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.
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.
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.
When I heard Polly’s eating disorder recover story I knew I had to share it. Working in the field of eating disorders can be frankly hard work. It is a long road to recovery and a battle. It takes dedication, support from others and challenging yourself at every meal time. However it is possibly and it is worth it. I hope sharing this inspires others.
“It took 10 years for me to finally ‘come out’ and be open about my Eating Disorder. But now I’ve come to realise that in being open I can help others, never will I keep quiet again. I hope that by sharing my story I can help you, or someone you know who is struggling, and show you that recovery is possible.
Why was I silent for so long? I didn’t think anyone would think negatively of me. At age 33 all my peers are open and mature enough not to judge in such belittling ways. Perhaps it was that people wouldn’t take me seriously as a health professional – I’m a Personal Trainer & Nutritionist who helps Mums get in shape. Ironic? Not really. Because needing to lose weight or gain weight often come from the same root psychological cause. I think a lot of it was that I just wanted to forget that horrible time in my life, sweep it under the carpet. But in doing that I’m not able to help and inspire others. The can of worms had to be opened.
They say that to develop an eating disorder you need to have the right genetics (science shows there’s a link), the right personality (typically perfectionistic and with high personal standards – me to a T), and an immediate trigger or stress at the time of developing the disorder.
I first felt fat age 8. My Dad got remarried and family life was changing. Not in a bad way, but a lot for a young child to process. I first made myself sick age 12 at boarding school. I was bullied, not for being ‘not skinny’ (I wasn’t fat), yet somehow I figured being thin was the answer. But the problem never really took off until, at age 17 at dance school (i.e. where we spent all day in a leotard being judged on how good we’d look on TV), and my then boyfriend was sent to prison. I was also living alone in London and had struggled to fit in at the college. On a subconscious level, all would be well if I lost 3 kilos. Then I would be happy. Reading this back, how silly does that sound now?
I only ever meant to take the laxatives (half a box of them) once, just to ‘erase’ Christmas day. Each day I would swear on ‘no more Yule log’ and it was salad from now on. I never binged, but every time I ate something ‘non-diet’, I took more pills. Or vomited. Or did an extra 4 hours exercise (it was the holidays, I had time). Or all of the above. Nobody knew. I was way too ashamed to tell anyone.
It was only when this cycle started to impact my daily life about 6 weeks later – skipping classes to make myself sick, blocking up the loo in my flat, not being able to think about anything else but my fat thighs and pathetic self-will, that I switched to a new tactic – restriction.
It started innocently enough – cutting out fat, then bread, meat……until I was probably living off about 500 calories a day of primarily vegetables, and my condition was noticed, I was removed from dance school, and put under the care of an outpatient clinic.
And herein began six years of treatment that I resisted as much as I could. Meal plans, counselling, CBT, supervised meals, meals in tubs to take home to eat, and three times I was hospitalised at a dangerously low weight. Nothing worked.
Why was I so resistant? To say I was miserable doesn’t cut close. If there is a Hell, I have been there. I was also diagnosed with extreme clinical depression unresponsive to medication, borderline OCD, showing bipolar ‘tendencies’ and one therapist suspected I had Borderline Personality Disorder, which some say is what Amy Winehouse had before she died. I self-harmed, and I attempted suicide twice.
But my eating disorder kept me safe. By this time it was a way of life, it was my identity, and in some distorted way it made me feel special. This is what it comes down to in the end – I never felt special. I felt like a worthless waste of space, yet ironically struggling with this eating disorder only reinforced how much of a waste I was. After all I was putting my family through so much stress and worry. None of it makes sense, but I guess that’s why mental illnesses are so hard to recover from.
So how is it that I can be here today, happier than I have even been in my life, married with two children, and helping other women learn how to treat their body well?
I often get asked what made me finally recover. Honestly? I don’t know. I remember being in a pub garden one summer with a couple of friends, fresh out of another hospital admission and going downhill already. One companion announced she was getting married, the other that she was pregnant. Suddenly for the first time since I developed anorexia, I felt lonely. The eating disorder had been my only friend who stuck by me, yet this ‘friend’ was turning against me. Everyone was growing up, creating careers, moving on with their life. I was stuck in this child like state, being left behind. If there’s one dream I had all my life even throughout the illness, it was to have children. A little girl I could bring up as my little princess. That was not going to happen if I carried on. I was at that time infertile and no man in their right mind would be attracted to an emaciated mess.
It was like I woke up, or a lightbulb went off, or something switched in my brain. I didn’t want this illness in my life anymore. This time I really didn’t want it.
That’s not to say it came easy. Anorexia is like having a little devil on your shoulder, dictating what you should and should not eat, telling you how pathetic you are if you give in and eat. I’m not going to lie – those voices are still there every day, even 10 years on. But there’s a difference. Now, I shout back louder.
It’s a fight, every day. I know people who seem to have completely recovered and they think the same way about food and their body as any ‘normal’ person. I may get to that place, I may not. But I’m happy, I’m healthy, and I will keep on winning this fight.
I’m not a counsellor or psychologist, but I have been there, I do understand. So if anyone wanted to reach out and chat, ask advice, or hopefully to tell me they’ve been inspired to keep fighting, I’m only an email or social media contact away. If I can help just one person, that can of worms was definitely worth opening. ”
Pollyanna Hale helps Mums lose weight and get their body confidence back via online coaching with www.thefitmumformula.com/. A qualified Personal Trainer, Polly knows from personal experience and though helping hundreds of women that there is more to having a healthy body than just following some cookie cutter meal plan. Long term success comes from learning to love yourself and your body and treating it with the respect it deserves. It doesn’t matter if you’re overweight or underweight, or somewhere in between. The weight is just a symptom. Everyone deserves to feel special.
1. Make recovery a priority:
This may mean taking a break from normal life. A year out. Recovery takes a lot more energy and effort than you may originally think. It needs to be right up your priority list. Time off work, school, certain friendships, travelling, exercise. Whatever it takes, this is important for this season.
2. Find yourself again:
What do you like to do? It’s often hard to know what things make you, you. The busyness of life gets in the way of our identity.
Book out some time to find you again. Try some activities you used to enjoy. Often creative projects can be a useful part of recovery. Maybe photography, baking, sewing, painting, collage, scrap booking, gardening, I love the phrase “Find what makes you come alive, then go and do it”.
Sitting in silence and paying your full attention to your breath and body can help you bring an awareness of your thoughts and feelings. This practise helps you let go of the unhelpful thoughts and be more compassionate to yourself. Practising letting thoughts go in your mindfulness practice will enable you to take this into everyday life so when an unhelpful thought comes along you are in a better place to acknowledge it, but not to act on it.
4. Value yourself :
Take time to look after your body: nutritionally and physically. Some self care time in your week can make a real difference and can remind you that you are important and worth looking after. For some people an eating disorder can be a form of self neglect and may have some punishment aspects to it. Creating the emphasis on it being good to care for yourself and give yourself pamper occasions helps build self esteem and love for your body.
Some ideas: A long bath, a manicure, pedicure, haircut, moisturising your body, shaving. Taking time to tidy your home, buy yourself flowers or something nice to look at each day, light candles in the evenings.
5. Fuel your body:
The right fuel at the right times of the day is vital. This may mean going against your feelings and thoughts, but with repetition a routine will evolve and habits will form.
It is likely your have no idea what normal eating should be for you now. Plan out 3 meals and 3 snacks a day with general timings to stick to if you can. There will always be days things don’t fit into your plan, that is also part of normal eating! For more advice take a look at my healthy eating in Anorexia post.
Go for as much variety as you can. There is no perfect meal plan, it’s all about making small steps and challenging yourself as often as you can.