Caught red handed.

I recently received the following feedback from another eating disorder treatment professional regarding my approach as she perceived it from reading this blog:

“It appears [we have] a differing philosophy in treating eating disorders. We don’t help clients to lose weight or make that part of our treatment plan. We help them regulate eating and discovering the underlying issues driving the ED behavior. Sometimes that results in weight loss. In addition, we have found that keeping the focus on weight and a restrictive diet maintains the ED. We do not recommend elimination diets such as the Whole30 as this is another way the ED stays active.”

I had rather a lot of feelings upon reading her response.

The first of these was the hot flush of shame, and thoughts that I’d been caught doing something wrong by an authority. Incidentally, shame and a fundamental belief in my own “badness” is one of the “underlying issues driving the ED behavior” that I unearthed in my own early treatment experiences. This was followed by a roller coaster of anger and defensiveness. So, first I dealt with the feelings: 73 deep breaths, a draught of lavender essential oil, a big glass of cold water and a long walk with my partner to talk it out. Thus soothed, I returned to my critic’s words for some reflection.

Going back over the feedback line by line, from a less emotionally reactive place, I made an interesting discovery: what she wrote has absolutely nothing to do with me or my treatment philosophy. In the words of Byron Katie, her response is not my business.  The feedback I received was the author’s reaction to my blog, which reflects her thoughts, her beliefs and her agenda, none of which are my business.

What is my business are my reactions in thought and feeling to the feedback I received and what I choose do with those. I could rant and rant here about how my post about the Whole30 virtually insisted eating disordered clients not do a Whole30. I could be all righteous and s@#t, but the only person ingesting that vitriol and raising her cortisol levels would be me.

Historically, I would have reacted to these kinds of difficult thoughts and feelings with a cascade of eating disordered behavior, but I’ve learned that the core of recovery is to employ mindfulness in order to be on guard for my triggers and access alternative coping strategies accordingly. In terms of treatment philosophy, this is also what I teach my clients, and what I have intended for this blog to reflect.

Here’s an another potential twist on things: my initial response to the feedback was an angry and defensive “That’s not true! I know what I’m ‘supposed’ to do in this field and I do it!” But what if, for the sake of argument, everything she wrote is accurate? Would that be bad? While the author of the comment reflects the conventional wisdom of our field, I am not entirely conventional in my approach.

While I certainly don’t make weight loss a part of every treatment plan, depending on the context and goals of my client, it’s sometimes included. For example, if I’m working with an obese binge eater who is trying to avoid knee surgery by losing weight, and that goal is the only thing that’s motivating her to work for recovery, then I’m going to honor that goal. We’re still going to need to explore the underlying issues supporting the eating disorder, and regulate eating, but in my experience not every person who wants to lose weight wants that from a disordered or distorted place. To my way of thinking, this is not dissimilar from noting that weight restoration is a goal for an anorexic client.

So.

This is me. This is my blog. These are my words. These are my beliefs. Some people won’t like them, and that’s ok. Some people will like them, and that’s ok, too. Ultimately, neither of those things are my business; my business is to make sure that I am ok with what I put out onto the interwebs, and for today, I am.

 

 

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Why the why is so key.

The Whole30 I did recently with my partner can definitely be filed under the heading context matters. The program was a no-brainier for him: struggling with IBS, overweight and taking a hit in the self esteem department, he was a prime candidate for a lifestyle change. My context, on the other hand, was a bit different: having spent a good part of my adolescence and 20s struggling with an eating disorder, and breastfeeding our infant exclusively, I was (appropriately) apprehensive about any plan that involved restricting my food intake. But, I am the primary food shopper and menu planner in our family (by inclination and by choice) so I really wanted to find a way to make a Whole30 work because it wasn’t realistic for him to do one without me, and supporting his health is an “I love you” I want to choose every time.

I did my due diligence, including reading and rereading this important article, and talking with friends and a counselor before deciding to take the plunge. The vestigial ghostly eating disordered part of my mind knew that, done mindlessly, this was a perfect chance to accidentally get too skinny, and I had to have daily conversations with that voice to keep myself honest.

I did a number of things in order to intentionally “fail” at losing weight on the Whole30 as a breastfeeding Mama in eating disorder recovery. This was not easy, friends. I had the “perfect” opportunity to relapse, and it required real intentionality to choose self love and health throughout. (I’m bragging right now. I am very proud of myself. Just saying.) I cut out any exercise beyond the babywearing up and down the stairs with laundry variety. I put gobs of coconut milk in my coffee. Breakfast was three eggs, a sweet potato spread with ghee and a palm full of olives. I ate dinner portions 150% larger than my partner, who is five inches taller than me and a former ice hockey player. To steal Melissa Hartwig’s phrase, I ate all the things.

When we weighed ourselves again after the month long program, I had stayed exactly the same weight, which while a disappointment to the ghost, was a victory and a milestone on the path of my ongoing recovery. (My partner, on the other hand, reports that his IBS has literally never been better managed and that he lost a significant and healthy amount of weight.) I did have a number of non-scale victories over the course of the month, by the way. My sleep, digestion and overall energy levels all improved. I broke a nasty MyFitnessPal habit I had developed postpartum. I reset my sweetness meter. I actually made more milk for my baby. Wins.

So why am I sharing this? Because choices. Because mindset. Because motives. These all matter enormously. So often in recovery, it’s not what you’re doing or what’s on your plate, but why. Many people do a Whole30 to lose weight, but it doesn’t have to be about that at all. Same goes for anything else you or I choose to undertake, be it exercise, a relationship, a career change… all of these can be recovery wins or purposeful self-sabotage.

You choose.

Answering this Question is Key to Recovery

Today’s Food for Thought, from Anne Cuthbert, M.A. of http://www.foodisnottheenemy.com

“What does disordered eating and body image protect you from? Do the constant thoughts distract you from thinking about or feeling about other parts of your life? Does it keep you in a safe world that you can control? Does it give you a good excuse to not go somewhere or be with someone in which you feel uncomfortable? There is always a reason for it. What is it for you?”

All or Nothing.

In case my clients hadn’t mentioned it enough this month, an excellent article about “All or Nothing” thinking showed up in my inbox a few days ago that sealed the deal on me writing about this topic.

For the uninitiated, All or Nothing thinking goes something like this: “I just ate x, which was not on my strict list of safe foods for my special and restrictive New Year’s resolution diet, and therefore I have ruined my day and I’m going to eat several more servings of x, as well as anything else I happen to encounter that is off-limits.” Other variants include the belief that an A minus is a bad grade, and since you just got one, you’re never going to do your homework again because what’s the point if you’re just going to fail, or that because you did not get this particular job, you are clearly unemployable and are never putting yourself through the humiliation of sending out a resume again.

There are a lot of problems with this kind of thinking. As my handy-dandy examples suggest, one of the most significant is that it tends to lead to quitting, inertia, anxiety, depressive thoughts and other totally fun experiences. The actions that flow from All or Nothing thinking are usually the opposite of effective. Otherwise known as ineffective.

Let’s take our poor sad friend on the All or Nothing diet who has “cheated” or “failed”: she’s really extra screwed because the rules of her diet were written by All or Nothing thinkers to start with, but beyond that, if the goal of the diet was to, for example, eat fewer treats, then responding to eating a treat by deciding she has failed and eating a whole bunch more treats is pretty counter-productive.

Here’s an alternative. (And for the sake of argument, let’s say it’s reasonable that the dieter has decided her health or self esteem or chronic headaches or whatever it is would be ameliorated if she ate fewer treats.) Rather than taking the All or Nothing path of deciding that all treats are off limits at all times forever (and therefore if she has one, she is a failure, and off the diet, and should “take advantage” of already having “ruined the day” and squash in as many treats as possible), she could think a more helpful, more effective thought. Something like “I’m going to pick one treat per day to really savor and enjoy to support myself in eating fewer treats overall. If I have a moment or day where I eat more treats, I’ll use that as a learning experience to see if there are any ways my plan needs to be adjusted.”

Now, if she eats an extra treat, she hasn’t failed, she has stumbled upon a piece of data that is a total gem because it’s going to help her figure out a more effective plan e.g. “Oh, I see that it’s not a good idea to eat my special treat when I’m distracted by paperwork because I won’t really savor it and I’ll be more likely to want more. Excellent! Good to know.” (Her therapist might have had to support her in re-framing things that way, but hey, it’s cool to ask for help.)

Similarly, with the A minus, and the job that doesn’t pan out, if the goals are academic success and employment, and the disappointment is a perception that these outcomes might not work out, quitting all together is only going to take our All or Nothing thinkers farther away from their goals. (Also, an A minus is a really good grade, and perfectionism is very All or Nothing.)

All or Nothing thinking isn’t logical by it’s nature because it’s usually driven by a strong emotion (shame, fear, remorse, despair, euphoria), which is the primary way to identify that you might be in the throes of it. Any action that you’re drawn to while experiencing a strong emotion is suspect, and worth putting through the All or Nothing test. And wouldn’t you know it: Mindfulness helps here. Holding awareness of your emotional state provides the opportunity to catch yourself in those heightened moments when you’re vulnerable to distorted thinking, which provides you with the opportunity to review your thoughts and action plans before tumbling down the All or Nothing rabbit hole.

Like so much of what I recommend to folks, this is hard work, but it’s a way easier path than holding yourself hostage to a cycle of unrealistic standards and constant feelings of failure. At least, I think so.

Everyone is TOTALLY FREAKING OUT ABOUT HOLIDAY COOKIES.

This morning, I got an email from one of my favorite nutrition writers, John Berardi of Precision Nutrition, which sounded an awful lot like what I’ve been saying to clients for the last few weeks when they come to me TOTALLY FREAKING OUT ABOUT HOLIDAY COOKIES. These are stressed people. Seriously unhappy people. Not exactly holiday cheerful. Because COOKIES. I had people TOTALLY FREAKING OUT ABOUT HOLIDAY COOKIES starting in early November, and I will continue to hear about COOKIES well into January. I’ve shared Dr. Berardi’s words below, but first, my take on this state of affairs.

As evidenced by my egregious use of capital letters, these are high volume, high intensity, high anxiety, high angst concerns. And I’m not trying to be mean about it: people are seriously suffering, and it’s very real. The problem is that we’re talking about cookies. In my mental landscape, a cookie is a palm-sized (or smaller, like those little round ones with the nuts inside and the powdered sugar – I love those) baked good that takes one to three minutes to eat depending on the size. However, for my friends of the freaking out, COOKIES are stomping through their mental landscapes crushing hopes and dreams like Godzilla having a very bad hair day.

The fear is real. It’s real, but it’s also a construction and a self-fulfilling prophecy. If a person starts thinking in November about how hard it’s going to be not to eat a certain food item in two months, and keeps thinking about how “bad” that food item is, and how she can’t control herself around that food item, it gives the damn thing an enormous amount of power. (It also ruins her November.) COOKIES are going to destroy her, she’s sure of it, and ensuring it. And of course, when late December rolls around, she’s going to eat them. How could you not eat something you’ve been debating about for two months? Will she enjoy the cookie? Survey says no. Because the minute it reaches her mouth, she’ll already be berating herself for how weak and bad and lazy and gross she is to have been subjugated by a COOKIE, rather than savoring its tasty flavor, reflecting on the family heritage the recipe represents or something else, you know, nice.

Because holiday cookies are nice. That’s about it. Some are tastier than others, some have memories associated with them, and some are kinda lame and taste like their cardboard box. But they really, really are a pretty minor, albeit pleasant, occurrence if you treat them as such.

Try this mindset on for size: Imagine yourself not thinking about holiday cookies until you’re actually faced with a plate of holiday cookies, perhaps at a party, perhaps on the table in the break room at work. Like, how you don’t think much about getting an oil change until it’s time to get an oil change. Now, assess the plate of cookies. Do you like this kind? Were they prepared by someone special? Are they appealing? Now, assess your level of hunger and your emotional state. Are you fairly full because you just ate a satisfying meal? Are you starting to feel that little nudge in the tummy that suggests it might be snack time soon? Are you bummed out and overwhelmed, or perhaps feeling a little festive? If you’re not too full, and not in an unpleasant emotional state where you’re more likely to be self-medicating than enjoying a treat, and there are cookies on the plate that are truly appealing to you, select the cookie that looks the best and eat it.  Feel free to take a bow.

Then walk away. Because you are not the cookie you just ate. You’re a mature adult human who, on occasion, when the moment is right, chooses to eat foods from the “treat” category because they are fun and nourishing in their own way. You’re not going to get fat. You’re going to get awesome. Because when COOKIES become just cookies, you get the power back, and you get to spend a lot more of your life thinking about other things that are a lot more interesting. Like, what to get your mother-in-law for Christmas. Or world peace. Or really anything.

(And, as a side note, if you are maybe still a little worried about the cookies: you’re much more likely to overeat the things if you treat them as a diet smashing super power, rather than a moderately enjoyable sometimes treat, because that’s how the restrict, binge, rinse, repeat cycle works. I promise, promise, promise you that you will eat fewer cookies if you allow yourself to enjoy them now and again than if you try to avoid all baked goods for two months and then go to your Nana’s house on December 25th.)

Now for the other guy’s take on things:

“My three little ones have been helping my wife and I with the usual chores: decorating the tree, creating cards with construction paper, preparing canned food donations for the local food pantry, and…making delicious cookies. But before you ask for my killer “healthy” cookie recipe, I have a confession: We’re not making not some low-fat, gluten-free, protein-packed, artificially sweetened, possibly-hiding-beets, “healthy” version of a cookie. Nope, we’re making the REAL THING. The kind of cookie that contains butter, sugar, and flour. The kind of cookie where you want a tall glass of milk to help wash it down. The kind of cookie most “nutrition experts” will tell you to avoid completely this year… Just dip some kale leaves into lemon juice with a splash of stevia and it’s exactly the same thing.

Anyway, when people learn that my family and I sometimes make treats like cookies…or go out for ice cream…or don’t eat 100% protein and vegetables all the time…they get a little confused. “But isn’t Precision Nutrition all about eating good foods and avoiding bad foods?” The answer, I’m proud to say, is no. Precision Nutrition is NOT all about eating “good” foods and avoiding “bad” foods. (I don’t even like those labels.) In a minute, I’ll share what Precision Nutrition is really about. But first I’m going to encourage you to enjoy some sort of cookie, cake, or cocktail this holiday season, too. In addition to songs, and friendship, and holiday cheer…

You see, every time you choose to eat one thing over another, you’re voting for what’s really important to you right now. Of course, you may not realize you’re doing that. But every decision IS a calculation. Of what really matters to you, in that moment. So, with the holidays here for most of us, what DOES matter to you right now?Is it… Feeling good? Connecting with loved ones? Truly nourishing your body? Feeding your soul? Remembering your heritage or family traditions? No judgement here. YOU get to decide your priorities. And  sometimes other things SHOULD win out over “nutrition”.

So I’m not here to tell you what to do, think, or feel. Or to make you feel guilty, ashamed, anxious, or deprived. Instead, I’m here to help you think through the question. To help you choose more consciously, with awareness and intention… Because shortbread and latkes taste great when made with love and shared with friends and family. They just do. And, while some people in fitness have a hard time with this notion, I think that feeling good is part of enjoying life and being healthy…

Here’s my first prescription: Enjoy a real cookie or two this holiday season! Or some other thing you enjoy but think is “off limits”. Just do it consciously, mindfully, and – as we teach in our coaching programs – slowly. Instead of scarfing it down and waiting for the guilt, taste what you enjoy. With intention. Then move on…

But even if you’re not ready to embrace this mindset yet because restricting is your only way to feel in control… Because you can’t believe that enjoying certain foods guilt-free is possible… Because you’re stuck in the middle of a nasty cycle of restrict, collapse, guilt, repeat… My family and I will still share some laughs, shed some tears, and nosh a few cookies this holiday season. We might even raise a glass of egg nog in your honor. Because, around here, we know that connection, love, and enjoyment CAN exist while working toward better health together. And we’re hoping that somewhere along they way you’ll discover the same thing.”

Problem? Solved.

Seems like a theme in sessions of late, and in the weekly group I’m running right now, has been  disordered eating as a multi-purpose problem-solving tool. Feel sad, bored, lonely, or scared? Experience success or failure that challenges your beliefs about yourself? Experiencing any discomfort in any realm of your life, be it professional, interpersonal or existential? Just do your food thing! Problem? Solved.

Well, except not exactly. But, when you’re in the throes of disordered eating patterns, that’s how life starts to look. The problem with this problem solving technique is… well, actually, there are several problems.

Problem number one: it works. In the short term. Most eating disordered behavior, be it restricting, binge eating, obsessive exercise or purging, does cause a short term change in your state. The behaviors are so addictive because they unleash a volley of neuro-chemicals that can temporarily shunt you out of whatever uncomfortable emotional state you’re in, as well as being sufficiently distracting and engrossing that the mind shifts off of whatever real-life pain you were experiencing. It’s important to acknowledge this: people would not do these “crazy” things if they weren’t effective. At least, in the short term. Understanding this can be the bridge to a kinder and more empathic stance towards yourself and the disordered eating patterns you’ve fallen into. You just want to feel better. That’s ok.

However, this leads us to problem number two: now you’re stuck. Because the behavior provides short term relief, you find yourself more and more consistently turning to disordered eating to manage problems. This cycle inadvertently teaches you that the only way to manage your problems is to do a disordered eating type thing, which keeps you from practicing, or attempting to practice, or even considering attempting to practice, a skill that won’t happen to also ruin your life while it is “helping” you.

Because problem number three: it doesn’t actually work. While the disordered eating may create a short term relief from discomfort, it doesn’t actually change anything. It doesn’t help you understand the root causes of your emotions. It doesn’t help you identify or change a destructive pattern in your own behavior or in a relationship. It certainly doesn’t increase your capacity to sit with discomfort without acting on it, recognizing that discomfort is a part of life, and as such, is transitory. Oh yeah, and while it was not solving all these problems, it was majorly messing with your health, thereby ensuring that you will be facing a whole bunch of discomfort that might otherwise be avoidable, in the form of obesity, fragile or broken osteoporotic bones, social isolation, financial problems or crumbling teeth.

So, what does work? In my experience, the first step is to watch your mind and body for telltale signs that you’re getting distressed about something. This might by churning thoughts or a racing heart, or, it may not be apparent until you find yourself swamped with an urge to do your eating thing. Sometimes, disordered eating urges emerge out of habit, but very often, they’re a sign that there’s something else going on.

Once again, mindfulness is at the heart of change. Without this practice of holding awareness (without judgement) so that you can catch yourself before you act on the urge and consider an alternative, you’re kind of screwed. To be blunt.

It’s like watching for light changes when you’re driving. It’s a lot easier to stop and avoid an accident when you catch the change to yellow than in the middle of the intersection when you realize you’ve run a red light.

Eating Disorder Recovery Skills Group Forming

Hi, folks – I’m putting together an eating disorder recovery skills group at my office in South Hadley, MA. The group will begin on Sunday October 5th, and will run on Sundays at 1pm until the first week of December. 
 
This group will be insurance-based (students with a referral will not have a copay if they have their college’s insurance); interested clients should contact me directly at kwaggoner@jameslevineassoc.com so that I can arrange for an initial screening, which will be a brief phone call to assess acuity and appropriateness, but basically if you’re at an outpatient level of care you’re probably going to be fine to join. Current clients need not go through a screening – just let me know you’re into it and I’ll sign you up.
 
If your insurance does not have a group benefit, the self-pay rate for the group is $20 per group. Clients may NOT attend on a drop-in basis. Although obviously if someone calls out sick with 24 hours notice I’m not going to yell. The age cut off for joining is 18, with no upper age limit. The group will run as long as I have a 5 person minimum, and I’m going to cap it at 15. Thanks!
 
– Katharine