Tag Archives: dietitian eating disorders

Guilt free eating?

This week I spoke to a new client. A lady who has previously had an eating disorder and now has recovered to a healthy weight but has some left over eating traits and food beliefs. She was very relieved and refreshed to hear my viewpoint of:

“All foods can be included in your diet, there are no Good and Bad foods, instead focus on enjoying your food, listening to your body, trusting your body and eating without guilt.”

It got us talking about why there is guilt associated with food. Such a huge and emotive topic.

We all know that food is something our body needs, without it we cannot live, too little food and we lose weight, not eating a balanced diet means our body does not function correctly and can be physically unwell. So where does the guilt come from?

From an early age we learn that some foods are not as good for our bodies. This is often taught in a very black and white manner, labelling foods as good or bad. Now I would agree that something high in calories, fat and sugar, like a slice of chocolate fudge cake, is not something we should be eating daily. However it isn’t a bad food… on the contrary it is delicious and can bring a lot of pleasure. 

Eating for pleasure is important. Lots of our experiences are associated with food. If we only ate for  our physical need think of all that we would missed out on. For example the pleasure of an ice-cream on a hot day or cake at a birthday. These experiences feed our soul, they are part of our social life and our emotional well being too. Food is more than just nutrition.

When we label a food as good or bad it affects the way we think and feel about it. So by labelling that slice of cake as “bad food” we feel we are being naughty/bad when we eat it. It can lead to anxiety before eating, judgement, criticism and then guilt afterwards. Our food rules therefore hold a lot of power and influence.

Having just worked with a TV production company on a food show, this topic also came up when they wanted to label a group of foods as good/bad. This instantly brought a red warning flag up in my mind. It became a great opportunity to talk about some other ways we could soften the language used and how powerful our words can be. This is definitely a journey I am on with my language both at home and as part of my work.

It is time to change the way we categorise foods. Instead of good and bad can we not see all foods as back on the menu, just some more occasionally than others? This is not an easy, overnight change but one that requires practise, patience and plenty of self compassion. The first step is to identity how you see foods, then try to catch those moments when you pass a judgment on a food or on your eating. Can you step in and reframe it. Instead of “I shouldn’t have eaten that ice-cream, now I feel guilty, it is bad for me” Rephrase it as “That ice-cream was really delicious and brought me a lot of pleasure”. Let’s bring all foods back onto the menu and start working towards loving our foods and ourselves.

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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Where should I set my weight goal?

Where should my weight goal be?

Why does my body keep on gaining when I want it to stop?

Why have I reached a plateau?

If you were perfectly in tune with our bodies you would be able to eat when hungry, stop when full, even decide what to eat whilst thinking about the signals your body was sending out. This would likely result in your weight remaining relatively stable. Why? 

The theory is that the body has a genetically determined weight set point. This is the point where the body functions best. It will work to gain/lose weight back to this point. So with small losses and gains of weight your body will adapt it’s metabolism to bring your weight back. 

If you constantly ignore the bodies hunger/fullness signals you can override this system and push the body into a new “settling point”. Your body will work to get back towards it’s set point but external factors may mean this is not possible so it compromises. This can explain why you find it easy to gain/lose a little weight below your normal weight but then have to make bigger changes to alter your weight further. It also shows why a WEIGHT BAND is needed and not a single figure. 

Dietitian UK: set-point-theorywhere-should-i-set-my-weight-goal

Looking at the research on weight restoration after people have been at a low weight you find it takes time for them to get back to their healthy weight bands. For example simulation using the data from the Minnesota starvation study show it took over a year for the men’s bodies to resettle back to within 5% of their original body fat. 

In my practice of eating disorders I see similar results. Getting the body to regain weight back to it’s former set point is not as easy as you would imagine. There can be phases of regular weight gain and then plateau periods. It can take a few months for weight maintenance to be established. Almost as if the body is testing to make sure it is safe for it to settle into it’s groove again. Following a pattern of either bingeing and restricting or eating more and then compensating another day will make it harder for the body to normalise itself. Mindful eating, a regular pattern of meals and listening to your body’s signals is the key.

When you lose weight, below the set-point, your metabolism decreases. Your body uses less energy for jobs such as digesting food. Your overall energy expenditure decreases and your resting energy expenditure decreases. So you use less calories than you were using. As you start to weight restore your metabolism will at some point start to increase alongside this. This can result in a weight plateau, but it can also help you justify eating more.

How do your work out your set-point?

This is the tricky bit. There is no direct way to measure it and it can change over time. For some women pregnancy will change the set point. Ageing can have an affect. Medications and illness too. 

What we do know is it isn’t likely to be dead on a BMI of 20. BMI is a guide and a range it isn’t definitive. So you may have to continue gaining past BMI of 20 and listen to your physical health signals. Your energy levels, your menstrual cycle, your bone health, the condition of your hair and nails, your blood results. Ignore the numbers on the scales and think about your body as a whole.

General tips: look back over your weight history. If you have had a stable period when you ate normally and were moderately active then your weight at this time will be a huge clue. 

Look at the weight of siblings and parents. If you are female think about the weight when your menstrual cycle was occurring regularly, this is a huge clue. 

Remember, the body wants stability and to feel safe. So give it a routine and listen to what it is asking you for. 

If you need any advice then do get in touch for a Skype or face to face consultation.

 

References:

CCI: set point theory http://www.cci.health.wa.gov.au/docs/set%20point%20theory.pdf

Mirror-Mirror : Set Point Theory: http://www.mirror-mirror.org/set.htm 

Muller, JM et al (2010). Is there evidence for a set point that regulates human body weight? F1000 Med Rep. 2010; 2: 59. Accessed via PubMed.

Having an Eating Disorder over Christmas.

I love Christmas and all the build up that goes with it, I’m like a small child with the excitment of it. For me it is special celebration. However through my work in eating disorders I know what a hard time it can be for some. 

Christmas brings with it a lot of socialising, which can mean a lot of different meals. Eating in restaurants, buffet events, and more alcohol than usual. Then we have all the delicious, but high calorie festive foods: mince pies, christmas cake and pudding, stollen, pannetone, yule log, pastry items, cheese, nuts and those tubs of chocolates. All of this can cause someone with an eating disorder a lot of anxiety and that is before we get to the Christmas meal itself.

Dietitian UK: Surviving christmas with an eating disorder

I know I will freak out over buffet food but I really want to go, what can I do?

How can I eat in front of other people?

Should I cut my intake down the rest of the day if I am eating out?

How much can I drink and how does it affect my calories?

The 25th December. A special day, spent eating, drinking and being around people you may not see all the time. In our family we end up having 2-3 Christmas days as we visit my side of the family and hubby’s side to celebrate with them too. So it could end up being 3 Christmas meals. Suddenly you are in an environment where you may eat at different times, have higher calorie foods at meals that you haven’t eaten for a while and are eating with different people. 

Will everyone be looking at me and watching what I eat?

If the Christmas meal is late what do I do about sticking to my usual meal plan?

How much should I have at that meal, will it be more calories than  I am used to?

What will this do to my weight?

I don’t want to spoil the meal/day for everyone but how what do I do if I am not coping?

Should I have dessert?

This year, I have spent time with each of my clients talking through their plans for the build up to Christmas. It’s been a real challenge for some with meals out with work colleagues and planning the Christmas Day itself. However everyone has a plan in place and I hope everyone will be able to relax a little and enjoy the moment.

Dietitian UK: Surviving Christmas with an eating disorder 2

Here are my top tips:

  1. Preparation is key. Try to get as much information about what is going to be happening in advance. If you take some of that element of surprise out of the equation you will reduce  the anxiety somewhat.
  2. Ask others around you for support. Let someone know that you may find this meal/event tricky and if so this will be your signal and give them ideas of what they can do to help. Maybe they can distract you with conversation or use a few motivational phrases to boost your confidence. 
  3. If people do not know about your eating disorder then they are unlikely to be watching you. If they are watching you then it is probably out of sheer intrigue. You could try smiling at them to show things are ok (even if they are not). Remember that this is a moment for you to enjoy and you don’t want to let little things get in the way of your recovery.
  4. Plan out which days you will be eating differently over the festive time. Then also plan out a list of foods you want to allow yourself to eat. When are you going to do this? Can you swap a normal snack for a mince pie? One of my clients worked out a mini mince pie was not that different to her usual cereal bar so that was an easy way to build a mince pie into her meal plan. Try not to let yourself miss out.
  5. The meal itself can be overwhelming. It is one meal out of 21 in a week. It is 1 day out of a week. If you eat an extra 700kcals that day, it only equates to an extra 100kcals every day that week – not enough to cause any effect on your weight. You need to eat an extra 250-500kcals everyday for your weight to increase, and even that is not enough for some people.
  6. The 80/20 rule – stick to your meal plan 80% of the time and you can come off your meal plan and relax more around food 20% of the time. It is a normal and healthful way of eating – for example think how people eat in a more structured way during the week but eat differently at weekends.
  7. Keep some meals on that big day safe and normal. It may be you can have a normal breakfast and morning snack but then you have a large lunch with dessert. Listen to your body and your wise thoughts. Check out those feelings of fullness – are they related to your emotional fullness, your anxiety or your physical fullness? Use your knowledge and common sense to decide what else you need to eat for the rest of the day. 
  8. Restricting, purging or exercising after a big meal is not the answer. It may help you feel better initially but it won’t help your recovery in the long term. Find ways to distract yourself – crafty things can be good, get a mindfulness colouring book (all the rage right now it seems!), phone a friend, hang out with that family member you haven’t seen in ages, suggest a gentle post-meal walk with people. 

Relax a little.

Enjoy the moment so you can look back and be proud of you.

Keep recovery in mind and keep going one meal at a time.

If you need any support get in touch and we can set up a face to face or Skype consultation.

Dietitian UK: Surviving Christmas with an eating disorder 3