#Stigma

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?

What’s up Doc?

What’s up Doc?

This is a slightly different post to my usual.

I want to talk about well-being amongst healthcare professionals.

The people that look after you when you are sick are humans too but it can be hard to view them as anything more than the doctor/ nurse/ psychologist in front of you. They have a life outside of the workplace, they have their own families, insecurities and problems.

Doctors, nurses, first responders & all members of the healthcare profession make huge sacrifices for their patients and do so willingly.

But who looks after them?

Mental health problems amongst medical personnel is at an all time high. If we don’t look after our healers they can’t look after you.

Yet, we are a profession that is notoriously bad at seeking help for ourselves. It’s a common theme of jokes “doctors/ nurses make the worst patients”. We provide diligence to our patients but it’s a hard pill for us to swallow when we need help ourselves.

What are some of the reasons behind the resistance for a healthcare worker to seek the same help they provide without a second thought?

A study published by the lancet offered several reasons for this.

An old fashioned and harmful rhetoric that still bleeds into the healthcare industry: “we don’t get sick, we treat the sick”. It’s hard for healthcare workers to accept they are not infallible and often this narrative alone prevents them from seeking help, often meaning problems are advanced by the time the do access care.

The well-being of doctors is becoming increasing challenged.

The medical field is an unusual one.

For most of us, we give up our twenties to dedicate ourselves to studying or long hours working as junior doctors. We are often forced to make difficult balances, missing out on important life events and socializing because of the restraints of the profession. It’s not uncommon to battle to get leave for major events such as weddings or funerals.

Often, we can’t just go home when our work day is supposed to finish because we are looking after someone in their moment of need. We stay late because we care.

But this can come at a cost.

Our contracts can mean constant changes, junior doctors move around every 4 months, sometimes this means transferring miles away from your loved ones. This can make things like registering with a general practitioner difficult.

Long shifts, antisocial hours, plugging gaps in rosters, studying for endless exams and extracurricular activities can take their toll both mentally and physically.

Often these are accompanied with limited access to healthy food or basic self care including rest, relaxation or exercise.

There is an undertone within the healthcare profession that being anything less than perfect 24/7 is failure. Fear of disclosure and the implications it may have on our license to practice I’m sure is a common barrier to seeking help.

Doctors have an increased rate of suicide compared with any other profession, high rates of mental illness, including depression, anxiety, burnout, imposter syndrome and substance abuse. But it doesn’t get talked about. It remains “taboo”.

The resources for help aren’t made readily accessible, the encouragement to seek help is virtually non existent. This needs to change as early as medical school training. This needs to be openly discussed and normalized. Otherwise the stigma stays and nothing changes.

Doctors are making life or death emotionally demanding decisions. This is what being a doctor is. But sometimes the weight of these decisions is enormous without resources to help.

The threat of litigation is real, the trauma of some of the decisions they face, with often no debrief or acknowledgement of the enormity of these decisions.

Burnout rates are increasing.

Dealing with uncertainty is something doctors become adept at, changes in rosters, no two days being the same.

Teamwork can be challenging when there is conflict between management and the frontline workers or finite resources.

It’s not uncommon to come across bullying and not enough is done to mitigate or reduce this.

If you are a healthcare professional what were the barriers you faced to seeking help? I’d love to hear your experiences

What do you think needs to happen to protect our community’s wellbeing? How can we do this?

There are some charities that exist but again they’re not widely known about. I’ll share some links below. If you know of other’s please share.

References:

Eating disorders, Stigma and Labelling..

Stigma has many definitions and layers.

But from my A-level psychology days the works of a psychologist Goffman defined it as an attribute that is “deeply discrediting’and reduces the bearer from “whole, to a tainted version” of themselves. Though much of his theory has been disputed most still accept this part of the definition.Goffman definition

“n. Stigma; the negative social attitude attached to a characteristic of an individual that may be regarded as a mental, physical, or social deficiency. A stigma implies social disapproval and can lead unfairly to discrimination against and exclusion of the individual’. Definition

Stigma is not a new concept, dating back to Ancient Greek and Latin, where it’s common meaning “a mark, or “sign of” as well as ‘to brand undesirable”, hence the origin of the word.

Labelling has been an area of great debate for decades. Various psychologists and sociologists have attempted to argue in favour of labelling and it’s impact upon stigma or refute it. Each arguing different consequences of labelling.

Regardless, one thing I have witnessed as someone with an eating disorder is a fear of attaching a label and the stigma associated with it. The reason I am writing this was prompted by a discussion with someone within the ED recovery community this week. They themselves were struggling with the label they had just been given at diagnosis. I recall vividly feeling this way, it served as a barrier to me seeking help.

It reminded me of my very first appointment with my then therapist. After completing the EDE-Q questionnaire and the weigh in, she said with conviction “You have anorexia nervosa”

I remember practically begging her to not attach “the label”, it meant everything to me, to not have this “blemish the tarnish” on my record. It felt dirty, shameful. Even though, I had know myself, in the moments free of the anasognosia I had had Anorexia for many years but NO one had formally named it, labelled it, discriminated against me for it. Suddenly this would be the first thing doctors saw on my record. It mattered.

This fear appears to be a common amongst many fellow eating disorder sufferers. I expect, though I cannot blanketly say so, for many other mental health issues.

Labelling has been attached to concepts including, self-fulfilling prophecy, stereotyping and stigma. Suggesting close interconnection. Labelling theory broadly states people behave or identify in ways that society or people have labelled them. This can also work on a societal level that people develop stereotypes attached to a label and expect specific behavioural patterns attached to those with a label. This can have positive or negative consequences.

Lending itself to the self-fufilling prophecy whereby an expectation results in fulfillment of embodying the label.

As these roles tend to be “deviant” from the societal norm stigmas can develop. These are derived from negative stereotypes and thus resulting prejudices and discrimination result.

The structure of stigma can then be further categorised into self stigma, label avoidance, public stigma, social and structural stigmas: ( this is by no way comprehensive and just my simpleton understanding). For this post I’m focussing on stigma within mental health.

There’s a breadth of information available pertaining to the many types, mechanisms and structures of stigma.

1. Self stigma: Self stigma impacts upon how you see yourself and your interpersonal relationships. Self stigma can be a barrier in recovery, in seeking help. It can distort perceptions of how you believe other people view you. An example in the case of anorexia might be: “ I am not worthy of help, seeking help makes me weak” self prejudices– “having an eating disorder is my fault, Why would anyone want to employ me, be friends with me”. Self-stigma and resulting discrimination: self-imposed isolation, the person cuts off from world and opportunities, including help)

2. Label avoidance: An individual may be aware of stigma surrounding a particular diagnosis and thus engages in behaviours to avoid the label. With respect to eating disorders this might look like: “having a diagnosis will mean I am vain, or I chose this “lifestyle” so they avoid seeing a heath professional. Prejudices that result- ‘I am ashamed to have an eating disorder, to be seen as someone with anorexia’. Discrimination: Concealing the “label” from my family or employer and therefore not being able to attend important appointments, because I am afraid I will lose respect and my career. The best way to combat this is through finding your voice, self-disclosure. This may be through sharing your diagnosis with a small circle or friends, family or being open to talking more broadly. (This is very personal)

3. Public stigma: Where general beliefs and prejudices are affirmed to a marginalised group ultimately leading to discrimination towards them. ‘People with eating disorders are vain, People choose to have eating disorders’. Prejudices may manifest as; employers are worried to employ the person, as they may fear their mental health makes them unreliable. Discrimination may result in a person not being employed.

4. Societal/ Structural stigma: this refers to policies invoked by large organisations or systems such as governments, health facilities that lay down restrictions on opportunities and rights of those with mental illness. An excellent example of this is weight stigma. The DSM-V label of atypical anorexia. Where this diagnosis is exactly the same in terms of criteria as anorexia with one difference the sufferer is not of a low BMI. The prejudice- fat people cannot experience as severe symptoms or implications as those who are underweight. Which is not the case. The discrimination that may result; many people living in larger bodies are denied access to health care or resources because of their size. This is a big one. Structural stigma is the one that affects marginalised communities. It’s interconnected to societal stigma. How we address this is through education, challenging the narrative. But it takes time.

There are MANY types of stigma and I have barely touched the surface. My aim was merely to shed light on how public, structural and self stigma are closely interlinked and can serve as a barrier to those with mental health problems from seeking help. Understanding the origins of stigma means we can continue to break down the cross links within it. My hope is that one day, no one will fear seeking help or a diagnosis because the label will not hold power.

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.

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

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.

You are NOT your Eating Disorder…

You are not “anorexic, or insert ED”

It’s never been you.

You have experienced anorexia/ bulimia, BED

It has been with you.

I recently shared a post on instagram after hearing a person with an eating disorder referred to as their disorder. “They’re bulimic”

It infuriated me. I wanted to remind that individual “they are not their eating disorder” It’s hard enough for the person to seperate themselves from this idea without it being fuelled externally. It continues the shame and stigma attached to these complex disorders.

I see this identity as the sufferer playing underdog to their eating disorder, but that does not mean they are that disorder. Most times the underdog prevails eventually.

This notion was something really important for me to hear when I first started the recovery process. From day one my therapist repeated this mantra, that I was not my eating disorder. Even when I didn’t see it or believe it.

We often attach our identities to the the eating disorder, because we have lost touch with who we truly are. That does not make the identity true or real.

Still not convinced? Picture this. You would not call a person suffering from cancer, “cancer”. The principle is the same for us experiencing an eating disorder. A person is not “cancer” anymore than a person is “anorexia, bulimia or Binge eating disorder” You have an eating disorder, it is not you.

When we embark on recovery, there maybe times where it is easier for the person to hold on to that identity whilst discovering who they are without that disorder. REGARDLESS, It is still helpful to be reminded that they are not their disorder. The disorder is acting as their safety blanket. Of course, early in recovery you will return to the safety of that blanket. But it’s a blanket, it is not part of you. Eventually you don’t need the warmth the blanket offers.

During recovery I think it’s important to explore who you want to become? Who is that identity?

Picturing who I want to be, what I want my life to look like helps me stay in recovery from anorexia. It helped me to see myself separately to the disorder I was fighting. Our values are completely incongruous. I don’t have all the answers and I’m still learning. That’s recovery and growth.

When we are amidst the throws of an eating disorder, for most of us our world becomes very small. There’s very little room for anything beyond- food, exercise and concerns with these. It’s all consuming and incredibly isolating. But- it’s not really what most people want from life.

Eating disorders restrict EVERYTHING.

Who wants to be 80 years old and look back on their life, and all it’s filled with is fear and anxiety over eating, body image, exercise. None of it matters. If we are lucky to reach an old age I want to look back on what my life was filled with, not an eating disorder. It is never too late to make this change. I don’t care if you have been the underdog to your eating disorder for 50 years, there is always hope you can recover.

My journal has been my haven for my recovery but also exploring who this recovered person is, what her goals, aspirations, values and worth are.

I promise you, my recovered self is not fixated on dietary restraint, exercise or control over shape. My recovered self is loud, doesn’t care for other people’s judgements, grateful for the process of getting from A-B and not just being at B.

That brings me onto my next point. G. R. A. T. I. T. U. D. E…

It is easy when we are having a tough time to focus on the negatives. But one thing I have learnt from recovery is there is always something to be grateful for. Even in the darkest of times when you don’t feel there is anything to be grateful about. There will be. Start small on those days. Gratitude, has really helped me ground myself and shift from the “all or nothing” thinking we so often experience with eating disorders. Black and white thinking is a prominent trait we share. I promise you, if you give gratitude practice a go, it’s very hard to stay in a negative space. I make it a daily practice now. I get it, you think I’m full of crap. I thought the person who suggested it to me was too. I thought it was hippy bull crap and I’d be making daisy chains. No.

Try this…

Everyday for a week, think of at least 2 things you are grateful for. It can be as big as you want or small as you want. Aim to build up to more than 2. Some days this will feel harder than others. It’s these days you need to find things. The way you see yourself and the world around you will improve.

You will discover your life beyond they eating disorder even if you don’t see it now.

But for those who need to hear it again… “You are not your eating disorder”

Please people stop it with the before and after pictures.

Before and after pictures are harmful on so many levels.

Firstly you see the diet industry, so called “wellness” industry’s using pictures to market their false products.

The premise of the so called before and after picture in this setting, suggests that image and weight is the marker of health. Which people, if you have read any of my blogs or IG posts you know this is bullshit. Like the Bullshit Mass Index (BMI).

None of these elements reflect a persons health and the idea that manipulating your body, or image is a way to get healthy in most instances is simply ludicrous.

Before and after pictures in the eating disorder community are extremely dangerous. They are often posted on social media. Without a trigger warning, monitoring and to the most vulnerable of audiences. They serve no place in recovery. Why?

1. It promotes the unhelpful myth that eating disorders affect only the emaciated. Sadly this is still the image the media portrays of someone struggling with an eating disorder. Which is not helping to raise awareness, reduce stigma or educate about Health At Every Size.

2. They inadvertently promote ‘thinspiration’. For those of you not familiar with this colloquialism it’s a term well recognized in the eating disorder community that encourages thinness and can lead to very unhealthy comparisons and behaviors. For this reason alone no matter how well intentioned before and after pictures are dangerous.

3. Just because someone has gained some weight, or lost it’s not reflection of health status. You have no idea of the physical or mental state behind the picture.

4. The can invalidate a person’s recovery. Seeing someone’s pictures may make an individual question their recovery and why they haven’t “recovered” like the post. The pictures do not portray the enormous effort, energy and mental struggle involved in recovery. They are not true depictions.

I have written on previous posts, mentally I was at my most screwed up, difficult place when I first weight restored. To show a before and after picture at this point declaring my “recovery” would have been incredibly inaccurate. This is not helping to raise awareness that weight restoration is only part of the recovery process. Mental recovery takes far longer.

When all consumed by my eating disorder there was barely a day went by that I didn’t take a photo to “check” my progress. It was almost a big of an issue as the scales and weighing. People with eating disorders use the camera as a form of body checking. Body checking is not a healthy behavior and does not help in recovery.

Photos-are personal. For some people keeping photos of themself at their sickest can maybe act as a reality check, or reminder of why they recovered. For others I can imagine it would be detrimental, like holding on to “sick clothes” regardless the photos should never be shared to show ‘before and after’.

Social media is a mind field for ‘before and after photos’ and it’s feeding the fat shaming, stigmatizing society we live in. So please if you’re thinking of posting a before and after pic, think before you do.

Why and who are you really doing it for, what message are you really trying to convey? If in doubt don’t share.

Medical education needs to change. Weight stigma is taught.

Healthcare professionals are not infallible and have their own biases

Apologies in advance for probably a relatively ranty post.

I am not considered overweight, I have been at the complete opposite end of the spectrum and have been often rewarded by health care professionals for being “healthy” when I was slowly killing myself.

When I was considered emaciated this positive reinforcement shifted, I met a lot of stigma from healthcare professionals.

Today I have just experienced horrific weight bias whilst at a medical appointment. A nurse who had my medical record on screen, open in front of us displaying my history: Anorexia nervosa.

Whilst I sat there she began to discuss how next week brings the onslaught of patients booking in for weight maintenance, counselling after “over indulging in the holidays”. She was clearly ignoring this history. She continued with her opinions and judgements regarding patients eating “bad foods” and expecting to lose weight.

My response was somewhat blunt, probably rude. I wish I was brave enough to point out my history but instead I shared my very anti-diet views. Explaining I do not believe in the multi million dollar industry that promotes dieting. I explained if there was a diet that genuinely worked the industry would not be in business. If people successfully reach their goals and stayed there there would be no diet industry. But I explained that simply doesn’t happen and leads to obesity. She went on to demonise foods. To me.

She started talking about a group of people who exercise every day “and aren’t overweight” and do not lose weight. She stated it’s because they aren’t dieting with it. “You can’t do one and not the other” if you cut out rubbish you will easily lose weight she went on to express. She told me how cutting out “unhealthy food, sugar” it’s easy to lose weight.

At this point I was like, are you fucking serious. You’re sat telling a patient in recovery from anorexia about losing weight and demonising foods and promoting the idea that weight gain is to be feared by anyone.

Again, I wish I had felt stronger to call her out. But there’s still a part of me that can’t quite do this in an non anonymous setting. I will get there.

It got me thinking and really feeling for patients. If someone with a history of anorexia, not that long in recovery and not overweight can be subjected to this. Then people who are considered “over weight” according to a BULLSHIT MEDICAL INDEX scale, aka BMI then this is horrendous. We are terrible in the health industry and really under educated in this area. This is one of the reasons I started this blog. To educate and reduce biases in health, society and reduce stigma.

Stigma does occur in very low weight too. When I was very unwell, doctors told me I was irresponsible, like it was a choice. I was marched across busy waiting rooms and made to step on the scales in front of audiences and then condemned publically if I’d lost weight or not gained. I remember one occasion being made to walk up and down a corridor (waiting area) by a GP to make sure my heart wasn’t failing, and saying aloud if you don’t put on weight by the next review you will be forced to be admitted. This is fucking awful when I think about it now.

Scales can be terrifying to someone with an eating disorder ( or no eating disorder)

If you are a healthcare professional: keep your own biases and fear of weight gain to yourself.

If you are knowingly looking after someone with an eating disorder it is highly inappropriate to make them step on scales with an audience, if you must weigh someone keep it neutral without judgment. Scales are one of the scariest things you can ever imagine for someone with an eating disorder, underweight or overweight. In my opinion scales in a hospital or doctors should not be in a public area.

If you have ever experienced stigma, judgement by a healthcare professional I am truly sorry. One day I hope we can shift the narrative. If you feel brave enough and you find yourself in a similar situation to that of mine today, please speak up. I promise I will try to myself next time.

Navigating recovery…recovery beyond Eating disorder “treatment”

Navigating anorexia recovery

I believe there are many milestones in eating disorder recovery. For starters the first day of entering recovery, this is always going to be the biggest. Monumental. Then after that there are thousands of milestones (some more like marathon check-points). Like the first time we conquer a fear food, and then reach the check point of there not being fear foods. So many. Getting your first period (if you lost it/never had), then its recurrence becoming so normal and boring and moaning about it like the general population. But what about when ‘our formal support’ becomes less required?

For those of us fortunate enough to have quidance, follow a treatment plan or having a coach etc, maybe it helps path the way. But, regardless for the most part, your recovery belongs to you. Own it!

I graduated from “regular recovery support” today. Feel like I have my big girl pants (pun very much intended). I have completed CBT-E, MANTRA and have now reached a point with my therapist (OT) to move to “check-ins” rather than scheduled, regular sessions or following some kind of plan.

I know for some people navigating the world beyond regular support, is scary and daunting. I get it, it means YOU are accountable for the ongoing recovery process. But that’s pretty cool right? You have gotten far enough into recovery to be able to make healthy decisions for your recovery. You’re moving towards full recovery and this is another check-point smashed!! That’s the way I’m viewing it. Part of recovery is learning to “cope” in an informal way, that’s life.

Just because my ‘regular’ sessions are finished does not mean I can’t continue growing my support network or learning. One of the things I’ve recently found to be instrumental to my mental shift is connecting with others who have had similar struggles, are struggling or recovered. There is tons of support, whether it’s real connection, following people’s blogs, podcasts or joining a support group, they all help to validate how we feel and strengthen our healthy self. So I’m not nervous about not having regular appointments. I’m proud I’ve gotten here. I’m grateful. If I can get here, I believe anyone can, because I never believed it at the start.

However, I am anxious regarding the next challenge in my life. Something I think for anyone who hasn’t had an eating disorder finds challenging anyway. That’s getting pregnant, becoming a parent. This is another area I think in medicine that doesn’t get spoken about or shared much. What happens when someone in recovery gets pregnant? Is it wise? Should O&G teams be aware? Do they ask or look for history of eating disorders?

I wanted to wait until I was solid into my recovery and even still I worry. I worry if the child will be small, pre-term, miscarry. Will I stay on track?

For my partner and me, having a family has been something we have always wanted. For reasons not related to my eating disorder, fertility is a difficult issue which I won’t go in to.

We are about to embark on IVF. This is something I haven’t entered into lightly, I’m all too aware of what’s required in the IVF process, the follicle stimulation, multiple hormones. This I’m sure is hard in a normal setting, but for those of us with significant body image issues to begin with, these issues need to be factored into planning. Hopefully help prepare the person for the changes and enable them to remain accountable. Support, hopefully can help to prevent slips.

Next issue, if we are fortunate enough to get pregnant… avoiding energy deficit. Some people experience nausea (both during fertility treatment and then in pregnancy). Hyperemesis gravidarum (aka morning sickness) this is not a good situation for someone with a restrictive eating disorder. Breast feeding post-partum.

Our bodies change throughout pregnancy. This is a fact. Something I am trying hard to prepare for. I feel going through the weight-restoration phase of recovery helps this, perhaps. My body has changed beyond any prior recognition and that’s ok, and I don’t even have a baby to care for and love. Or to explain my pregnant looking belly, aka recovery belly. I like to think that having a child will mean that none of the ‘HH’ thoughts will matter, because that child will be the most important, most amazing achievement I will ever have. But I wanted to share this because people with eating disorders go through pregnancy. It never gets spoken about and I don’t know whether we look for it in medicine. I think people could have help and support. I expect there are many people with eating disorders too afraid to share their struggle with the medical team, for fear of judgement, lack of understanding. What will I do?

Not really sure what the point of this post is, other than I’m happy to be here. I hope if you’re reading this and perhaps your treatment has just ended and you’re freaking out, or you’re starting recovery alone or with help, you can just know that there’s support available. Support doesn’t have to be formal or structured and remember celebrate the milestones. Navigating this is like an ultra-marathon but with no clear finish line.

Some online support groups and resources….

1. Beat eating disorders UK: https://www.google.co.nz/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjxuaHD3a7tAhX2yDgGHUGiCXcQFjAAegQIAxAD&url=https%3A%2F%2Fwww.beateatingdisorders.org.uk%2Fsupport-services%2Fonline-groups&usg=AOvVaw2LpFetlZFjVyKJ6Sg1WWaX

2. Recovery warriors (Australia):eatingdisordersqueensland.org.au

3. Various options US: https://centerfordiscovery.com/groups/

4. EDANZ: New Zealand. Various resources. https://www.ed.org.nz/parent-carer-support-groups

SHOULD, is not a nice word..

Photo by Noelle Otto on Pexels.com

Should has no place in most daily language, but especially not in eating disorder recovery

Should implies rules, an obligation. That word is the reason I’m sat on my ass writing this. I was looking forward to going for a run, or joining my husband at boxfit tonight. However throughout the day at work I started to feel tired and that what I probably needed was to chill out with the cat.

Then that sneaky SHOULD word crept into the foreground. I heard my thoughts say “you should go tonight, you’ve not done anything all week”

That was the point I decided I will not exercise today. Exercise should be a priveledge/ pleasure, not a punishment.

This “SHOULD” demand was from my eating disorder, “HH” thinks I should exercise today, but that’s the very reason why not. A few months ago, I would have acted on this demand, the next day I would find it harder to eat or I’d feel more anxious about what I was eating.

Now I move my body because I want to, because it feels good, not because I feel I have to. The discomfort I used to feel if I missed a day of exercise was insurmountable before. I have to really listen to where the intent is from, whether it’s my voice, or ’HH’s.

I’m feeling proud, I can sit here and write this, instead of dragging my butt out to torture myself without enjoyment. Because I know when I truly want to move/ exercise it’s for me and not for the service of ‘HH’.

I have been a runner all my life. One of my favourite things even a a tiny child, before the days of my eating disorder was to go outside in the rain. As I got a bit older, if my athletics session was a wet session it was like Christmas for me! I loved the feel of the rain and being hot and the smell of it on the track or grass. Then ’HH’ showed up some years later. And my running, exercise was no longer for me, for the fun. It was all about targets, shifting goal posts that I would never be satisfied with.

It would be like the world ended if I had to miss a day, or I’d exercise when I was injured, sick and obviously that’s not fun. I’ve had to work really hard in my recovery to re-kindle my healthy relationship with movement, channeling that child who loved running in the rain and not the crazy person running in gale force winds/ all weathers all hours.

I took a period of abstinence, but not an extended period. I had a good support to help me workout where the intent was from. Some days I had meltdowns when I knew it wasn’t my healthy self and had to abstain. But doing that has got me here. If it feels wrong it is wrong. Exercise/movement is never meant to feel shameful, guilt driven (pre or post), like a chore. It’s a pleasure/ priveledge. Today was a day I know it was not for me, rather for ‘HH’. One day by continuing to listen to my healthy voice over and over, ‘HH’ won’t suggest I move when I don’t want to. The voice will be gone.

Challenge, Practice, Repeat…..Recover I hope.

Today was definitely helped by ‘Recovery Warriors” resources. Check out The Recovery Warriors app, website. They are currently holding a ‘holiday special” with lots of useful resources and videos etc. https://www.truewarrior.me/holiday-support

https://www.instagram.com/recovrywarriors/

Eating Disorder Recovery – Recovery Warriors
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Clothes shopping in eating disorder recovery…

Phases of clothes shopping through recovery is Like “the origins of man” demonstrated by this spongebob gif!

I went clothes shopping last week. No one tells you how hard this experience is in recovery.

I decided to charity shop my “skinny” clothes. I will never need them again. It’s almost like a grieving process. I never liked how I looked at my lowest weight. I was self conscious. But buying small clothes was something my ED used as targets. Although I never felt better when I met them. I actually felt worse and worse, especially when nothing actually fit. When I started gaining weight, “HH” freaked out. Suddenly nothing fit and I felt self conscious all over again.

EDs will try and make you hold on to old behaviors or reminders of it. For me it was keeping these clothes “just in case” but they were holding me back. How can you recover with the thought you might one day fit in the clothes that fit when you are nowhere near your natural body shape or size. You can’t stay there. Not healthily anyway.

Buying clothes throughout the “weight restoration phase” is traumatic. I would recommend if you’re going through it, you don’t do it alone. It’s triggering no matter how far in you are or how committed. I would say this corresponds to the third picture in the gif. You are in no mans land. You’re not in the emaciated shell, you have fat in weird places so it’s hard to find things that fit and feel comfortable.

I went with a friend I could trust and my husband. I asked them to ask me questions like, how I felt in the clothes rather than making comments about appearance or fit. I looked for clothes I’d feel comfortable in at this stage in my recovery where my weight isn’t evenly distributed. Clothes that would accentuate other features that I’m less insecure with. For me this was flowy dresses. I have spent a long time in clothes hiding my weight for the other reason. I don’t want to hide my shape at all now, but I do want to feel comfortable. ‘HH’ longs for the old clothes but healthy me sees it a triumph of how far I’ve come.

You don’t have to like your body, I have become relatively neutral towards it. However uneven distribution, clothes shopping with size tags, mirrors is not fun. I also only bought a few things I really needed rather than a whole new wardrobe.

I didn’t do it all at once and checked in regularly. I talked through my HH thoughts with my psychologist.

Last week I went shopping on my own. It wasn’t that hard. It doesn’t need to be hard. Plan what you need, check in with your support and look after yourself.

Reckon this stage 4th sponge bob on the gif. Powering through, accepting the changes. Grateful for what you can do in your body and with your recovered body. Don’t think it’s necessary to love your body but if you do that’s a win and definitely the last sponge bob on the gif.

My Story.

Chances are if you’ve stumbled upon this page, you’re like me. Searching for answers, help, validation, recovery from an unhealthy relationship with food, body image. Other wise you would not be here. Maybe you still tell yourself , you’re fine and don’t have a problem, but looking for recovery blogs/ sites is not normal. Or, perhaps you know you have a problem with food, exercise, restriction, body image and you want to RECOVER.

There is no shame in asking for support…

Whether you are contemplating seeking help for starting recovery or just needing extra support in recovery, there is NO shame in this.

My mother in-law reminded me of this just this week. I just came off nights. ( I am a doctor). During those nights I received a nightly text from her “ have you stopped and snacked yet, it’s very important munchkin” I am incredibly grateful for this, this love and support really helped in moments where it could have been easy to listen to the ED voice. There are times like nights, times of stress and busyness where I need a little support and I’m not ashamed. On these days I celebrate little victories and focus on gratitude, like how grateful I am to have this person rooting for me.

Eating disorder recovery is hard. It is the hardest thing I have ever done, likely the hardest thing I will ever do.

Anorexia crept into my life slowly and in a surreptitious manner. It took me a long time before I saw it there and I remained in denial for even longer.

I became a hollow shell of myself. My eating disorder overshadowed my entire being.

I started running when I was 11, this was my happy place. I had always been a happy, bubbly easy going child. I first recall feeling uncomfortable in my skin when I was mid teens, following comments from some boys at school about my ‘muscled arms’. It didn’t lead to me doing anything about it and I also didn’t really care about being thin at this time. I suppose the comment began to chip away at my subconscious and wear me down. Eventually athletics training became a way I could hide my disorder.

I remember becoming very health conscious and cutting food groups out of my diet as early as 14, I deemed bread and chips to be “unhealthy” and I cut them out of my diet. I was confused at the time why I was doing this, but I passionately believed this was the right thing to do and I remember telling my parents I no longer ate bread or chips because “I didn’t like them”. The first time I noticed my rigidity was a family holiday and instead of enjoying these foods I refused them despite my best friend at the time and parents trying to persuade me otherwise and I remember feeling “clean” and “good” for refusing. It became an addiction. Restriction became my drug.

This would become my norm and increasing rules and rituals cemented.

I was tired all of the time, I underwent extensive medical tests, yet my eating disorder at this time remained hidden from the spot light. I was diagnosed with a bone marrow disorder and this further overshadowed my eating disorder and fueled my need to control.

I would force myself to attend athletics training sessions despite feeling exhausted. I would eat right before training, knowing full well it would make me sick during the practice, and I would be praised for working hard.

No one could have stopped it happening. And the shitty thing about eating disorders by the time they are recognized they are already entrenched.

It wasn’t until almost a decade later when my eating disorder had robbed me of my personality and my health, I was forced to confront my demons. By now I was working as a medical doctor and there were times where in order to make important patient decisions it would take up any remaining energy I had left.

There were times where my vision would blur when I stood, if I stood for long periods or too fast I would pass out. Still I refused to acknowledge the eating disorder’s presence.

No matter the appointments I attended, the eating disorder was so entrenched in me by this time I was still losing weight. The eating disorder would gaslight me, telling me I didn’t actually have a problem, it wasn’t a big deal. My mental state was deteriorating. The smaller I got, the narrower and more warped my view of the world became.

Threatened with being sectioned I knew I needed to fight for something.

My husband was incredibly supportive and so determined to help me get better. I wanted so much to make him happy and give him back a life, and so I fought. I fought for him until I had the motivation to fight for myself.

Everything goes on hold when you are battling an eating disorder or supporting a loved one.

My husband would leave work at the drop of a hat to attend appointments and support me at meal times.

Life paused because of my eating disorder. The shame and guilt of this is insurmountable and weighs heavy. The only way I could improve this, was to fight for my recovery and get better. And so I fought. Sometimes I fought bite by bite, meal by meal. Eventually it becomes less of a battle.

Sadly there is very little in my history that is unique because those of us that have been through an eating disorder share many similarities.

One thing I am aware of, was my privilege to seek help, when so many others are not so fortunate. It was through seeing this I found a new motivation of recovery, to give back. To use what I had learnt in a productive way to help others. This is one of the reasons I started this blog. Reading other people’s lived experience has been so instrumental in my own recovery.

I was so buried in my eating disorder I believed that was my brain. It’s a brain that goes against everything you believe in and convinces you it’s the only thing that matters. It convinced me my life’s purpose was to count numbers, control my intake, shrink my body and my worth was measured solely on rigidly following these. It made me believe there was no life beyond this.

There were times where, I was terrified of carbs, which became dairy, which became fats and ultimately food. Literally every food group became terrifying. Thank you diet culture, I say with upmost venom behind that.

One of the ways of overcoming my eating disorder misconceptions was learning why I needed each food group. Removing any vocabulary that demonized any food. Seeing all food as equal. Bite by bite this became easier. There are still times where my eating disorder tries to complicate things, to lure me back to believe the fears. I remind myself of my truth and my reason for fighting in these moments. I reject diet culture in all forms.

Developing confidence in my own decisions around food and body and knowing what I am doing has been huge in my recovery. I am no longer being reliant on a team. I am trusting myself more with each day.

Our lives have gradually returned to “normal” if not more enriched for the struggle we have overcome. Life holds so much value to me now, having nearly lost it I’m incredibly grateful to be here.

One of the worst parts of starting recovery was telling my parents. It took me so long to muster up the courage to talk to them about it. I was so afraid of their disappointment, they wouldn’t understand and would make me feel I had done something wrong. One thing I have learned is you don’t need people to understand, because, realistically very few can unless they have walked the path of an eating disorder. Support and love & compassion are qualities that really assist you. Learning to forgive yourself and set boundaries to build your close support network is something I have worked on during the recovery process.

Finding my voice in recovery has taken away much of the eating disorder’s power. It felt like each person I told I regained power. It forced the darkness of the eating disorder into the light. Removing a lot of the secrecy, shame and associated isolation. Having the eating disorder out in the open has forced me to be accountable. Sharing my struggle has given me the biggest gift of connecting with others.

I feel thankful to be here.

There is nothing about recovery I regret other than I didn’t choose it sooner. I promise it is worth the work and you won’t regret recovering.