Slip sliding away? Cutting corners and accepting sub par eating disorder recovery.

It's hard to tell that something's missing.

Kelli’s cutting corners on her meal plan. You know, measuring her cereal—but then picking off a few pieces to eat less than she measured. And Dan revealed that for months he would crumble some of his cookies, his planned dessert, and then leave it over, along with spilling—intentionally—a few ounces of his milk at meals, most every meal, at home.

In a way I was pleased.

No, I’m surely not looking to fill my schedule with long-term patients who stay stuck with their eating disorder. And I’m not giving them the half full perspective, suggesting that at least they’re eating something, that it’s only halfempty and could be worse. Meal plans are not designed with the intention of our patients eating only 50% or even 95%; I never over estimate what patients need to eat.

But for Kelli and Dan, sharing that their eating was falling short was a significant step forward. It spoke to being real and acknowledging where they were struggling in an attempt to be held more accountable. They were positioning to overturn their eating disordered thinking and actions. It was a significant move toward recovery.

For Kelli, it was the first time she cared enough about recovery to rat on her eating disorder. Once she verbalized it, there was no going back; she knew I’d be asking her the details of her intake and about her tendency to cut corners, even if she later regretted her honesty with me. Yes, I knew what her eating disorder was up to now.

For Dan, it was his inability to maintain the facade of recovery when he trulywanted to be free of the deception, and perhaps the eating disorder as well. He was challenged to reconcile the inappropriate weight loss in light of his misleading overrepresentation of his eating when he confronted me each visit. In both cases, I was truly pleased to hear them come clean.

That said it is not my role to set the bar low. And while I appreciated their honesty, the work still needs to be done. It is not enough to simply acknowledge where things fall short. Like “oh well, I skipped my snacks this week—all of them!” Honest, yes, but not good enough for recovery.

"What if I’m stepping down from a program?"

Some things are just not acceptable.

I realize that moving from a more intensive level of care to working exclusively with your outpatient team is a very difficult transition. Recovery can feel like a full-time job, between the scheduled appointments and the mental energy and planning.  Juggling eating disorder management with a less than supportive environment, together with your day to day stressors is nothing short of challenging. And slips happen.

But expected or not, it’s not okay to cut corners.

You know it, don’t you? While some health care providers may tell you it’s normal, and they’re understanding and compassionate, I feel otherwise. Why? Because these behaviors speak to how active, how loud your disorder remains. It’s not okay to accept slips even though people often do. Meaning, simply acknowledging that your eating or behaviors are not what they need to be is not enough. Yes, slips happen, but there needs to be some action steps put in place to resume recovery.

And it’s not okay to accept a subpar food intake or weight gain because of such thinking as “at least your weight is higher than before” or “at least you’re eating something”. And let’s not forget that your activity—which doesn’t seem to you like exercise—is greater than when you were in your program. Yes, even day to day movement—casual walks, cleaning, caring for young kids—counts. Really, this is no time to be cutting back on your food intake.

There really is a way out.

If recovery is the goal, cutting corners has no place. It does nothing positive for your thoughts, nor for your medical stability nor your treatment success. Any short term allure of weight loss may be met with less than pleasant consequences.

The problem is that less than full recovery will become no recovery. It’s a slippery slope. In some ways it seems even riskier being at a better place than where you started, yet not where you need to be. Because you may breathe that sigh of relief, and feel you can relax now—and stop pushing. You’re feeling much better than you had before, so you no longer worry. And so the motivation drops.

It’s so easy to be drawn into the thinking that you really haven’t changed your eating much, just a bit here and a bit there. I mean, you’re still eating, right? Do the math—three meals and 2-3 snacks a day. Believe me, even cutting back a bit each time will add up over the days and weeks.

I don’t care that your labs are fine. It doesn’t matter that you have a runners’ pulse. And I’m surely unimpressed that your weight hasn’t changed much. I will not settle for cutting corners—nor should you. That is, if you really do care to move beyond your disorder. Am I sounding like that Tiger mom? 

What an amazing sign, from the Gates Foundation building, Seattle.

It’s time to come clean—reach out to your supports. Tell them how you’ve cheated—not you, but your eating disorder—and be forthcoming with your struggle. Then put a plan in place with your team, with your family or friends, to add the support you need to turn things around.

I hope you’re inspired. You do deserve better than this disordered life.

You may also like these posts about recovery:

http://dropitandeat.blogspot.com/2011/11/quick-fix-for-your-struggle-with-eating.html

http://dropitandeat.blogspot.com/2011/04/lessons-about-eating-from-big-apple.html

http://dropitandeat.blogspot.com/2012/05/lessons-about-eating-disorders.html

http://dropitandeat.blogspot.com/2012/03/normalizing-eating-and-hiking.html

http://dropitandeat.blogspot.com/2012/05/my-mothers-day-message.html

http://dropitandeat.blogspot.com/2012/12/overeat-restrict-over-exercisejust-for.html

Lessons from the Tiger Mom

A Nutritionist's View on Achieving Success

Twice last week I was accused of acting like a Tiger Mom. Interestingly, the accusers were not my own flesh and blood. Rather, they were two patients, independently, who described my Tigress-like approach in my sessions with them.

Unaware of the Tiger Mom associations, evolved from Amy Chua’s book “Battle Hymn of the Tiger Mother”? Briefly, this Yale Law school professor recently published her memoir on parenting, Chinese parenting, focused on tough love strategies and exceptionally high standards. She writes that “an A- is a bad grade”, and has been known to reject her young daughter’s homemade birthday card, saying “I deserve better than this” throwing it back at her child. She states:

"Chinese parents can do things that would seem unimaginable — even legally actionable — to Westerners. Chinese mothers can say to their daughters, "Hey fatty — lose some weight." By contrast, Western parents have to tiptoe around the issue, talking in terms of "health" and never ever mentioning the f-word, and their kids still end up in therapy for eating disorders and negative self-image. ... "

While I admit to having not yet read the book, it certainly appears that success is measured by how things appear on the outside (such as mastering a musical instrument to perform at Carnegie Hall, as her daughter did at 14). Happiness, and psychological health, however, apparently are of no concern.

Now back to my patients. Neither Jane nor Dana was called names in our sessions. And my focus was hardly limited to external measures of progress, such as weight, for instance. Yet their descriptions of my counseling approach I could only translate as “Tiger”.  And rightfully so.

A literal “Ouch” was uttered, as I strongly linked Dana’s recent eating disordered slip with the very destructive pattern she sees in her mother. I very directly pointed out the inconsistencies between what she stated she wanted to achieve and her unhealthy behaviors. After much time working together, this grade was substandard and for eating disorder recovery, simply unacceptable. I told her I had come to expect better from her. And strict limits were set regarding behaviors that impacted her safety and the safety of those in her care. While her behavior is her choice, I could not support working together unless some clear limits were established, including accountability for medical stability.

As for Jane, who has been working with me for more than a year, she casually described (to an Intern sitting in on our session) my lack of warmth and fuzziness at our initial meeting. Perhaps she even mentioned distant? Can’t remember, or simply blocking it out. But over time, she reported, she saw another side of me. Let’s call it the Koala Mom side.

The Koala Mom, so beautifully and lovingly described by Dr. Amy (http://skepticalob.blogspot.com/2011/01/battle-hymn-of-koala-mother.html) is warm, fuzzy and supportive. She trusts her offspring have the competence and wisdom to do the right thing, to have good judgment, and to be true to them selves. Koala Mom offers a “safe place to escape from the pressures of the world”. And KM wants to build their inner strength so they can cope with disappointments and difficulties when they arise.

Perhaps it’s a bit of a leap, but the parenting role we play as counselors and nutrition therapists cannot be ignored. On the Tiger side, denying you privileges, including engaging in physical activity, traveling, even driving a car, is often essential—for your own safety. And often, few others will step in to set these very necessary limits. And if they did, if might be difficult to hear from those that are closer to you. These limits are set out of care and concern. They are not punishments, merely safety measures, road-blocks to prevent you from detouring into an abyss. I may present what appears rigid, (as described in a phone conversation with one parent today). Yet this very parent, in the same call described how safe and trusting her daughter had become of my guidance.

Yet if I fail to be appropriately nurturing, to be part Koala Mom, to support you in making your own decisions, I am truly sorry. It’s not that I don’t trust you. It’s not that I don’t believe your stated intentions. It’s just that eating disorders are fickle. They don’t always behave rationally and sensibly. Motivated to recover, you’ll come to appreciate this. Like Dana who admits that my direct and seemingly harsh stand, while troubling to hear, was just what she needed. Yes, it shook her up, and got her back on her feet. At least for now.

And so at times, my Tiger Mom side may emerge—seemingly strict, tough, heartless. Tough love, maybe, but with only the best intentions for recovery. But I hope you’ll have absorbed my encouragement and belief in your ability to get through. Perhaps, as patients have reported, believing in you even when you have stopped believing in yourself.

And hopefully you’ll know that you have a voice that I am always willing to hear—even if I don’t always agree what you might be saying.

You won’t always like what I have to say. (Or, the recommendations of your own nutritionist, or therapist, or doctor, if it goes against your unhealthy intentions.) But please consider that this seemingly callous approach is anything but. It comes from truly caring about your success and recovery. And the need to balance the Koala with the Tiger.

I'd love to hear what you're thinking, so please comment!