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Eating Disorder Recovery: Q&A with Sarah from Psychforum

Wednesday, December 16th, 2009

Below, Sarah shares her struggles with anorexia and how she recovered and now leads a fulfilling life.

1. How and when did your eating disorder start? What do you think contributed to it?

My anorexia started developing at seventeen and I probably didn’t recover to a normal weight for two years. I had always been aware of my body since childhood — I went through puberty and was the first girl at school to get boobs. From thirteen, I probably started weird food habits with bingeing and guilt. At seventeen, I was under increased pressure with high school exams and going to college and started getting bullied by other pupils at school.

My background was the usual — high-achieving perfectionist, been bullied, mum was very diet-conscious. I started a diet and just didn’t stop until I ate very little. The control you feel is cliché but true. Not only do you get a physical high from starving but glee from under-eating everyone around you. I thought that being thin would put me beyond the criticism of my teachers and bullies, and so I wouldn’t have to keep thinking about it. It made me feel independent. I didn’t ever feel attractive though. Your sex drive collapses to nothing and your body always looks wrong.

2. What motivated you to seek treatment?

My family recognized it before I did. My older sister convinced my parents who were rather bewildered, who sat me down with a list of the symptoms and asked if I recognized myself in it. I denied it, got angry and tearful, but agreed to go to a primary physician.

I suppose I went along with treatment because I was physically weak and unable to resist (I once cried in a restaurant when faced with a baked potato!), somewhat embarrassed (lots of weird ED behaviors) and probably didn’t think I needed it, so no great change would happen. I remember teachers and friends being concerned and that I would just shrug off. My parents hadn’t told the extended family. It was brutal when I saw my granddad for the first time and he thought I was dying.

3. Eating disorders are tremendously treatable but the key is to find the right treatment. How did you go about seeking services?

I’m English, so everything was done through our national health service and was free. My GP (primary physician) started treating me for depression. I was very underweight, but he encouraged me to start eating more (so I didn’t drop) but didn’t give me a target weight initially. This was a good approach for me. I had some time and space to get used to eating more, my obsession with food declined, and I started feeling a bit stronger and could tackle other issues. Obviously this didn’t happen at once. I was pretty sneaky and constantly trying to hide food or exercise more and for the next couple of years, my weight went up and down from underweight to normal a fair bit.

I was referred to a couple of sessions with a psychologist before I moved cities. In college, I started seeing a non-ED counselor while I got referred to services and then was enormously lucky to receive outpatient treatment at a highly specialist ED unit. I’d go once or twice a week for very structured counseling. It was based more around body image, self-esteem and used a cognitive-behavioral approach than really looking at nutrition. (ED sufferers know loads about nutrition — they just rationalize that they are somehow the exception to it!). I would see the in-patients when I visited. They were so sick-looking and frequently throwing tantrums: I suddenly saw that that’s all their lives would be, and I didn’t want it.

4. What led to your recovery?

The treatment was fantastic: intensive, focused away from weight and on depression and self-esteem. I started treatment within five months, so perhaps the behaviors weren’t too embedded. I started developing hobbies and new friends. I had space from my family to build my own life and take responsibility. I’ve always been bookish and found reading books like The Beauty Myth really helped to redirect my anger away from my body to the idea of an ideal body standard. My GP told me I was anhedonic, and taking pleasure in nothing was no way to live. I was fascinated every time I saw myself in portrayals of ED, though after a while I stopped reading too much because I wasn’t sure it made it better. ‘Misery memoirs’ can be templates for behavior too.

I was bored too. EDs are really boring. Think of all the parties and teenage fun I missed out on! I remember my doctor explaining that people only think of food when they are hungry. So for normal people that’s 10 percent, and if you are starving or disordered, it’s 90 percent. You become obsessed with food and weighing yourself and exercise and it’s just a waste of brain space.

I had to stop caring and comparing myself to others. People with EDs tend to see separate qualities not the whole package — i.e., that girl has much thinner legs — and don’t appreciate their own personality, career, friends and physical qualities. I went to a competitive university where many girls have EDs, but in the end I was only responsible for my health.

5. What were the toughest parts of your recovery and how did you get through them?

Recovery isn’t linear, and it’s not something you “win” at. It’s slow, it’ll be hard work, and you will still have guilt for a long time. You have to stay mindful about unhealthy influences: friends who “fat-talk,” celebrity magazines (which judge bodies and give out ED-type advice), diets foods (food should be about nourishment). Some trashy magazines encourage starvation level diets, exercise to purge calories not for health reasons, include weird tips like eating off small plates or restricting to something bonkers like the master cleanse. They all do that terrible “circle of shame,” picking out and judging bodies (always women). It is exactly the same as the internal monologue of someone with ED observing herself in a mirror.

I didn’t take up exercising properly again (I had exercise bulimia too) until this year and have maintained my weight and take pleasure in it. Throwing away all the children’s clothes (really) and photos was a big step. Really, I probably wouldn’t want to see a picture of myself like that now. Getting over the embarrassment of mental illness is crucial. I can be fairly open — if I met an old school friend who asked if I was ill, I could happily admit it, but I don’t tell new people unless I have a reason.

You also have to grow up and realize you do have a responsibility to your family, community etc. I once gave a talk to a bunch of schoolgirls after the school had requested a student ED survivor from my university. They kept asking questions which were really methods and wanted to know my final weight. I didn’t disclose as I didn’t want them to target that. The same kids wrote me letters afterwards admitting their own issues. It was heartbreaking. The school set up some kind of counseling service.

6. Do you still struggle with eating disordered thoughts and behaviors? If so, how do you overcome them?

Thoughts but not really behaviors. I am very critical of myself generally, not just my weight, and have to consciously stop “disasterizing.” Disasterizing is what my psychotherapist called assuming the very worst and an unrealistically bad outcome — i.e. thinking that a meal out will result in a three pound weight gain, an unexpected meeting with my boss means getting fired. I had to relearn how to consider and react to situations in a calm and realistic manner. I’m a big fan of self-help books, especially those based in CBT (cognitive-behavioral therapy) techniques and looking at compassion, mindfulness, etc.

I still have a list of ten bad ways of thinking and read it occasionally. The biggest tip I have while you’re recovering is to act the opposite: Feeling fat and avoiding social situations? Just go. Think you can’t wear the skirt? Enjoy it. Avoiding a food you don’t know the calories of? It’s a cake, not a bomb. The world won’t end.

I challenge the anhedonic tendencies by looking after myself, seeing friends, not pushing myself too hard, getting sleep and good food, and indulging in bubble baths! I volunteer with disabled kids and the homeless, which taught me compassion for others, and also for myself.

7. What are some misconceptions about eating disorders?

That people with ED are selfish. Often, they are excessively empathetic. That the mother/family is to blame, maybe or maybe not, but the individual is important too. That you can’t recover. You can. That weight rather than the eating patterns are important. I’ve seen normal-weight bulimics in MUCH worse physical conditions than anorexics.

8. Many people don’t realize the physical consequences of eating disorders, including electrolyte imbalances, irregular heartbeat, osteoporosis, severe tooth decay and digestive problems. Did you experience any health problems as a result of your eating disorder?

I stopped getting periods but that came back once my weight was up. I have no idea if my long-term fertility was affected. My sleeping patterns have never been restored. When I was ill, I was too cold, sore or manic to sleep. It takes a while to get used to this whole new body once you are well. I got big boobs again!

9. What can family members do to help a loved one with an eating disorder?

They have to realize that they can’t fix it alone. Finding a doctor who understands ED is crucial, but you might have to fight for treatment while fighting your angry, fear and ill child/sister/lover, etc.

I have a lot of guilt about what I inflicted on my family. They really did think I was dying. They did the right things: They educated themselves, they avoided confrontation and they examined their own behavior. I have a younger sister, and despite what happened with me, she’s incredibly happy and body confident.

10. Anything else you’d like readers to know about eating disorders?

It’s common, it’s an illness not some self-indulgence, and it’s not the end of the world: You can recover. People who claim they can’t recover are in denial or haven’t been treated properly.

Eight years later, I’m happy, successful, have lots of friends, hobbies and a great job. I have boyfriends and a sex life. I am comfortable with what I weigh and how I eat, even if I have days that I need to coach myself through. You are the only person who’ll be with you every day for your whole life. Be your own best friend!

Learn a Secret Celebrity Weight Loss Trick to Try at Home

Saturday, July 18th, 2009

Ever notice those celebrities with the tight derrieres, sleek profiles, and great posture and wish you knew their secrets?  Here’s one of the best, and you can even do it within your own happy home: walk!

You probably have seen photos in gossip magazines of celebrities walking briskly in Beverly Hills, striding along a beach, or hiking in Aspen.  They know that fast walking is one of the best ways to lose weight and keep it off.

Walking is great for your health, easy to fit into the busiest day…and it’s free!

Celebrity fitness pro Leslie Sansone has created an easy-to-follow, energizing video designed to guide you through a brisk five-mile walk in your living room. A free preview is available on the Exercise TV site

An ExerciseTV trainer, Leslie developed her In-Home Walking programs as a way to give everyone (not just celebrities!) a method for getting fit, losing and managing weight, and becoming healthier.

After all, not all of us live in an area that’s safe for walking.  In addition, concerns such as bad weather or a sick child can tamper with even the best intentions for an outside walking program.  That’s where the idea of walking at home comes into play.  And it literally feels like play, thanks to Leslie’s cheerful spirit and variety on the video.

Also available from the site are soft hand weights and the Leslie Sansone Talking Pedometer.  The weights are great for getting those toned arms, shoulders, and back muscles that so many celebrities possess.  And the pedometer is another way to motivate yourself.  By keeping track of how many steps you take each day (don’t forget to include that five-mile walking video!), you can motivate yourself to take just a few more steps.  Before you know it, you’ll be averaging ten miles a day!

What drives people to overeat?

Friday, July 10th, 2009

Balancing food intake and energy expenditure is a complex process that involves two systems in the brain: a need-based system that triggers hunger when the body requires energy, and a reward-based system that triggers the desire to eat. The two sites are close to each other anatomically and work like parts of a machine.

The need-based system involves metabolism. It’s the part that monitors calories and receives signals from the body — for example, shifting levels of glucose or the hormones insulin and leptin — that tell you you’ve eaten enough and it’s time to stop. If you’re genetically prone to becoming obese, you may not be very sensitive to those signals, and you’ll eat more before stopping than someone who is not obesity-prone.

Everyone’s system strives to maintain a constant weight, or set point. The set point can be shifted upward, but only over time. If you overeat during a single meal — say, a big Thanksgiving dinner — your body goes into overdrive to try to get rid of those excess calories. But if you gain weight gradually, your body eventually will become accustomed to a higher weight and work to maintain it.

Your guide to keeping it low carb

Thursday, July 2nd, 2009

While most people are excited preparing their big menus for this year’s 4th of July party, many of us that are trying to stick to our eating plan find it a big challenge to stick to plan. If you are invited to a party at a friend or relative’s house, sometimes you don’t have much control over what is being served and could feel pressure to eat what is provided. The best thing you can do is K.I.S.S. your way through the weekend.

Keep it simple stupid (K.I.S.S.); don’t be tempted by all the dishes that aren’t on your list of allowed foods. Don’t think that just because your Aunt Sarah made that potato salad you grew up on that you simply must have some. Instead, focus on the foods that are acceptable for your current phase and be sure to keep plenty of them on hand. This may mean that you need to bring some items yourself so that they will be readily available. If you bring enough to share, who knows, you might just strike up a conversation with someone looking to get healthier and lose some weight.

Stick to the basics; when you are given burgers and hot dogs, toss the buns and add some additional veggies and lettuce and make it a big “grilled out salad.” Keep fresh, raw veggies on hand for snacking between meals and don’t give in to the left over cookies that could be calling your name from the table. As always be sure to stay hydrated when out in the sun this weekend. Keeping your body full of water will also help keep your appetite under control.

Get creative; bring a new low carb dish that you can share with everyone there. You will be surprised at how acceptable others will be if you are proud of your dish and tell others how great it is. Even something as simple as a good mashed cauliflower dish with some cheese and bacon bits will be very tasty and many people will enjoy it even if you have to talk them into trying it.

Be safe and have a great time this weekend. Stay on plan and surround yourself with foods that will keep you from getting off track and could lead to binges. If you are headed to the lake or beach, that this opportunity to get some additional exercise by means of swimming, running, skiing, or even something as simple as spending extra time playing with the kids.

A Superior Diet Pill for Loosing Your Weight

Thursday, December 18th, 2008

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Weight Loss Medications: yes or no?

Thursday, December 11th, 2008

There are a number of new weight loss medications available on the market today. However, these drugs are not intended for the average person who has an extra 10 pounds to lose before their wedding. Prescription weight loss medications are designed for people who are significantly obese or have weight-related medical problems that must be corrected quickly to prevent further complications. Here is a basic guide to determining if weight loss drugs may be right for you. Of course, you must always consult your doctor for a thorough evaluation and prescription.

There are certain guidelines concerning who may be prescribed weight loss medications. A patient must have a body mass index that is over 30, unless they have other obesity-related health conditions such as heart problems, diabetes, or high blood pressure. These severe medical conditions lower the body mass index requirement to 27. Whether or not a medical condition is obesity-related and grounds for prescribing medication can depend on the doctor, so get a second opinion if you disagree with your doctor’s assessment. These health problems can become severe if left unchecked and prescription weight loss medications may be the answer you have been looking for.

The most common weight loss medications work by suppressing the appetite. These types of diet aids have been around for decades, with amphetamines and Dexedrine being used even back in the 1950s. A new type of appetite suppressant drugs use a slightly different mechanism to achieve the same result, reducing their appeal for abuse. For example, the popular drug Meridia inhibits the release of a certain type of brain chemical that is responsible for signaling hunger. This way, the patient never even gets hungry, so there is no feeling of depriving themselves of something they want. Unfortunately, Meridia is known to increase blood pressure and heart rate, making it unsafe for many people with cardiovascular issues.

Besides the weight loss medications that suppress appetite, there is another class of drugs designed to interfere with the body’s ability to absorb fat from food. Xenical was the first of these lipase inhibitor medications to be approved, hitting the market in 1999. These drugs work by inhibiting the body’s production of lipase, which is a necessary part of the fat absorption process. Without this enzyme, fat molecules cannot be broken down and will pass harmlessly through the digestive system. The side effects of Xenical show the drawback to letting fat leave the body in its unprocessed state, with cramps, flatulence, diarrhea, and anal leakage being the most common.

Testing is always being performed on new drugs for the commercial markets, so it is only a matter of time before there are better options for people wishing to lose weight. Some developmental medicines have received short-term FDA approval, but they have shown too many side effects to be approved for mainstream use at this time. With some more refining by the pharmaceutical companies’ research and development departments, they should be available as part of the next wave of prescription weight loss medications.

First, make sure you’re ready

Tuesday, December 2nd, 2008

Your weight-loss success depends on your readiness to take on the challenge. These questions can help you judge whether now is the best time to start your weight-loss program.

  • Are you motivated to make long-term lifestyle changes that require eating healthy foods and exercising more? Be honest. Knowing you need to make changes in your life and feeling up to the challenge are two different things.
  • Do you currently have distractions in your life that may prevent you from committing to your weight-loss program? You may set yourself up for failure if you’re distracted by other major events in your life, such as marital problems, job stress, illness or financial worries. Give your life a chance to calm down before you start.
  • Do you truly believe that slower is better? Losing weight at a relatively slow pace has proved safe, healthy and effective over the long term. You should aim for a weight loss of 1 to 2 pounds a week.
  • Are you realistic about your weight-loss goal? Remember, losing as little as 10 to 20 pounds can improve your health if you’re overweight or obese. Ask your doctor how much weight you can safely lose.
  • Do you have family and friends to support your weight-loss efforts? It certainly helps to have someone in your corner. If you don’t have someone you can rely on, consider joining a weight-loss support group.
  • Do you believe that you can change your eating habits? Sounds easy to do in theory, but in practice, it’s often difficult. It’s hard to cast aside established behaviors.
  • Are you willing to become more physically active? Increasing your level of physical activity is essential to losing weight and keeping it off.
  • Do you have time to keep records of your food intake and physical activity? Keeping records increases your chance of success. You’ll be pleasantly surprised by how helpful it is to track your progress.
  • Are you willing to look at past successes and failures in weight loss and other areas of your life? Learn from the past about what motivates you. Keep working to resolve barriers that might prevent success.
  • Do you view a healthy-weight program as a positive experience? Lose weight because you want to and not because you think it’s expected by others.
  • Have you resolved any eating disorders or other emotional issues that make it difficult for you to achieve a healthy weight? If you have a tendency to binge, purge, starve or overexert when you exercise, or if you’re depressed or anxious, you may need professional help.
  • Do you believe that a healthy weight is a lifelong commitment? Achieving and maintaining a healthy weight is a lifelong process. There’s no going back to your old behaviors. Are you ready to make a permanent change?

If you answered yes to all of these questions, you’re ready to make the lifestyle changes necessary for permanent weight loss.

If you answered no to one or more of these questions, you may not be ready. And that’s OK. Explore what’s holding you back and face those obstacles. In some cases it may be a simple matter of timing. For instance, you may need to resolve other problems in your life. In other cases, you may need to work on related issues — such as your feelings toward weight loss or your willingness to commit to permanent changes.

You may be able to make these changes alone, or you may feel you need additional help. Educating yourself about the process of successful weight loss and maintenance is a start. For example, learn more about the dietary changes necessary for losing weight. See a dietitian or enroll in a behavioral-based program — a program that can help you change the behaviors that can interfere with weight loss, such as eating when you’re stressed or bored.

If you’re ready for weight loss but fear you’ll become discouraged quickly, think toward the future. As you become more physically active and make dietary changes, you’ll feel better and have more energy. And rather than thinking of weight loss as a short-term drudgery, view it as an enjoyable lifestyle change that persists indefinitely.