For the last 9 months that this site has been up and running, and in the years before that, when I supported those with eating disorders on another site, I was, and am, constantly peppered with anything from requests for more proof to outright hostility towards the Homeodynamic Recovery Method guidelines for recovery.
Maria Bowen: Flickr.com
I’ve been accused of taking advantage of fragile and emotional eating disordered sufferers; forcing those who are ‘damaging their bodies’ with continued weight gain, to end up at weights that are supposedly dangerous to their health; and of creating some cult where only true believers are welcome and where skepticism is simply muzzled outright.
H8ers gonna h8, as they say. However, for some who are attempting to recover using the Homeodynamic Recovery Method (HDRM) guidelines, the attacks can be debilitating and provide lots of fodder for an eating disorder to rear its ugly head.
I should point out that many hostile folk will cloak their questioning in the mantle of skepticism, but it is most certainly not skepticism on their parts.
A skeptical mind is not a dogmatic or closed mind. A skeptical mind is neither wedded to the status quo, nor blindly accepting of a brand-new way of doing things without first assessing all the available data. Skeptics take nothing a face value.
You will note that most who wear the cloak of skepticism are taking everything about the status quo at face value. They are dogmatic, not skeptical.
Dogmatic: characterized by an authoritative, arrogant assertion of unproved or unprovable principles.
I intend for this to be the post that helps you deal with dogmatic people when it comes to your recovery efforts as well as further frame in your own mind the realities of following the HDRM guidelines.
Never Answer a Hostile Question
It is not always possible to tell, from the first question that is asked, whether someone is hostile or simply curious, but asking for clarification usually fleshes out that distinction pretty quickly.
Answer the first question with a question:
Questioner: “Don’t you think that following these guidelines will make you fat?”
You: “Is that something you are worried about for me?”
This tactic places you firmly in a position of curiosity about their motives and interests, and it sets the tone for you not having to exclusively defend your position while they pepper you with questions.
If the questioner is truly curious, he or she is looking for information, not an opportunity to simply cross-examine you to show you, and the world, that you are wrong before the Court of Public Opinion.
Conversational Aikido
There is a Japanese form of martial art called Aikido that is a wonderful metaphor for how to address the hostility you may face from some, if you choose to recover using the HDRM guidelines.
Aikido is the action of blending with an attacker’s force and re-directing it to neutralize that force, rather than opposing it with equal and opposite force.
Conversational Aikido is not a theory of improved human interactions, but it should be. It is just something I made up, and it has its roots in motivational interviewing. It is however clearly distinct from MI in that it is not exclusively applicable within the counselor/patient framework, nor is it scientifically tested.
It’s Not About Difficult People
There are endless “How to Handle Difficult People” programs offered by leadership and management training organizations and they usually Jesus bug (Gerridae family of water surface skimming insects) on the surface of psychological concepts that borrow heavily from Western individualistic and positive thinking biases.
Training formulae for handling said ‘difficult people’ involve proper paraphrasing to confirm what they are saying; encouragement to keep expounding on their points; remaining calm; breathing; distracting; minimizing; keeping it logical; and avoiding contact wherever possible.
And of course there are all sorts of amusing articles that label different kinds of difficult people, as though we can simply sort them as one would different colored jellybeans or Smarties™.
Human beings are not jellybeans or Smarties™. I have yet to meet a single individual who is a “difficult person”. I’ve met plenty of people who have difficult facets to their ways of interacting. I’ve met many more who have various insecurities triggered in certain environments and that will create very difficult reactions.
And I can certainly attest to the fact that resiliency directly ties in with the prevalence of difficult interactions that people will have with others. People who are stressed, ill, delayed in various maturation facets when it comes to personality traits (see Is there an eating disorder personality?), trying to overcome very difficult life circumstances (past or present)…certainly have little left over to support smooth human interactions all the time.
Now we’ll look at the foundations of some of these more fraught interactions.
Successful Resolutions
Western philosophies of individualism and positive thinking are limited in their ability to really help us handle difficult interactions.
Individualism
The challenge with staunch individualism is that there is an inherent attitude that if an individual has behaved in a certain way or treated others in a certain way, then they are almost always deserving of a baseline of acceptance and respect. When an individual is actually physically violent and/or murders another, only then are we comfortable rescinding that acceptance and respect because they have clearly violated another’s individual rights.
And while I can certainly argue that communal obligations in other cultures can be tremendously limiting and individually effacing, that is likely because I am a product of a Western culture myself.
Because it is the water in which we swim, like fish, we struggle to even imagine an alternate way of interacting. Consider this oft-repeated phrase:
“Well she has a right to her opinion and she has a right to state that opinion.”
Does she?
In many societies around the world, while your thoughts are your own, your right to verbalize them is not automatically allowed, never mind respected.
Consider that an unasked for opinion does not necessarily require of you that you accept the person’s right to express it over your right not to hear it. I am not recommending that you become close-minded, but rather that it is reasonable to insist that there be tit-for-tat, and that should someone insist you listen to her opinion, then she must sit and listen to yours in return.
Positive Thinking
Positive thinking has its roots in Calvinism and it is a dominant way of living in North America and hence much of developed world. What could be wrong with thinking positively?
Primarily positive thinking curtails critical assessment of the status quo. Notably, those who are most hostile to the HDRM guidelines for recovery are steeped in positive thinking, forcing them to assume that the status quo could not possibly be anything other than the ultimate solution.
Positive thinking presumes a just and fair world. If you follow all the rules and are not a Negative-Nelly, then you will be rewarded with health, happiness and a long life.
When Barbara Erenreich (author of: Bright-Sided) was diagnosed with cancer and expressed with various on-line support communities her anger and frustration at having developed breast cancer, she received an intense stream of vitriol, fear and hatred from other members of these on-line communities. The consensus was that such negative feelings would ensure that she would not survive her cancer.
Optimism (positive thinking) and pessimism (negative thinking) are both rooted in fear and anxiety— they are two sides of the same coin. An optimist fears breaking the rules of positive thinking and acceptance of the status quo, as it would ‘ensure’ a bad outcome. A pessimist fears that entertaining the possibility of a positive outcome will absolutely ‘ensure’ her hopes will be dashed.
A realist accepts that hopes may or may not be realized and that the world is not always fair. If you suspect you are engaging with an optimist or pessimist in discussing the HDRM guidelines, then anticipate that her world view will not allow for measured consideration of things she fears too much to contemplate.
Conversational Aikido to the Rescue
I am not even close to being a conversational aikido master, but I strive for it as an approach. On those rare occasions where I can even apply a bit of the philosophy, I find it defuses antipathy and hostility and allows for some debate that is edifying rather than hurtful.
Empathy is not a synonym for unrelenting acceptance. Conversational aikido is a way to show empathy while not simply taking the punch in the gut at the same time. Just because you can identify and empathize with the fact that the person is lacking resilience, has been triggered by the topic at hand, or is particularly threatened in some way, does not mean you express that empathy by standing there as her punching bag. You will blend and neutralize the force directed against you.
The blending effort is to come up along side them with questions to have them clarify their own requests. The neutralizing effort is to neither feel sorry for them, nor superior to them, but rather respect the force of their conviction while deflecting it.
Deflection is not actually about explanations and excuses, it is a minimal gesture encompassing both grace and a firm expression of your own boundaries. Deflection is about not owning their fears and anxieties, but allowing them some room to express them. Deflection is also about identifying the weakness within the attack itself. And here’s how we go about that:
Do You Know What Remission from an Eating Disorder Looks Like?
One of the biggest challenges we have in gaining widespread understanding of eating disorders is that there is expert disagreement on what constitutes a “cure”.
Eating disorders are chronic neurobiological conditions and researchers in the field definitely agree on that point today.
Sadly, researchers and practitioners rarely cross paths. If you have a health care practitioner who tells you that it is not about the food, then hire a new practitioner who is more familiar with the Minnesota Starvation Experiment, the work of Walter Kaye, Janice Russell, Andrea Garber and Shan Guisinger (just to name a few).
There is no cure. Again, if you have a practitioner who assures you he or she can cure you of your eating disorder, then hire a new practitioner.
The Agency for Healthcare Research and Quality states “it may take as long as one to two decades for original research to be put into practice.”.
“Discrepancies between evidence-based, efficacious interventions and what actually occurs in practice are frequently so large as to be labeled a “chasm” by the Institute of Medicine. These gaps occur across prevention and disease management behaviors, and across settings, conditions, and population groups. Well-publicized reports by RAND researchers have documented that on average just over half of recommended health care practices are implemented, and the situation may be even worse for prevention and health behavior change interventions.” 1
You can achieve a full remission of an eating disorder condition, but that is not the same as “normalizing” your eating behaviors. By definition, you cannot have normal eating behaviors in the sense that you will never be someone who does not have an eating disorder—the eating disorder will either be active or dormant.
You can, however, develop protective and similar-to-normal eating behaviors, with the right recovery effort and that will greatly improve the chance of continued dormancy of the condition.
And that brings us back to the question: do you know what full remission actually looks like?
We’ll come back to this question later in this post…
Do You Have Any Direct Experience or Examples that Suggest Continued Restriction Can Co-exist with Full Remission?
In case you are unaware of the well-known statistics on anorexia nervosa (keeping in mind AN is simply a facet of the same neurobiological condition that includes bulimia, orthorexia, anorexia athletica and restrict/reactive eating cycles) here they are again:
A study by the National Association of Anorexia Nervosa and Associated Disorders reported that 5 – 10% of anorexics die within 10 years after the condition has been activated; 18-20% of anorexics will be dead after 20 years. Only 30 – 40% ever fully recover.
Also within the same study, the mortality rate associated with anorexia nervosa is 12 times higher than the combined death rate of ALL causes of death for females 15 – 24 years old (that includes car accidents). 20% of people suffering from anorexia will prematurely die from complications related to their eating disorder, including suicide and heart problems.
Clearly, the current approach to treatment is failing on all levels.
We have practitioners telling patients to continue exercising, return to exercise as soon as possible, stop gaining weight and start restricting calories again, avoid binges, reach the lowest point on the ‘healthy’ BMI scale and call it a day, eat protein/avoid carbs, eat carbs/avoid fats, eat some fats/not other fats, that they are not too underweight, that they are gaining too fast…not a single one of these warnings and prescriptions has any evidence-based medicine behind it.
The primary reason current treatment approaches are failing is that some 30 years’ worth of research that suggest better ways of getting to a full remission have not permeated practitioner mindset.
To those who are irate and outraged at the calorie intake guidelines you find on this site, ask them if can they point to anyone (themselves included) who may have successfully achieved and maintained remission for more than two years while applying lower calorie intakes than those recommended in the HDRM guidelines? Furthermore, ask them to provide doubly-labeled water trial method data on what energy intake is required in recovery.
Relapse is the norm precisely because patients do not persist with calorie intake guidelines (and more) found within almost all inpatient settings (equivalent to those found in the HDRM). As soon as a patient is considered medically stable, he or she is released from an inpatient setting and promptly encouraged to ‘normalize’ his or her eating behaviors.
The fear of obesity so clouds the ability of the practitioner communities to provide reasonable guidelines, that it is all but impossible for a patient with an eating disorder to get anywhere near his or her optimal weight set point, let alone normalize all the biological functions that have been damaged by long bouts of semi-starvation and other forms of restrictive abuse such as excessive exercise.
Do You Know What Someone Like You Who Has Never Dieted Actually Eats to Maintain Weight and Health?
(hint: it’s not 2000 calories a day).
That’s right. And yes, that incorrect estimate is splattered everywhere all over the popular media and by authorities such as the World Health Organization as well: women should eat 2000 calories a day and men slightly more. Except it’s wrong.
Healthy non-dieting adult women (25y+) of average height and weight eat on average 2500 kcal/day (see doubly-labeled water method trial data on this site). Average height and weight refers to a range within the bell curve that includes 2 standard deviations from the norm— meaning that those at the absolute peak of the bell curve and a little bit on either side too are included in that measure.
Explanation of a bell curve: we can plot human populations on a graph where BMI is the horizontal X axis and the number of people is measured on the Y axis. The more people who have a certain BMI, the higher the line on the graph goes. The shape of the line in the end resembles a bell, hence the name “bell curve”— not many people have low BMIs, tons have average BMIs, and not many have high BMIs.
While we’re at it, do you know what the absolute normative value (the peak of the bell curve) might be for body mass index for adult women around the world? It’s BMI 25.44.
Oh, but of course then you will cry “Obesity”! It might be worth reviewing the papers found under the category "Obesity" on this site to get clear on the concept.
BMI 25 is Overweight. BMI 30 is Obese. Evil, Evil, Bad, Bad.
Do you know how the concept of “overweight” or “obese” came into being? Do you think it was based on actual health risks associated with those body mass indices?
Think again.
Here are some excerpts from the Fat series (you should really read it):
“Anyone between BMI 25-30 is considered pre-obese.
There are two primary sources upon which the above health information, widely disseminated and generally presumed to be correct, was based:
McGinnis, JM, Foege, WH. (1993) Actual causes of death in the United States. JAMA 270, 2207-2212.
Allison, DB, Fontaine, KR, Manson, JE, et al.(1999) Annual deaths attributable to obesity in the United States. J Am Med Assoc 282, 1530-1538.
The first one did not even discuss obesity as a contributing factor for early death. In fact the authors of the study made attempts to try to stop having their data misrepresented [NEJM, 1999], but the data continue to be misinterpreted to this day.
In the second study the authors only controlled for age, sex and smoking and therefore assumed that if someone had died, and he or she was obese, that the only cause of death would have been obesity. A facile conclusion that neglects to control for levels of activity, genetic pre-dispositions to other serious illness, history of weight cycling, use and/or misuse of diet drugs, bariatric surgery…the list is long.”
Despite such misrepresented data, at the end of the 1990s the World Health Organization shifted from using the definition of average body mass index range to “healthy body mass index range” and also overnight identified those within the BMI 25-29.9 range as no longer healthy.
Check out this part of the Fat series if you want to really understand this properly:
Fat: No More Fear, No More Contempt Part VII
We have never lived longer and have (likely) never been heavier. If ‘obesity’ were the health crisis it is made out to be, then where is the commensurate drop in longevity outcomes? It’s just not there folks.
And often the argument back on that is that we live longer because of medical advances. Wrong again. In the developed world, more people have less access to medical resources than ever before. In fact in the past 25 years our average life expectancy increased by 4 years, but access to medical care for a quarter to a third of the population commensurately decreased in that same timeframe.
Eating Equals Hugeness
Have we ever gotten anything more wrong than this? Well yes, human history is strewn with our false leaps to assume cause where none exists. But you’d think that by now we might have learned a thing or two about how wrong we get these things on a regular basis.
Body mass index is not correlated with food intake at all. Pause for effect (Statistics from the Healthy Eating Index Table 10, 1998).
How much you eat has absolutely no effect on how much you weigh.
That’s a confusing statement isn’t it?
Clearly if you starve, you lose weight. And clearly if you re-feed, you gain weight.
The key to understanding this statement is to add a critical clarification:
Once you are at your body’s optimal weight set point, how much you eat has absolutely no effect on how much you weigh.
If you are either under or over your body’s optimal weight set point then it is going to work extremely hard to have you return to that set point.
Human beings can fritter away over 600 calories easily in non-exercise related movement. 2 And they will do so, and be unaware of it, if the body determines that the food they have eaten is not needed to maintain health and weight.
When we restrict calorie intake the body also has a way to manage it, but it costs. Now the energy deficit has to be addressed by filling the deficit from within the body itself.
Most biological systems are run to an overdrive level with certain key clamps put on the system to keep it at an optimal state. It is biologically more expensive to try to run a system right to 100% all the time than to run the system to 200% and just use a few hormones or enzymes to clamp it down to 100%.
Our body is probably quite literally built to burn off excess energy in our sleep if it has unneeded excess.
But restrict your calories and now all of the limiting hormones like leptin, ghrelin and insulin and others are left scrambling because you have just dumped the entire metabolic system to well below its 100% functional level. Leptin is a clamping hormone. With nothing to clamp down on, it plummets in our blood streams and this creates a cascade of shut downs throughout the body.
We have evolved to overeat and maintain weight easily, in our sleep no less. We have evolved to survive some environmentally imposed under-eating as well, but not with the same ease and not without some heavy-duty damage for which we must account.
Some lizards can indeed drop their tails, when threatened, as a way to avoid a predator. “The loss of the tail (called autotomy)…is stressful to the lizard, especially if that lizard stores critical fat deposits in the tail, such as leopard geckos. Not only do they need to spend energy healing the stump and regrowing the tail, but the loss of fat may occur at a critical time, such as during gestation or a period of low food availability.”3
Think of dieting as autotomy for humans.
Do You Know Anyone Who Is Class III Obese?
Class III Obesity is BMI 40 and above. Chances are good that very few of us have ever known anyone to fit this classification because it is present in only 4.8% of the population. 4
Quoting again from the Fat series:
“Until very recently, the health risks of obesity were thought to be well understood, with a straightforward correlation between increasing obesity and increasing risk of health problems such as type 2 diabetes, coronary heart disease, hypertension, arthritis and cancer. It is becoming clear, however, that the location of fat deposition, variation in the secretion of adipokines and other factors govern whether a particular obese person develops such complications.” 5
Andrew Walley and his colleagues further state in the discussion of their meta-analysis that“being obese does not necessarily mean being ill and, indeed, it is likely that very good health is required to establish and to maintain extreme obesity (emphasis mine).”
Do You Know Anyone Who Is Obese (BMI 30 and up)?
Now the chances of knowing someone between BMI 30 to 40 is significantly greater than knowing someone over BMI 40, but the issue is not the amount of fat tissue, but whether they are unwell or not.
And if the person you know who is over BMI 30+ has chronic conditions and illnesses that are traditionally associated with the presence of excess fat, then do they have a history of going on diets and coming off of them?
Many assume that just being BMI 30+ automatically dooms you to heart disease, diabetes, bad cholesterol levels, etc. But do you know of anyone who is BMI 30+ who has not dieted periodically? Likely not.
And critically, there is some disturbing evidence that it is weight-cycling that is more closely correlated with poor health outcomes, than simply accepting and staying at your body’s optimal weight set point:
“…for the vast majority of obese individuals, lifestyle-based weight loss is not maintained over the long term (Wing et al. 1995). This is particularly concerning, given that weight cycling is associated with greater weight gain over time (Van Wye et al. 2007) and potentially worse health outcomes, compared with individuals who may have maintained a stable body weight (Blair et al. 1993; Wannamethee et al. 2002). 6
Quoting my Fat series again:
In a study involving 692 female adolescents, weight-loss attempts predicted elevated increase in weight and onset of obesity over the 4-year study period [E. Stice et al., 1999].
No matter their starting weight, the young women in the study had a 3.24 times greater chance of obesity onset than non-dieters. The risk was no greater for girls who started overweight than those who were underweight or normal weight at baseline [ibid.].
So when your 13-year old daughter decides she is going to diet because her thighs are getting too big, do you tell her that she’s over 3 times more likely to become clinically obese that way than if she just didn’t diet at all? I’m thinking it might be a good idea.
Do You Know What Your Body’s Optimal Weight Set Point Might Be?
This is a bit of a trick question, because first of all there has to be some acceptance that your body has an optimal weight set point. Again, the practitioner and popular media realms lag far, far behind the research on this topic.
Albert Stunkard, one of the godfathers of research in the areas of binge eating disorder and obesity, argued in his research finding back in 1982 that appetite suppressants need to be used in perpetuity or not at all because it is not tolerance that impacts rebounding of weight, but rather an inherent weight set point that pushes back on the actions of said appetite suppressants. 7
To be clear, I don’t support the use of any appetite suppressant for any reason. Ever.
“It is concluded that regulation of body weight in relation to one specific parameter related to energy balance is unrealistic. It seems appropriate to assume that the level at which body weight and body fat content are maintained represents the equilibria achieved by regulation of many parameters.” 8
The problem for us is the word “theory”. In the English language the word is usually assumed to mean the opposite of “fact”, or at the very least something imagined but not provable. However, “theory” in the scientific community means something quite different.
That there is a way our bodies maintain a weight (within 4-5 lbs. or so); that each individual appears to have a distinct weight set point; and these points vary significantly across the entire population, are actually facts. The reason that the word “theory” is added is because scientists are testing its existence to identify the mechanisms of how the body actually achieves this feat.
You will read all manner of incorrect garbage in the mainstream press about how you can change your weight set point permanently using diet or exercise, or both. The only way that a weight set point is permanently adjusted is by restricting calorie intake in perpetuity (and usually at increasing levels as you age—autotomy for humans, remember?) or removing parts of the brain, as has been unequivocally proven with animal studies.
Why would we have an optimal weight set point? Because fat (adipose) tissue is not a storage unit, it is a critical hormone-generating organ in our bodies. The fact that it can also act as a storage unit for energy when an individual is faced with famine, does not mean that this ability comes with no negative health outcomes attached.
Clearly you mess more with this organ’s ability to function by dieting, than if you just left well enough alone.
And the question at the beginning of this section was a trick question on two fronts: 1) you have to know that it is a scientific “theory” and therefore it is a fact, not a imagined concept and 2) no one can answer the question because our optimal weight set points are not decided by us or anyone else. They just are what they are.
We Are Multivariate Systems Living in a Multivariate World
Dieting (restricting calorie intake to lose weight) may be partially to blame for illness and disease in those with more than average fat deposits, but it’s not the only cause.
If you have never read The Secret History of the War on Cancer, by Devra Davis, then I recommend it for any and all true skeptics out there.
Already this post is too long (as always), so I won’t get into too much detail here, but suffice to say that some 77,000 chemicals found in everyday household items—cosmetics, cleaning products, furniture, carpeting, personal hygiene products— are completely untested. These chemicals exist in everything around you simply because no authority has said that they should be safety-tested first.
Many of them are endocrine disruptors or mimickers, meaning that they interfere with your body’s synthesis and maintenance of hormones, or they mimic our natural hormones so that they increase the overall level of the action of those hormones in our bodies.
And how do all of those chemicals impact the largest endocrine-producing organ in our bodies (fat)? We are only beginning to find out in research and therefore you can be sure that it is not even on radar when it comes to health care practice.
Some of it has hit mainstream media, such as the possibility that bisphenol A and also phthalates (I just love typing out that word!) play a role in the onset and development of obesity. 9 Of course, these articles are about getting your attention and creating anxiety (eyes to the article), but underneath their fuzzy presentation of the data, there are real results that have indeed got some legs (meaning the evidence is building).
Thing is, we are all walking toxic soup mixes these days, so why aren’t we all suffering from excess and increasing fat tissue along with heart disease, cancer, high blood pressure, and diabetes despite our best efforts to starve and stay on a treadmill for hours on end?
Enter the multivariate system.
In science a variable is something we manipulate in a research trial to see if the manipulation either proves or disproves the theory that is being tested.
If I wanted to determine whether taking candy away from babies makes them cry, then the candy becomes the variable in my experiment. I’m going to manipulate that variable to see if my theory, babies will cry if candy is taken away from them, is true or false.
That is a single variable trial. Almost all trials are designed to test a single variable. And there are often elaborate statistical manipulations involved in trying to rule out other variables that may have impacted the outcomes of the trial but were not specifically part of the trial itself.
Problem is, most investigations are not as simple as taking candy from a baby.
If I inject polonium into 100 test subjects, and they all die, then I don’t have to analyze the impacts of other variables (their heights, weights, diets, activity levels, illness histories)— by the way it is decidedly not ethical to inject polonium into people!
But in most situations there are multiple variables that have an effect on the subject and also interact with other variables at the same time and the outcomes are not as obvious as a hypothetical polonium trial.
Thus multivariate statistical analysis was born as a craft in our modern world.
How does this have anything to do with your handbag making you fat? Well the handbag might have a role in Susan’s adipose tissue increasing beyond what was optimal for her, but not in fifty other cases that are also carrying around the same handbag as Susan.
What is different about Susan? A multitude of things. What is different about each of those 50 other subjects? A multitude of things. Trying to pick apart whether one variable is more impactful than another on each system (because each human being is his or her own biological ecosphere as well) is a beautiful craft but not to be confused with undisputed facts.
“Lies, damned lies, and statistics.”
(variously attributed, likely popularized by Mark Twain)
The take away from this section is to know that optimal weight set points are real and that there may be a complex interplay of multiple variables (dieting, endocrine disruptors, genetics, sleep disorders…) for some people that will trigger the onset of an increase in the size of the fat organ (beyond its optimal state) and there will be an accompanying inflammatory state that predisposes that person to illness and disease. In those cases, dieting will worsen the size of the fat organ and the state of inflammation as well.
Homeodynamics
“Who exactly came up with the term and theory of homeodynamics is not clear, but presumably it may have been Martha E. Rogers, an RN, in the 1970s. From a biological perspective a homeodynamic state more accurately recognizes that organisms do not have a single homeostatic state, but rather interact with stressors and stimuli within their environments such that they are constantly developing new states of stability in a dynamic way.
We tend to define this experience in the context of getting an eating disorder into a robust remission as developing your "new normal". Biologically, you will not go back to your previous homeostatic state, but rather you will develop a new state of heightened resilience that reflects you, as an organism, having learned and changed to accommodate the introduction of a chronic neurobiological condition.” Gwyneth Olwyn
The body works very hard to try to maintain an optimal state, and therefore it is not a static state (homeostasis), but rather a dynamic one in reaction to myriad environmental and internal variations.
Can we break the body’s ability to stay within its optimal state in any permanent way? I don’t know and no one else seems to know either. However, the body is far more resilient than we ever tend to give it credit for, and the most significant barrier to having a body fix itself seems to be our own inability to be patient with it.
I do know that a fear of fatness and obesity is not a good enough reason to keep an eating disorder activated and running your life.
But I Won’t Get Fat Will I?
We are almost near the end of this long post, where I will wrap up by talking about what a full remission from an eating disorder looks like, but before I go there, let’s address the elephant in the living room shall we?
Not all patients on the eating disorder spectrum have twinned their condition with a fear of fatness, but in today's world most do.
If 4% are optimally going to rest between BMI 18.5-20.9, and another 5% are BMI 40 and above, and 70% are between BMI 21-27, then 21% are going to be optimally between BMI 27-39.9. These data are all extracted from Statistics Canada from 1978 – I specifically use data from the 70s because I can successfully push back on the so-called obesity-skew in our BMI population averages that presumably impact the data from the 1990s onwards (a skew that represent demographic shifts and not ominous 'disease' epidemics).
Odds are most of us will be optimally between BMI 21-27. Both weight and height are highly heritable traits. You tend to be about the same size as your parents, basically. But high-heritability simply means that the genes are the dominant players in shaping the trait. Nature via nurture always recognizes that environment can shape how those genes will be expressed.
“Weight, like height, is a bell- shaped curve, and someone has to hold down the upper standard deviation from the average, although few women accept this fact…Most media promote an unhealthy thinness or impossibly lean muscularity. The narrow range suggested by insurance company tables or other charts for individual weights are often used inaccurately. These weights are averages, not norms.” 10
Mehler is right. Few women and men will accept that their optimal weight set point is not at the peak or to the left of the peak on that bell curve because our society is more than happy to viciously discriminate against those with an above average adipose organ.
We have had so many on the site say that they would rather suffer the massive health, social and emotional consequences of their eating disorder, or be dead, than be fat. Indeed. They are only expressing what is the norm in our society.
“People would rather be dead than fat. In a poll run by Esquire magazine, two-thirds of respondents said they would rather be stupid or mean than fat. At least 54% said they would rather be run over by a truck than be extremely fat.” 11
For this sad statement on the human experience today I have no solution.
I cannot tell you that you will not be fat. I can say odds are you will be somewhere between BMI 21-27. While I wholeheartedly believe that being naturally, optimally fat beats death, stupidity, meanness or being run over by a truck, who am I to tell you to rise above all the horrific discrimination and cruelty in your day-to-day life because you are ‘unacceptably’ yet healthily fat?
Still, because I am a skeptic, I can still embrace hope while at the same time knowing that my hopes may either be realized or dashed because it is not a just or fair world. So I continue to hope that individuals will pursue a full remission from an eating disorder in spite of the fact that they might risk an optimal weight that is healthy but shunned by society.
And Finally, Here’s What Full Remission from an Eating Disorder Should Look Like
I have seen some shocking, spectacular success and I have also seen some heartbreaking relapses. It is important to recognize that relapses loom large with the eating disorder spectrum. It is why in the Recovery Journal I have a section at the end of the journal to help folks create their Relapse Reversal Intervention Kit. Life has a way of bringing lots of challenges our way and it will be exactly at that time that the eating disorder is happy to make its reappearance in your life.
“Thanks everybody for your help, posts and advice. You are all incredible girls and boys and I wish you all the best in recovery. It is a tough fight, but I know you can all do it and heal once and for all…I really enjoyed believing I was a normal person for a few months. It was nice to have that hope and to laugh and have energy and eat without fear. I embraced recovery since the very beginning. Unfortunately, I can't accept my body in such a high, over the average weight. I'm giving up, but I gave all of myself in this. I tried. For everybody in the forum, please understand that I'm the exception of the rule. But at least I tried. Please, don't give up before you get your period or are stable in your weight. At a BMI below 25, you're in heaven and perfectly healthy. Thanks everybody! I hope you all have a great life! Andrea”
The above post was submitted by Crowl130 (a.k.a. Andrea) on April 5, 2012. It was, in fact, the exact same day that Samantha Michelle Danow died from health complications due to an eating disorder. Andrea had persevered for months with her recovery effort. She had returned to regular menstruation and arrived at BMI 30. She is now presumably in active relapse. I hope she returns and I hope for a world where BMI 30 is just a silly series of letters and numbers signifying absolutely nothing.
I share these sad stories because hope is not going to be enough to get us there. Do the HDRM guidelines offer you a guaranteed remission? Absolutely not. But at least there is some hard science behind the guidelines to indicate that if you can slog through it, this is what awaits for you:
“Today…things are so much better. I can concentrate at work, I look forward to seeing my friends as much as possible. I’m so busy with living my life that I don’t even have time to think about food or counting. I eat whatever I want whenever I want. I have energy. The sexy bricks* are back. I go on DATES and enjoy myself (actually, I’ve never been hit on as much in my life!). I see myself clearly now (no more self distortion! Whee!). I feel like myself and not like a shell of a person putting on a happy face every day. I'm not saying things are perfect now. Of course we all have our days. But I can truly say that right now, I am free, happy and so grateful. You all deserve to be happy and free. Every single one of you.” [Torontogirl, Forum Post, 2012]
(*This refers to a great little meme created by one of our members, kayebunny, describing how sexual interest (which disappears during active calorie restriction) had returned to her and hit her like a ton of bricks—sexy, sexy bricks).
“Heck yes to the fact that remission takes a lot of hard work. My hormones/mood took a good year to settle down once I reached a healthy weight, and I still have to be careful if I have a stomach virus or if I'm under a great deal of stress (as I am at the moment, coincidentally), because I appear to be biologically wired towards undereating. But under normal circumstances, when I'm otherwise healthy and stable, I can feel the benefits of having put so much hard work into recovery. I usually eat intuitively, I feel fit and strong, I am much calmer and happier (again - not at the moment! But I'm blaming a relationship breakdown/work for that), I have no urges to restrict and am quite happy with my body. It's not an impossible goal by any means, as long as you are prepared to tolerate a LOT of discomfort during weight restoration and for a while afterwards, and to be careful for longer than that not to accidentally slip back into old habits.” [GiantfossilizedArmadillo, Forum Post, 2012]
“I Feel great I like the way I look with the extra weight, I feel very womanly and I never thought I would feel like this, I thought I would hate being this weight. The anorexic thoughts still whirl around in my brain but they are so much weaker and I am able to tease them out and see them for what they are, and ignore them and get on with my life…The scales and how I weigh is only a number, I am not going to weigh myself and just go with how I feel in my clothes/mirror which is pretty content at the moment.” [Strongsandy, Forum Post, 2012 ed.: Strongsandy’s menstrual cycle also returned after 20 years’ of active restrictive eating behaviors.]
“… I am very much able to conceive, weight stable (well judging by my clothes I am losing weight, now, but without restriction) and eating 2500-3000 calories a day to hunger while being utterly sedentary. I have ditched vegetarianism and there is literally not a single food I won't at least try. This process has forced me to realize who I am and what is important to me, and to stop being embarrassed or apologetic of those things. I am actually humbled. I know I am fortunate to have gotten where I am in such a miraculously brief period of time. I know I am unusually resilient. But it has not been easy, on the contrary it has been the most difficult, uncomfortable thing I've ever taken on. But every awful unbearable moment is worth it when I can now laugh, cry, speak my mind, think, write, eat, drink, love, decide, dream... In fact, I don't think there is anything I CAN'T do if I want to, except maybe go back to my old ways :)” [Freckledbean, Forum Post, 2012]
“Lately I’ve just been feeling so unbelievably REFRESHED and.. dare I say it… HAPPY. I actually haven’t felt this way in such a long time. I’m not so tense, I smile more, I actually laugh and I’m beginning to reintroduce past hobbies into my life like sketching and playing piano ☺ I am learning something new and different about myself everyday, even if its something small like realizing I actually DON’T like the taste of boiled veggies. What excites me most is that I’m beginning to see a future for myself. In the deepest state of my eating disorder, I never thought I’d be able to continue studying, and that I was a hopeless wreck. I thought there was no hope and no point in trying to recover. But now, whilst I acknowledge I’m still VERY MUCH a work in progress and whilst I’m not quite sure where I go from here—I do know where I have been, and that’s a place I NEVER want to return to. I’ve seen unhappiness and it’s not for me. AND even if everything on this site is complete gobbildygoop (which I highly doubt!), I DON’T CARE!! because I’m happy and proud of what I have achieved through this website. The inspiration and motivation I receive here is more than enough to let me know that recovery is what I want and strive for.” [Gbee1294, Forum Post, 2012]
“Then last January, age 20, happy with myself for reaching a BMI of 21 once again, and trying to get that down to a BMI 20, my binging got worse… I knew about Gwyneth’s site…, but I never applied it to myself - I also thought it was all lies just to get those with EDs to gain weight (and I didn't have anorexia! I was a binge eater! little did I know)…But I took a look at the site, read everything, and I knew that my binging was due to restricting, I knew that I never had a "real" recovery, even though I wasn't obsessed with eating healthy or didn't have any fear foods anymore. I was semi-recovered, and I had to have a real recovery. So I did. It was not easy, especially as I was already up to a BMI of 23 before even fully deciding to go for it. Now my weight has been stable around BMI 25-26 for over 2 months. Well, I think it has been anyway, I stopped weighing myself.” [Funkii, Forum Post, 2012].
“I am 8 years into recovery, and my BMI has stabilized around 24-25. When I first started re-feeding/gaining/recovering, I also had noticeable differences in where the weight was increasing -- and yes, I did notice a lot was around my abs! Over the years, it has sure redistributed and I am back to my natural body shape of a pear. I know everyone is different, and so everyone's experience will be different. But, I hope sharing this is reassuring for you. This whole thing is a process and the body knows what it is doing. Trust the process. Glad to hear that you like your body!!! I like mine, too.” [Tealorca711, Forum Post, 2012]
“I knew I wanted recovery, but I still begrudged my body for the food it wanted, I hated it for the way it decided to use that food (tummy rolls!), I panicked when it yelled for more, I lost it when it would never seem satisfied and I thought it was so 'conniving' when I couldn't trick it with something other than what it begged for. And then one day I thought of my body, the only thing that will stand by me from day one to my last day. The poor mistreated thing that has borne all my cruelty and yet did its best to keep me going. The trusted friend who now responds even as I am not fully true to it.I thought of a happy body in a healthy mind. A relationship where I honour its demands, marvel at its functioning and am grateful for it does for me. I wanted that relationship. That peace and trust. It has helped me a lot along the way. When I am unsure, I still trust it, because I know I cannot trust my mind yet. And I am beginning to love it - even if it 'looks' wobbly and weird! Just like a baby fascinated by its limbs as it watches its fists in wonder, I smile at the rolls of whatever in all sorts of odd places and wonder at the amazing things going on inside!I hope this helps at least some of you find the peace between our bodies and our minds!” [Duoinside, Forum Post 2012]
“Yesterday, I had an embarrassingly melodramatic crying session because I'm at the highest weight I've ever been at in my entire life. And when I stopped crying, I was done. I let go of it, and I went bowling to celebrate a dear friend's birthday. While there, I was not thinking about how I looked. I was not focused on what my next meal would be and when I would eat it. I didn't feel like I was spending time WAITING for something (who knows what), as life has felt to me for 4 years straight. I was there. I was actually there. Fully present in the moment. Making everyone laugh. Letting out high-pitched squeals and giggles, myself. The craziest part? I didn't even realize I was missing this - this inexplicable part of myself - until it returned to me last night. I don't know if it's because ED has spent so much energy convincing me over the last few years that I'm a complete, whole person, while quietly making me forget about my pieces that went missing, covering up the fact that I've been broken... I don't know. All I know is that I met myself again last night. And it felt like reuniting with my best friend in the entire world.” [Artemis, Forum Post, 2012]
“I can barely believe it, but it's true.... not even six weeks into recovery, still deeply entrenched in extreme water retention, muscle aches, fat on the midsection, and now tingling extremities, I got my period, which has not spontaneously happened to me for well over a decade.... for the longest time I NEVER thought I'd see another true period again, and here it is!! (So that's why I was crying all day yesterday...!) Okay, just had to share that. :)” [Kerrie, Forum Post, 2012]
“My whole quest for weight loss that spiraled into an ED was all in an effort to get healthy so I could have children. Before during and after ED we were trying to have a baby, with no success. Years at Drs., thousands of dollars on tests, fertility meds, etc. years of heartache and got nowhere. I have been in recovery since Nov, weight stable for just over 2 months, 5 regular cycles in a row. The 6th cycle is nowhere in sight, because I'm pregnant!! Completely out of the blue, I'm pregnant! After everything we have been through to try to get here, we're here and all I had to do was eat. No Dr. said eat, they all said I was fine, if I had not have found you I wouldn't be here now, I wouldn't be about to get everything I always wanted." [Buttercup, Forum Post, 2012]
“This is a journey that changes us and when I truly embrace it I find I am gaining so much more than I would have imagined. I think the message that keeps going through my head the most often is how much I want to be free of the vanity and self-absorbed nature of the disease. Sacrificing my life, happiness, relationships, family, and future children for thinness or attractiveness is absurd. This is not why I was put on this Earth and nobody but me really cares that I weigh 10 or 20 lbs more or less. I'm here for so much more and its time to get to work on those other things! Don't get me wrong, every day I have to convince myself to keep going, its not as if my mind is always in recovery, but whatever happens from here, whether I make it to the end or not, I know that what I've gained through the climb up the mountain of recovery will stay with me forever and change me for the better if I let it.” [Blue Dolphin, Forum Post, 2012]
The above posts are just a sample of submissions of course. Not all of the individuals quoted above are in full remission. That’s the point. Where recovery efforts end and true remission begins is not some walk-across-the-stage-graduation-certificate-definable moment. It’s a practice. You practice your remission every single day from the moment you begin following the HDRM guidelines.
Trust but verify – the mantra of skeptics everywhere.
This site is home to a growing and staunch community of skeptics :-) and it is an honor for me to try to support such skepticism in the face of society-wide dogma and fattism.
HDRM Guidelines:
Eat to the minimum guidelines for your age, sex and height every single day. More is supported and highly recommended.
Do not weigh yourself. At all.
Do not exercise or work out at all. Remain as sedentary as possible.
Never restrict food intake (for life)
Replace restrictive behaviors with non-restrictive ones when faced with food anxieties— get psychotherapeutic support to help with that process.
Women under age 25: 3000 calorie a day minimum.
Women over age 25: 2500 calorie a day minimum.
Women over 5’8” should bump up the minimum for their age by at least 200 calories, if not more.
Women under 5’0” can consider lowering the intake guidelines for their age range by 200 calories, but remember it is an absolute minimum and eating more is always better.
Men under the age of 25: 3500 calorie a day minimum.
Men over the age of 25: 3000 calorie a day minimum.
Men over 6’2” should bump up the minimum for their age by at least 200 calories, if not more.
Men under 5’4 can consider lowering the intake guidelines for their age range by 200 calories, but remember it is an absolute minimum and eating more is always better.
Keep in mind that all the intake guidelines reflect what energy balanced individuals need. In recovery you need more.
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