body at any shape size and understand a number on the scale has no bearing to who you are as a person or your health?

But, I find sites like this are dangerous in the ED recovery community, they do not realise the potential harm they could have. This particular individual has a large following. Many of the followers suffer with binge eating and the blog is the last thing a person experiencing such should be taking notes from. Dieting no matter how you look at it is restriction. Restriction is no friend to bingeing in fact restriction causes bingeing.

I recently shared this checklist on my social media- it serves as a way to protect myself and maintain healthy boundaries.

Resources:

Recovering from an Eating Disorder doesn’t Automatically Guarantee Life Will be Perfect..

But when life is challenging , you won’t have an eating disorder to contend with as well.

Rather naively, I think many of us hold this notion of “if I could just fix my ED, my life will be perfect”. So let me get in there early and save you the “aha” in months/years to come, set your expectations now, be realistic .

This is something I have come to realise throughout my recovery. The many times I’ve contemplated what recovery means, how I define it, what life will look like beyond my ED.

As I’ve gotten further into recovery and shifting away from my eating disorder, it’s become increasingly apparent that recovering from an eating disorder does not mean life will ultimately be all rainbows and flowers once the ED is conquered. No. That’s just not possible. But, life’s so much better, just putting this out there early.

But, the big thing here, the “aha” moment for me, was recognizing recovering from an eating disorder means we have tools to help us when life throws us a curve ball and returning to the eating disorder does NOT have to be an option.

Additionally when something in life happens out of our control, not having to contend with an eating disorder simultaneously, means we are better equipped to handle the stress.

An eating disorder is a big problem, not a solution. It may feel like it gives you control and comfort around times of difficulty but I promise you, that is the mask of the ED. It is definitely an added problem that you do not need.

Recovery will not mean that when you have a stressful time in your life, a loss or lots of change you won’t experience human reactions such as anxiety, low mood or whatever else we all feel according to life events. Recovery doesn’t make you some kind of super hero that doesn’t feel or get rocked by anything- but it does mean you don’t resort to dangerous/ maladaptive coping mechanisms that you have relied upon until this point. Learning to feel has been a skill I’ve developed in recovery and how to respond to these feelings.

It would be unrealistic to believe you will never have a day of insecurities, or god forbid a bad body image day. Because even people who have never experienced an eating disorder experience these human emotions. But if you’re recovered you won’t obsess over them, you will be able to deal with them and it won’t “ruin your day your week or even your year”! Yes I did just do that.

Recovery is a beautiful thing and it means something different to everyone. The recovery process is not the same for any of us, but I do believe it is important to consider your expectations of what it will mean for your life.

Personally, it has led me to an understanding that beyond ED Recovery work, in order to remain in recovery, l will need to put work into ongoing stress management, imposter syndrome and work anxiety. For me they are interlinked.

It is highly likely this will mean continuing with therapy of some kind to help me work with these issues, because I want to protect my health legacy.

One thing I know, life stressors are not something that are going away because it’s part of life, everyone has problems. BUT don’t let having an ED be one of them or believe that once you have recovered you will be a unicorn and NEVER have another issue.

“Weigh days” in ED recovery

Your worth can never be defined by a number

Weigh day in recovery This used to instil dread and fear into me and so I want discuss this further as I’m willing to bet it’s a common experience in recovery.

I’ve already talked about my tenuous relationship with the scales. However in early recovery when we are “ nutritionally rehabilitating” the scales can be important in therapy. Weight restoration can be an integral part of ones recovery.

I was doing my usual re-reading old journal entries and so many were about “weigh days”.

For me, I used to experience extreme anxiety leading up to weigh day and then days following.

Why is “weigh day”so traumatic for someone in recovery?

People with eating disorders tend to obsess over numbers, whether it’s calories, clothes sizes, or the frigging number on the scale. The numbers torment us. We live by them, we fear them. Therefore on the days I had managed to gain weight my eating disorder voice would throw a full on wobbly, if I’d lost it would throw a full on wobbly. You cannot appease an eating disorder.

For my family the “weigh days” were important to them, they were afraid it was one of the only ways the could tell if I was “doing ok” or slipping because of the secretive nature of ED. This reinforced the anxiety as-well, the concern of feeling like a failure or the threat of more focus being placed on me. But, I had lied before, many times and so I respected the validation they needed whilst I rebuilt trust.

The “target weight” issue

I personally don’t feel that “target weights” are helpful to most of us with EDs. I completely get why health professionals use them, but I personally feel that they have the potential to perpetuate trepidation and internal judgements that exceeding that target weight is to be feared or avoided.

Realistically most of us go way over. We go over because we need to, it’s called overshoot and it’s natural. It’s your bodies way of protecting you in case another famine arises. It’s why when people continually diet end up heavier because their bodies no longer trust them. However eventually when you let go of the diet BS, your body figures it’s shit out. But try rationalizing that with someone fighting an ED voice and going against an entire society who shares the ideology weight gain is a negative.

I believe holding on to my target weight kept me stuck, every time I got close to I’d bail on my recovery efforts, if I surpassed this arbitrary number I slipped. Until I let go of weighing and ate unrestricted. For some I imagine having a rough idea of a target may help them but for many like myself it can be a sticking point.

I know that, eating disorders love to hold on to numbers, to manipulate our thoughts and behaviors. Mine convinced me I needed to know my weight in early recovery to “monitor progress to “check”. Let’s cut through the crap, my eating disorder wanted to know the number as a “form of control” to ensure I wasn’t “gaining too much, too fast” it colluded with the numbers and therefore my behavior. This was continual until I was willing to accept my motives to know the number was not healthy.

Additionally certain values held specific connotations to previous relapses, or behaviors. For example the “target weight” hurdle was a huge trigger. I found it almost impossible to reach or pass when I knew the value because my eating disorder voice would get so much louder.

Recovery is hard enough, why make it harder for yourself by observing the scales? If you follow the recovery process, eating enough, not engaging in behaviors your body will recover and reach its natural weight without your eating disorder trying to complicate/ control things along the way.

For a while, I couldn’t know my weight, or (when agreed with my therapist) we reduced the weigh days.

There are pros and cons to this. Weight provides teams with anthropological information about recovery.

Regardless of whether it’s vital you are weighed you do not need to know your weight, you have the right when you attend a medical appointment to be blind weighed.

Fast forward to now, I’ve been in recovery for a while, there are days where I feel a draw to the scales. I know it’s never about the scale and I return to my recovery tool box to find what I need. I do not weigh myself. If I have to be weighed I would like to think it would cause little more than an internal stir.

If I have the situation where I have to be weighed:

I will likely follow my own healthy voice’s advice and ask for the number not to be made known to myself. Because, weight has no value to who we are. We do not need to know. It’s not worth giving the unhealthy part of my brain ammunition.

Arrested State of Development…

Aka feeling stuck.

Last week I was setting my intentions for the New moon. Whilst beginning to manifest and set in place the foundations of those intentions, I had a realisation.

When we are experiencing an eating disorder we are living in a state of “arrested development”. Loosely this is defined as a cessation of growth, this can be both psychological and physical. Initially ALL of our focus and energy is used in sustaining our eating disorder, then it becomes recovery orientated, both requiring substantial energy and attention.

I’m in the process of some major life changes and upheavals over the coming months with a ton of uncertainty. I’d been ruminating over the fact I wasn’t where I wanted to be, in terms of the standards I’d set myself for my career, my life. I was feeling resentful to the time lost to my eating disorder and to some extent recovery.

It dawned on me, for the last two years I have been fighting for my recovery, fighting to have a life not dominated by and eating disorder and before that I was expending all of my energy on the disorder itself, leaving room for very little else. I was feeling frustrated that I was now “no longer considered the best doctor of my cohort”. This is an egocentric attitude I need to work on anyways, but I have always been a perfectionist and through uni I had never settled for second place. Now, academically I am viewed as “capable”, but not excelling. There is nothing wrong with this, it’s how my brain processes this that is the problem. Now, I’m the doctor who has the good rapport but hasn’t necessarily recalled every hazard ratio from every journal ever written, but this was me, a long time ago. Before my life priorities had to change.

I realised some of the standards I’d set myself had become external expectations and now I don’t match those either. Again, this is not a problem, it’s how you react to this. The thing is I have been trying to be “that standard”, but I’m not, I can’t be right now. I essentially took two years out. If I was a professional athlete I couldn’t expect to compete at the same level after two years out, it’s the same here. The difference is, the people with those expectations don’t necessarily know I have been trying to survive and recover again, this was because I kept my eating disorder hidden through fear of stigma and so why would they? It was only recently I felt able to be open about my journey.

It’s only now that I was beginning to feel “bored of having to be recovery orientated” and have so much more mental capacity I could see unmasked I had been living this state of arrest. It’s releasing, I’m ok with who I am. I’m proud of what I have overcome and where I am. Letting go of unrealistic standards and expectations is what’s helping me in my health legacy and provide my patients with care. I think it would be unhealthy and unrealistic to want to be the same person we were before recovery.

How can we develop and grow when our worlds are so minute and focused on such specific details such as weight or that grade. I didn’t have the energy or time to be reading the journals I now am, when I was merely trying to survive.

I worry about my colleagues, the pandemic will fuel burnout, but unless the healers have a place to heal themselves this won’t go away. I wish for the unforgiving environment that is the healthcare profession to become a more open and compassionate one. One that does not depict personal struggle as failure. I shared my struggle not so long ago, because this unrealistic image of what a doctor should be is harming those that look after you, the more we normalise the narrative the healthier the healers.

I do think recovery burnout is a thing, it’s emotionally, physically draining, it becomes tedious but for the days where recovery is not boring it’s important to keep recovery orientated.

Hypothalamic amenorrhea #1

This post is not intended as medical advice and I am not an expert. I write this with lived experience, the intention of raising awareness and promoting self advocacy.

Have you lost your period?

Losing your period is never something that should be taken lightly, it can be a serious indicator that your body is functioning suboptimally.

What is Hypothalamic Amenorrhea?

The absence of a period for 3 or more months related to an problem with the hypothalamus. The hypothalamus is situated in the brain it connects our endocrine system to our central nervous system. It has many roles- it basically acts as a regulator for many of our bodies systems. It is the main regulator of the pituitary gland which is the where central regulating hormones are released. Some of those hormones include reproductive hormones, needed for menstruation.

Hypothalamic amenorrhea- When the control centre of the brain that regulates hormone secretion– is turned off.

Why does this happen?

There are several factors that can lead to disruption to the hypothalamic signalling. This post is focusing on the reproductive aspects- hypothalamic amenorrhea. My intention is to give a brief outline to help you understand 1.why it happens, 2. Why doctors don’t necessarily consider it when they see someone in front of them.

Factors that lead to HA:

◦ Energy deficit, this is the biggest factor and can occur due to a plethora of reasons. One of those is dieting. Whether this is through intermittent fasting- where the regular signals are not being maintained, caloric deficit, or excluding specific food groups such as cutting carbs/ fats, they all disrupt the signalling from the hypothalamus.

◦ If your hypothalamus perceives energy deficit it shuts down non vital functions of the body. It keeps you alive, it’s like a book balancer. What you don’t “need” it cuts. Menstruation is a function of reproductive health. Therefore, it is not a vital component to staying alive. Therefore it shuts off this non vital function, in order to preserve other functions including keeping your heart beating. This is another reason why we tend to feel COLD ALL the time when we are in energy deficit or have HA- the generator shuts off the heater to conserve other functions.

◦ Weight loss regardless of your size. You can have HA at any BMI. Firstly, If you lose weight it’s likely related to energy deficit, however when you lose weight you lose important regulating hormones (leptin) which are in fat cells and this is part of the feedback system to the hypothalamus.

◦ Stress. Something that puts stress on your body can disrupt periods. This may be through emotional or physical stress. Cortisol turns off the hypothalamus. Therefore it can cause you to lose your period.

◦ For similar reasons to above- exercise especially high intensity exercise can raise your cortisol by placing stress on your body. Additionally it can lead to energy deficit and weight loss and so it’s continues the issue. This is part of “female athlete triad”

Unfortunately HA is a common issue, however it’s not always recognized. Partly because it’s not understood and there are many misconceptions around HA. For instance people inhabiting in larger bodies are often rewarded for their weight loss efforts and exercising, but we know that HA can occur at any size. But often we are not as open with healthcare professionals about our lifestyle and they often don’t enquire.

When women lose their periods they are sometimes then commenced on the contraceptive pill to “restart” their cycle, or in some instances diagnosed with Polycystic ovarian syndrome (PCOS).

Unfortunately this is a problem because the management of PCOS- is often the complete opposite of HA. The contraceptive pill does not address the underlying issue, energy deficit. A bleed induced by the oral contraceptive pill is not a real period. If you took the pill away likely the person would not bleed.

I lost my period for a long time, thankfully I have healed from HA personally.

When in the depths of my eating disorder I did not advocate for myself or share my situation with healthcare professionals. I was advised at times to take hormones, I was not advised to stop/ reduce my exercise or eat more for instance. Getting a diagnosis is challenging because one, we don’t share and two it’s not always on the healthcare professionals radar.

However sharing knowledge with health professionals can help raise awareness.

I am no expert, I write this purely from personal experience and getting to know people within the recovery community.

I encourage anyone who has lost their period to seek medical advice, there are many reasons for this not just HA. But if you are someone who could be at risk of this you may need to advocate for yourself here.

I’ll write a separate post about some of the myths and issues associated to HA.

Diet pills, we don’t talk about this in ED recovery enough

Diet pills/ appetite suppressants… another side of eating disorders we don’t readily talk about. We should.

Over the years I have used many forms of products that were labeled as either “diet pills”, appetite suppressants, detoxing or laxatives .

I probably started using them well before I developed a full blown eating disorder. Raising the question for me, are they a gate way drugs to eating disorders?

Taking diet pills is disordered in itself. I trialed all sorts , I bought them without really knowing what the active ingredients were. Which for me, is completely against my personal values. I’m a scientist and to be so driven to take something purely for the goal of weight loss is baffling. I’m the kinda gal that has to know the how, why and the risk/ benefit of anything. However diet pills were different.

I remember buying my first diet pills in secondary school. I thought it would be a “quick fix”. They are addictive.

Soon diet pills became a part of my ever expanding routine and rituals.

I would hide this behaviour from others, which means I knew what I was doing wasn’t normal. I was incredibly secretive about this behaviour. It eventually expanded to other drugs including laxative abuse.

Neither diet pills or laxatives result in weight loss. The weight loss associated with laxatives is water weight. It’s purging and extremely dangerous.

I felt cleanest when I was emptiest and high from ignoring hunger pangs, and even more euphoric if the hunger was suppressed. Sometimes I felt superhuman. But I wasn’t. Looking back now, I only felt happy if I was empty. I wasn’t happy outside of this. I was numb.

I’m fortunate I don’t have lasting effects from the laxative abuse. Many are not so lucky. Laxative abuse is not something to be scoffed at or ignored people can be rendered incontinent or dependent on laxatives for life in order to be able to poop.

Diet pills are also dangerous. Not only do I believe they encourage disordered eating and other behaviors they can be harmful in themselves. Many of the diet pills or appetite suppressants are widely available without prescription or worse over the internet without any safety regulation. That means many of the products have not been approved for use in humans let alone approved as safe. You do not know what is in many of them. The drugs that are rigorously tested and checked require approval from the Food and Drug Agency (FDA). Anything without out this approval stepping into completely uncharted waters and potentially very dangerous. I had signs of liver inflammation when I started recovery and signs my liver was struggling. When we don’t know what we are putting into our body we really are playing with fire. Thankfully my liver recovered.

Social media is rife with adverts selling these hazardous products. Companies that sell them are also cunning and as soon as a drug is labeled as dangerous, they rebrand the same product. I bet you have seen celebrity’s used as promotions for such pills, claiming celeb X had a miraculous result to their product without any ill affects. When in reality I am willing to bet, the celebrity NEVER takes them. But people who engage in disordered eating or want to fit into the societal norms are easy targets. I was. You name it I tried it. I have intentionally omitted the product names of anything I took, as I do not wish to trigger or promote disordered actions. Frankly I know that when I was in the depths of my eating disorder if I heard about a new product, I was onto it as soon as I read about it, and so I know what goes through some of our eating disorder brains.

I want you to see that it’s something we don’t talk about enough in the eating disorder community. However, I am confident it’s a hell of a lot more common than we think.

I’m not going to pretend stopping this behavior wasn’t difficult. It was but it is completely possible. I can’t imagine putting something I had no idea the content or safety of into my mouth now (unless it is food).

I went cold turkey- I flushed my pills and binned all the detox teas. It was one of the first behaviors I tackled in recovery ( that and the Fitbit, which is a post enough in itself) Fitbit aka handcuff.

Now when the adverts appear on my social media I either report them or remove them.

Diet pills are an odd one, but if you want to recover they have to go. They don’t work and who know’s what damage they’ll do.

Let’s make this discussion part of eating disorder recovery and bring it out in the open.

Your Weight Is Not Your Personal Responsibility

Photo by Brett Jordan on Pexels.com

Some things are not supposed to be controlled. They are not our personal responsibility. Weight is one of them. I repeat, your weight is not your personal responsibility or choice.

This may sound controversial because we have been taught that our weight is inversely correlated with health. But this is oversimplified and largely untrue.

We cannot “healthily” manipulate what’s not supposed to be manipulated.

Your weight, much like your height or eye color is predetermined, by genetics. But it’s influenced by environment, your health, your diet history, & both diet and exercise. The latter two are only small contributors. With all the other factors that you have no influence over, it’s futile trying to micromanage. If you go too far in one direction, your body will fight it to live in homeostasis.
If you are genetically built to live in a larger body you will never have a “healthy” smaller body regardless of all the exercise or dieting you do. It just won’t work, the body will fight it and you will see all of the negative effects of this.
The larger body you were born into was healthy.

What’s prompted this post is following announcements from the UK governement they may financially reward weight loss in a campaign to “fight obesity”. They talk about providing incentives with subscriptions to restrictive diets such as weight watchers and slimmers world. This is such a harmful campaign. Further more, this announcement was released in the middle of national eating disorder awareness week, the theme of this was Binge Eating Disorder (BED) (1). Binge eating disorder sufferers are already statistically less likely to seek help than any other eating disorder, despite it being the most prevalent eating disorder. 1 in 50 people in the UK are expected to be affected by BED. A staggering 40% of people in the US following weight loss programmes meet the criteria for BED (2). BED is a serious mental disorder with physical side effects. People with BED, consume large quantities of food quickly without feeling in control, it is NOT the same as “over indulging”. Patients often restrict heavily between binges which fuels the cycle. Often patients with BED do live in larger bodies, they are “obese” by societies definition. The UK government’s message is damaging and harmful to those with BED. Weight stigma is a huge problem in society and in healthcare. Patients with BED are stigmatised, invalidated and often do not seek help. They are too commonly prescribed restrictive diets as an answer. However evidence has proven time after time, binges follow restriction.

Campaigns like this, will have a ripple effect, making access to treatment all the more difficult. More patients are likely to develop eating disorders such as BED, following restrictive diets will not end well.

I anticipate- the “obesity crisis” will increase after everyone regains the weight they lose and more, furthermore it is encouraging disordered eating, which will raise the incidences of eating disorders. Without tackling the core issue of weight stigma, many of those eating disorders will go undetected. “Atypical anorexia” is another diagnosis used by the DSM-V ( diagnostic, statistic manual psychiatric disorders) to diagnose patients with anorexia but are not underweight according to BMI. However Anorexia can manifest in any body shape or size. The difference is the weight stigma those suffering with anorexia in a larger body experience. They are often congratulated for their disordered behaviours, not taken seriously making access to help more difficult.

Let’s discuss BMI. The BMI was invented by a Belgian mathematician in the early 19th century. Lambert Adolfe Quetelet was a mathematician, statistician, sociologist with an interest in anthropometric sciences (3). Anthropometric study is essentially is body measurement study. He had no medical training. He has since been heavily criticised for his population studies of BIPOC and labelling people of colour as “separate species”. One of Quetelet’s areas of interest was in the “average man”, he used data including height and weights to help him determine this.
His studies were largely population based, cohort studies, mostly including white European males. He developed a formula to calculate a ratio of body weight to height squared, after an observation that there were weight and height variations within populations. More specifically that weight did not appear to be directly proportional to height, he discovered weight varied in proportion to height squared. This became known as the Quetelet index, before Ancel Keys renamed it the BMI in 1972. Ancel keys a famous physiologist, attempted to prove correlation with obesity, BMI and poor health. He did not succeed.
The BMI was not used to determine health it was to show “population averages”. It was designed to track population’s weights. It did not measure adipose tissue, or account for muscle. Once again it primarily referenced white European men.

It can therefore not be used as a predictor of individual health status, at best it’s a population screening tool, particularly if that population is white, male and European.
It identifies potential “population risk” of certain diseases such as diabetes, coronary artery disease. However an individual’s BMI, in isolation is not helpful, as a person can have a high BMI but very little visceral fat which has been associated as a greater risk factor. Muscle mass contributes significantly to weight and therefore BMI.

Interestingly, the optimal BMI for mortality is actually within the “overweight” category on the BMI scale. The most optimal BMI statistically from latest studies is actually 27 (4). Yet the BMI scale has not been updated to reflect the definition or risk stratification. Go figure.

The more I learn the less I know, but the more I want to know. Nutritional science is an incredibly complex field of science. It’s also a very difficult area to interpret. I am relatively confident in my ability of interpreting scientific papers coming from an oncology background, but I do not feel equipped to interpret and advise patients on nutritional science. The studies I tend to go to as my default for information and decision making in my career comes form the “gold standard” of evidence, which is data from meta-analysis of randomised control trials.

Meta-analysis analyses data from big randomised trials. (For anyone non medical or non scientific, randomised control trials (RCT) are the holy grail of investigating an intervention. It involves studying two groups, randomised to receive the intervention or a placebo. The difference in the two groups is studied. For example a group of patients with diabetes are randomised to receive a new blood sugar lowering drug. One group gets the drug, the other does not. The changes in their blood sugars are observed. You can control for variables because people are selected based upon specific characteristics, such as age, starting blood sugar levels for example.

Nutritional science is difficult to interpret, because, the studies are largely cohort studies (population based), i.e. you cannot ethically conduct randomised control trials in this field (i.e. you couldn’t restrict a particular nutrient from a group). You cannot control the variables that vary like you can in an RCT (you have no idea how much carbohydrate someone eats compared to the next or how their body actually uses it). Interpreting them is difficult. Therefore I feel uncomfortable ever promoting something I have little or no understanding in. Examples that have come from nutritional science are: the “carbs are bad”, high fibre diet and colorectal cancer risk reduction, ketogenic diet, vitamin E and reduced risk of developing alzheimers. But, unlike medical studies, we cannot control variables in the studies and then apply them to individuals or draw cause and effect. Vitamin E, has been shown to reduce the risk of Alzheimers, but when you look at how, it is not actually understood. Therefore taking a supplement that is not that same as the vitamin E absorbed from a persons diet is just not generalisable.

At medical school we get minimal training on nutrition, yet we are asked important questions that I feel we are ill equipped to provide. I find it concerning when people advocate things such as low carb diets as a one size fits all, pun intended. It’s an issue, there are so many shades of grey. However I am confident in my knowledge and the evidence surrounding BMI, and weight bias. Weight bias is dangerous and our lack of understanding or inappropriate use of nutritional science is concerning. Nutrition is also a luxury and we do not acknowledge this. I am a white middle class female, I acknowledge my privilege, what this means is I am fortunate to be able to choose what I eat. Many people are not as fortunate and they eat what they can, therefore prescriptive diets by nature are also not available to a large population, and yet they are stigmatised for choices that are actually not really a choice.

The BMI was never intended to be used as the measure of individual health, that is is used for today. It is also not applicable to a wider population as it included a narrow cohort. Yet we base such importance on a number that never had any intention for medical use.

For anyone who has received weight stigma or bias, please understand you are not alone. Binge eating disorder is serious and everyone should be able to access help. We can be healthy at any size.

References:
  1. BEAT Eating disorder Awareness Week: https://www.beateatingdisorders.org.uk/edaw
  2. BEAT information page BED: https://www.beateatingdisorders.org.uk/types/binge-eating-disorder
  3. Quetelet index: https://pubmed.ncbi.nlm.nih.gov/17890752/
  4. BMI associations and mortality: Change in Body Mass Index Associated With Lowest Mortality in Denmark, 1976-2013 Afzal, S., Tybjærg-Hansen, A., Jensen, G. and Nordestgaard, B., 2021. Change in Body Mass Index Associated With Lowest Mortality in Denmark, 1976-2013. https://jamanetwork.com/journals/jama/fullarticle/2520627?resultClick=1

Recovery isn’t about never making mistakes

Setbacks will happen, because life happens.

Whether you are just starting recovery or have been on the the path for some time setbacks are inevitable.

It’s okay. It doesn’t mean you can’t recover, I absolutely believe recovery is possible.

But not preparing for setbacks is setting yourself up to fall. After all perfectionism is part of the issue right?!

I am happy that I will one day consider “succeeding at anorexia” as my biggest failure. A setback or relapse does not mean you have failed at recovery.

Setbacks teach you things and pave the way for what might be ahead. They prepare you for a fulfilled life without your eating disorder.

I’m hoping my latest setback will help you.

I’m not ashamed I momentarily took my foot off the recovery pedal. It happened, I’m back in control and wiser for it.

Why did it happen?

Well if you’ve read any of my previous posts you will know I am a firm believer that eating disorders have a strong neurobiological component fueled by energy deficit. Energy deficit being the match to the flame if you like. The physical and psychological symptoms that follow being the fire that is contributed by everything else such as environment, stress etc. The important thing is the match in the genetically vulnerable.

I have just finished a set of night shifts. Night shifts to the average person without a history of an eating disorder can reap havoc on health, both physically and mentally. They disrupt your natural circadian rhythms, they can be socially isolating and routine can become difficult.

I’ve worked shifts for years. I know it’s a time where previously I have allowed my eating disorder to thrive. Therefore, armed with this knowledge I planned to avoid falling into the trap of my eating disorder.

Knowing I cannot allow myself to slip into energy deficit I made preparations to attempt to combat this. I ate more before work and before I slept, I planned out snacks to take with me.

But life happened. I missed some breaks and a few snacks. I was lacking sleep and so my appetite was lacking, I hadn’t made self care and routine a priority.

I didn’t think much of it in the craziness of the shifts, but when I found myself unable to eat 3 meals a day when I came off my shifts I knew I had slipped.

I haven’t had “fear foods” for sometime.

I haven’t thought about engaging in disordered behaviors such as concealing what I was/ or wasn’t eating, for months.

I haven’t listened to the voice tearing me to shreds in the mirror for the longest time ever.

But suddenly it was all there I was right back in it. I found myself wanting to control my intake, to compensate for every “ unhealthy” choice I was making. I recognised a familiar welcome feeling of emptiness that in truth I had actually forgotten. The emptiness euphoria made me contemplate giving up on recovery. After all if I’ve fallen so easily after so long, what’s the point in continuing? The intense draw to the scales returned, I had to fight to not give in to the temptation. I know that no number on that scale would have had any importance, but to my eating disorder it would have been used as firewood.

I danced with the temptation of a full blown relapse. However, I reminded myself it was all lies. If I didn’t put this match out I’d be amidst a wild fire that only wants to destroy.

I needed help. I needed support. I’m not ashamed of that.

My eating disorder tried to make me carry the weight of shame. But that’s another reason I knew I needed to put the match out.

I enlisted support from my support network. I chose to let them in. For the few days following, making decisions around eating felt like an impossible task. The thoughts were so loud. I have now reinforced routine, I challenged the “fear foods” that re-emerged and I prioritised taking care of myself by resting, talking and eating. Instead of pulling myself apart and focusing on “failure” I’ve chosen to treat myself with compassion.

I feel back on track. Ive bounced back. With more knowledge and information for my next set of nights- I need to prepare further. I will carry more snacks on my person. I will increase my intake. Self care, such as yoga, journalling and talking each day will be a priority and not an after thought.

My tool kit is more substantial.

Recognising a slip is vital to enable you to seek help and the support you need.

Recognising it early can help you get out quickly.

It’s obvious to me these slips came from:

⁃ Skipping meals (no matter how innocent)

⁃ Eating in isolation.

⁃ Blasè attitude “no big deal”

These are known triggers for me. Knowing your triggers can help you prevent and identify potential setbacks/ relapses.

Preventing setbacks is not always possible.

But planning what to do in the event is key.

Make your relapse prevention plan. Update it with each learning experience.

Seek help.

Most of all- choose to get back on track. Choose to put the match out, don’t start the fire. A moment of struggle doesn’t mean failure. Be kind to yourself and keep going

Check these out:

Relapse prevention plan mirror-mirror: https://mirror-mirror.org/recovery/607-2

Relapse prevention/ recovery maintenance sheets from cci: https://www.cci.health.wa.gov.au/-/media/CCI/Consumer-Modules/Overcoming-Disordered-Eating—Part-B/Overcoming-disordered-eating—09—Relapse-Prevention.pdf

Two years in recovery..WAKE UP CALL

TW and this may be difficult to read.

Yesterday a memory came up on my Facebook feed.

A trip we made to Sri Lanka in March 2019. My final wake up call before seeking help for my eating disorder.

It was not the wonderful experience that it should have been, or our pictures from our travels captured. They say “a picture paints a thousand words’, but most of what you see is what my eating disorder did for years, fake an exterior. It was this trip that I for the first time in 15+years, began to see how much of an issue my eating disorder really was.

For years my eating disorder had concealed the negative impact it was having on me.

My eating disorder was slowly killing me. If you are starving, you’re slowly dying. My friend if you need this sobering reminder, people die from eating disorders. We forget this when we are dancing with the devil. Or perhaps, we no longer care, when it’s painful to sit, or our body is covered in fine hair because we can no longer keep ourselves warm. We ignore message after message from our bodies until, if we are lucky we WAKE the FUCK up. It’s not just us that our eating disorders impact upon. Truthfully when engaging in behaviours and driven by the numbers, I didn’t worry about the effect each action could have on my partner, parents, brother, friends. But our actions do matter, If I had have continued I would have likely ended up as a stark statistic. Remember, YOU matter, your life matters and you affect many people’s lives. Please wake up.

That trip I felt completely lost and trapped in my relentless behaviours that had been by my side for years. I had no idea how I was ever going to step outside of the grips my eating disorder held on me. But I knew something needed to change or I would slowly but surely die.

What made me wake-up?

I realised I wasn’t living. If I wasn’t living, what was I? It became so obvious to me on this trip because Sri Lanka is full of beauty, but I felt nothing but cold.

I was done with the comments from peers and concerned looks. I hated it.

I was done with feeling nothing but bone cold, ALL OF THE TIME. Even in 30 degrees heat. I wanted to see past the brain fog and constant chatter.

I didn’t want to live like that anymore. I couldn’t live like it anymore.

This was not the first time I had had a moment of clarity, a few years prior I knew things were far from in control, but I didn’t seek help. I thought I could fix myself by eating a little more. Things got better for a time, but without support things soon descended back to the familiar chaos and calm of my eating disorder.

But this trip was different. Something needed to alter. I had reached “rock bottom” and I had to crawl out.

I wanted to be present, to share the experience but my eating disorder bled into everything. It was all encompassing. I was afraid for the first time. I was scared this was either going to be my life, or it would take my life.

It was the first time I realised how much stronger the eating disorder voice had become and how buried I was. I feared I had lost myself forever, I couldn’t recall when I was last in the driver’s seat of my thoughts. This was a sobering moment, at the same time I felt powerless to do anything about it.

These moments of clarity would pass again, and my eating disorder would begin to fool me once more that I was in fact fine, convinced me I wasn’t “sick enough” or that I even had an issue. However my healthy thoughts, were desperate to be heard and me listen. And so, it was this trip, I shared with my partner some of my story, although by this time it was hardly a secret.

Even though this trip was incredibly painful, I remain grateful for it, because it was like a wake up call and it kickstarted my true recovery process. Seeing pictures of the trip makes me sad for memories and experiences my eating disorder stole from me but I’m so thankful to be where I am now. Writing this.

If you’re in this dark place, THERE is always hope, It is never too late to seek help. And, you don’t have to go at it alone. You don’t have to have answers. Choosing to reach out of help is the biggest step, the rest will follow if you trust in the process and take that massive leap of faith.

There are stages we go through prior to starting recovery and then during recovery itself. I think we flip flop between them whilst we go to war with the two voices in our head. But we can all win, it is possible.

To me the stages look something like this:

◦ The “I’m fine. I’m just super healthy. I’m totally in control” stage.

◦ “Something’s not quite right with what I’m doing, but it’s ok right? I know I can stop if I want to. But I don’t want to” stage.

◦ The “Shit, I can’t stop. Well better just keep going. It will pass. It’s not that big a deal?” Stage

◦ The, “Ok, I think this is probably a problem. Not sure I want to do anything about it. But not sure how long I can keep going on like this” stage

◦ “Ok, I’m so done with this, I can’t keep living this way. But I don’t feel I have any control. I’m not sure I can stop” stage. This is the point I got to when I sought recovery. It’s one of the scariest decisions I’ve ever made.

◦ “Let’s try this recovery malarkey out. What do I have to lose? But I’m so scared of the thought of change”. Stage

◦ The, “Oh my god, this is way too hard. I’m never going to recover. Why even bother trying” stage. I think it’s common here, we often resort to old behaviours intermittently whilst making small changes in recovery. But the small changes matter and count.

◦ Then something clicks/ it’s like a switch. Recovery becomes easier. It’s still bloody hard but it’s less of a monster than the one that’s been dictating your life. This stage, you start to question your eating disorder thoughts, your own thoughts start to become clearer and in the foreground more frequently.

◦ It doesn’t take much for your ED to lure you back, a slip or relapse happens. But you learn from them and each slip you get wiser. Recovery gets stronger, you get stronger.

◦ Now you really want this, recovery feels achievable . You begin to see who you really are, what your life can be without this hitchhiker. You remain vigilant and know how recovery can look and you make it your mission to not go back. You’ve got this. Your actions and thoughts are all protective of your recovery, you have worked harder than anyone will ever know to be here.

Recovery is always possible, no matter how deeply trapped, lost or afraid you feel. Wake up, and rejoin the world, you deserve a full life and the world deserves to have you in it.

Check out the links below for seeking support/ starting the conversation:

  1. https://www.beateatingdisorders.org.uk/recovery-information/tell-someone
  2. https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/how-to-talk-to-a-loved-one
  3. https://www.ed.org.nz/getting-help/what-to-do/

Strength in vulnerability.

“Strength in vulnerability” Sound like opposites to you?

I have lived my entire life holding this belief. With the sense that showing vulnerability was demonstrating weakness. How incorrect this belief is.

From the wise words of Brenè Brown:

“Vulnerability is the birthplace of love, belonging, joy,courage, empathy, and creativity. It is the source of hope, empathy, accountability and authenticity. If we want greater clarity in our purpose or deeper more meaningful spiritual lives, vulnerability is the path.” (1)

This concept is a difficult one, when we have spent our entire lives believing weakness and vulnerability are one of the same.

But for me, I didn’t truly understand the meaning of vulnerability. Why is it such a difficult emotion for us to experience, why do we numb it?

Brenè Brown defines vulnerability as “uncertainty, risk and emotional exposure”.(1) I feel this depicts eating disorder recovery in one sentence, it’s beautiful; and it’s true.

People in recovery are anything but weak, I am yet to meet or speak to someone with an eating disorder who I consider weak. The people I have come across are some of the strongest, kindest, most resilient people I’ve encountered on all parts of my life.

Eating disorders are encompassed by guilt, shame and fear of being vulnerable. Feelings and emotions are viewed as weakness. During recovery, emotions that had been buried, lost or numbed are reclaimed and owned. Sometimes, all at once!! Some days in early recovery it’s a cluster fuck of emotions. Recovery is learning to tolerate these emotions and not numb out. This is embracing vulnerability.

Vulnerability for me has been, fear of being perceived as weak, judged, failure or a disappointment.

My eating disorder numbed everything,including these feelings but at the cost of all my positive emotions.

Exploring vulnerability has opened up my authentic self. I have never felt so vulnerable than these past 18 months, admitting my imperfections, my shadows.

I don’t see vulnerability as a negative now. It’s neither positive or negative, it’s just part of what makes us all human.

“Imperfections are not inadequacies; they are reminders that we’re all in this together.”(2)

Why shouldn’t we show vulnerability if it’s the foundations of how connections are made, creativity and passion is discovered? Connection can overshadow shame.

Yesterday I did something I would have never imagined myself doing, even a few months ago.

I shared my experience with anorexia publicly on my personal facebook account. It’s National Eating Disorder Awareness (NEDA) week in the US, which will be followed by the UK and Australasia next week. And So I decided, why not share my most “feared” secret with the hope of encouraging others to seek help, de-bunk myths and stigma and challenge attitudes.

I’m not going to pretend it was easy. It was more terrifying than either of the bungee jumps, sky dives I’ve done. Not nearly as scary as starting recovery, which is why I felt so compelled to do this . I know I am not alone but I am lucky, so lucky I have had help and support. It took nearly 2 decades to seek the help, which is sad, because this is not uncommon.

If my share changes one attitude, helps one person reach out for help then a little bit of fear is nothing. I’m fortunate I have found my voice. Many people remain struggling in silence. I’m not advising everyone to share their stories. It’s taken a long time for me to reach a place of acceptance and resilience. I know there will be some negativity from sharing such. It will come from ignorance. I feel equipped to deal with these because the majority of responses have been positive and most importantly I didn’t do it for the external validation. I am happy enough with who I am, I did it for those who are not. Those battling stigma and shame everyday.

There’s tons of ways to raise awareness for a subject, not everyone will comfortable with sharing personal accounts and that is ok. Have a look at some of the links below, NEDA and BEAT of how we can raise awareness and fight stigma.

For a deeper look at vulnerability, shame and guilt I recommend checking out:

1. Brenè Brown: TED-Ed https://youtu.be/iCvmsMzlF7o

2. Brenè Brown: Book; https://www.amazon.com/Daring-Greatly-Courage-Vulnerable-Transforms/dp/1592408419

3. NEDA awareness week: https://www.integratedeating.com/blog/2021/2/22/national-eating-disorders-awareness-week-2021

https://www.nationaleatingdisorders.org

4. BEAT: https://www.beateatingdisorders.org.uk/edaw

References:

1. Brene Brown (2017). Daring Greatly : How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead. Penguin Random House Audio Publishing Group.

2. Brenè Brown: The Gifts of imperfections.