I Had No Idea! Secrets About Eating Disorders

We can't always tell just by looking at someone 
that something isn't right.

There are no excuses for perpetuating misinformation about eating disorders. No justification exists for minimizing eating disorders based on BMI, for generalizing them by age or gender, or for continuing to blame parents for causing them. While the news media may sensationalize and sometimes distort research, social media can fight back to correct misinformation. So read on, and please share!

Today starts a week devoted to spreading the word about eating disorders with the theme “I had no idea!” Thank you NEDA, the National Eating Disorder Association and promoter of Eating Disorder Awareness Week, for inspiring this post.

Random thoughts come to mind when I consider what this theme means to me—and what it might mean to you.  My beliefs and knowledge about eating disorders have evolved over many years, to which I credit the Academy for Eating Disorder listserve, the FBT researchers and Laura Collins and FEAST, blogs like Carrie Arnold’s  and my many, many awesome patients and colleagues. 

What I’ve learned over the decades

Got your period? This doesn’t minimize your diagnosis of anorexia, if you meet the other criteria. And resuming menses after being without a period does not mean you have fully recovered. No, the work is not yet done.

Obese and anorexic? How can that be? You do not need to be below the BMI chart to meet criteria for anorexia. Really. Unfortunately, you are the ones who most often fall through the cracks. And you are continually subjected to messages that your weight is the issue. I am truly sorry for this. Health care professionals need to be educated! 

Eating disorders are quite common in males, straight and gay. Males get anorexia, and struggle with bulimia and binge eating. Their focus on bulking up their muscle mass may seem like a cultural norm, but may be the sign of an underlying disorder. Check out Roberto Olivardia’s work on men and eating disorders.

Time to look at eating disorders a bit differently.

Over 30 or 40 and struggling with an eating disorder? You are not alone! Eating disorders are not just a teen thing. You can be living with an eating disorder at any age—an eating disorder that never resolved, one that reared it’s head again after previously recovering, or one that developed later in adulthood. Check out Dr. Cynthia Bulik’s work on this population. 

Parents don’t cause eating disorders. And parents shouldn’t be sidelined in the treatment of kids with eating disorders. They play an integral part in recovery, particularly when your poorly nourished brain fights you on eating. Learn more about how families can help from FEAST, from scholarly articles and other from resources.

Barbie didn’t cause your eating disorder. Sure, the media may impact how we see ourselves but eating disorders are much more complicated, involving genetic predisposition, environmental triggers and support for maintaining the disorder. We don’t know exactly what causes eating disorders, but it won’t be long before we understand the genetics. See what research is underway and how you can help the study of eating disorders and genetics.  

People don’t plan to have an eating disorder. It’s not a decision sufferers made. Individuals with anorexia, bulimia and Binge Eating Disorder aren’t simply refusing to change when they maintain their behaviors. Change is complicated—by fear, anxiety, and hard wiring of behaviors. My patient shares some wisdom we can all learn from here. 

It’s not so easy to just do it as this post describes. In spite of my many years of working with clients with eating disorders, I don’t think I fully grasped how many obstacles to change there can be—that is until Cate. Writing Food to Eat and feeling I was living her struggle with her was beyond enlightening; it heightened my sensitivity to things I had taken for granted—the planning to eat, shopping, cooking, and ultimately eating. 

Let's work to not live by diet rules and restriction, 
but to trust what our bodies both need and enjoy.

Recovery is possible, even for those who have lived with an eating disorder for many decades. But it has to start with the belief that change is possible. Connect with a treatment team-a therapist, an eating disorder dietitian and an MD, and reach out to friends and family for support. I now know that it is not too late to.

Want to help others recover? Share this post to increase awareness of eating disorders, and check out this awesome new eating disorder support by Cate. 

Oh, and please tell me what you think! Thanks for reading.

Speak Up, or You Will Be the Biggest Loser. And That’s Not a Good Thing.

Rapid weight loss is incompatible with mental and physical health. Period.

I beg to differ with Daily Beast columnist Tricia Romano, who believes Rachel Frederickson’s extreme weight loss on the Biggest Loser is none of our business. And I disagree that her weight is just a tad lower than a healthy BMI. And Rachel’s BL trainer Bob Harper is simply wrong when he assumes that “…when contestants leave home ... they are in charge of themselves.” 

Admittedly, I’ve never watched more than a few minutes of TBL—I found it intolerable. Yet the show is unfortunately quite popular. Many of my plus size patients report being inspired, identifying with the desperate contestants, tolerant of the verbal abuse and crazy diet and activity demands. They're smitten by the fairy tale that rapid weight loss through extreme measures works. And that extreme weight loss equals extreme happiness. Let me inform you otherwise; I yearn to protect you from the damage, both visible and hidden, from this diet mentality.

But first, about Rachel—the latest victim 

My summary of The Biggest Loser.

It was a media frenzy as Biggest Loser Rachel Frederickson returned to the show, 45 lbs below her “healthy” weight of 150 pounds when departing TBL. She weighed in at 105 pounds, a 155 pound total weight loss. And the $250,000 reward money was likely the least of the motivators. If you’ve ever known anyone who’s lived with an eating disorder, you know the situation well. It may start with a seemingly reasonable weight loss goal, typically with a common diet. And then once that goal is met, their goal gets reset. “Just five more pounds”, they think. “Then I’ll be happy/ satisfied/thin enough.” Yet for some, no amount of weight is ever quite enough, and the struggle continues. It moves from perhaps a sincere interest in losing some weight—perhaps at the recommendation of their doctor, even—to something completely different. 

And while it is frequently said that eating disorders are about control, the experience of the eating disorder sufferer hardly feels like being in control. Rumination about food and weight and eating consumes thoughts, and normal life comes to a halt. Social activities are put on hold to accommodate diet rules, and isolation becomes the norm. They may be visibly underweight, or appear to be of average or even over weight. Starvation can occur at any size. Really.

As for the Daily Beast writer’s comment “at 5 foot 5 inches and 105 pounds, Frederickson’s is slightly below the recommended BMI. But she’s also small-boned and lithe”, allow me to respond. For her height, midpoint of a healthy range may be 125 pounds by the charts, but at less than 90% of that weight (under 112 pounds), most women lose their periods. As for athletes (she was apparently a world class swimmer prior to her weight gain) a higher weight range is generally expected as healthy, with increased muscle mass. 

Of course there are small boned, women who were always petite, for whom a lower weight certainly may be okay. Weight, as I mentioned, is not the best measure of health. But a significant weight drop below one’s highest weight, referred to by researchers as weight suppression, may have undesirable effects, including precipitating eating disorders. 

Rachel reports feeling fine, but the evidence tells us otherwise. Exercising 3-4 hours per day strikes me as a big red flag for preoccupation with her weight. It’s not her fault, though. The Biggest Loser promotes rapid weight loss and unrealistic goals. We know from a classic starvation study by Dr. Ancel Keys in 1944 that starvation resulting in even a 25% weight loss—much less than her almost 60% drop in body weight—impacts thoughts, moods, sexual desire, and eating behaviors. All that, in addition to the slowed heart rate (no, it is not an athlete’s low pulse), low body temperature, and abnormal menses. 

Three, maybe four exercise classes a day, is her reported activity, while consuming under 1600 calories from a 'healthy' diet. Excuse me? 'Healthy diet' is a term that simply doesn’t apply to this intake relative to activity. I don’t care how healthy the individual foods are, whether they are organic, whole grain, whatever—there’s nothing healthy here. This is a severely restrictive intake for this level of activity.

It’s none of my business, Tricia? On the contrary. I can’t simply sit and watch and not shout out how outrageous and unhealthy this is. I am not, however, faulting Rachel. The Biggest Loser took a vulnerable contestant—perhaps no different than other contestants—a woman who reports emotional overeating resulting in a 100 pound weight gain following a breakup. They turn out an excessive exerciser, who’s restricting her calories and likely quite unhealthy by many measures. 

Call it the flip side of the same coin—first likely struggling with binge eating now struggling to trust her body and her signals and eat to meet her needs. Are we to view this as success? Not in the least. Were her eating behaviors addressed? Was she given strategies for coping versus using food or food restriction or compulsive exercise? Was she guided to learn to trust her hunger and her fullness again, or simply instructed to count calories? 

A former contestant, Ms. Hibbard acknowledges the unhealthy behavior she and others practiced on the ranch, particularly preceding weigh-ins (similar to what Weight Watchers report). Contestants, she claims, “dehydrated themselves through excessive workouts in warm layers of clothing, drank only coffee because it acts as a diuretic and ate little to nothing.” She adds: “I feel I did a vulnerable disservice by not saying on television the night of my finale. ‘I’m sad, and I’m sick from being on this show’”. (http://www.nytimes.com/2014/02/09/fashion/Biggest-Loser-Rachel-Frederickson.html?_r=0)

Hibbard might have been late to speak up. But we don’t have to be silent. The impact of a show like The Biggest Loser is dangerous—to its contestants, and to its viewers. It promises health, while causing harm; and it delays and potentially complicates contestants’ preexisting eating disorders. It shames participants through their weight loss struggle, and turns viewers to criticizing the Loser, like Rachel, for whom continued weight loss may feel out of her hands. 



Don’t accept the promise of rapid weight loss, or believe that extremes of eating or exercising will work. Because they never do.

Essential Weight Loss Tips? There Has to be a Better Way.

A winter storm has its risks. The biggest? It keeps me home with time on my hands trolling the Twitter feeds and Facebook messages. I read, filter my thoughts, read, filter, read—and then I can’t take it any more and feel the need to speak out. Earlier, I tweeted: ‘The only #cleanse you should be doing is a facial one. You know, soap & water or alternative. GI cleanses are disordered’, after reading an MD’s unintelligent praise of ‘cleanses’ (in quotations, because there’s nothing cleansing except your perception that you are removing those treacherous toxins.)

Then I came upon my professional organization’s tweet, “If you're hoping to lose weight before winter's end, these tips can help!” with this link. http://www.eatright.org/Public/content.aspx?id=6847

It’s hard for me to say just why it annoyed me, but I’ll try my best to explain.

Is this the best message we as RDs can offer? It’s a message of calories in/ calories out. Pick from all food groups! Exercise! Eat smart (as opposed to stupid, I suppose). Personally, I’d run the other way if I were looking for weight management guidance. It feels insulting to intelligent, well-informed readers. And it fails to acknowledge a couple of major points.

1) Actively dieting is not the answer and 2) eating and activity are not simply information-based decisions.

Were the authors thinking readers would respond with “Wow, I had no idea calories and activity were involved?” or “So simple! I’ll just choose from all the healthy food groups! That should work.” Or “Ohhh, it’s about moderation!”

As for BMI

For some, self-acceptance of a weight higher than the population-based weight and BMI charts is in order. A high BMI based on the population charts may be perfectly acceptable for you, if you maintain a healthy lifestyle. Similarly, a normalBMI hardly defines you as healthy (or normal) if your behaviors aren’t so healthy—if you engage in restricting and overeating, use purge behaviors, including compulsive exercise, have a rather restrictive diet, or poor quality intake.

Perhaps instead of having a “Calculate your BMI” ad on their page, they could include a ‘plot your personal BMI’, to help you evaluate whether you’ve been maintaining a healthy pattern over the years; a high BMI at the earliest ages suggests that genetics may play a role in your weight and size. Just as you wouldn’t expect that your shoulders would become narrower or your eyes would change shape, you shouldn’t believe that your BMI percentile should be changing much. Acceptance of this not-so-minor-point may be the best medicine for many!

But if your weight or BMI have been climbing inappropriately, you could use much better guidance than my national organization provided.

So in an effort to redeem them from the pitiful piece, I’m pulling a few thoughts together. Ask yourself:

Is it legitimate to be concerned about your weight? Has it changed inappropriately? Or are you focusing unnecessarily on your weight, the New Year’s phenomena, when really you are a reasonably healthy and fit person? I caught an episode of Sex and the Citytoday at the gym, and Carrie said a most fitting line: “the problem isn’t with your thighs, the problem is with your head.” (This, in response to her friend kvetching about the size of her thighs and her body image.)

If it is legitimate, explore what’s in place, and what needs to change.

Are you aware of your hunger? Do you allow yourself to respond to it, or are you living inside your head, counting calories, or points, or carbs, for instance?

Do you let yourself get to the point of famished, only to overeat, then regret it, then set more rules again, perpetuating this cycle?

Do you eat beyond a comfortable level of fullness? Do you let your black and white thinking get in the way, suggesting that you’ve already blown it, resulting in you throwing in the towel, so to speak? Some CBT (cognitive behavioral therapy) may be in order.

Yes, there are other ways to self-soothe.

Or do you eat for comfort—because you’ve had a hard day—or as punishment, because you feel you don’t deserve any better? Maybe you’ve simply given up, feeling that nothing you do can even make a difference.

Are you overeating as a rebound to years or months of restrictive, rules-driven eating? Are you overeating only on ‘forbidden foods’? Time to learn how to work those in with permission to eat all foods that you enjoy—not just those foods that fit ever-so-nicely into the food pyramid! “Eat desserts less often”, the Academy for Nutrition and Dietetics recommendation, is hardly the advice you need. Setting more rules is not the answer.

Must we view desserts as forbidden?

Is your eating chaotic? Do you have balanced meals and snacks? Perhaps some help with planning is in order.

And have I mentioned patience? You've been living with your eating behaviors for a very long time, many years, no doubt. Let's not expect that they will consistently change after just a week or two.

Do you set realistic goals? You’re not stupid—of course you know exercise might help if your activity is low (and your intake is adequate). But maybe the obstacle is your belief that if you don’t have 60 minutes to spend, or can’t sustain exercise at 85% of your target heart rate range that it’s not worth doing any activity! 

Perhaps it's time you acknowledge your frustration—with messages from the media and the medical community, with false promises of quick fixes for your weight, with conflicting messages about what’s the right way to eat, and with insulting guidance from those who should know better. Yes, there is another way, which includes self acceptance and insight about the limits of what you can change. And, a shift to understanding how your thoughts and behaviors play a critical role in your eating.

Your thoughts? Thanks for reading (and in advance for commenting and spreading this advice!)

Role modeling with the Lean Cuisine diet. Who needs the reality check?

Adorable, yet strikingly painful. 

                              (If a video doesn't appear above, click here)

Young, school age children, sharing their observations about their moms’ and their dads’ eating. These are strictly their observations, without judgement— except for the stink of some of the cleansing pepper drinks they refer to. The contrast made by Lean Cuisine is that eating their frozen dinners as a strategy for weight loss—that is normal!

Well isn't it? Not unless you are a 4'8 woman, non-competitive athlete. To have one of your main meals of the day, your lunch or dinner, coming in under 300 calories is hardly adequate for most anyone. Yes, even though it does contain some carbs. And the suggestion that it, in itself, is a meal, an adequate meal, is quite problematic. Who do you blame when you are left feeling hungry after this meager intake? No one but yourself, no doubt. Calling it an appropriate meal replacement is misleading, unless you add a glass of milk, a fruit, a salad with some oil and vinegar or nuts, for instance.

We know all the Lean Cuisine eaters in this YouTube video have families, including kids—young, impressionable, school age kids. So let's think for a moment about dinner time in these homes. "Here, sweetie, you can eat the chicken dinner I made for the family, I'll just eat my (inadequate, 300 calorie) frozen meal. You know, because I need to lose weight." Or "You deserve to eat this great tasting meal I've made, but not me—I'm too fat!" Or maybe, "Why don't we all live on Lean Cuisines, so you can have control over your portions too; because I don't really trust that I or you can manage when there is more than a limited amount of food in front of me!"

Fast-forward several years and let’s imagine these innocent kids as adolescents. Do they feel entitled to eat an adequate plate of food? Or do they, like many a patient I've heard from, feel limited by the messages they heard from their parents (yes, parents, because dads put forth much of the same diet shtick so to speak). Like Dana, she may struggle to ever eat more than half a sandwich—that's how much her mother allowed herself. And like Allie, she might be counting her calories, limiting them to the boxed frozen dinner amount that her mom thought was right.

What do these kids end up taking from this? That their frozen-diet-dinner-dependent moms are the sane ones, as the video implies? Or that their moms and dads (and maybe them, too, when they’re grown ups) dislike their bodies, and certainly can't trust themselves, their ability to eat enough, their body's signals, their ability for their body to be forgiving if they ate a bit too much one day. They learn that normal family dinners are things other people can have, but not them. This is just the price they have to pay to lose weight.

Are you stuck in this place? 

Are you the adult child of such a dieter, who never learned to trust her own eating? Or simply struggling as of late, desperately dieting, relying on prepackaged foods and calorie-restricted meals? Consider cooking--see the recommendations made by "Thursday's patient" to ease the process, or check out Food to Eat for more support, with its 25 recipes in an easy to manage format, justifying the merits of each dish and its nutrient content. Serving sizes are suggested, but are by no means restrictive. Suggestions to enhance the meals are provided, along with sections to help you get out of your own way--to change your perspective about food and respond to your needs. And check out the links below, including sample recipes.

Kudos to Lean Cuisine for pointing out how crazy our culture is, with moms and dads filled with body loathing following all sorts of nonsensical diets. If only they can see that their video stopped short of pointing out the irony of their own product.

http://dropitandeat.blogspot.com/2010/08/size-matters-but-not-how-you-think.html

http://dropitandeat.blogspot.com/2011/03/normal-eating-taken-too-far.html

http://dropitandeat.blogspot.com/2011/02/who-or-what-decides-how-much-you-eat.html

http://dropitandeat.blogspot.com/2010/11/honor-thy-hunger-and-thy-fullness.html

And from Food to Eat: 

http://dropitandeat.blogspot.com/2010/11/pecan-pumpkin-pancakes-you-can-feel.html

http://dropitandeat.blogspot.com/2010/10/how-to-cook-healthy-meal-before-eating.html

Someone You Care About has an Eating Disorder – How can you help?

There is no one better suited to write this post than the person struggling with an eating disorder. No, it's not my post; it's a heartfelt, insightful guide from someone really in the know about what those in recovery desperately need from their caring community. This post didn't come easily. It was 'Thursday's Patient's suggestion that it be written, and my invitation for her to write it. And it took guts to put it out there, to stand naked, so to speak, and shout out that help is needed.

Read it and respond--on this post and to your loved ones. Email, FB, Twitter--share it however you'd like. But do share it. Because the more you express your needs, the more you can be supported; the more you withhold, the safer your eating disorder is, maintaining the status quo. Enjoy!

It's going to take more than this to recover. But it's
certainly a start.

Someone you care about has an eating disorder, maybe she is anorexic or bulimic. Maybe she abuses or misuses laxatives, diet pills, diuretics or compulsively exercises. Maybe he eats when he is with you but you are not sure if he eats when he is left to his own devices. 

I know how difficult, painful, and maddening it can be to watch someone you love engage in such unhealthy behavior. I also know that you are aware of and afraid of the risks, both to their health and survival as well as to their emotional well-being. I know how you feel, because there are people in my life, whom I love, who suffer from bulimia, anorexia or ED-NOS (eating disorder – not otherwise specified). They exercise for hours a day, restrict their intake, and/or purge if they perceive that they have 'overeaten'. I get mad, frustrated, scared and sad. And the trickiest part is that I behave the same way - because I also have an eating disorder. And I know what it is like to desperately need support from my loved ones, the people who are mad, scared and sad because of my disease. See the conundrum? I can’t make you understand what having an eating disorder is like but as someone who has struggled with this disease for over twenty years I can tell you how difficult it can be to ask those closest to me for help when I am struggling. 

It's an Uphill Climb 

The door to change may be open, but you just might need support
breaking out.

Eating disorder recovery is a series of ups and downs. We climb the mountain, trip on a stick, land on our asses and sometimes slide all the way back to the bottom (and the slide down hurts). Sometimes we can pull ourselves up, dust ourselves off, tighten our shoelaces and gain elevation back up the mountain. We do this with the help of our providers. These are the people that really do keep us alive and accountable - and they hold the hope for us when we feel like even just standing up (never mind climbing) is impossible. We see them often; as Lori always says, “recovery is a full time job”. Weekly, I see Lori (my trusted rock-star dietician), I see my therapist, and a clinical hypnotherapist to work on issues that contribute to my eating disorder. When things are not going as well as my team would like I may also have to throw in a visit to the medical doctor and a second appointment with Lori. I spend hours and what feels like a million dollars a week. 

Sometimes, despite this high level of support, I'm still a dusty mess sitting at the bottom of the mountain. There are times when we need more. Sometimes that means a higher level of care, and other times it means a higher level of support from the people in our lives.

Needing Support – Not Wanting Support 

"I'm so ashamed asking for help! If only you could read the signs that
I'm struggling."

Have you ever had to ask someone to help you move a heavy piece of furniture? Do you remember feeling like you should be able to manage it on your own? Maybe you tried. You pushed with your entire upper body and it moved a smidgen. You decide you will make more progress if you push at an angle - you shift to the right, you shift to the left. You're sweating. You sit down, put your feet against the wood, bend your knees and push with the strength of your lower body. But all that happens is your own bottom slips out from under you. The furniture has not moved. You have two choices, leave it in the middle of the room or ask for help. 

For me, asking for help during a relapse or a major slip is painful, humiliating, and exposing. I feel like I am admitting failure and weakness (AGAIN). My pride has shriveled. I feel like a source of unending concern, burdensome and unworthy. My friends/family are supposed to love me no matter what though – and my treatment team says I have to call in the troops. So I reach out. For those of you on the receiving end of this plea for support – you might feel lost. You are afraid to say the wrong thing, you want to say the right thing, and you don’t know which is which.

Please know that the eating disorder (often referred to as 'ed') always tries to boss us around. He is an uninvited guest. We try to ignore him and tell ourselves that he lies to us and is not really on our side, but sometimes we might need you to remind us. Even as I write this I am forced to edit out my eating disorder voice. The thing is, he knows that if you follow some of these suggestions, then I won’t be so aligned with him and may not follow through with his demands. My eating disorder is threatened by your knowledge – and if recovery is my ultimate goal then this is a very good thing.

The suggestions below assume that your loved one is asking for support and is motivated to move toward recovery. If this is not the case then it may be that your only choice is to encourage your friend that more intensive treatment is warranted.

  

   1. Think with your heart. It sounds strange to think with your heart; don’t we feel with our heart and think with our brains? But your heart is where your compassion lives and the friend who sits before you, having just revealed what feels like a gaping wound, needs compassion, or she's going to bleed out.

2. Depending on what point in recovery your loved is in, the grocery store can be a major source of anxiety (think being in a room filled with your most feared animal!). In my early recovery days, having a friend with me while grocery shopping was the only way I could make it up and down every aisle and to the register. With someone there I also couldn't get caught in the trap of studying nutrition labels - which could not only take up hours but could lead to me shutting down and walking out of the store without any food.

3. Cook with your friend or prep with your friend, or even just sit nearby while s/he organizes and cooks meals for the week. Your presence is incredibly helpful. A social distraction is always a good way to help get through a stressful situation.

4. Plan for meals together and push through excuses - ed hates this. Your company and the structure you provide just by being there goes a long way. When I left residential treatment my friends and family were ready to have dinner that night and breakfast the next day. They didn't smother me and it wasn't every meal (although some do need this some of the time), but it was consistent support. I was transitioning from residential to day treatment and it was the weekend, we all knew I had to get in every meal and every snack between Friday and Monday morning when I would return to the day program. I was so grateful for their help.

We need support, but we need to move from our complacency!

   5. Do not ignore signs of slipping! I know this puts you in a precarious and uncomfortable place and I am sorry for that – but for me, the longer I feel like I am “getting away” with engaging in eating disorder behavior the worse things get and the louder my eating disorder's voice becomes (“You're fine, see, no one even noticed that you skipped lunch, lost weight, went running, threw away your snack, spilled out your juice”). So, call us out on it, gently but confidently.

6. Ask questions without assumption. I know you don't trust ed, and you shouldn't; but remember that your loved one is in there, too. So ask, instead of accusing (“Is it ok with your treatment team that you joined the gym, went to yoga, walk every morning, eat diet food, etc.”). Asking helps us to feel safe enough to tell you the truth. We don't want to lie to you, but even more we don't want to disappoint you.

7. Keep it Simple Sweetie (my therapist says it all the time) When s/he asks for support don't complicate the discussion. She says, “I'm struggling, I need your support”. You say, “thank you for telling me. Of course I am here for you”. Use the voice that says you care, not the one that says “AGAIN?!” Maybe you are feeling that, but let that be your’s, she can't hold that for you at this moment. Ask, “How can I help?”.

8. Know that your friend is not asking (at least most aren’t) for you to be her therapist, her dietician or her mom. She is asking for your love, patience and company.

9. Check in – for me this sounds like, “How is the meal plan going”, “Are you managing to resist the urge to exercise?” or “How was your appointment with Lori?” or “Does she feel like you are ­­­­headed in the right direction?” or “How is your team feeling about where you are at?”- those last two are really safe because they put the ownership on the provider's opinion rather than your friend – who, let's face it, you don’t always trust. Insert sad face here.

10. Don’t assume that this go at recovery will look the same as the last. Remember that each step toward recovery is different than the one made three years ago, a month ago, or even last week. There are times that we want it so badly but truly, despite our best efforts cannot get out of our own way. Sometimes, we just need someone to hoist us up off our butts, hand us a walking stick and hike beside us as we start back up the mountain.

It's easier to get down when you have some support
and accountability.

11. Make sure we know we are not alone. Having an eating disorder is very isolating - it’s part of the trick of the disease. Recovery can feel equally lonely without the proper support. If you notice that your friend is becoming more isolated please reach out, their eating disorder won't let them reach out to you. Say, “I miss having lunch with you,” or “I noticed I don't hear from you about having dinner together – can we make a plan?” or “Can we talk about how I can help you get back on track by us eating together?” Please don't take it personally (hard, I know) – we want to be with you and miss you, but ed doesn't like when you're around – he knows you’re stiff competition.

12. Do not criticize, blame, or yell. Don't use “you” statements: “You just have to eat,” or “You are acting so stupid”. Do use “I” statements: “I'm afraid the next time you purge you could die”. “I feel like your team should know you started running again” or “I'm worried about you, I’ve noticed you've been eating less”, “I'm worried about how much you’ve been going to the gym”.

13. When all else fails call your mother! In all seriousness, when more intensive treatment is not on the table for your loved one (no matter what the reason) suggest to him/her that they stay with you for a few days (or vice versa if logistics are not a hindrance). If that won't work suggest that s/he stay with family until they are back on their feet. My mom and ed really don't like each other; as a result when she is with me skipping a meal is never an option as I cannot bear being in conflict with her. So, if I need a 'reboot' she will come stay for a couple of days - Lori always knows that when mom's here no meals are skipped or skimped!! 

There are so many 'do's & don'ts' in supporting eating disorder recovery - and just like everything else, they vary from person to person. When in doubt why not just ask your friend how you're doing? Ask him/her if she is finding any of your conversations triggering or unsupportive. Allowing for this openness not only supports her recovery but nurtures your friendship. It's a win/win, right? Writing this forced me to remind myself how important my support people are to my recovery process. I am stubborn...and I often tell my team "I am fine" and "I can do it on my own; no need to involve anyone else". And while sometimes this might be true - everything is easier and more enjoyable with a bit of help and support. 

So, as uncomfortable as this all can be, reach out to your friend/loved one and support his or her journey to a better life.  

It is my hope that this post has given you some hints on how to do just that. Lastly, if you are suffering with an eating disorder, remember that you are not alone. Reach out to someone who cares about your well-being, show them this post, their support might be just what you need to get to the top of the mountain.

Thanks for reading,

“Thursday’s Patient”