If you need any help with this then do get in touch.
One statement I hear regularly in my eating disorder clinics is “I feel like I’m going mad, all I think about is food”. Now whilst an eating disorder is a mental health illness it is not a sign of madness. However you can feel so consumed by your thoughts of food that it feel that way. Why? Well let’s have a look at some of the symptoms of being underweight….
Back in 1941 there was a landmark study conducted by Ancel Keys called the Minnesota experiment. The aim of this study was to get information on how to refeed those starving from famine conditions. 32 men completed the study, 12 of these were studied for 8 weeks to assess their baseline intake before the trial began. Then they were all starved for 24 weeks, with their intake reduced from 3,200kcals to just 1,600kcals/day served in 2 meals. which led to a 25% loss of body weight. Now take a note of the number of calories, yes these men would have been more active and lived a different lifestyle but 1,600kcals led to them being starved. Many of the diets that are advertised today are much lower in calories that this, so are they really healthy for our bodies?
Fascinatingly the men showed a lot of the symptoms we see in people suffered from an eating disorder. They become obsessed with food. Some read cookery book and stared at pictures of food. Cheating become a huge issue with them trying to find extra snacks. One man became psychotic, having vivid dreams of eating flesh and threatened to kill Keys, he was dismissed and after a few days these dreams and thoughts went away. This to me highlights the affect being a low weight can have on your thoughts and mental health. If you have an eating disorder and are a low weight that pre-occupation you have with food can totally be related to your body being undernourished. It is not you going loopy, it is the impact of being malnourished.
These men displayed a biological drive to eat, their hunger was increased and felt out of control. Keys ended up having to have each men chaperoned to stop them eating other snacks when not in the hospital. Our bodies are built to live and to live we need food. So they will do all they can to get us to eat. When you restrict your intake it makes perfect sense you will hungrier than before, stronger signals are being sent out and the body is going into amber alert. So that pre-occupation with food is actually a normal, biological sign that your body is working and doing it’s job.
The good news is, upon being re-fed, for most men, these symptoms disappeared. They were refer back to their usual weight and felt a lot better. Their thoughts, mood and emotional state improved alongside their physical healthy. Some of these men were interviewed in 2003 and they reported being glad they took part in the study, but there being some lingering after-effects. Some were worried about food deprivation for years afterwards. This can also be seen sometimes in recovery from an eating disorder, which is why it is important to focus on recovery happening in stages and being a continual work in progress.
If any of this has hit home to you and you feel like you need some support, do get in contact with me, see your GP for advice or check out the B-eat website who have a helping and a list of eating disorder specialists. Taking that first step can be the hardest but with good support around you, recovery really is possible.
On the surface this may seem like a good idea. We know the UK population is getting larger and we need multiple ways to help teach people about how to eat for their health… is a diet really the best way? Almost everything in me shouted out “NO” when I read about WW opening it’s doors to teenagers. Part of that may be because I work with lots of teenagers with eating disorders/disordered eating and I know that many of them have gotten to the stage where they need specialist support because of “dieting gone too far”. They started on a diet to lose a little weight and then either liked the knowledge of being lighter, maybe they were complimented or felt they looked better so they lost a bit more and then even more until it spiralled out of control.
Diet that are focused on weight loss and controlled your food intake via calories do not work for the majority of people longterm. They instead set you up for yet more dieting or for a lifetime of being confined to the same dietplan. Do we want these teenagers to be controlling their intake all the time or bouncing from one diet to the next whilst their weight increases? Or should we instead move away from the focus on weight and to a focus on health related behaviours instead?
We know that weight can increase the risks of certain chronic disease and that weight loss helps reduce these. However, this does not mean that you cannot be healthy at a larger size or that you are healthier because you are slimmer. Your size does not define your health.
I would love to see an approach where we counter the negative diet messages with positive changes to make for overall health. Encouraging teenagers to eat more plant based foods, to be active daily in fun ways and to choose wholegrain lower sugar options could make a difference without the intense focus on dieting. Education around hunger is something I try to do with anyone I work with at any age – for example, what is it, what does it feel like and when to respond to it. It needs to be about equipping and empowering the person.
Looking at the bigger picture is also key and something that a diet alone will not do. For example:
Why is the person overweight? Are they overeating for a reason or is it that the whole family is overweight?
What is happening in family and social circumstances?
What is their weight history?
How are they coping with life right now? Stress, anxiety, loneliness, tiredness and low mood are all factors that can affect weight and it may be that the weight gain is a symptom rather than a cause.
I do not have the answers but I do know that encouraging teens to diet is not it.
You can see my quote in the Daily Telegraph for this topic.
I’m constantly on a journey with my clinical practice and dietetic thinking. One of the keys to a good health professional (or any professional) in my mind is one who constantly evaluates their practice, the evidence, the new trends and uses this to shape how they work and think.
I started work as an eating disorder dietitian in 2007. On my first day I was handed a box file that contained a few black and white print outs of out of date dietary information and told those were all the resources. There had been no dietitian for 5 years. I built up the resources, my knowledge and educates the team as well as myself. As a lone dietitian on a psychology based team it was at times very tough but it was the making of me and I loved it. When I left that job I had experience of helping run a day care programme, groupwork, meal support, out patients, inpatients and I had gained a whole new language. I am so thankful for those years.
Now as someone who works in the private eating disorder field I am constantly working to better the support I offer. Not so that I am better, but because I want to do myself out of a job. I want to see my patients recover, I want them to have a good relationship with food, I want them to no longer need my support.
We live in a weight focused culture. I personally struggle with this. I would love to not weigh anyone who comes to clinic, yet most of the time I have to. Working with people who are very low weight it would be negligent of me to not know what their weight is doing. It has to be a focus, but I don’t want it to be the primary and only focus. So we get it out of the way, debrief and then move onto other areas. Weight is never an easy topic and is certainly not foolproof. The simple idea of eating so much leading to so much weight gain every week just isn’t that simple in the community. There are so many factors than can complicate the picture. Activity levels, mental energy used in work/study, looking after children, anxiety etc… So focusing on the weight alone can make it slow, hard and distressing.
Instead of a weight focus only, I like to work with people looking at their relationship with food. We may look at the their food beliefs, busting any incorrect ones. Ideas such as carbohydrates are fattening or I shouldn’t eat fat are common ones. It doesn’t always work but I try to stay away from calories and strict meal plans and instead focus on eating regularly and including a good balance of foods at meals. No food is off limits, no food is good or bad. Switching the focus from weight to health has always been one of my aims. Instead of what foods you need to gain weight I look at why food groups are good for your health and how restriction is unhealthy and can cause physical harm. Finding out what foods people have been avoiding and why, is always a good place to start.
As people make progress it can be so liberating to weigh less often and incorporate more freedom into the meal plan. Learning to listen to those signals of hunger and fullness can be very scary and overwhelming at first but it opens up a whole new future and a way of eating that will see you through life, with no need to restrict, binge or diet every again. Let’s make that the goal.
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.
“Recovery is like riding a wild stallion. It is unpredictable, you will likely fall off many times. You will go through emotions ranging from fear to excitement, feeling out of control at times and clinging on to anything you can. Keep getting back on the horse, keep holding tight, sit up tall and go with the ride.”
There are many times in my working life that I just wish I had a magic wand to make recovery easier. The fact is, recovery is hard, damn hard and it takes a lot of guts, determination and hard work to even make a start on it. Once you start it can feel like it just gets harder at points, so you really need to plan and have support in place to help guide you and keep you going. Here are some things that can help the ride.
Have a social support structure in place
Deciding to make changes to your eating may sound simple, but once you plan it and then actually have to put it into place, it really gets harder. Having people around you who you are accountable to, people who will sit with you in the hard moments, challenge you to keep going and celebrate with you too. True friends and family who love you for you but want to see you healed up and able to live life to the full.
Have professional support
Yes you can do it on your own. However an eating disorder is an isolating illness, it can be a long and lonely path. So having a professional or a team of professionals who you trust is a good idea. People you can get the right information from and trust it, people who will challenge your thoughts, assumptions and beliefs and believe that you can do this.
Being in the right place at the right point
There is a cycle of change that I often use with people to talk through how you need to be in the right mindset and the right point of your life to begin recovery. This is especially key if you are in the community, recovering at home. In a eating disorders unit things are a little different and you have more support and encouragement. Take a look at the phases below and see if you can identify where you are. Recovery can be a cyclical process where you move forward 5 spaces and then back 2 spaces, but do not give up, this is normal.
Stages of ED recovery
- I don’t think I have a problem
- I might have a problem but I’m ignoring it or I don’t care
- I don’t know how to change but I want to
- I tried to change but it didn’t work
- I can stop some of the behaviours but not all of them
- I can stop the behaviours but not the thoughts
- I can be free from my eatind disorder some, but not all the time
- I am free from behaviours and thoughts = recovered
Have goals in mind
You need something to aim for. Why do you want to get better? What will life be like when you are free from your eating disorder? What do you want to do with your life that you cannot currently do. I recommend writing out or creating a vision board showing where you want to get to. Write out your dreams and dream big. Then use this as a motivational tool, put it up where you can see it.
Surround yourself with the positive things
Part of recovery is about changing your mindset and the way you view life. It can be so easy to see the negatives about your life and yourself, then use food as a way to help with this. Or to get drawn into the negatives about weight gain. I challenge you to instead see the positives. Why is weight gain good? What does it mean for your body and your life? Grab hold of those negatives and turn them upside down. Having motivational phrases and images around you can be really helpful on those days that thinking is too tricky.
Go do it. I believe you can.
What’s in your toolbox?! I was recently at a meeting and friend turned to me and said “I have a strange picture that I’ve seen, it’s you with a golden toolbox. It’s like you have everything you need in that toolbox to deal with life”.
This spoke volumes to me as a person and as a health care professional. Having worked in a team which was predominantly psychological I was immersed in the language of the therapists and the word toolbox often came up. I sat in on plenty of group therapy sessions and got to experience a whole range of different therapies. Also, in our team meetings we used these skills on ourselves as part of the debrief process. It showed me how important it is to look after not just your patients, but yourself. If you have a life with some stress in it (let’s face it that is probably everyone) then you need to have some skills to hand that help you deal with that stress. Stress and anxiety can be a huge factor in an eating disorder, in mental health conditions and also to physical digestive issues such as IBS. When you have a stressful event how do you respond? What does it trigger in you? When you know how you respond you can start to work on a more effective and helpful mechanism.
I will never forget my interview for my eating disorder post. I was asked such an eclectic mix of questions that I had no idea how I had done on leaving the room. When I received the call to say I had the job, I asked why I was chosen. The response “we could see you are robust and able to cope with the strains of this work”. In the eating disorder field this robustness is certainly needed. I continually need to keep on top of my own anxiety and practise what I preach.
I want to highlight some skills or tools that we all, health professionals, patients, people, could include in our golden toolbox. Tools you can use regularly for moments of anxiety, tools you can pull out for those emergency moments.
I remember being on a train that got stuck in a tunnel and suddenly feeling trapped and my anxiety levels rising. It was not an experience I was prepared for and suddenly I knew I needed to use one of my tools. At that point visualisation of a calm beach with lapping waves and some square breathing helped immensley. I know if I had not practised these skills previously, I wouldn’t have been able to use them there and then. So practise really is the key.
Here are some of my favourite toolbox tools that I use myself and recommend.
I’m a seasoned journalling fan. This is something I have always done since my teenage years, I now have a lot of full notebooks with a collection of my teen angst, my working life, my spiritual life and my family life in them. Looking back it shows me how I have evolved and where my stress triggers are. I can see the patterns that I fall into and work on improving my reactions. I dig out my journal when I have a moment I need to work through, when my mind feels cluttered or when something erupts! I also love to journal the good and positive, so any life events or just when I get the urge.
If you are on a recovery journey then I recommend that you journal daily or at least 4 times a week. It needs to become a discipline and a part of your coping mechanism. A good way to start is to write down 3 things that went no so well in your day and how you could have dealt with these better. Then always finish on a positive, so 3 things that have gone well or that you coped with well. You can also take a single scenario and write out alternative endings. Using an eating disorder example: You had an argument with a friend, this increased your stress and you responded by missing your snack. Thinking through why this was not a useful response – restriction of food does not help your emotional well being, it is a quite fix but not a long term cure. Now you have missed out on some nutrition for the day and your body is hungry. Your body needs regular food right now as you work towards recovery. So take a think through how you could have responded instead…. maybe you could have gone for a walk, taken a bath or done some mindfulness to help you reduce your anxiety after the argument instead of turning to food.
Mindfulness and Breathing –
Such a buzz word at the moment, but this is not a fad. I’ve been using mindfulness with eating disorder clients for over 10 years and I’m sure it has been used for far, far longer than this. Just 10 minutes before a meal or after a meal can make a huge difference. It is all about calming your thoughts and body. I personally love just deep breathing, there are so many variations on this so try a few out. For me, the breathing is something that spills over from Pilates practise and so I get a double benefit from Pilates of exercise and mindfulness. There are some great free resources to help here.
This is something to decide upon according to your recovery stage. Exercise can be amazing as a mood booster and a de-stresser. However if you are working on weight gain then it will also have an affect on this. If your BMI is less than 17.5 then you will want to modify your exercise so that it is physically safe.
I often suggest that people put together a list of distraction techniques that they can use. For example, after a meal, or when a the urge to binge strikes, at times when anxiety levels are rising it can be useful to have an activity planned. Things like craft, having a friend to call, painting your nails, reading a book, cleaning out a cupboard – something that immerses your mind and changes your thoughts. Puzzles, crosswords, knitting, collage are all great things to have on your list.
Positive thoughts –
Those anxious, negative thoughts are something that we all get. It is how we deal with them that is key. I love the thought of noticing the thought, and finding the opposite reaction. So turn that negative into a positive. If you practise this regularly it can turn into a habit that you hardly notice you are doing. I’m now working on this one with my children too, teaching then that there is always a positive side to things. It is a great skill to learn at a young age but one that you can learn at any age.
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.
Having an eating disorder can make you feel invincible, it can sometimes be hard to see how being underweight and restricting your food intake can cause physical health issues, but there are so many knock on effects of being a low weight. When your body is not getting the nutrition that it needs it can lead to knock on consequences for your bone health as the minerals are take from yoour bones for use elsewhere in the body. Another big one is muscle wasting throughout the body including your heart. Your brain will start to conserve energy and shut down some less vital functions, brain power, memory, reactions and concentrations can be impaired. The blood may not be pumped as well around the body leading to cold extremities. Mood swings and poor sleep are common. Skin, hair and nails will start to suffer. I’ve had some people who have lost their hair in large clumps. Less of a physical symptom, as your body craves nutrition your mind becomes increasingly pre-occupied with food, recipes, the next meal, it can become all consuming.
If you or someone you know is struggling with restricting their eating, it can be helpful to think through the physical affects on the body and use these as a motivation to focus on slowly eating more. If you need help with this, seek out an eating disorders therapist, dietitian or see your GP for signposting.
I work with people with Skype, so get in touch if you need support.
The label of good and bad foods annoys me. It is one of those labels that I find hard to get away from when I am talking to people as it comes up constantly. I spend a lot of time trying to break that idea down in people’s minds. Google it and there are over 71,800,000 links talking about what foods are good/bad, what bad foods are really good, the best good foods to eat and so on. But do good and bad foods really exist?
Bad foods seem to be ones that are high in sugar, fats and calories. Foods that are “not healthy” and that exert a “bad” affect on the body. They can range from fast food, processed food and high fat/high calorie snack items to carbohydrates and dried fruit.
We have a complex relationship with food. Trying to make it fit into just one camp is tricky. Look at the major food groups – carbohydrates, protein, fat, dairy, fruit and veggies. Then look at lentils. They are put in the protein group but they contain carbs and are a portion of veggies too.
Let’s take it to a more philosophical level. Can a person be labelled as good or bad? Take an object like a razor blade. Is it good or bad? One the one hand it can be used to shave and on the other hand it could be used as a weapon.
So by trying to label foods as good or bad we are over-simplifying it. Foods are really neutral. Labelling them automatically places them into one category. Let’s take chocolate as an example. On the one hand this is a high calorie, high fat food that is often laden with sugar, so could be classed as a “bad food”. However dark chocolate contains iron, magnesium and fibre. It has antioxidants including polyphenols, catchins and flavanols and may help lower blood pressure plus reduce LDL cholesterol levels. Some research suggests it may help with cognitive function too making it sound like a pretty amazing food to be eating. Even fruit and vegetables can have their negatives, too many carrots can turn the skin orange due to excessive beta carotene!
No single food is to my knowledge nutritionally complete. We need a combination of foods in order to provide the body with all the nutrients it needs. This includes the full range of essential fatty acids and some sugar too.
The old phrase “All things in moderation” is actually very true. Instead of looking at a food in isolation we need to think about how often we eat a food, how much or it we eat, combined with what else we are eating and adding to a food. Limiting or not allowing yourself to eat certain foods can actually lead to you craving them more and then over-eating them. Food is something to be enjoyed rather than denied, so a small amount of the things you like really can be good.
So instead of labelling foods as good and bad, or healthy and not healthy, how about we change the way we view it. I let my children eat all foods, including cake, sweets and chocolate. However they know that some foods are best to eat in small amounts as they can lead to their bodies getting sick. A good example of this is a weekend recently where we had multiple parties, leading to a lot of party food being consumed. Both children had tummy aches and were slightly constipated! An excellent time to highlight that they had eaten more biscuits and cakes, less fruit and veggies and their bodies were complaining. We talked about how these foods are delicious (the words of my toddler boy) but if you eat too much of them they can make you feel unwell.
How do you label food in your mind?