Medical Advice
I get occasional input that medical professionals advise those attempting recovery from an eating disorder to ease up on the refeeding, or resting, or both. Often that advice is shared with me as evidence that the unrestricted approach to resting and refeeding I reveal through the published research evidence, here at the ED Institute, is dangerous, medically unsound, and harms vulnerable people.
I have worked with many medical professionals on the not-patient side of the consultation space (i.e. administrative overlordship) and I have let you in on the rather disheartening secret that actual medical advice founded on clinical trials and research is the lesser of the contributions you receive as a patient. Biases and limiting liability drive most of the interactions between healthcare professionals and patients today (Beige Food Nine).
When a physician tells you one of your biomarker results suggests you should eat more vegetables and get more exercise, or that you need to restrict your sugar or fat intake, do you have a clear sense of the biases the physician might have about you and how much that might be driving the “advice” you’ve just received? And how comfortable might you be at attempting to try to lower any bias you identify in that physician to then try to elicit actual medical advice?
People with eating disorders are least likely to deal with discrimination from healthcare professionals when compared to those with other mental health issues. That’s great. However, the main reason for this is unfortunately that their condition is seen as an overzealous application of very attractive traits in society. This then leads to undervaluing the seriousness of the condition and the level of distress and misery that living with an active eating disorder actually entails.
No one with schizophrenia ever hears from a nurse or doctor: “I wish I had your problem. I could afford to hear more voices driving me to lose my connection to what’s real and what’s not,” but many an emaciated eating disorder patient has heard “I wish I had your discipline. I could afford to lose a few pounds!”
While people with eating disorders are not othered and dehumanized in quite the same way as those with other mental health issues, they are diminished and dismissed. Most healthcare professionals find them both perplexing and wearying. Basically, they are irritating. They just need to ease up a bit on their overly intense application of “super-healthy” behaviours and yet they’re so over-the-top dramatic about doing so. They are often childified by healthcare professionals because they are seen as toddlers with their black and white thinking and overly dramatic responses.
And yes, these attitudes are prevalent even in eating disorder specialised inpatient settings. Often it’s worse in those spaces because many who specialize in the field have active eating disorders and they frame their own recovered (but not too much) path as proof that it’s just a matter of easing up a bit on the very desirable traits of dietary discipline and physical activity in order to live your best life.
If you want to immerse yourself in our most robust and dogmatic spaces of fattism and healthism, look no further than any healthcare setting anywhere.
Thought Exercise
Let’s say I have two white women of the same age and height.
They both embarked on recovery from an eating disorder at the same time. They are both college-educated professionals as well, let’s make them lawyers. These women see the same GP and they are now both classified as obese, using the fattist and clinically unfounded standard applied in healthcare spaces.
They have just had the same biomarker screening tests and they have both been diagnosed with borderline diabetes as per the clinical guideline cut-off (see Diabetes One and Two for details). The physician advises them they need to eat healthy foods, cut back on fatty and sugary foods and get regular exercise.
One woman says: “Unfortunately, I am in recovery from an eating disorder and restricting foods marked as unhealthy and exercising will trigger a relapse for me. I am only a few months into my recovery and I definitely feel proud of my progress and that my body is working to find its way back to an energy balanced state. Given where that diabetes result sits, do you think we might be able to retest in three months to see if there’s a worrying trend? And are there any other things you could suggest so that I can move the needle on the blood sugar results without resorting to diet and exercise?”
The other woman says: “I have been following this online program for how to recover from an eating disorder and the woman who runs it says I can’t eat healthy foods or exercise at all even if my doctor says I have to.”
The first woman has done two things that help nudge a practitioner beyond fattism, healthism and advising treatment protocols that limit liability for the practitioner: 1) she has avoided using clinical terminology that can have practitioners defensively double down on protocols, and 2) she is framing her treatment preference while seeking expert input. She does not say she wants to wait three months and test, rather she asks if that is feasible. She takes ownership of her recovery path and does not let her eating-disordered thoughts jump at the chance to reintroduce restriction of food and energy depletion through exercise.
Advising a practitioner that diet and exercise are never treatments available to you is no different than someone having to advise their practitioner that they have an allergy to penicillin when they need antibiotics for an infection.
The second woman is struggling with her recovery journey. She feels the cultural judgments of fattism and healthism that are wrongly embedded in that biomarker result. The physician’s treatment plan acts as a hurtful admonishment of her eating and resting choices in recovery. Her reaction is one of being caught doing something very bad. Saying that someone else “made me do it,” is her way to try to ease a very distressing level of shame.
Unfortunately, that second response reinforces the bias and attitudes among healthcare professionals towards those with eating disorders. There is tremendous, and not unwarranted, practitioner suspicion towards online health information. However, by deflecting the choice she has made to recover in asserting she is blindly following something some stranger said online, she effectively loses her agency within the healthcare appointment as well.
While the irony will be lost on the healthcare provider, they will swoop in to make the decision for that woman as to what is in her best interests, because they are the expert. And in so doing, they reinforce the bias in the healthcare community that those with eating disorders are in need of an adult in the room.
Part Two March 13.
