Our Needs Matter

Part III: Eating Disorder Recovery

Trigger warning: This post includes content related to eating disorders. If you are struggling with an eating disorder, please reach out to the National Eating Disorders Association (NEDA) Helpline. Call (800) 931-2237, or use the “Click to Chat” option. If you are experiencing a crisis, call 911, or text “NEDA” to 741741.

There is no quick, easy way to recover from an eating disorder, but, with support, full recovery IS possible.

When I am struggling with my eating disorder I need…

compassion.

I want you to know that I am trying to fully recover, but there is no quick or easy way to do so. I want to recover, and I have made much progress on my recovery journey. (Major victories: I have not engaged in intentional weight loss in over four years, and I have not measured my food for three months!) I need you to understand that my eating disorder is not your fault, and you cannot fix me. With your support, I can, however, fully recover.

In order to take care of myself today, I have to make my own decisions about food and movement–even if that means I make slip-ups. I have to attune myself to my hunger and fullness cues. I have to continue to honor those cues, especially hunger, more and more until I am eating fully intuitively. I have to move my body when I feel the urge to move energy or emotions through me, not to change my body, and, as importantly, I need to honor my need to rest, too.

I cannot stay in recovery or fully recover without help. I need support. You can best support me by following these guidelines, which I adapted from Eating Recovery Center’s “Do’s and Don’ts for Family Members and Friends of Individuals with Eating Disorders:

Please Do Not…

1. …talk about your diet.

In fact, please do not diet at all. It will not give you the health, happiness, sustainable weight-loss, or status that you seek. For a reminder of the biological, neurological, and other reasons that diets are ineffective, check out my three-post series on why diets do not “work.” I respect you, so hearing about your diet makes wonder if maybe dieting is okay. However, dieting is certainly not okay for me. Remember, it is a major risk factor for eating disorders, and it would almost certainly lead to a relapse for me.

2. …label foods as good or bad, healthy or unhealthy. Do not give me nutrition advice.

Kale and candy are morally equivalent. Further, neither of these foods alone would create a healthy diet. We need a variety of foods to create a healthy, balanced diet, including both vegetables and sugars. Our bodies are intuitively capable of providing cravings for whichever micro- and macro-nutrients we need over time. I am trying to tune-in to these natural cues from my body. Right now, this means a lot of broccoli, bread, and chocolate for me. Further, food is not only about health and nutrition; it is also about connection and pleasure. Remember, it is unhelpful to feel shame about our food choices.

3. …pressure me to eat more or differently.

I am very aware that if I feel like you are trying to get me to eat more total calories or even just shift my diet to consume more fat, my eating disorder voice gets considerably louder to drown you out. I need to make these decisions on my own. Also, no matter your intentions, if you suggest I eat fewer carbohydrates, it is not helpful. Carbohydrates are an important part of a balanced, healthy diet. Perhaps I eat more of them than I necessarily need and more than some other people, but that is okay. It is important for me to honor my Italian heritage and the foods that bring me connection and pleasure. This means I eat a lot of bread.

4. …label exercise as good or bad, healthy or unhealthy. Do not give me exercise advice.

After recovering from compulsive over-exercising, I no longer take part in most types of traditional, gym-style “exercise,” and that is important to me. I participate in the movement that feels good to me, and I am learning to do that more intuitively. I want the ability to move to pass emotions through me, and more importantly, to take part in joyful, values-based activities. I also now value rest and recuperation. I find that intermittent hiking in the mountains with good friends and family is a movement that does support my well-being.

As fat activist Regan Chastain (who holds the Guinness World Record as the heaviest woman to complete a marathon) says, “Running a marathon and watching a Netflix marathon are morally equivalent activities.” I wholeheartedly believe this. Participating in exercise does not make you an inherently “good” person, and relaxing certainly does not make you a “bad” person. For most people, some movement supports physical health. However, engaging in exercise you do not enjoy for the purpose of changing your body is very unhealthy — both physically and mentally. The amount of movement that promotes an individual’s health varies much from person to person and even for an individual over time. (Further, as many people in the fat acceptance and body positive movement have stated before me, nobody is obligated to pursue health-promoting behaviors, including exercise.)

5. …positively or negatively comment on anybody’s appearance or weight,

including your own, mine, or even a stranger’s. On that note, don’t tell me I look better when I gain weight. The disordered part of me hears, “You look uglier.” If you comment that someone who is thin is beautiful, the disordered part of me hears that you equate thinness with beauty. Value body diversity, including size diversity. Use language that promotes fat acceptance and body positivity. Start by removing “overweight” and “obese” from your vocabulary. Those terms are incredibly problematic. Choose “larger body” or “fat” as neutral descriptors.

6. …blame yourself.

Remember, eating disorders develop for a whole host of biological, psychological, and environmental reasons. Mine was mainly triggered by a shallow ex-boyfriend (after living through the cultural low-fat diet craze of the 1990s).

It is not your fault.

7. …give up on me;

full recovery is possible.

Please Do…

1. …Model healthy eating.

Practice balanced, flexible eating. This includes generally honoring hunger and fullness cues and occasionally eating past fullness for social or emotional reasons. Demonstrate that all foods are welcome in your food repertoire. Only exclude foods that you need to for valid medical, ethical, religious, or taste preference reasons. For example, if you have celiac disease, please abstain from eating gluten. If you are a vegetarian who empathizes with animals, please do not eat meat. (However, do not restrict meat in trying to change your body’s shape or size if you do not feel ethically compelled to avoid it.) If you hate the taste of kale, for Pete’s sake, do not eat a raw kale salad without dressing. Eat what your body desires, when it desires it, in the amount that satisfies it. Find pleasure and nourishment in food.

2. …Remind me how recovery will bring me closer to living a life in line with my values.

Acceptance Commitment Therapy (ACT), developed by psychologists Steven Hayes, Kelly Wilson, and Kirk Strosahl,  is an effective, scientifically rooted type of therapy used to treat eating disorders. Although several eating disorder treatment facilities still rely primarily on dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT), Eating Recovery Center (the treatment center that treated me) uses ACT as one of its main forms of therapy. In his book, The Happiness Trap, Russ Harris explains that you can view ACT as a formula:

A = Accept your thoughts and feelings and be present.

C = Connect with your values.

T = Take effective action (Harris 2008, p. 228)

He describes six key principles of a meaningful life:

1. Defusion,
2. Expansion,
3. Connection,
4. The Observing Self,
5. Values and
6. Committed Action.

Defusion is the process of accepting thoughts as just thoughts and allowing them to pass through without giving them too much importance; expansion is making room for feelings; connection is being present, focused, and engaged in the moment; the observing self is taking an out-of-body awareness of our thoughts and feelings; values are determining what is the most important and meaningful things in your heart; and committed action is “taking effective action in line with your values” (Harris 2008, p. 227-228)

If I am making decisions that do not align with my values, gently help me redirect so that I am making committed actions that do align with my values compass.

3. …Remind me of the non-appearance qualities you appreciate about me.

In order to fully overcome my internalized fatphobia and fear of rejection/abandonment, I need to know you value me as a human being. I need you to reassure me that as my body inevitably gets larger, older, and experiences other changes over time, you will not love me any less. No, I should not need this reassurance, but in our culture (i.e., diet culture) that idolizes the thin and with the internalization of my experience of appearance-based rejection, this reassurance is a powerful counter-argument when fear arises.

4. …Plan activities that do not revolve around food.

Hike with me so we can connect over my value of nature. Go to a museum or read with me so we can connect over my value of learning. My identity revolved around food and body for a few years; help me create a deeper purpose and connection in my life that has nothing to do with food or bodies.

What values-based activities do you enjoy?

5. …Let me make my food and exercise choices, and let me take charge of my daily routines.

See “Do Not” numbers 2-4 above. I may occasionally make decisions that do not best support my wellbeing. The process of recovery is not linear, and that is okay. As long as I am on the recovery journey (i.e., I have not completely relapsed), I will learn and grow from my mistakes. Trying to fix me will be ineffective and could backfire.

If you are supporting a loved one with an eating disorder, ask them about this one. Some people need/prefer to be held accountable by loved ones.

6. …Get help if you need it.

There are now so many resources for people who are supporting loved ones with eating disorders. Check out websites, such as Eating Recovery Center’s webpage for families of people with eating disorders and their Family Support Center or National Eating Disorders Association’s webpage for How to Help a Loved One; attend a support group, such as The Eating Disorder Foundation’s free Support Group for Family & Friends; or find a therapist for personal counseling. As the saying goes, “You cannot pour from an empty cup.”

If you are a loved one of someone with an eating disorder, what resources have you found helpful for supporting your loved one and for supporting your own mental health?

7. …Love me unconditionally.

If you love somebody with an eating disorder, ask them how you can help. What looks supportive to them may be very different from what feels supportive to me. Everybody’s journey is different.

If you are struggling with an eating disorder, and you need support but do not know how to ask for it, feel free to share this post and tell your support network which “dos and don’ts” resonate with you.