Why recovery isn’t just about weight restoration

eating disorder recovery

Three reasons why recovery is beyond merely physical

 

Weight restoration can be a crucial indicator of recovery on one’s healing journey from an eating disorder. When weight restored, you might feel stronger and may have reversed your symptoms related to starvation syndrome – which is already a significant and remarkable achievement!

While reaching your restored weight can positively affect your pathway to food freedom, it is also a hugely uncomfortable challenge to face eating what feels like vast amounts of food and experience rapid weight change. We empathise with you!

Studies have shown that eating disorder recovery heavily involves biological and neuropsychological factors, where those who are on the recovery journey report hope, support from others, and self-acceptance as integral in the process. (1)

Recovery is non-linear, and there is a need for more complex and flexible measures to understand the endpoints, timelines and processes of recovery. (2) It is necessary to recognise why it may not be too helpful to make weight our sole focus of recovery – and why it’s vital to think much further outside the box.

Below are three reasons why eating disorder recovery goes beyond the return to a ‘normal’ weight and other factors to consider on your healing journey, too. 

 

ONE: Health goes beyond physical measures.

We know that our whole health, particularly in eating disorder recovery, comprises far more than just weight. Mental, social, environmental, occupational, spiritual and emotional health are all relevant and valid facets when it comes to our health, too.

For example, if someone was injured in a potentially fatal car accident, but their fractures had now recovered, we wouldn’t assume that all of the trauma and fear that may have surfaced from this singular event has magically disappeared. 

It could take this person years before they feel comfortable travelling by car again. This could cause restriction in other areas of their life – such as in their occupation or social life – perhaps even evoking feelings of guilt or isolation. From this sole experience, we can see the consequential impacts on multiple forms of our health.

In the same way, although a stable weight may be reached, this doesn’t mean that we are in the best mental or emotional state that we would be considered ‘recovered.’  The weight gain itself could stir up inner conflicts too, so it is important to learn about how to cope with this.

These additional pillars of health cannot be defined or measured by a number on a scale or a portion size. So, putting weight as the threshold by which one is recovered can be seen as reductionist – losing sight of the broader picture.

You must also consider your emotional resilience, the relationship with have with your body and how you interact with the world around you.

 

TWO: Remembering the power of cognition.

Only looking at weight restoration as a measure of healing from an eating disorder assumes that this objective measure is the only indicator of recovery – and that our personal experiences and cognition is also healed through weight restoration.

Thought and behaviour play a massive role in our recovery. Although our weight may have normalised, this doesn’t mean that our mindset is positively aligned with achieving a complete and sustainable recovery. It is also beneficial to identify and detach our recovery ‘self’ from our eating disorder ‘self.’

Reaching a place of freedom, intuitive eating, and body compassion is no easy feat, and particularly for someone with an eating disorder, this may still feel like a lifetime away. They may still experience body shame and have a massive fear of gaining weight or continue to feel extreme hunger throughout the day. All of these can be signs that they may still be a long way off recovery. (3)

Those healing from an eating disorder may feel guilt for any weight changes or uncomfortable eating large amounts of food and limiting their heavy exercise routines.

Although recovery may be visible from a weight perspective, we do not know the whole story of someone’s mental state and any silent disordered thinking that they may experience. 

A big part of healing from an eating disorder is our mental health and self-talk – so again, ignoring this misses out a significant factor of one’s recovery path.

 

THREE: There is no such thing as a ‘normal’ weight.

It is important to remember that weight is an individual and relative term and that there is no one-size-fits-all approach when it comes to our bodies. 

You may have reached what is considered a ‘normal range BMI,’ but this is a social construct and one that has been criticised in the media time and time again for its potential inaccuracy. Weight is not a highly accurate measure of health – read why here.

Weight is personal to you – it goes beyond a number on a scale and involves how you feel and perceive yourself at that weight. It also doesn’t account for our unique build and other health conditions or situations that may shift our set point weight or what feels ‘normal’ for us. (4)

Focusing on weight implies that people are recovered through reaching a number on a chart and may further reinforce the visual stereotype of an eating disorder – being thin, emaciated, and usually female. 

We know this stereotype is often inaccurate, and eating disorders can manifest in any body shape, gender or race. The idea that all eating disorders look the same on the surface is simply not true. 

This may lead people to believe that they are not ‘sick enough’ due to their now-restored weight, and they may not feel an urgency to continue to recover or may feel they no longer need to. Being unwell is not a ‘look’ – and so it’s important to consider health from a more holistic viewpoint. (4)

We hope you enjoyed this article and are sending you plenty of strength and positive energy, no matter where you are right now. This kind of self-work takes immense courage, and we are here to support you along each step of the journey. 

Reach out to us at hello@embodyhealthlondon.com to chat with one of our specialist dietitians and book a discovery call today!

 

Priya Chotai, BSc ANutr

EHL Team x 

 

 

 

 

 

 

References

  1. Bardone-Cone AM, Hunt RA, Watson HJ. An Overview of Conceptualisations of Eating Disorder Recovery, Recent Findings, and Future Directions. Curr Psychiatry Rep. 2018 Aug 9;20(9):79. DOI: 10.1007/s11920-018-0932-9. PMID: 30094740.
  2. LaMarre A, Rice C. Recovering Uncertainty: Exploring Eating Disorder Recovery in Context. Cult Med Psychiatry. 2021 Dec;45(4):706-726. doi: 10.1007/s11013-020-09700-7. Epub 2021 Jan 2. PMID: 33389444.
  3. Bardone-Cone AM, Johnson S, Raney TJ, Zucker N, Watson HJ, Bulik CM. Eating disorder recovery in men: A pilot study. Int J Eat Disord. 2019 Dec;52(12):1370-1379. DOI: 10.1002/eat.23153. Epub 2019 Aug 16. PMID: 31418898.
  4. Hayden, M. Why ‘Weight Restoration’ Isn’t Recovery — ThoughtsbyKenz. 2021 Jan; Retrieved Nov 26 2021, from https://thoughtsbykenz.com/posts/2021/7/11/why-weight-restoration-isnt-recovery

Beliefs holding you back from full recovery

limiting beliefs

Three limiting beliefs your eating disorder has you believe

 

Recovery is hard enough as it is, not to mention when we hold unhelpful limiting beliefs that prevent us from reaching our full potential.

A limiting belief is a state of mind, conviction, or belief that you think to be true that limits you in some way.

We work with hundreds of clients who feel limited in their recovery due to these beliefs. Whilst, of course, we are all unique, there are some common limiting beliefs that many of our client’s experience. 

In today’s blog we are going to explore a handful of these beliefs and hopefully shed some light on why they are worth reframing. Because after all, beliefs are ever-evolving – not static.  

 

#1 FULL RECOVERY ISN’T POSSIBLE

Let’s start by saying… full recovery IS possible and it’s never too late to begin!

Why do we feel so strongly about this? Because we witness this possibility every day and research says it is, too.

With the right support and willingness to make change, you CAN recover.

What is full recovery?

It could be defined as an improved quality of life due to being free of all eating disorder symptoms and returning to a healthier body weight (if underweight). Beliefs and attitudes about body image, food and exercise are also normalised and healthy.

Factors that make it more challenging:

  • Not being aware of the eating disorder or of having a problem: If you’re here reading this, this likely isn’t you! Therefore, the world is your oyster! For those that are not aware, the right medical support is needed to ensure they are stabilised and then there is scope for engaging in recovery. 
  • Severity and duration of the eating disorder: The longer and more severely you have lived with your eating disorder the longer it may take to recover. But don’t let that put you off. Think about how much your life is impacted by the eating disorder – do you really want that to continue into your future? How much longer can this go on? You’ve got a life to live!
  • Anxiety or depression: Eating disorders often present with anxiety, depression, or obsessive-compulsive disorder (OCD)1,2,3. Therefore, to recover fully it can be helpful to have the right therapeutic interventions to deal with the anxiety and/or depression alongside the eating disorder.
  • Low self-esteem and perfectionism: It have been shown that some of the maintaining factors of an eating disorder are underlying clinical perfectionism and low-self-esteem4. This tells us how engaging in a therapy is helpful to address underlying causes. 

 

#2 I WANT TO RECOVER IN A “HEALTHY” WAY

You want to have a go at recovery, but don’t want to eat that because it’s “not healthy”, right?

Holding onto “healthy” or “clean” eating is keeping you trapped. Healthy/clean eating in the context of eating disorder recovery is likely just a restriction dressed up with a halo.

We have to be very careful of this, because we also run the risk of recovering from one eating disorder into another – for example, from anorexia into orthorexia. This is NOT a good thing. It can be just as harmful and is not freedom!

Healthy eating has many definitions. It is perceived as a “good thing to do” in society and therefore if we suggest that our choices are based on “healthy eating” then it can be a get out of jail card for the eating disorder, and it can continue to go under the radar.

What do we know about the eating disorder staying under the radar?

Eating disorders THRIVE in isolation. If you are not allowing yourself to be honest with your intentions for healthy or clean eating, you are not allowing yourself to find food freedom.

It’s immensely important to challenge ALL foods as part of your recovery – including “fun foods”. If this doesn’t happen, food fears will continue to creep in and limit you from living a full life.

 

#3 I WANT TO RECOVER, BUT STILL BE IN CONTROL OF MY WEIGHT

In order to fully recover, we need to be able to accept that our body will change. Our body’s weight will change across our life. If we are still gripping onto the idea that we can “stay skinny” or “not gain any more weight” then we are letting our eating disorder control us.

The desire to still be in control of weight is driven by FEAR. We are scared. We fear what weight gain might look like, people’s opinions, what it might feel like, and what it may mean about us.

In order to overcome the fear of weight gain, we have to stop and move away from any weight-controlling behaviours. This is absolutely necessary. Every time we engage in weight control behaviour, we teach our brain that it needs to be afraid of weight change and that keeps us trapped in a negative loop of other unhelpful eating disorder behaviours such as the restriction-binge cycle or purging and over-exercise.

When we learn to let go of the control of our weight, we make room for SO MUCH more in our life. How much time a day do you spend thinking about your weight or ways to control it? Yes, too much. What else could you do with that time? Imagine the possibilities!

Your weight is the least interesting thing about you. Don’t give it so much of your energy. You are a whole person, you have so much to give to the world – the world needs that.

To learn more about how our dietitians can support you in your eating disorder recovery, book a free discovery call.

Zoe Light, RD

EHL Team x

 

 

 

References

  1. Godart N.T., Flament M.F., Perdereau F., Jeammet P. Comorbidity between eating disorders and anxiety disorders: A review. Int. J. Eat. Disord. 2002;32:253–270. doi: 10.1002/eat.10096.
  2. Godart N.T., Perdereau F., Rein Z., Berthoz S., Wallier J., Jeammet P., Flament M.F. Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J. Affect. Disord. 2007;97:37–49. doi: 10.1016/j.jad.2006.06.023
  3. Garcia S.C., Mikhail M.E., Keel P.K., Burt S.A., Neale M.C., Boker S., Klump K.L. Increased rates of eating disorders and their symptoms in women with major depressive disorder and anxiety disorders. Int. J. Eat. Disord. 2020;53:1844–1854. doi: 10.1002/eat.23366
  4. Fairburn C.G., Cooper Z., Shafran R. Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behav. Res. Ther. 2003;41:509–528. doi: 10.1016/S0005-7967(02)00088-8

 

The power of yoga in eating disorder recovery

yoga and eating disorders

Yoga as an embodiment practice

 

There is a growing interest in the benefits of practicing yoga for those struggling with an eating disorder. You might be wondering how a form of exercise could help with eating disorder recovery – however yoga is about so much more than moving from pose to pose or sitting cross legged on the floor. By promoting slowing down and turning the awareness inwards, yoga encourages a harmony between the mind and body that is lost through the eating disorder.

In this article, we’ll do a deep dive into the benefits of yoga in eating disorder recovery and the evidence supporting it.

 

What does the research say?

There is plenty of evidence supporting the benefits of yoga in eating disorder recovery. To describe a few…

One study of a group of women with Bulimia Nervosa or EDNOS found a significant decrease in eating disorder psychopathology after six months of twice-weekly yoga classes.1 The most significant impact was seen in a reduction in eating concern, weight concern and restriction.

Similarly, a study of women between the ages of 18-30 found a reduction in body-image dissatisfaction and spent less time focused on their appearance when they practiced yoga twice a week for twelve weeks.2

Another small study of adolescents with an eating disorder being treated as outpatients found a significant decrease in anxiety, depression, and body image disturbance after completing a weekly yoga class for twelve weeks.3

 

What is it about yoga that supports recovery?

Yoga can be uncomfortable, both physically and emotionally. By offering a safe space that is free of distraction, there is the opportunity to process and release emotions that may have been pushed down for a long time or coped with through the eating disorder. You might also find you can prove to yourself that you can survive hard things and that discomfort will pass. Learning to sit with discomfort and respond to your feelings rather than react are key skills for eating disorder recovery, as they allow you to navigate the urge to engage in disordered behaviours.

Another idea that is emphasised in most yoga classes is meeting yourself where you’re at. This means not comparing yourself to others, or even to your own “best self”. Instead, yoga encourages you listen to your body in any given moment, and to give it what it needs. Some days your healthy self will want a little more movement; some days it will need rest. Both are okay!

We said earlier that yoga is not just about the poses, but they have their place too! Moving (or holding still) with mindful intention allows you to connect in with your body without any focus on appearance. Despite an often-obsessive focus on the body, eating disorders leave us feeling incredibly numb and disconnected from our physical selves. Too often, we treat the body like the problem, when reconnecting with it can actually be the solution.

 

What should I look for in a yoga class?

Not every yoga class is going to be helpful, especially in the early stages of recovery. Choose classes that are gentle and focused on relaxation and stretching rather than more intensive movement. These classes are sometimes called “Yin yoga” or “restorative yoga”. Yoga classes that are trauma-informed, or even specifically directed towards eating disorder recovery are also out there – we suggest Googling what is available in your area.

Like almost all good things, diet culture has unfortunately found its way into some parts of the yoga community. While many studios are “safe” spaces, not all will be. Have a look at their website and social media to see what kind of messaging they promote and avoid any that refer to using exercise or food to change your physical appearance.

It should also be noted explicitly that while we obviously believe in the power of yoga in supporting eating disorder recovery, it should be practiced in combination with other treatment modalities and should NOT replace traditional evidence-based treatments. Make sure you discuss with your team before you introduce any exercise!

To learn more about how our dietitians can support you in your eating disorder recovery, book a free discovery call.

 

Karli Battaglia, APD

EHL Team x

 

References

1. Karlsen K, Vrabel K, Bratland-Sanda S, Ulleberg P, Benum K. Effect of yoga in the treatment of eating disorders: A single-blinded randomized controlled trial with 6-months follow-up. International Journal of Yoga. 2018;11(2):166.

2. Ariel-Donges A, Gordon E, Bauman V, Perri M. Does Yoga Help College-Aged Women with Body-Image Dissatisfaction Feel Better About Their Bodies?. Sex Roles. 2018;80(1-2):41-51.

3. Hall A, Ofei-Tenkorang N, Machan J, Gordon C. Use of yoga in outpatient eating disorder treatment: a pilot study. Journal of Eating Disorders. 2016;4(1).

 

This happens when you stop weighing yourself

weighing yourself

As soon as you wake in the morning, you tense up… you place both feet on the ground, take a breath and sigh in apathy just hoping the number you see this time might just be enough… feel like enough… but to no avail, is it really ever?

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Three reasons you’re secret eating

secret eating solution

As the name suggests, secret eating is a disordered eating behaviour that involves eating at times, in locations or in ways where you won’t be seen, with the intention of hiding what or how much you’re eating from other people…

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Three steps to challenging your food rules

anti diet food rules challenge recovery

How to move away from the shackles of diet culture by challenging your food rules 

 

If you’ve ever felt guilty or anxious around food and eating, you’re probably be influenced by your food rules.

Food rules are beliefs about foods that are collected over time and form the basis of our food choices when we are not eating intuitively. They dictate things like the types of food you’re allowed to have, how much you should eat, and the timing of your meals and snacks. You may not even realise how many food rules you have until you start your journey towards intuitive eating and begin to question the reasoning behind your eating habits!

This article will give you three simple steps to help you get to the bottom of your food rules and overcome them, in order to learn to eat based on your internal body cues.

 

ONE: Renourish your brain

In order to do the difficult work of changing your thinking patterns and belief systems, you must first ensure that your brain is functioning to the best of its ability. We know that the brain needs a tonne of energy to do its job properly; this means that getting adequate nutrition is one of the most important steps you can take if you want to change your cognitions.

One of the most well-known studies showing the effects of inadequate nutrition on the brain is the Minnesota Starvation Study. Amongst other ground-breaking discoveries, the study found that the restriction of calories causes impaired concentration, reduced alertness, poor comprehension and problem solving, and reduced motivation. Learn more about the effects of starvation on the brain and body here.

Ensuring you are eating regularly and adequately to give your brain the fuel it needs will make the next two steps that much easier.

 

TWO: Unpack the rule

It can be helpful to understand the origin of your food rules and what exactly they mean to you. This can allow you to develop a deeper understanding of you thought processes, making it easier to challenge them.

Some questions you can ask yourself to begin this process are:

  • Where did this rule come from?
  • When did I first begin following this rule? What triggered this?
  • What do I believe this rule will achieve? Is this belief logical?
  • What are my specific fears around breaking this rule?
  • How is my life affected by this rule?

 

THREE: Conduct an experiment

The most effective strategy for breaking down food rules is experimentation. Put your scientific hat on and approach your beliefs with curiosity and a methodical mindset.

The first step of this is to select a rule to challenge. Begin with the more flexible and less fear-inducing rules – there’s no need to throw yourself in the deep end!

Next, form a hypothesis about what you think (or what you fear) might happen. This might be structured like “If I do X, then Y will occur”.

Here comes the scary part – testing your hypothesis out. You might like to ask a friend or family member to support you through this if you’re expecting it to be particularly difficult. Keep in mind that you may need to test your hypothesis several times in order to come to a conclusion.

The last step is to evaluate the results. What actually happened? How did this compare to what you expected to happen? If it was different, can you come up with an alternative belief that might be more accurate?

Continue to repeat this process with all your food rules, gradually progressing to the more challenging ones. With patience and practice, you’ll be eating according to your body cues in no time!

If you believe you would benefit from individual support with your journey towards intuitive eating, our expert dietitians are here to help! Get in touch at hello@embodyhealthlondon.com to learn more about how we can work with you to achieve your goals.

 

Karli Battaglia, APD

EHL Team x

 

What happens within the body during eating disorder recovery?

eating disorder recovery refeeding syndrome

What you need to know as you embark on your recovery journey

 

If you’re in recovery from an eating disorder, we want to start by saying that we truly believe recovery is possible for every person! However, we also know that the early stages of recovery can be particularly scary as you face a tonne of new sensations and experiences. In this article, we’ll walk you through just some of what is going on inside your body during the refeeding phase so that you know what to expect during this period.

 

What will happen to my metabolism during recovery?

In a period of malnutrition like what is typically seen in those with eating disorders, the body slows the metabolism to preserve what little energy it is getting. However, as nutritional rehabilitation begins, the body becomes hypermetabolic.

This means that your body kicks into high gear and begins to utilise the fuel it was previously lacking, initially going towards repairing the vital organs and processes needed for survival.

Metabolism can remain heightened for several months. Until nutritional rehabilitation is complete, a person in eating disorder recovery will need more nutrition than someone of the same weight, height and age who has never had an eating disorder.1

Attempting to maintain one’s weight during recovery through the partial restriction of food can cause the proper functioning of systems like digestion and reproduction to be sacrificed for more life-sustaining processes. This is why it’s SO important to get adequate nutrition, no matter what that looks like for you

 

What will happen to my weight during recovery?

Changes in weight are extremely common at the beginning of the refeeding process, but not for the reasons you might think!

The first cause is the body stabilising, moving from a catabolic state to an anabolic state – in other words, the body shifts from a state of decomposition to a state of repair. This can actually cause some initial weight loss in the first week of refeeding, but this will neutralise.

The second cause is the body becoming appropriately hydrated. People with eating disorders can become extremely dehydrated from behaviours such as laxative or diuretic use, purging, excess caffeine consumption or refusal to drink water. They may also be over-hydrated if they are consuming excessive amounts of fluid. As hydration levels balance out, shifts in weight should be expected.

Over time, weight will gradually increase as lean mass and fat mass are formed. Lean mass is usually created first, to rebuild the skeletal muscles (ie. those used for movement) and to repair damaged organ tissue.2 Fat mass typically comes later in recovery, and is often first seen around the abdomen to protect your vital organs.

It’s important to remember that reaching weight restoration is not the end of your journey, and that it is the thoughts, beliefs and behaviours that truly determine recovery.

 

What will happen to my digestion during recovery?

During a prolonged period of starvation, such as that seen in eating disorders, energy that would normally go towards maintaining the structure and function of gut is sacrificed for more imperative survival processes. This causes issues with digestion such as gastroparesis (slowed gastric emptying), reduced gastric capacity, tissue wastage within the gastrointestinal tract and slowed colonic motility.3 This is all just to say that the gut stops working how it should.

Thankfully, this is reversible with good nutrition! However, it takes time during the refeeding phase to repair the gut and restore its function. This means that in the beginning of recovery, it’s unfortunately common to experience discomfort or pain, nausea, constipation, bloating or distention, and premature fullness.

As you give your gut (and the other systems in your body!) the nutrition it needs to repair, you can expect it to return to its fully-functioning self.

Remember that eating disorder recovery is a long game, and it can take up to 12 months to fully restore from a state of malnutrition. It’s incredibly important to have a great support team around you to guide you through it – and that’s where we come in!

Reach out to us at hello@embodyhealthlondon.com to find out how we can help you on your journey towards recovery.

 

Karli Battaglia, APD

EHL Team x

 

References

  1. Marzola E, Nasser J, Hashim S, Shih P, Kaye W. Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. BMC Psychiatry. 2013;13(1).
  2. Golden N, Meyer W. Nutritional rehabilitation of anorexia nervosa. Goals and dangers. International Journal of Adolescent Medicine and Health. 2004;16(2).
  3. Georg S. Gut Function in Anorexia Nervosa and Bulimia Nervosa. Scandinavian Journal of Gastroenterology. 2003;38(6):573-587.