Weight Stigma in Healthcare Harms Us All

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The following is a guest blog written by Deirdre, who has given us permission to use her real name.

All my life, I’ve been sick. I can remember being five years old and waking up in the morning sobbing because my eyes were swollen shut, I could not breathe, I was always tired, and had severe skin conditions and rashes all the time. I had to go on nasal sprays, steroids, oral allergy medicines, and eye drops almost year-round from that age. Around the age of 14, I started to present with vomiting up bile every single solitary morning before proceeding with my day. Despite complaining to doctors all my life about all these things, I was ALWAYS considered healthy. The number one indicator for doctors? I was thin. I always had a “healthy” BMI, and all my bloodwork looked good, so nobody ever took me seriously.

Fast forward another decade. At this point, my body was so inflamed from consuming gluten – a protein which I later found out I was severely allergic to all along – that I had gained a significant amount of weight. I was 24 years old at this point, vomiting and having diarrhea after every single meal, suffering with mental illness (depression and anxiety, some from trauma but also largely because I *never* felt well and had no choice but to press on), smoking cigarettes constantly to suppress my appetite, abusing Adderall to suppress my appetite, exercising excessively (3-5 mile runs, 10 on weekends, and 2-hour workouts daily). Doctors still would not listen to me.

When I was thin, my health complaints were ignored because I was thin. When I was big, my health complaints were ignored because I was big. This is how weight stigma harms people of all sizes. When doctors are trained to view the BMI as such a strong indicator of our health, they tend to miss out on treating the whole patient and the concerns they are actually presenting. In this way, fatphobia continues to dominate our medical fields in the most insidious ways, regardless of a patient’s size.

When I was younger, I felt like my only sustainable solution was to put restrictions on my eating. I felt like I needed to do everything in my power to just not really eat. The only thing that ever felt good to me was mint chocolate chip ice cream. It was the one food that never made me sick. I ate a pint of it nightly, then would feel guilty, throw up the next morning involuntarily, feel good about that because I was disordered in my eating habits by then, and the cycle of “weight management” continued to wreak havoc on my life and destroy my gut health, self-esteem, and brain chemistry.

At 25, I was accepted to my dream graduate school for my health degree, and thus I was always in Boston. This meant finally seeking out primary care at Fenway Health and getting a fat-positive, conscious, and compassionate doctor for the first time in my life. Dr. Karen Kelly literally saved my life, as I know I would have attempted suicide that year if I had not met her. I was at my wit’s end.

Karen’s team allowed me to face away from the scale when they took my weight. I told Karen all the symptoms I’ve always had. She referred me to an incredible gastroenterologist who finally listened to me and tested me for a bunch of autoimmune gastroenterological diseases.

Notice that only now, because I finally was seeing a fat-positive doctor, was my weight looked past in order for me to receive the care I truly needed. My current health care team, including Karen, is amazing. It is a shame that all the doctors I ever saw prior assumed that being thin meant I was healthy. That mentality destroys a doctor’s ability to see clearly, and my chronic autoimmune disease was completely missed for 25 years as a result. If my celiac disease had been caught sooner, it could have meant avoiding severe damage to my organs, and possibly even reduced my chances of long-term health implications. Now I have to live with whatever damage has been done.

More and more public health research is finally showing that fat people can be healthier than thin people. More and more people are catching on that the BMI as a marker of health is a limited, archaic, outdated, weak, inaccurate, and frankly incredibly lazy way to approach medicine. It is a way for doctors to not do their jobs. All doctors should first and foremost be researchers and scientists listening, looking, and hypothesizing with open minds. I am almost the heaviest I have ever been now, yet my cholesterol, blood pressure, oxygen, etc., are all fantastic.

The concept of weight management is a barbaric and inhumane way for any doctor to practice. One hundred years from now, we will look back at the ways we tried to force mutilation on humans through diets and bariatric surgeries and see the oppressive reality of that kind of hatred of fatness. Doctors that focus on “weight management” and miss what is really going on need to start being held accountable – sued and fired by their patients.

I think that numbers are detrimental, and so is excessive monitoring of size and shape. We came here to live in these sacks of skin as vessels for our non-physical selves, our souls, and nothing more. The BMI is bullshit and was invented by an astronomer in the 1800s who only used white Anglo-Saxon males in his sample size. BMI does not account for muscle mass, bone density, or genetics. It does not leave room for all the boobs and butts and hips our bodies create to cushion us or to grow or feed our babies.

Someday I will have chapters in a book titled “the BMI is racist,” and “the BMI is sexist.” Once I am a doctor or nurse practitioner, I will create a new tool for epidemiologists to test that will actually be inclusive of all sexes, genders, races, etc., without poisoning our minds with self-doubt and self-mutilation.

If I had unbiased doctors all my life, I may have been diagnosed with celiac disease much earlier on and could have potentially saved myself from having cancer or infertility someday. I hope to live a long life and to have children and grandchildren, and I hope to leave them in a world with less weight stigma and more active listening, especially in the field of medicine.

Praising Adele’s Weight Loss Is Fatphobic

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The following is a guest blog written by “Sarah,” a nurse practitioner in the Boston area, who strongly believes in utilizing Health at Every Size (HAES) and anti-diet approaches in both her personal and professional lives. She has been Joanne’s patient for about six years and is in recovery from an eating disorder.

It is no secret that our current society is obsessed with physical appearance. The perceived attractiveness of a person very much determines how they are valued, respected, and treated. This is especially true in regard to women, and to an even further extent, celebrity women. 

At this point, I am sure most of you have come across recent media stories of renowned singer Adele’s dramatic weight loss. After an Instagram post from Adele of herself in a form-fitting dress, with a caption giving a mention of her birthday and a shout-out to the first responders in the midst of the COVID-19 pandemic, comments swarmed in that had nothing to do with what she actually wrote. Now there were some comments that highlighted the fact that we should be praising Adele for her immense talent and not her appearance. Five or ten years ago, some of these comments would probably not have existed, and therefore that does highlight the progress we have made in rejecting diet culture and in the public knowledge of this movement. However, the majority of the comments praised her new, thinner, more “acceptable” body. 

Now I want to make it clear that I know absolutely nothing about Adele as a human, including her diet or exercise regimen. It is truly none of my or anyone else’s business what Adele decides to do or not to do in regard to her body. Even as someone who fully believes in HAES and is very anti-diet, if Adele did intentionally seek a smaller body, I can’t say that I blame her. Our world is a hostile place for those of us living in marginalized bodies. If you are fat, disabled, trans, poor, non-white, or any iteration of these, you are subjected to discrimination and othering. Therefore, it is no wonder why one would want to attempt to fit into a more socially respected body. 

I would normally say that it is unfair to assume anything about Adele’s means of attaining this new look, but in recent articles, she does discuss a particular diet of a VERY scary low number of calories (*trigger warning) and a rigidly structured exercise plan. Again, it is no one’s business how Adele decides to treat her body, but by the DSM standard, there is no question that she would be diagnosed with an eating disorder. I recognize that this is more of a systems issue, and those who mean well by praising her new body are operating under a fat-phobic structure. While eating disorder behaviors are considered concerning when the individual is thin, these same behaviors are encouraged for those who are in larger bodies. It is what we are taught and how we operate as a culture; it is no wonder that full recovery from eating disorders is so challenging (and oftentimes unachievable).

Now let’s get down to the real issue and meaning behind Adele’s weight loss (which really has not much to do with her at all). Body autonomy is part of the HAES movement, and I fully stand behind this for Adele or anyone else. It is the mere fact that a single picture can prompt so many comments (positive or negative) about one’s body that is the core issue here. 

The focus by others on a changing body, in a positive or negative way, often keeps people from recovering fully. If we lived in a world where a body was just a body regardless of how large or small it became, this would not even be a topic of conversation. Although it is an inevitable fact that bodies fluctuate for various reasons throughout the lifespan, we cannot seem to accept this as a society. Naomi Wolf stated: “A culture fixated on female thinness is not an obsession about female beauty, but an obsession about female obedience. Dieting is the most potent political sedative in women’s history; a quietly mad population is a tractable one.” Diet culture and fatphobia are the prime examples of this. We are taught that our worth depends on other people’s evaluation of us and that how our body looks to others matters more than how it feels to us. Especially as women, we are taught that making others happy is more important than making ourselves happy and that the most important thing is that others will like and approve of us, and therefore it is no wonder that we constantly rely on external validation to prove our worth.

Being fat and/or gaining weight is seen as the ultimate failure, and there is countless evidence of this belief expressed throughout history. We see and hear examples of this in our everyday lives, whether we recognize it or not. It is more common knowledge these days that “diets don’t work,” but we have yet to make significant progress in the idea that one’s body does not determine their worth. That is not to discredit all of the amazing progress that the HAES community has made, and as someone in a straight-size body, I cannot speak to the true experience of someone living in a larger, marginalized body. However, as a woman living in constant recovery from an eating disorder, I can say that the fear of weight gain has held me back in so many ways throughout this journey. Fatphobia truly affects everybody (whether they realize it or not) but is much more pervasive for women. 

I now know that these are reactive thoughts stemming from decades of diet culture brainwashing and the instinctual need to belong as a human. These messages have become even louder throughout the COVID-19 pandemic. Not only are we separated from many of our in-person support systems, dealing with real threats to our health and vitality, but we are relatively stuck at home with our thoughts. Although I do truly believe sitting and ruminating in these thoughts and fears can lead to growth in so many ways, it is also extremely triggering. We have less access physically and maybe financially to certain foods, and this can be triggering in itself.

To add to this, those who suffer from eating disorders and also live in larger bodies are especially vulnerable given the extreme fatphobia that knows no boundaries. There have been countless news articles claiming that people living in larger bodies are more susceptible to COVID-19. Not only is this untrue, but it is incredible healthism and just another example of diet culture profiting from our fears. Attempting to change one’s body size in the hopes of health and immortality has never worked in the past and scientifically never will. It is disappointing that these messages of blame and shame are being touted instead of compassion, inclusivity, and actual scientific facts, especially during this time. 

So how do we begin to change as a culture? By recognizing that beliefs and facts are not the same. By rejecting diet culture and recognizing that our body size or health status has nothing to do with our worth as humans and by treating others with respect and dignity just because they exist. As the wise Ragen Chastain said best: “Health is not an obligation, barometer of worthiness, or entirely within our control,” and this could not be more relevant in our current climate.

Wins and Losses: Old Habits Die Hard

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The following piece was written by one of Jonah’s patients who wishes to only be identified as a 36-year-old male.

Befitting the New Year, you would think I’d be writing about my resolutions for 2017, but I have a win from this past Thanksgiving that I’d like to share.

A little about me

I was a dancer as part of a performing arts group, and I traveled throughout the world dancing and performing in various venues — some as big as football stadiums and others as intimate as a small conference room. I was very fortunate to have this experience growing up (I began performing at the age of 16 and “retired” at the age of 26.) and feel grateful to have the talent and courage to pursue this sort of lifestyle. I’ve been to almost every U.S. state (excluding Alaska and the Dakotas) as well as various cities around the world — Paris, Amsterdam, Taiwan, Yokohama, Toronto, etc. I loved seeing all the different cities and how different cultures interacted within themselves, with other cultures, and even with their surroundings.

As you can probably imagine, traveling the world was glorious, but it was not easy by any means. I lived out of a suitcase for 6 months at a time; missing family events while I was on tour was the norm; and our sense of “home” was based on how long we would be staying in Anytown, USA. We were also at the beck and call of the directors and the schedules they created. Rehearsals every day, 7 days a week from 9am to 6pm (or some days even later if we didn’t have a show); additional performances that really strained every minute for “ME” time; and when and what to eat (and usually how much to eat) were always decided for us. It’s not as bad as I just made it seem. Like I said, it was quite glorious. It was nice to not think about the outside world — everyday tasks were managed for me. It really allowed me to focus on why I was there: to be the best performer I could be.

Perfection is attainable…right?

Dancing, much like any other sport, is really tough on the mind, body, and spirit. To be the best, you really have to work hard and be committed to the craft (not to mention have good genes and be somewhat of a natural talent). After all, the producers don’t give solos to the 2nd-best dancer. Dancing is also very specific — there is only one correct way to stand in first position. Any slight variation thereof is, well, simply incorrect. One might perfect their skills in other sports (i.e., one might work hard enough to make 9 out of 10 free throws), but in dance, there is always something that can be improved. So the idea of dancing “perfectly” does not exist. Yet, to be accomplished in dance, you constantly strive for this perfection. The struggle to jump higher is real. Turn faster. Turn faster! TURN FASTER! Even though these pressures mainly came from within myself, I became so worried (and obsessed) about being the best that nothing I did was ever good enough. Somehow, I thought I could achieve something better than perfection.

This battle bled into all aspects of my life: from personal relationships and self-confidence to body image and diets. Especially the latter. I distinctly remember a moment during the high point of my career. We were in dress rehearsal, putting together the finishing touches before our big opening night. At this point, we were all dancing 7 days a week for 6 to 7 hours per day. I was in peak fitness. I also wasn’t eating much because there was a portion of the performance where the men had to perform shirtless, and well, I was self-conscience about that since I wanted to look perfect. I mustn’t have weighed more than 130 pounds (I’m 5’10”.). My director approached me and suggested I watch my diet for the next few days because I would be standing next to some of the other men. She glanced over at the skinniest performer. She didn’t need to say the words, “and you are bigger than he is,” as the look was enough for me to really think about what I was doing and, more importantly, why I was doing it.

That moment was so pivotal to my career as a dancer. For me, dancing was like having a relationship with a double-edged sword. I loved to dance and was so passionate to share that with the world. I was enamored by the craft, while being pricked by both ends, as dancing created an environment that allowed me to neglect healthy eating and nutrition choices. I have trouble dealing with and embracing my own body image (The constant critiques towards a dancer are never-ending.); I struggle with the concept of working out to live a healthy life versus exercising to burn calories/lose weight; and even more, I have a hard time figuring out how to tune in to my body to find what I want to eat, when to eat it, and, more importantly, when to stop eating because I’ve reached an acceptable level of fullness.

Now (over 15 years later), my life is completely different. I’m not dancing anymore, so there’s that. I knew I wasn’t going to be able to dance into retirement, so I decided to pursue a different career and won’t bore you with those details now…just know that my life as a world traveler is much less exciting. What is exciting though is that I’m the leader of my own ship. I am in control of how my story goes, and I’ve come to love this freedom in most aspects of my life.

Setting expectations

Years following, I had the hardest time staying “in shape” — I would try any sport that would help me keep the pounds off: yoga, running, triathlons, obstacle course races. And even though all the training helped to maintain my body shape, I was still unhappy with the results I was experiencing. After talking to my sister-in-law about her nutritionist, I thought I’d give it a shot.

You should’ve seen me in my first session with Jonah — looking back now, I think it was quite comical — I came into the office, strong and confident, ready to establish expectations for our future work. I said, “Listen, you can put me on any kind of diet, but I won’t give up my sweets. I love them too much!” I didn’t realize I had the experience all wrong — it wasn’t about the sweets. I would then be educated about the different theories of nutrition, their applications, and the work I had ahead of me.

During our sessions, we would work on binge eating, recognizing fullness, honoring my hunger, and celebrating my relationship with food. We talked about embracing my body image and what that meant for me. We formalized strategies for upcoming occasions where my old habits would challenge my new relationship with food. Most importantly, we didn’t give up my sweets!

So…about that win!

As I mentioned earlier, I have trouble accepting my level of fullness. I went from being told what to eat to complete eating freedom, so you can imagine the binge eating every Thanksgiving, year after year, leaving the dinner table filled to the brim with stuffing, cranberry sauce, and mashed potatoes. You name it, I would eat it — if I didn’t really like the taste — or even if I was already full — or because there was something about missing out on the taste that I couldn’t let go — or because I didn’t want to upset the host by not eating the food they’d so lovingly prepared for us that day.

I wanted this Thanksgiving to be different from previous years, however. This year, I came to dinner with a plan on how I was going to eat during this meal, and I was determined to stick to it! (Spoiler alert: I did!)

Plan of attack

Through my work with Jonah, we were able to formulate a plan, and it was simple (in theory). I was going to take an inventory of the available foods during our Thanksgiving feast. As I walked around, I recognized foods that were appealing to me — I really tried to tune in to my intuitive eating skills — and what foods I could skip out on. I say “in theory” because by doing inventory, I also had to accept the foods that were appealing and give myself permission to eat those foods without guilt (For the record, I love bread and butter…lots and lots of butter.).

The result: I don’t really like all three varieties of stuffing, I don’t need to eat them all, and no one was going to heckle me about trying them all. Most everyone else was too busy serving themselves anyway. This quick walk-through allowed me to really honor and respect my hunger. It gave me the opportunity to carefully select the foods I was so excited to eat — it was Thanksgiving after all.

For the first time I can remember, I left Thanksgiving dinner feeling comfortable in my own skin (and clothes) by not overeating. I am still on the high from this win, and it helps give me confidence going in to whatever meal comes next. It might not be the most exciting win, nor does it mean I am over battling my other eating issues. But it is a “W” in my column.

Don’t get me wrong

I have good days and bad days. There are days where I eat multiple times throughout the day without ever consulting my intuitive eater. There are times when I feel like I really need to get to the gym to burn off that cookie I had earlier. Even though my day-to-day’s nutrition success fluctuates, what I’ve realized is that it’s a work in progress, and I won’t deny myself (and you shouldn’t either) the ticks in the “W” column (the everyday wins). I’ve earned that “W” and proudly display it on my sleeve (Ok, not literally. I am writing this anonymously, so if I wore a “W” on my sleeve, it might give me away.). You should too. No matter how big or small.

The Struggle Is Real

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The following is a guest column by one of Joanne’s patients, Ashley, a 28-year-old female. We sincerely thank her for sharing her story.

Processed foods.  Whole foods.  Organic.  GMOs.  Good Foods.  Bad foods.

When did all of these labels become so powerful? When did we stop listening to what our bodies wanted to eat, rather than what the media deemed appropriate? If you are a person living in this country, my guess is that your food intuition got drowned out somewhere in your childhood/adolescent years. For many, once we gained the wherewithal to understand the outside world and the messages being thrown at us via TV, radio, internet, we were no longer allowed to listen to our bodies and were told the “right” and “wrong” ways to eat. Or maybe you are one of the rare people that maintains a healthy, nonjudgmental relationship with food. If so, please don’t change your ways; you are unique and courageous.

Let me start by saying that I have been in recovery from a restrictive eating disorder for about three years. At the height of my eating disorder, I felt as though I could not escape the judgmental voices in my head that were only amplified by the outside messages I was receiving. I have never been considered an overweight child or adult, but at a young age, I became hyperaware of my food habits and developed an overwhelming fear of being fat. Growing up in an affluent town, where the pressure to succeed in every way, shape, and form became the standard, maintaining a “thin” ideal was the only way I felt I could succeed, as I did not believe I was successful enough in my studies at school. I was very studious and maintained As and Bs, but this was not comparable to the others around me in high-level AP courses with perfect scores. With this frame of mind, I turned to food restriction in the hope that if I couldn’t be the smartest, I would strive for the “perfect” body instead – whatever that even means.

I later learned that food would become a perceived source of control for when anxiety took hold in my life. Generalized anxiety, with a bit of obsessive compulsive behavior, is a genetic component of my brain chemistry that I inherited; it is a feature I share with others in my family. This seems to be a common theme amongst those with eating disorders, and thus I am not unique in this. My life became consumed with thoughts of food, body image, and the fear of becoming fat. I never thought I was dieting, just “eating healthy.” Striving to increase fruit and vegetable intake, and getting physical activity, in and of itself is a great thing. However, it is commonly a gateway mindset to disordered eating. What most people don’t understand is that an eating disorder is not something that is chosen or easily reversed. A lot of people have said to me “just eat,” or “you have nothing to worry about; you’ve never been overweight.” Trust me, I would not choose a life full of counting calories and innate voices telling me that if I maintain my thinness, I am a better, more beautiful person. That is an insurmountable amount of pressure to be put under, so no, I did not choose to think and act this way. Of course, an eating disorder, while potentially deadly in its own right, is not necessarily a terminal disease, and for that I am very grateful, but that does not mean my story is any less important or challenging. It is a taboo social/mental health issue that we don’t often discuss (until most recently), but I would like to put an end to that. Many of us suffer in silence with voices telling us that we are not thin enough, or that if we put on weight, we will not be loved. I myself did not have the discussion with many of my closest friends until a year or more into recovery.

I can tell you that although I have come a remarkably long way in my journey to recovery, these voices never go away; they only get quieter. I have come to terms with the fact that this may be my own destiny, but that doesn’t necessarily mean food has to run my life in a negative fashion. It has been embedded into our brains as a society that there is a certain way to eat, and not to eat. For some reason, food has gained a moral power, and we are judged on character by what and how much we eat on any given day. For those of us who have struggled with any form of eating disorder, it feels nearly impossible to ignore the flood of messages we receive on an hourly basis regarding food choices. For some, it may be easier to block these harmful messages out, and for that, I am envious.

By nature, I am an easy target for the influence of what I refer to as “Ed” (as in Eating Disorder), the alter ego voice that reinforces negative and irrational food thoughts and behaviors. I was an insecure child growing up in a high-pressure minicosm within a larger society that places increasing value on the “thin ideal.” Trying to navigate the steps to recovery has felt impossible at times in the modern-day era, where food and body size remains a constant topic of conversation. This hyperawareness of food is a fairly novel phenomenon. The seemingly harmless recipe blogs found on Pinterest, fitness blogs, and health research articles have grown in numbers, highlighting the fact that food obsession has become the norm. There have been periods in recovery where I had to deactivate my Facebook account and/or unfollow certain websites in order to regain my sanity and focus on what works for MY body and holistic self. The number of conflicting (and often untrue) facts and opinions on the “best,” “healthiest,” “clean” diets, available at our fingertips is more harmful to achieving a “normal” food mentality than we realize. Even something as seemingly innocent as family, coworkers, and friends asking what I was having for lunch or dinner, or what was in the lunch I brought to work. The analysis and chatter regarding food trends and health is inescapable, and when I took a step back and became aware of it, I recognized my OWN disordered comments with others. I became more sensitive to asking others about their food habits, or how I complimented them, such as the common, well-meaning “Wow, have you lost weight? You look great!” The number of disordered messages that this single statement holds is often overlooked, as weight loss is praised and often equated with beauty.

A very tricky component of my recovery process is that I enjoy cooking (and have to say I am quite decent at it). I often justified cooking my own meals because it was cheaper and “healthier.” Now while that is certainly true, I now realize that measuring and calorie counting every morsel of every meal provided me with an immense feeling of control. I continued with these obsessive thoughts and behaviors for over 3 years, and only about a month ago did I literally throw out any form of measuring cup or spoon. Over the past year, I began forcing myself to eat out once a week or more, where I couldn’t count calories or micromanage the ingredients in whatever I ordered. What I have learned in regards to this is that control feels safe, but rebellion is uncomfortable, and progress often does not occur without discomfort.

In my recovery process, the practice of “intuitive eating” has truly given me hope. For those of you who are unfamiliar with this style of eating, it is basically a practice of getting in touch with your body’s needs, wants, cravings, and satiety. Instead of “how many calories are in this sandwich?” or “how many calories have I eaten today?” the focus shifts to “what is my body in the mood for, and how can I create that? What type and quantity of food is going to make me feel nourished and energetic?” I have to say that honoring my hunger intuitively has been one of the most difficult challenges throughout the recovery process, but without a doubt, the most rewarding and satisfying. Eating without internal judgment? I have never known what that feels like or what it truly means. I may never fully recover from my eating disorder and have come to terms with that idea. However, I continue to learn about my body and coping skills in ways that I never thought possible. I will continue to have great days and very anxious days, but overall, I can say with confidence that life is truly brighter when food freedom feels just within my grasp.

Warning Bells

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The following piece was written by KC, the mother of one of our patients.

I heard the faint warning bell early but didn’t really want to believe it. When she got in the car after a trip visiting a friend and asked if I noticed that she had lost weight, when she started to eat “healthy,” when she became “lactose intolerant” (really? since when?) and couldn’t eat ice cream, when chicken repulsed her– all of these behaviors I noticed. The running and working out increased but it was under the guise of getting ready for fall practices. I started to get nervous, but I kept waiting for her to get tired of the running, to get tired of reading labels. This was my daughter who never considered her size– who would happily try on any clothes– and only knew her weight when she went to the pediatrician. It was not until she told me her weight one morning, at which point I said, “Enough!” and then a week later told me, with what I thought at the time was a rather smug smile, that she had dropped another four pounds that I heard the cathedral bells tolling loud and clear.

I spent the next six weeks taking her to the pediatrician in the practice who was the most knowledgeable about eating disorders– mistake #1– I should have taken her directly to a specialist. She also began therapy with a psychologist who was finishing up her doctorate and had “some experience” with eating disorders– mistake #2. Being referred to Joanne as her nutritionist was the only step she made towards recovery in those first six weeks. I remember clearly my daughter’s initial visit to Joanne because it was the first time I felt I had an ally in the battle against the eating disorder. My daughter sat perched on the end of a chair with a sweatshirt and a down coat on clutching a cup of black coffee while I sat there sweating because it was so hot in the office. Joanne was extremely patient and kind while explaining her meal plan in spite of my daughter’s overt hostility. My daughter contained herself until she reached our car and then started to sob. Uncontrollably sob. Crying was nothing new in our house– she had been doing it daily for months– but looking back I realize it was the first time someone challenged the eating disorder, and it was angry.

The six weeks prior to my daughter entering a treatment facility were incredibly painful. I ate every meal and every snack with her when she was home. And it took her forever. Plus it drove me crazy the way she ate each meal– veggies first then protein then the grain. There were many forbidden topics in our house. No one could discuss exercise or bodies or food. What went on the plate had to be eaten. No one could say that he or she was full halfway through the meal. The list went on. And again, she cried all the time. At one point she confessed that prior to the meal plan, if she ate two apples and a bowl of soup as her food for the day she could tell herself at night that she had done a good job. I learned later that it was actually the eating disorder praising her. After she showered, I would find fistfuls of hair in the drain. She had a bald spot in the front of her head. We took the full length mirror out of her room. I packed up all the clothes that she used to body check and gave them to the Red Cross. She wore pajama pants, baggy shirts, and sweatshirts. Her behavior became child-like– she wanted to sit on my lap, sleep with me, wouldn’t leave my side. We could no longer go out for dinner as a family or a couple. It was far too stressful. When I was not with her, I worried that she was throwing her food into the garbage disposal– when she did come, no one could enjoy his meal– the tension and anxiety emanating from her was palatable. When my husband and I were finally able to get an appointment at Children’s for an evaluation, he expressed concern about her being taken out of school– not to be a part of the peer group. I had to bluntly tell him that our daughter was already gone, and the only hope we had to get her back was residential treatment.

It was frankly a relief when she finally entered treatment. I can honestly say that I could not handle her disorder on my own, and she needed good professional care. Picking the treatment facility is a personal choice, but I am very glad she landed where she did. Her case worker was incredible, and the women who managed her daily were loving but firm. She stayed for a period of time, and we began to measure the success of a day by how many boosts she had to drink or not. I’d like to say that she came out of treatment fully recovered but that was, of course, not the case. I was extremely lucky to be able to put together a post-treatment team for my daughter whom she embraced and respected. Her school was incredibly supportive, but I have heard horror stories where schools have not been. Families who have been told that no allowances would be made– it was either sink or swim. I will be forever grateful to her school administrators for working with and not against my daughter. An acquaintance whose child was a recovering anorexic visited with me while my daughter was in treatment. She imparted some wisdom which I found to be extremely helpful. One, it is not her fault. Two, following the meal plan and finishing her meals is non-negotiable. There is no negotiating with the eating disorder. And finally three supports, love, prayer (if that is one’s thing), and food will help to battle against the eating disorder.

It helped me to think of the eating disorder as a separate entity from my daughter. A few months after she got home from treatment, I made a flippant comment, and she laughed, really laughed. It was her first spontaneous expression of joy in months. I am so proud of her because she has worked incredibly hard to separate herself from the eating disorder. She has listened to her team, gone to therapy, followed her meal plan, and found books on her own to study. She has also developed a spiritual side to her personality which in our barely-go-to-church-on-Christmas family is a wonder to see. She has embraced her treatment and truly wants to get well. Does all this mean she has fully recovered? No, she has not. There have been setbacks, but I am extremely hopeful that she will live a full joy-filled life which has no room for an eating disorder.

No Such Thing as Perfect

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The following piece was written by one of our patients, KC, a 32-year-old female from Wellesley.

Growing up as an athlete encouraged me to develop a commitment and eventually a passion for health and fitness. Over a year ago, that commitment turned into an unhealthy obsession. I lost the balance I once had and quite honestly it happened without me even realizing it. It took control of my life and isolated me from my friends and family and ultimately, it led me down a path of sadness and despair. This is my story of how strict discipline, unwavering dedication and the pursuit of perfection turned my otherwise healthy lifestyle into a battle with Orthorexia and exercise obsession.

I always looked to exercise for stress relief and an outlet when life became challenging and quite honestly, I still do. It was the one thing I could rely on. I felt a sense of calm when I planned strict workouts and meal plans. Sticking to them built my confidence, but failing to do so broke me down. I had to be perfect in order to achieve my goals of being fit. This discipline isolated me, but also made me feel better than everyone else. The more perfect I was, the more I separated myself from the average person. I looked down on everyone that didn’t share my passion for health and fitness.

I eventually developed such strict, unattainable rules failure was the only outcome. Each day I had to eat more cleanly and train harder than the day before. Even if I did achieve this for a period of time, I wasn’t capable of maintaining this intensity and in my mind the only solution was to be more strict. I started a food journal, something I have done my entire life off and on. In order to control my “bad” habits and cravings I felt it was necessary, although it only set me up for more potential for failure. The dieting world promotes food journals as a way to control calorie intake and unnecessary binges. I believe it can be a positive tool for those trying to develop better eating behaviors. However, this only contributed to my perfectionism, obsession and unrealistic ideals for myself. The more I recorded, the more I restricted.

At the time, I was experiencing discomfort with my stomach, which I blamed on my eating habits. It caused sleepless nights and uncomfortable days so I developed another rule, no eating past 8pm. This eventually ruined my social life. I had to rush home after work to eat dinner and declined all invitations to go out. For a while, I was convinced that it made me feel better physically, but the guilt I felt from avoiding parties, friends and anything social greatly affected my self-esteem. I justified it by telling myself I had to stick to the rules and staying out too late would no doubt ruin my workout the next day. The irony was despite following my rules and avoiding social settings my workouts weren’t always perfect. This only added to the growing feeling of failure and ultimately I wasn’t happy.

At this point, my dedication should have given me positive self-reinforcement and contentment. I was nowhere near content. I was exhausted all the time, injuries were creeping up, and I wasn’t enjoying myself at the gym like I once was. In addition, as hard as I was working out, I felt like my body looked awful and therefore I needed to push myself harder. This vicious cycle continued for months. I couldn’t look in mirrors because I felt like I wasn’t getting the results I should be. I avoided anything social because I felt like I needed to reach that level of perfection in order to feel good enough in my clothes to go out and be around people. I was stuck in a rut of failure, frustration and disgust. I found myself constantly comparing myself to others. I felt if I could maintain healthier habits than the people around me, I was ultimately more dedicated to fitness than anyone else.

One temptation that I always tried to control was my love for sweets. I figured if I eliminated eating them altogether I could get even better results at the gym. In reality, I didn’t get better results, I just deprived myself of something I enjoyed for the sake of achieving that perfect image. The interesting thing was I never defined what perfect was. I was constantly chasing something that wasn’t realistic. I just figured I would know what perfect felt like when I got there, but of course I only found sadness and disappointment.

My fitness became my identity. I figured it was the only real reason people liked me. They knew me as the fit girl. If I did overeat and not train hard enough, I wouldn’t be living up to that fit girl image. When I did overeat the punishment I put myself through at the gym was extreme in addition to depriving myself further of the nutrients to get rid of the heavy bloated feeling as a result of the overeating. My meal planning became so structured, I completely lost touch with listening to my body and I didn’t trust my body to make the right decisions. I would force myself to eat things I didn’t even want because they were ‘healthy’ and in my mind would get me closer to my goals. I planned my meals a week in advance and I ate based on the clock, not how my body felt. I had to eat 5-6 meals a day to get all the nutrients in I needed whether I was hungry or not. I realize now, I never enjoyed what I ate or really tasted my food. It took all the pleasure out of eating.

Despite the fact that I was so sad, I was still able to fake a smile. Everyone in my life knows me as a happy person so I had to keep that up. I’ve had people say to me, “You are so happy all the time, I don’t know how you do it”. Honestly, at this point in my life, I didn’t either. I was able to be happy on the outside, but miserable on the inside living a life of solitude. I knew after months of feeling this way something had to change. It was wearing me down physically, emotionally and psychologically. Initially, I was fearful if I got help I would be told that my lifestyle was crazy and obsessive and would be encouraged to drastically reduce my exercise intensity. Reluctantly, I went to therapy.

Talking about my fears and habits helped, but I didn’t change. I realized a lot of our conversations focused on my nutrition, especially when I talked about my stomach pains. My therapist encouraged me to see a nutritionist. I willingly agreed to this because it was such a passion of mine and maybe this person would be able to finally help me reach my goals. I didn’t realize it at the time, but it ended up being a life changing decision that opened my eyes to a severe pattern of disordered eating. I had no clue how much food was controlling my life. My rules and relationship with food took priority over everything in my life. Until I started talking about my feelings toward food and the role they played in my life, I had no idea how much I was under its control.

I was encouraged to read a book called ‘Health Food Junkies’, a book that focused on the eating disorder Orthorexia Nervosa. It was absolutely eye opening. I identified with every story and every statement made about what I now realize to be an unhealthy relationship with food. This really started my journey to truly becoming healthy in my mind and body. I had to relearn how to listen to my body. I had no idea what I felt like eating because I lost touch completely with trusting what my body was telling me. I remember being in the grocery store without my list and recipes for the first time in months and I felt completely lost. Despite feeling lost, I did have a sense of excitement going to the grocery store and shopping based on what I wanted to eat not what I should eat. To relinquish my rules was terrifying and I was afraid to fully trust myself. I wanted to get better, but was fearful that it would have a negative impact on my body. If I sounded conflicted, I was.

I will never forget the session when I was encouraged to eat a cupcake for dinner. Restricting myself from all sweets made me crave them more. I was excited to have this freedom. Within that next day, I bought two huge cupcakes and ate them on the way home in the car for dinner. I was finding sprinkles in my seat for days after. It was the first time I listened to my body in months and it felt empowering. I knew this was the turning point in my recovery. Cupcakes for dinner blew my rules out of the water and it felt pretty awesome.

I started to really believe that listening to my body was the way to achieve the results I wanted all along. It was telling me exactly what it needed to keep me healthy. My body told me when to eat and what to eat. I also started listening when it told me to take a day off from the gym. My social life and relationship with family were becoming strong again. I felt truly happy. For the first time in a long time, I realized being real was a much more fulfilling lifestyle than being perfect. To this day, I carry these valuable lessons with me. I am still one hundred percent committed to my health and fitness. It will always be a passion of mine, but I allow myself the freedoms I never did before because to me this is what it truly means to be healthy.