**trigger warning – food pictures and descriptions below**

One thing I’ve been trying to do this summer is get back to back to eating in a way that lines up more closely with my ethical system. Obviously, there is the veganism. But, there are other things too – like going to the farmer’s market, eating organic (or, as organic as I can afford), focusing on whole foods (by which I mean unprocessed foods, not the store), aaaaaannnnnd cooking!!! Cooking is still largely overwhelming to me. Something about combining ingredients and trying to count it all creates very high levels of anxiety, confusion, etc. Portioning is also difficult, so I eat more pre-portioned things than I would like, because of the trash associated with it. But, I figure, the first aim is that the food has to get into my body, and for now if that means I have some frozen Amy’s meals or some pre-portioned things, I’m going to let that be okay.

I am, however, making progress now that it’s summer. I have more time to plan food, deal with the anxiety, go to farmer’s markets, etc. One thing I’ve learned is that when I reincoporate something back into my diet – tempeh, most recently – I need to eat it a few days in a row if it’s going to “stick.” Also, as an incentive to cook, I bought myself a new cast-iron skillet. For a while, I wouldn’t let myself cook in cast-iron because it’s the “best/healthiest” way to cook because supposedly you actually get more iron in your diet that way.

With cooking, if I stick to whole, vegan ingredients (and not too many ingredients or it gets overwhelming), I’m actually starting to get some enjoyment out of it again. And I’m actually starting to feel good about what I’m putting in my body. I had forgotten what this felt like.

So, for example, one of my new favs to cook is a vegan tofu scramble:

It includes: lite firm tofu, tomatoes, cilantro, onions, mushrooms, red and yellow peppers, Spike seasoning, Bragg’s essential aminos, garlic, dried basil, Daiya vegan “cheese” sprinkled on top (gotta get that endurance fuel!*)

This is a meal that I have come to feel good about. At some point I need to be able to use regular (not lite) tofu, and oil (not just pan spray), but this is a big step. I hadn’t let myself eat this (too nourishing) in probably a year or so. Maybe a bit more. Now it’s pretty thoroughly reincorporated.

And then there’s traveling when vegan and in recovery. I’m going to D.C. for a few days and I have absolutely no idea what the food situation will be, the availability of vegan food, etc. So, my RD and I did some planning. My packing chaos looks like this:

Let’s just say: 8 soymilks to stand-in for supplements, some granola (new food!), vegan Luna bars, vegan Clif bar & Clif zbars, fruit leather, Annie’s vegan gummy bunnies (new food!), chocolate covered soy nuts (new food! And yes, I’m super annoyed they’re south beach as well), vegan nu go bars (my fav protein bar), vegan wheat crackers, primal strips (vegan jerky), electrolyte water (no dehydration for me!). This is more than I would normally take for four days, but since the availability of vegan food is questionable at best, I am prepared for a worst-case scenario in which I have significant trouble meeting my nutritional needs at meals. Some of these foods are highly processed (the bars, ahem), but overall, they’re foods that I feel good about putting in my body and I feel secure knowing that I have the means to stick to vegan foods so that I don’t have to deal with the anxiety/frustration/disappointment in straying from that.

So, I’ve been thinking about veganism and the role that it plays in my recovery – specifically in regard to choice. First and foremost, let me reiterate: I am an ethical vegan. My veganism extends beyond my food choices – I don’t wear animal products (leather, wool, silk), and all of my personal care products (shampoo, soap, shaving cream, make-up, etc.) are vegan. But, in the eating disorder world, veganism is often equated with restricting (Aimee Liu makes this mistake in Gaining, a book which I otherwise thoroughly LOVE). Yes, being vegan limits your choices. If you’re not vegan, think about your favorite restaurant. Think about what options on the menu would and would not be viable if you’re vegan.

This is what gets a lot of people up in arms. The response often is, “You just want to be vegan so you can restrict!” Of course there are some people who are ill who use veganism/vegetarianism in that way. But, the restriction is not about the vegetarianism. It’s about the eating disorder. And if one is going to actively engage in the eating disorder, one is going to actively engage. Claiming veganism might make it a bit harder to spot to other people, but the restriction is about the eating disorder, not the veganism, and if one is determined, it will happen, vegan or not.

So, let’s think about dopamine now. One of the posts that I linked in my last post – Structured on the ED Bites blog by Carrie Arnold – discusses the fact that people recovering from Anorexia Nervosa often need a meal plan because our brains process dopamine differently, and therefore we have very little gauge of whether we are making “the right” decision. So, without that internal gauge of “Yes, this is good” or “No, this is harmful,” decision making can quickly become overwhelming. So, that’s why many patients may find it helpful to have a meal plan to help them structure and guide the the decision making process. Carrie Arnold also talks about how choices often need to be limited – the example that she uses is that instead of saying “What kind of grain would you like with dinner?,” it might be more helpful for someone recovering from anorexia to be asked “Would you like rice or pasta?” (I think that this must be partially why grocery stores are so daunting for so many of us. SUCH an overabundance of options.  – What do I choose? Am I making the right choice? How do I know? Should I get this or this . . . or this . . . or that?!) I’ve seen my RD use this tactic with people when they’re struggling with meeting their meal plan in nutrition group – if they need more, she just comes over to them with a couple of options and says “Choose one” or “Choose two.” Or, she might say, “Would you like nuts or a supplement?” But it’s never, “How do you want to make up for that?” because . . . so many options! How would one know what decision to make?

So, what if the structure of veganism isn’t bad? For me, the fact that being vegan often pares down an overwhelming abundance of choice is really, really helpful. Sometimes when I go to strictly vegan restaurants, I get someone paralyzed by the multitude of choices (What do I get? What if I don’t choose the right thing? What if I think I know what I want, but I don’t? What if I want something else after I’ve already ordered? What if I want two things? How do I pick? Etc., etc.) It’s too much; I can’t gauge if I’m making the right choice. I think that further into recovery, this will improve as I keep having healthy choices externally reinforced by my treatment team. And it’s better than it used to be. But, what if one of the fringe benefits of ethical veganism is helping reduce the anxiety of overwhelming choice? What if veganism *in recovery* actually makes eating more manageable, not more restrictive? What if people with eating disorders are actually capable of having ethical/spiritual/moral beliefs that affect what they good about putting in their bodies, as I’ve mentioned in a previous blog post?

What if the fact that so many people go through at least a “phase” of vegetarianism in recovery is about making overwhelming choices more manageable? What if those of us in recovery need ongoing methods to help structure our decision-making? Is that really so bad?

I was catching up on my google reader (I’m WAY behind, clearly) and saw that the executive director of my treatment center got coverage on the ED Bites blog, by the wonderful Carrie Arnold. (I’m sure some of you follow this blog; it’s a well-known one!) In fact, she liked her presentation at the 2010 Salzburg International Conference on Eating Disorders so much that she dedicated two posts to it. Yay!

Post #1 is on “The Noisy Brain,” eating disorders, and eating disorder recovery. Found here: ed-bites.blogspot.com/2010/06/noisy-brain.html

Post #2 is on the need for structure and meal plans in anorexia recovery specifically, and it talks about how neurochemistry impacts decision-making, etc. Found here: ed-bites.blogspot.com/2010/06/structured.html

I commented on the entries, under this blogger name – Sayhealth. I’d love to hear your thoughts!

I know I’ve been absent for, well, quite some time. What can I say? Life happens, you know?

Regardless, I’m just gonna go ahead and jump right in here, because this whole Jillian Michaels saga is making my brains ooze out of my ears. And I need my brains. I find them helpful in this whole saga that is graduate school.

Let me be frank. I don’t particularly care for Jillian Michaels. While I admire her personal tenacity and while I appreciate that she at least seems to care for the people she works with, I think that the way that she pushes the contestants on “The Biggest Loser” is abusive and unhealthy.

Do I hate that she’s marketing dangerous and harmful weight loss products like diet pills? Abso-fucking-lutely!! AND, do I watch The Biggest Loser? Occasionally. Is this a healthy decision on my part? Not particularly. Do I like The Biggest Loser? NO. I hate it. I hate, hate, hate it. I’m digusted by the way that the show turns eating disorders (and, no, I’m not saying that all obese people have eating disorders) and obesity into a sideshow. I hate that they teach methods of weight loss that are eating disordered, extreme, unhealthy, and unsustainable. There are so many reasons I hate “The Biggest Loser.” But that’s another blog post.

What I am going to do in this post – as much to my own surprise as anyone else’s – is defend Jillian Michaels’ right to decide to adopt rather than have biological children. Because it is her choice. And, frankly, I think that there’s nothing “wrong” with her reasoning for it, and I don’t think she should actually have to justify it at all. She’s not hurting anyone. She’s not committing a crime. It’s her body and her choice.

And yes, I do have personal stakes in this. I, too, expect to end up adopting rather than having biological children. I have a number of reasons for this. One is that the genetic component of eating disorders worries me, and these diseases very clearly run in my family. Another is that there are so, so many children who have already been born and who need good homes, and I know that I could provide that home for them. I also have adopted cousins and one of my closest mentors has three adopted children, so the choice to adopt seems just as “natural” to me as the choice to have biological children. And, frankly, like Michaels, in terms of pregnancy, I don’t know that I can “handle doing that to my body.”

And, you know what? That’s legitimate. I don’t know if I could emotionally handle the changes that pregnancy brings. And, even if I could handle pregnancy emotionally (or phsyically), I don’t know that I want to.

Michaels has been unfairly criminalized – as if she said that pregnancy alters all women’s bodies in negative and adverse ways. As quoted in the Salon piece linked above, one journalist claimed that  “in one fell swoop, [Michaels] insulted many of her biggest fans and murdered the self-esteem of many expecting mothers and women who have recently given birth.”

But, here’s the thing. Michaels said that she “can’t handle” pregnancy in regard to her body. She did not say that pregnancy ruins women’s bodies. She did not say that changes that come with pregnancy are inherently negative or undesirable. She simply said that she does not feel that she could handle those changes. And, as someone else who’s weight has shifted immensely and painfully over the years, I sympathize.

Furthermore, as someone who believes that women should be able to choose – without guilt or the need for justification – whether or not they want to have biological children or be pregnant, I actually say, Kudos Jillian. I respect your choice and your willingness to make it public. I know numerous women who do not necessarily want to have biological children because they do not have a desire for – or might even have an aversion to – pregnancy. Yet so many are afraid to voice that opinion because of exactly the backlash that Michaels is experience. So, thank you Jillian. Thank you for legitimizing our voices too.

What do you all think?

Wait, wait! I’m here! Really! I know that it has been a deplorably long time since I last posted.

This quarter has been TOUGH.

Last month, a woman in one of my classes very suddenly and publicly committed suicide. I have never dealt with suicide on this personal a level, and the tragedy of it hit me HARD.

Then, just after I was beginning to crawl out from under the shock and sadness of that, some extremely difficult family matters hit, resulting in a pretty major PTSD flare-up for me.

And yesterday, my parents had to put down our family cat of almost 18 years.

It’s not been an easy couple of months. The good news in all of this is that I have not, for the most part, resorted to my eating disorder to cope with this. A few months ago, I doubt I would have been able to say that. Instead, I have turned to my support system and my treatment team, all of whom have REALLY stepped up to the plate and have committed to helping me get through this in productive, health ways. I am in awe of them (and, I’m not going to lie, kind of in awe of myself, which is a new feeling!).

So, between practicing self-care, giving myself time and space to cope with all of these challenges and emotions, and doing as much school work as has been reasonably possible, there has not been time for much else.

I do feel as though I’m beginning to resurface. And I am glad to be reentering the world!

Somehow I block this out every year until, about, December 30th. Maybe even the 31st. I get so focused on just surviving the holidays without my e.d. taking charge that I forget about New Year’s resolution time. I just get through Thanksgiving and Christmas, then spend a few days focusing on being mindful and not restricting or exercising to “compensate” for having allowed myself to be festively flexible. Just as I think I’m out of the woods – I’ve made it, I haven’t fallen back into behaviors, I’ve stayed in contact with my team and my support network – I’m slammed back into reality again.

This year, that reality slam (which is much different than a productive reality check!) happened at my New Year’s Eve party. Upon one of my friend’s arrivals, we exchanged greetings, I offered him a drink (he decided on water), and I told him there were snacks in the living room. He replied, “Oh, god. I’m boycotting food.” He went on to explain that he ate “too much” over the holidays, so he needed to cut himself off. I left the room and made myself a plate of healthy, nutrient-filled snacks. He ended up doing the same.

Then, the commercials started. Dexatrim, Bally’s, Nutrisystem, all kinds of exercise gadgets and plans, xenadrine Ultra, even ads marketing gum as low-calorie and saying that chewing it will prevent you from giving into sugar cravings (aka eating, aka I know many who would consider this to be an eating disordered behavior). Then today, the amount of runners on the trails in the city was INSANE (we’re having a snowstorm, keep in mind), Whole Foods was advertising ways to lose weight, gym parking lots were packed, etc., etc.

So, there are the obvious things about this. Diets don’t work. It’s okay to eat differently over the holidays. Exercise should ideally be about health, not weight loss. There are no inherently good or bad foods. We don’t need to feel guilty for eating. And all of these messages are incredibly important and need to be spread around in order to counter all of the unhealthy, unbalanced messages out there right now.

But the message that I was to spread is this: Don’t forget about the people in your life who are struggling with eating disorders. And don’t forget yourself. It’s so easy to think, “Phew! We made it through the holidays!” And that is important. The holidays can be ROUGH, especially for people with eating disorders. Yet, we must remain attentive. I know that, personally speaking, this is one of the hardest times for me. Everyone is talking about weight loss, exercise, resolutions, etc.; it feels like some sort of exclusive club that I can’t join. It’s alienating. It’s incredibly triggering.

If you know or work with people with eating disorders, please keep in mind that this part of the holiday season – when it is seemingly over – can be very, very challenging, and we may need continued support. By that, I don’t mean sit us down and say, “So, how are you feeling about New Year’s resolutions?” But, do be ready if we need to vent about it, or talk about it, or process it. If we bring it up, help us to counter the resolution insanity with conversations about healthy and sustainable balance. And if we don’t address it directly, you can offer support simply by being there, by offering words and model behaviors that are balanced and nourishing, by avoiding talk of what you need to “improve” or “change” about yourselves, or what we need to “improve” or “change” about ourselves.

And if you have an eating disorder, it’s okay to continue to ask for support after the holidays. It’s okay to do it year round, for that matter! And it’s okay to not make a New Year’s Resolution if you do not want to.

Personally, I won’t be making any resolutions this year. For me, I know that resolutions can lead to black and white thinking. In my head, resolving to do something means I *must* do it, and I will be a failure if I can’t follow through.

This doesn’t mean that I don’t have goals. This doesn’t mean I won’t try my best to work on things in 2010 (just as I have been in 2009 and will be in 2011 and beyond). But, I will not set myself up for failure. I will be human.

In 2010, I will try my best to . . .

allow myself to lean on my treatment team and support network for models of healthy, balanced behavior to help me get through this resolution madness.

acknowledge that my situation is different than most people’s, and what are healthy resolutions for some are not necessarily healthy for me.

nourish my body, get to a healthy weight and work with my dietitian to maintain it because I deserve to be happy and healthy and strong and nourished.

with the support of my treatment team, once again begin engaging in moderate, self-affirming activity, like yoga and outdoor cycling (when it gets warmer!).

forgive myself when I make mistakes, and focus on the good that I have done, so that I will be able to continue building on it, rather than giving up because I feel like a failure.

allow myself to feel good and believe it when people compliment me.

avoid all or nothing resolutions, and continue seeking balance, support, healthy, and reciprocity.

What are your thoughts on this matter?

I’m going to tell you about a low point in my life. The truth shall set us free, right?

One day, I saw a friend’s status update on gmail. It said something to the affect of, “Oh, lord, I have cankles. Why??” I’d heard the term cankles before, but I wasn’t really sure what it meant. So, I went to the most scholarly, reliable source of information that I could think of: Urban dictionary. There are many definitions for cankles, and they’re linked here. But, BEWARE: reading them could cause both obsession and binding rage. At least, that’s what it did for me.

The definitions for cankles are overwhelming fat-phobic and sexist. They objectify and devalue women’s bodies, and many of the definitions specifically mention obesity,”fat chicks,” or fat bitches.” Charming, I know. I was outraged when I read these. (I have yet to check out the entry on “cankle dyke” because I think my head will probably explode.)

Yet, for all my outrage and my ability to deconstruct the misogynist bullshit in these definitions, I was suddenly VERY aware of my ankles. The obsession set in quickly. I googled pictures of cankles, trying to discern if mine qualified. I found this charming “Say No To Cankles” ad from Gold’s Gym. Later that night, unable to restrain myself, I asked my partner if I had cankles. He was not aware of cankles as a concept, so I made him google pictures of cankles with me for about 20 minutes before he finally said, “You don’t have cankles” and left the room.

I still don’t know if I have cankles. And yes, that is my leg in the picture above. I’m not asking for validation here, or fishing for you all to say, “Oh no! You don’t have cankles!” My partner said it. It didn’t help. But, it’s not really about whether we actually have them now, is it?

Here’s what’s ridiculous (okay, it’s one of many ridiculous things): I LOVE to bike. I love it. This summer, when my cankles obsession set in, I was cycling a minimum of 50 miles a week. I have had to give up cycling for the time being because my weight is too low right now to sustain it. However, I still do a lot of walking. My legs are *strong*. And yet, I am worried about CANKLES. My weight is too low, and I’m worried that my ankles might be too fat. Or my calves might not be toned enough. REALLY?? All of the women in my family carry their weight (I hate that phrase) in their legs, so I have always been obsessed with them. But I was never obsessed with my ankles until everyone started talking about cankles.

So, yes, the media DOES play a role in eating disorders and body image obsession – at least for me, and I suspect that it’s the case for many others. This is different than saying it’s THE cause of eating disorders. Perhaps it a cause. Perhaps it’s just something that perpetuates them. But, I think we need to really look at the fact that eating disorders MUST be about a lot more than brain chemistry. Again, I don’t know that we can separate the two. I don’t know that we can say biology loads the gun, environment pulls the trigger. Maybe it’s the other way around. Maybe environment is primary. Maybe it’s not. Maybe environment an biology and experience and family are all so intertwined that we just can’t separate them, can’t give primacy to any one of these factors.

It’s not a coincidence that in a time of rising media influence, the vast majority of e.d. sufferers are women.It’s not a coincidence that as unrealistic body ideals get stronger in regard to men’s bodies, the rates of eating disorders are rising in men too. Rates are also rising in areas of the world that have recently been inundated with “Western” media. Though obsession with women’s bodies and thinness is certainly not new, the ability to spread such obsession-inducing terms and campaigns so far and so easily is new. There may be a strong biological component for eating disorders, but we have GOT to examine the world around us, the structures of inequality, the forces of capitalism (want a great way to make money? break down bodies and make people obsess over each tiny part and what they can do to improve them), the role of the media, etc., and I think we are being irresponsible if we don’t. Biology doesn’t exist in a vacuum. Eating disorders don’t exist primarily in women just by chance. Cankles aren’t overwhelmingly gender-specific just because Gold’s Gym felt like making it that way for no particular reason. Yet, the media doesn’t cause eating disorders in everybody, which shows that biology, experience, etc. are obviously also important. We need to keep a holistic, intersectional view here. We can’t disentangle these things – they affect each other, and that necessarily demands that treatment be multi-faceted.

As for me? I’m done. I will not let the media have this part of my body too. My ankles are mine! I’m saying yes to my ankles, cankles, whatever! My ankles are strong. They carry me to and from school each day. They carry me around the biggest university in the country. When the rest of my body is ready, they will help me get back on my bike, where I feel free. I have put my ankles, my body, through so much, and it has not given up on me. I am my body. I am my ankles, and no one gets to degrade them. Who’s with me??

 

 

For more spot-on cankles critique, check out Julie Parker’s blog, Beautiful You.

Also, I’m still interested in all of the topics I mentioned in my previous post – I just couldn’t let this go by! But I’d still love to here what you a would like to hear about!

I feel so absent! I have so much that I want to write about, but alas, midterms hit last week. For me, that meant my own midterms as well as grading student papers! It’s been a bit daunting. But, I think I’m in the clear – at least for another week or so.

I’m off to a conference later today – The National Women’s Studies Association – in Atlanta. wOOt! Come on, weather in the 70s! :-) Hopefully it also means I’ll have some downtime to blog. Some things I’m thinking about – ideas sparked from other blogs (Surfacing after Silence and When Ed Moved In) as well as some things that have come up in support group, with friends, etc – are:

- The role of humor in e.d. treatment and recovery.

- Eating disorders as a “choice”

- Eating disorders, eating disorder recovery, and identity.

- Importance of liking, and feeling liked by, treatment providers.

I’m also WAAAAY behind on reading blogs, so I suspect I’ll be thinking about more as I catch up. And I still need to reply to a couple of comments on my last post! If any of these topics pique your interest, or if you have any thoughts about them, please let me know!

Well, actually I’m not. I’d like to, but I don’t have a horse. Also, I don’t really know how to ride. I’ve only done it a handful of times, and I’m *still* amazed that I didn’t bounce right out of the seat when I hit a canter.

I want to address this article about eating disorders and equine assisted psychotherapy (EAP) that is circulating the internet at an impressively fast rate!

First, let me locate myself so that you know where I’m coming from. I have not participated in EAP. Do I think it would be beneficial for me? Absolutely. Do I think I can recover without it? Of course. Though EAP might be helpful for me personally, I know I can recover without it because I recognize that EAP is one tool among many for treating people with eating disorders, and not a primary treatment. Though I’ve never worked with animals as a client, I am very interested in the use of therapy animals to promote healing. There’s a very good chance that I will incorporate animals into my own clinical practice someday.

What shocks me about this article is not it’s skepticism – many people are skeptical of EAP, and I think that’s largely because it’s true that not a whole lot of research has been done on it. However, not a whole lot of research has been done on the use of DBT with people with eating disorders,* and yet the author of the article is willing to jump on board with that (he even considers it an empirically-supported treatment, even as he recognizes that the empirical evidence has serious holes). No, what shocks me is that people are backing this article even though the author has a very clear, very strong bias. I know that science isn’t bias-free. I absolutely think our cultural and individual values will influence what we find and what we look for.

But, really, in this article, in the *third* sentence, he describes the reaction of him and his wife as “appalled.” Okay, he’s not a fan. I get it. But, seriously, if this article were on DBT and the author made such a strong, negative pre-judgement about the use of that therapy, I’d hope that people would be as skeptical of the author’s biased viewpoint as they are of the therapy. Or at least, I hope they’d take it with a salt lick.

He makes the point that EAP is said to be helpful for a wide-range of mental illnesses. Perhaps this is presumptuous. Perhaps it is not. It’s hard to say without the research. But, CBT has been shown to be effective for a whole host of mental illnesses, and yet that’s not questioned in the same way. And yes, we have research to support CBT. But CBT did not magically become effective when the research said it was. It was ALREADY effective, just like EAP might be. Maybe EAP is effective for some disorders, maybe not for others. Maybe it’s effective for some clients, but not for others. But what is the harm in having more therapeutic tools and experiences at our disposal? And have we considered that perhaps there’s not a whole lot of research on EAP because it’s so often stigmatized, or delegitimized before its researched? (This is not the first article I’ve seen like this recently.)

The thing is, EAP, like DBT actually, is not meant to be a “first-line” therapy in the treatment of eating disorders. It is meant to supplement other modes of treatment. And yes, there is not a lot of evidence for that. And, at the same time, it doesn’t take a whole lot of expertise to look around and see that for some, working with or being in the presence of animals helps them to open up in ways that they might generally feel unsafe doing. Obviously this is not true of everyone, and just like every treatment method used for eating disorders, EAP should not be used for everyone. It’s not a panacea. Nor is DBT. Nor is CBT. Nor is re-feeding. Nor is FBT. Nor is psychotherapy. Nor is nutritional counseling. If there is one thing we know about eating disorder treatment, it is that, more often than not, treatment requires multiple kinds of care and multiple therapeutic modalities to be effective.

So is the jury still out on EAP? Sure. Is it still out on DBT? Yes. Is the neuroscience that many of us are rallying behind still quite new? Yes. But one of these things is not like the other. Why the premature writing off of EAP? Sure, there needs to be more research done. Absolutely. But what if we left the possibility open of having another way to heal people, rather than having such a strong (and premature) bias against it? Frankly, the fact that the research is yet to be done also means that we haven’t proven that it doesn’t work. It could be incredibly effective for treating eating disorders, and we wouldn’t know that yet either.

Every treatment had a time when it lacked evidence. Every one. That’s the nature of research. So, personally, I’m going to support the use of EAP for clients who feel it would be helpful. If you ask me, the more treatment methods there are, the better equipped we’ll be to meet the individual needs of clients who are fighting this devastating illness!

* I have nothing against the use of DBT in e.d. treatment. I’m actually a proponent of it, and I personally have benefited immensely from having DBT be part of my current treatment. That said, there really is very little evidence to prove it’s efficacy for e.d. treatment yet. The small amount of literature that is there is focused mostly on bulimia nervosa and binge eating disorder. But someone has to be the pioneer if a treatment will ever gain empirical support!

First of all, thank you all for your comments on the last post! I decided not to respond on that post because it was really about hearing others’ opinions, and I did not want to impose my own.

I will, however, proceed to do that now. ;-) Thank you for humoring me!

Like a few of you said, I absolutely agree that patients/clients should have input as far as whether or not they know their weight. And, I acknowledge that this can be a challenge, especially with patients who are having trouble separating what is best for them and what is best for the eating disorder. When I had my intake with my current nutritionist, we went to the scale, and she just said something like, “We do blind weight here.” It wasn’t presented as a choice, though obviously if I had protested, we could have discussed it (I know that she lets others see their weight because not knowing triggers them). But, I didn’t protest because I was RELIEVED. I know that she if she had presented seeing my weight as a choice, I would have chosen to see it. My motives in seeing would have been driven by the e.d., as I know that I do better with blind weights. But, at that time, I didn’t have control over the e.d.; I would have looked because that’s what Ed wanted. I needed her to take control over Ed by making the decision to do blind weight, because I was not capable of doing so at the time.

I think that, for patients in the later stages of recovery, the decision about whether or not they see their weight should be made in collaboration with their treatment team. I fail to see how wrestling control and agency away from a patient in this area would be helpful to recovery. So, if a patient wants to know her/his weight, and if the treatment team agrees that it is for recovery-positive reasons, I absolutely think that the patient’s weight should not be kept from her/him.

That said, I also think that a patient should not be forced to see her/his weight. This recently happened to a friend of mine, which is what inspired this post, and it was incredibly detrimental to her, and bolstered her e.d. And I actually think that it’s quite possible to go for a very long period of time without knowing one’s weight. I went for a period of years without knowing, and now, unless I let myself look at a GP appointment, I don’t know what it is. If a patient chooses to continue with blind weights, yes, it will take a bit of a commitment to maintain that outside of the treatment center – they will have to ask to skip being weighed or be weighed backwards at Dr. appointments, they will have to commit to not buying a scale, etc. – but it really is very do-able. And there are other ways to gauge one’s weight that allow a bit more for natural fluctuations in weight – how one’s clothing fits, for example. I think we confront the reality of our weight and/or changing weight everyday, whether or not we label it with a number. And I think that, for someone who continues to choose blind weight, if she/he does encounter a number unexpectedly (on a doctor’s chart, for example), if treatment has been truly effective, she/he will be able to cope productively.

Personally, I’m glad that my team enforced blind weight when i needed them to, and I am glad I’m able to choose to continue with it. AND, I’m glad that for other people, they us different methods – one’s that are more effective. I guess this goes back to my firm belief that, generally speaking, e.d. treatment – including whether or not patients know their weight – needs to be about the individual, rather than about blanket policies.

 

I know that the topic of whether or not people in treatment for eating disorders should be told their weight is currently under debate at my own treatment center, as well as a number of others. Blind weight (where the patient does not get to see their weight) is often standard practice in eating disorder treatment, especially for clients who have a strong drive for thinness as a symptom of their e.d. However, some treatment facilities insist that clients in outpatient care or extended care see their weight, as it is something they will have to face at least sometimes in the “real world.” Occasionally treatment providers leave it up to the client to decide, though this of course can be dangerous too if the client is unable to separate what is best for them from what the eating disorders wants. So, I’m wondering . . .

What’s your opinion on the matter? Should whether or not a client knows her/his weight depend on the eating disorder diagnosis? Should it depend on the level of care? Who gets to “weigh in” when it comes to weight? Who decides what is best?

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