Tag Archives: bulimia nervosa dietitian

Eating Disorders: Why can’t I recover?

Working in eating disorders as a dietitian is the very hardest part of my job. As a freelancer I cover a huge variety of roles. In my other world as a Pilates teacher and studio owner I have an altogether more energetic and flowing role. Yet it is working with eating disorder clients that uses the most of me, pushes me hardest, and pulls on my mind, spirit and emotions. 

 Some of my hardest work is with the “stuck” clients. Those who really want to change, really want to break free, really want help…. and yet they just can’t do it. It is so very hard for them as you can see they do want to get better. Imagine this – knowing how you are living is ultimately going to shorten your life, make your life difficult and lead to you not being able to do a lot of things and yet not being able to change it. Life with an eating disorder is a very hard life.

Often there is a specific weight that they cannot push past. 

Sometimes there are behaviours such as exercising or purging that they cannot give up.

Change can be made, but only to a point.

 

So what causes this “stuckness”?

An association with a certain weight.  

It is not uncommon for me to being working with someone who 100% agrees that they need to get their weight to xx kg. We put a plan in place, they are working towards it really well, everything seems to be on target and then the “stuckness” hits just before our weight goal. Why? It could be that when they were last at this weight they didn’t like their bodies/themselves, someone said something negative about them or that something traumatic happened at this weight. It could be they have never been that weight before, it is the highest weight they will have reached.

I like to work this through with people. 

“What will it be like being this weight”

“How will it change your relationships and how you see yourself”

“What will be better and what will be worse?”

I also remind them that you really cannot predict how it will feel and be until you get there. Using the analogy of a night in a hotel. You can guess how it will be, you can imagine how you may spend the time with your partner, you can predict the layout of the room, the hotel and the menu. However you cannot really be sure what it will be like until you get there. Even if you have stayed there before, things change, things feel different at different stages of life.

2. Not wanting to move on.

Having an eating disorder can for some be a way of escaping. Escaping growing up, escaping emotions, escaping reality. So getting better means that you have to deal with all those tricky issues. You cannot run away any longer. You have to put on those big pants and be a grown up. It isn’t necessarily going to be fun, but in the long term it will be worth it. 

I find using some motivational work can be beneficial here. Looking at the pros/cons of change. Planning out a vision board of where they want to be in 1 year, 5 years time. Talking through the real reasons they need to get better. For most people there is something driving the desire to make change. Examples are wanting to have a certain career that you can’t do at a low weight (nursing, law), wanting to have children, wanting to be able to go travelling.

3. Invested in the Eating Disorder.

This may seem like a strange one. If you have had an eating disorder for a long time it can be hard to imagine not have one. It becomes part of who you are. It becomes part of the way that other people see you, relate to you and care for you. If you no longer have an eating disorder there is an uncertainty, how will others see you, will they still care for you, will they still take time over you? If you no longer have an eating disorder who will you be? A huge part of this is all around knowing your identity. Spending time journalling can help with this. Thinking about who you used to be, who you would like to be. What are the things that make you come alive inside? Spend time doing those. What are your dreams and aspirations? What things are you good at? Asking someone close to you the question “What are my giftings or what are I good at?” can be very revealing and helpful.  Once you have an idea of who you could be outside of your eating disorder you can push yourself to move past it.

Working on your relationship can also be helpful. If these are strong then you know that people will care for you always, with an eating disorder or not. Being in a sick role means you are seen in a very different way. Being recovered and healthy can expand and move your friendships and relationships to new levels. 

Being stuck in your eating disorder recovery can be a very natural part of the recovery process. If you are in this place do seek some help. Do spend time journalling, talking, being creative and finding who YOU are. To look for a good therapist and dietitian near you in the UK the B-eat website is a good starting place. Or drop me an email as I work with people around the UK by video call.

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How to prevent a binge.

When most people think about eating disorders the image of a low weight person who restricts their food intake comes to mind. Anorexia Nervosa is the most commonly talked about and known about eating disorder. However there are other kinds. I also work with people who suffer from Bulimia Nervosa, binge eating disorder and a mixture of all the above.

Whilst restricting your food intake can sometimes be understood as “dieting that has gone too far”, bingeing is less socially acceptable. In my mind both of these ways of eating are problematic and indicate underlying issues that need to be worked through. An eating disorder is a horrible illness that is hard to understand for those around the person, it can be consuming for the person and it takes a lot of willpower, guts and hard work to conquer it. I hugely admire the people I work with who make those steps towards beating this nasty mental illness.

A true binge involves eating a large amount of food in an uncontrolled manner. We are not just talking half a packet of biscuits. Some binges can range into several thousand calories. Some people describe a switch being flipped, they are unable to stop and are almost in  trance like state. After a binge you are likely to feel very uncomfortable physically due to the amount eaten and you may feel uncomfortable emotionally and psychologically. Many people have an urge to compensate – for example exercising, purging (vomiting) or restricting their food to make up for the binge.

 

The science

You cannot vomit up all the calories you have eaten. The maximum you get rid of is 60%. Absorption starts in the oesophagus so by the time food gets to your stomach you have already absorbed some.

Restricting after a binge leads you into a cycle. When you restrict you end up really hungry at some stage which then leads to another binge. 

You would need to do a lot of exercise to burn off all the calories from a binge. 

So the best answer is to try to prevent a binge from happening in the first place. Now this is easier said than done. It will take time and be a work in progress. My top tip is to not expect to just stop bingeing and to expect a relapse to happen. When it does, it is ok. Just get back on track as soon as you can.

 

Preventing a binge:

1. Identify the key times you binge. Think about the Why, Where, When and How it happens. 

Why – how do you feel before a binge? Bored, tired, upset, angry, hungry?

Where – is it linked to being on your own, in a certain place?

When – does a binge happen at a certain time of day?

How – how do you get the foods you binge on? 

2. Use the above information to think about how you could stop a binge occurring. Is there an activity/place you need to avoid? Can you limit access to the binge foods?

3. There should be a point just before a binge occurs when you are thinking about bingeing. The idea is in your head. This is the point to stop it. Jump in there and say NO. At this stage you need a distraction. So write out a list of things that could take you away from the binge, that keep your mind and hands busy. Good options can include doing something crafty, calling a friend on the phone, having a shower, journalling how you feel, having a bath.

4. Look at your meal plan – it need to be structured with regular meals and snacks to prevent you getting too hungry. It may be that building a snack in at a key time will help prevent a binge. 

If you do binge DO NOT PANIC. Get right back on track with your normal eating plan as soon as possible to stop that restriction, bingeing cycle. 

You can do it. I know it.