Dear parent Of a child in eating disorder recovery: please don’t go on a diet

Dear parent, I have been seeing your child—both adolescent and adult—for the past few months for recovery from an eating disorder. We have been doing a lot of work together to introduce all types of foods in adequate amounts at regular times throughout the day. We’ve challenged many different food rules that have gotten in the way of your child being able to truly listen to their body and take care of it well. We’ve challenged fears around foods that are seen as “unhealthy” or might promote weight gain. We’ve worked on incorporating foods that they like regularly so that they feel competent around all foods. We have even worked on learning to accept their body’s natural size instead of fighting it and hating it. Your child has been making so much progress, but recently I’ve noticed a difference in your child’s anxiety around food and increase in the need to restrict quantities or types of foods. I’ve noticed your child go back to old behaviors that we’ve been working hard to decrease. And then I discovered what might be playing a role in that.

 
Dear parent of a child in eating disorder recovery
 

Your child told me that recently you chose to go on a diet (or “lifestyle change”) that includes cutting out some food group or macronutrient, eating only certain portion sizes, watching what you eat, or starting up a vigorous exercise routine. I get it—just as there are enormous pressures for your child’s body to look a certain way, there are enormous pressures for your body to look a certain way. You have been told that health is certain size and that you are more valuable at a smaller size. I know that your intentions are pure. But here’s the problem, it feels like complete hypocrisy for your child to be told that he or she can’t diet while you can. When she sees you dieting and pursuing a smaller body, she receives the message that restricting and getting smaller is something to be valued and pursued. The one thing she thinks makes her most important or allows her to best cope, she’s not allowed to do. She receives the message that certain foods are bad or unhealthy, and that she should avoid them. She receives the message that she shouldn’t trust herself around food. I know that your new eating style seems innocent enough or you may even think you’re hiding it, but you’re not. Your child notices when you leave the bun off your burger. Your child notices when you skip on dessert every time while the rest of the family is eating it. Your child notices when there are no “fun foods” in the cabinets or when there are “healthy” food replacements in the fridge. Your child is hyperaware of every bite that goes into her body and yours. Unfortunately, your diet is brining feels of jealousy, inadequacy, guilt, and shame because your child is “less than” for no longer trying to change her body or restrict her food intake.

 
Dear parent with a child in eating disorder recovery
 

What your child really needs is an environment where food freedom and flexibility is encouraged. They need support at meal times to eat scary foods or scary amounts of foods. Eating food with someone is a lot easier than eating it alone. It gives them a sense of permission if you’re doing it as well. I’m not saying that you have to eat every meal with them or match their intake, because they do need to learn to take care of their own needs, which are different from everyone else’s around them. What they do need is an environment that is free from language about good and bad foods, who is losing weight, or guilt for food consumed. They need an environment that celebrates diverse bodies and celebrates people for who they are instead of what they look like.

Parents, I don’t want this letter to be condemning or shame-inducing. I don’t think you’re a bad parent for doing what everyone in our culture says is normal. But I do want you to see how your behaviors are impacting your child’s recovery. Home is place that should be the safest for your child to recover and I want you to be able to connect that environment with an environment that is free from weight loss pursuit. Please put aside your desire for weight loss and instead foster an environment where your child is fully supported for recovery—I promise, you’re child’s recovery is worth every “extra” pound.

 

*I mainly used the pronoun she, but know that I do not believe eating disorders only occur for females. I do not want to promote the belief that eating disorders only occur in females because it is a growing problem in the male population as well.

**If you struggle with knowing how to support a family member struggling with an eating disorder, check out the Parent Toolkit by NEDA, or schedule an appointment with your child’s therapist or dietitian to talk through how you can support them.

"Your weight doesn't determine your health"...but sometimes it does

I think it's pretty evident that I'm a non-diet and weight neutral dietitian if you follow me along on Instagram. I tell clients all the time that ultimately, I don't care where their weight ends up. In school I was taught about BMI, ideal body weight, and acceptable weight ranges. I DO use some of these to help determine a starting point for where I want my restrictive clients to end up, but ultimately they are simply equations that don't take into account varying shapes and sizes. And unfortunately, none of them allow for larger bodies to be considered okay. Thankfully, I now know that people can be healthy in a variety of shapes and sizes and that I simply cannot know the health of someone simply by looking at them. I also know that fat, fit people are far more likely to survive heart attacks, cancer, car accidents, etc than thinner, "normal" weight people. You can absolutely be healthy in a bigger body.

 
"Your weight doesn't determine your health"--but sometimes it does
 

So no, I ultimately don't care about people's weight. I care about their behaviors. I care about their mental wellbeing. I care about what's going on in their heart.  If a client is no longer restricting, listening to and honoring hunger signals and cravings, not manipulating food or exercise to control weight, having a normal period and other health indicators, and experiencing freedom with food, I don't care that their weight may be a few pounds lower than what I estimated. I also don't care if they are experiencing the above and are a few pounds heavier than I originally expected. The weight is not the ultimate issue, the heart and mind are. 

BUT, that doesn't mean that I believe you can pursue eating disorder recovery from anorexia and not gain weight in the process to becoming mentally healthy. No, ultimately the disorder is not about the body size. But the body size absolutely impacts the mind and it's ability to heal. We know that weight loss is a major trigger for the development of an eating disorder. It doesn't matter if the weight loss was intentional through dieting or unintentional through getting the stomach bug, mono, or other illness. For those that are predisposed, the weight loss seems to "flip a switch" in their brain that then tells them they need to move more and eat less. You can have someone who previously had no body image issues get sick, lose weight, and then become terrified of gaining weight and feel the need to restrict all of their eating. The more starved a person becomes the more preoccupied they become with their weight and the more fearful and anxious they become around food and their body. We also know that the more starved an individual is, the less they are able to think cognitively because their brain simply does not have enough energy to process everything properly. So it's two-fold, the starved brain can't think clearly due to lack of energy and it is stuck in the eating disorder mental illness. 

It's interesting when we think of restricting for some sort of event. The eating disorder brain convinces a person that they need to cut back on calories or increase exercise for some sort of event coming up, such as a special dinner, work party, etc so that they can eat freely and without stress because they've created some caloric margin. That seems to make sense--reduce calories earlier in the day or for a few days so that when the event comes and you eat more energy than normal, you don't have to stress about gaining weight because you'll be back at zero instead of the plus. But we find that is not the case. We find that if a person with anorexia restricts before an event (or several days before), that they actually experience MORE stress at the event, not less. The further they are in energy deficit, the more the brain tells them they need to restrict calories. The answer to creating less stress is eating more, so that the brain is not in further energy deficit.

 
Event restriction doesn't decrease anxiety
 

Clients who are gaining weight and getting their hunger signals back tell me all the time that they are concerned about gaining weight forever because their hunger is so strong. I get it--the brain is making you think about food ALL. THE. TIME. And that's because it and your body are starved. But once the body and brain are well fed, those constant thoughts about food, intense cravings, and intense hunger pangs lessen. However, this happens once the body reaches the point at which it is no longer in starvation or restriction. And this point may be higher than what they want it to be, what is deemed their ideal body weight, or a "healthy" BMI. Reaching a BMI of over 18.5 doesn't mean that the body is now healthy and where it wants to be. In fact, most people need to be well over it in order to be fully recovered. 

So, for those of you reading who are pursuing recovery from an eating disorder, you simply canNOT gain full recovery without adequately feeding your brain and gaining weight. If you're working with a therapist and hoping that you will have an aha moment without weight restoration, I'm here to tell you that it is very unlikely. You need to first gain the weight and THEN you will be able to do the brain/emotional work that is needed. You've got to get your weight to the point where the brain re-flips that switch so that it is no longer in the eating disorder mindset. It's interesting that the more weight you gain, the less you actually care about the size of your body and the less fearful you are around food. It's no surprise that research has shown that patients who discharge from in-patient treatment at a higher BMI have a higher success rate those who do not. The key is that you HAVE to get your body and brain out of energy deprivation. 

With my clients, I'm not looking for the point at which their body is healthy, I'm looking for the point at which their mind is. There is sometimes a difference. And if we want to see true eating disorder recovery, we as healthcare providers and caretakers need to throw out our fears and preconceived ideas that a person "should" be a certain size. We need to get rid of the fears of people being fat and instead care about the fact that they are healthy physically, mentally, and emotionally. I know the thought of gaining weight is terrifying for those of you stuck in your restrictive eating disorder, but the only way to truly get out is to start eating more and let your body decide where it needs to end up. 

 
Mental health is the goal, not just physical health
 

If you're struggling with restriction, bingeing, purging, or simply a stressful relationship with food, I am accepting virtual clients and would love to walk with you on your journey to eating disorder recovery.

2018: Not new you, but your best you

First of all, HAPPY NEW YEAR!!! It blows my mind that 2017 is already over. I’m incredibly excited about what lies ahead this year while still basking in the joy of the holidays these past few weeks. While thinking about this new year’s time, I started to think about all of the pressure that has been mounting for how we are suppose to change and become a version 2.0 in 2018 (woof, that’s way too much pressure for me). It seems as though our culture identifies growth or becoming a “better” person only with becoming thinner, fitter, and healthier. Yeeshh, what a narrow view—and one that often ends  in disappointment.

 
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So this year, I would like to propose a different goal for 2018—not becoming a more aesthetically pleasing person or a food-pious person, but instead to become the you you want to be (or used to be).   

Growing up, I was such a ham. I LOVED putting on plays and productions for family and friends. I thrived on attention. I was also super creative and enjoyed scrapbooking, making things out of clay, cutting hair (I had a life size Barbie doll head—kinda creepy when you think about it), building miniature towns from foam, and drawing. I was compassionate, and felt emotions strongly (I cried for WEEKS after seeing our high school’s production of flower’s for Algernon).

Somewhere along the way, those characteristics started to fade. My goofiness disappeared and was replaced with perfectionism and worry. My creativity was clouded by thinking more logically and analytically. My emotions were muted. In college I recognized how different I was, but figured it was normal to change as we mature and have life experiences. 

However, as I go through this intuitive eating journey, I’m becoming more of who I used to be. My carefree nature is coming back, and I’m enjoying life a lot more. Things that used to rock my world, just aren’t a big deal anymore. I’ve been freed up to enjoy life without taking it too seriously. I’ve also noticed that I’m WAY more emotional. I cry during every episode of This Is Us (but then again, who doesn’t? You’d have to be heartless...). When people cry, I cry with them. I find that I now experience a whole range of emotions much stronger.

 
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And all of these characteristics came as I loosened my control of food and my body. Letting go of the restraint allowed me to have less anxiety and just enjoy life without having to control every little area. As I stopped restricting, my brain stopped thinking about food all the time, which freed me up to actually feel things. I no longer numb or avoid my feelings using food/restriction. And it’s WONDERFUL!! I missed the person I was as a kid and am so glad to be back. 

Intuitive eating and eating disorder recovery is about more than just food. It impacts every area of your life—freeing you up to live the life you want and be the person you want to be.

With the new year, there is all kinds of talk about becoming a better version of yourself. But what if the “better” version of yourself is actually the old version of yourself before you became bogged down with weight and food concerns? What if the better, more compassionate, more present, more available person is the one that is less concerned with looks and health? What would it look like for you to pursue that rather than what we’re sold all the time?

I’d love to hear how you plan to do this!