Making Enemies 101: Tips From the Blogosphere

Anger. All I could feel was their anger. Their perhaps valuable messages got muffled, but I was left with my tail between my legs. That was my experience of reading a couple of blogs I respect and frequent often, one with a focus on eating disorder recovery, one on size acceptance of the obese. No doubt this post of mine may provoke more anger—that is not my intent. And while these two topics may seem vastly different, I hope to show that they have many commonalities.

Laura's Soap Box

I have learned a lot from Laura’s Soap Box: http://www.laurassoapbox.net

It has, more than anything, strengthened my stance that we have no time to waste, when it comes to recovery; that the ever-hopeful practitioners that patiently wait while engaging in therapy often do so for way too long. And especially for the young anorexics and those new to their eating disorder behaviors and thoughts, those with a narrow window of time for weight restoration for growth and development, for preventing hard-wiring of their approach to eating. The parenting style, more loving tiger mom than most of us like to approach, has its merits. Yes, for survival and health, it takes a tough parental stand.

Yet when I read the post http://www.laurassoapbox.net/2011/10/why-words-matter-and-whose-job-it-is-to.html I was struck not by this very appropriate message, but by the anger and frustration at parents and practitioners who haven’t mastered the art of (eek) Maudsley? Family-Based Therapy? Modified? I’ll refer to it as Maudsley-style from this point forward, so as not to incite more anger.

I’m guilty. 

It's a long way to travel to get to where we need to be.

I admit it. In my 25 years practicing as a dietitian, I have never formally been taught this approach. (Nor, for that matter, was I formally trained in an academic setting on eating disorders; they were only minimally covered in my graduate studies). I have learned what I know by educating myself through eating disorder conferences, literature, as well as more recently through blogs like hers. And, through seeing vast numbers of eating disordered individuals over my career. From my understanding, in this approach, nutritionists/RD have no place. But that’s another story. In my version, RDs play a very valuable role.

Anorexia recovery is not one-size-fits all.     


Many families I see are not candidates for this approach. Some are quite dysfunctional, frequently making supervision at mealtimes disastrous; it would take years to educate them about their inappropriate messages, to correct their nutrition misinformation—I could go on. And we just don’t have that kind of time. Caution: I am in no way suggesting that these dysfunctional families caused their child’s eating disorder, merely that they are in no position to take charge of the recovery.


Some families aren’t candidates, as I see it, as they have too many other demands, such as caring for another family member—a parent, a child with special needs, a newborn, working multiple jobs, etc.

Some families certainly could learn to use a Maudsley-style approach—if they were prepared to take the time. Yet I find many parents want their kids fixed—they bring them for care with an unrealistic perspective on what recovery entails, how it is measured and how long it might take. And most importantly, they have no idea how important a role they play as parents, Maudsley-style or non-Maudsley-style.

I say some intentionally. Many parents couldn’t be further from this description. They are present, physically, and emotionally for their kids; they are anxious to know just what they could do to help their child, and how best to do it, and they adjust their schedules to make treatment appointments a priority. They are scared, but they work on accepting that treatment is a process and takes time. 


In such families, some of the kids with anorexia may be supported by their parents, without the parents having the level of supervision and involvement I understand a Maudsley-type approach to have. They set appropriate safety limits, from a health standpoint (ie—they respect and enforce the outpatient team’s recommendation that there is to be no physical activity, for now). But their children are able to make progress, measurable progress with weight restoration and vital sign changes, that enable them to continue in this setting, without their parents taking charge of their food plating or supervising their snacks. And they are able to engage in therapy, both mental health counseling as well as nutritional counseling in the process.

But then there are those for whom the Maudsley-style approach is perfect. A willing family, with the time it takes to be an active player, to be intimately involved in refeeding. Parents willing to shift the relationship to that of supportive team members, fighting the anorexia along side their child, taking charge the way their unhealthy child can’t, at this time. And I have seen recovery with both these approaches.

Treatment for eating disorders needs to be as varied as the individuals with the eating disorders. As health care providers, we too are not a homogeneous group, not by specialty, not by style and approach. We also get frustrated and angry, when we encounter patients and families, as well as other medical providers who fail to support our stand, to set appropriate limits to ensure recovery. We too recognize that it takes a nourished mind to engage in the process of recovery and decision-making, a role many starving anorexics simply cannot do.

I believe we all share the very same goal—to foster recovery and normalize life for the individual as well as the family dealing with anorexia. And we need to stand united in this goal. There is no single best treatment for all individuals. But educating with a consistent message about the seriousness of eating disorders of all types and the need for treatment and support is essential.

We put our heart and soul into doing the work we do.  But few will respond well when faced with angry rants—by me, by parents, or by Maudsely-style bloggers. We, too, are works in progress.  

And yes, I will soon address the other angry blog in an upcoming post.

This Time It’s Simply About The Calories

Piedmont: Great Wine, Great Challenges

I’m a snob. I admit it. When it comes to food, it’s got to taste good. Because I intend to really taste it. To enjoy it. To savor it. Every bite of it.

But Thursday, after many long, hot hours biking the grueling hills of the Piedmont region of Italy, we were hungry. Really hungry. The hills took us much longer than expected; we had no idea what it really means to be in shape for riding hills!  And the snacks we carried? We downed those within the first couple of hours.

So we rolled into a tiny town, known for its hazelnut production. Now give me a dessert with hazelnuts and chocolate and I would’ve been just fine. But that didn’t happen—no bakeries in sight. But it didn’t take us long to identify the only eating establishment around. Think retro, stale, cigarette-smoke-filled air luncheonette before it turned quaint and chic.

In our broken Italian we ordered the only Panini that sounded acceptable. Oh, and a salad.  What comes to your mind when you think salad? Fresh, crisp vegetables? A brilliant assortment of colors, flavors, and shapes? Think again. They offered what is known as Russian salad—a heaping mass of mayonnaise, containing diced potatoes, peas and a speck of carrot.  We had it along with the white bread sandwich packed generously with cheese. And I neglected to mention (how could I forget?)—that there were two rolled up sardines with olives. At least they added some color.

Well, I ate at least 90% of this lovely meal. And I hated every bite. (Although given my sweating from the unseasonable heat, the sodium rich sardines and olives were much appreciated.) This was so far from the fabulous cuisine I had heard so much about and had begun to enjoy my first day in the Piedmont (more posts about those meals to follow). The Piedmont, after all, is know for the Slow Food movement http://www.slowfood.com/international/6/faqs, amazing wines (Barolo, Barbaresco and Barbera) and white truffles (these are intense mushroom like fungus, not chocolates, my friends), with their distinctive flavor which embellishes foods with a mere drop of a truffle infused oil.

At this point, exhausted and overheated, depleted of energy, it was strictly about the calories, the fuel. I wasn’t going anywhere without eating this awful meal. I had no other options. I couldn’t find my voice in this language I barely spoke, and I suspect there were no other options, given the appearance of this place. Yes, mayonnaise-laden salad with a bland cheese sandwich was the only answer. Simply non-negotiable. There was nothing else to do but eat it.

Provence, not Piedmont!

What’s the meaning of this post? It’s not about my disappointment, of things not going as planned—that could be a whole other post. It’s not about adjusting expectations, because who could have expected this? Never mind that the biking was a total drag, nothing like our fantasy rides through Provence with climbs we could manage and stunning varied vistas to distract along the way.

No, the meaning is much more literal. Sometimes it comes down to Nike’s message—Just Do It.

For those of you who undereat—I know there are times when you are not hungry, and eating seems totally unnecessary. And when a fat-containing food may overwhelm. Or you question why you have to eat more than everyone else around you. Or the uncertainty of a meal’s content leads you to want to choose the safest route—food aversion. Or the allure of not eating, or restricting, promises a pleasant disconnect which might be so welcomed at this moment.

As for the overeaters and binge eaters (and anorexics, too)—skipping meals or snacks certainly sounds promising. Why take in those extra calories when a coffee will suffice? Because sometimes, you need to just do it. And when you’re feeling hungry even if no one else is, you need to just eat—because you need to begin to listen, to trust your body and its signals. Because you so deserve to be well nourished. Because your size has nothing to do with your need for nourishment in the moment. Yes, you too, need to trust it’s okay, it’s necessary to eat. And that you deserve to eat, regardless of what others’ glances may suggest, in spite of the messages from family members you hear or replay in your head, regarding your need to lose weight. Be in the moment, and trust that you should eat.

A cool drink after a long day of unmanageable hills and bad food!

I won’t be heading back for another Russian salad-filled lunch in the Piedmont. But I’m pleased I was able to fuel up for the challenging ride back. In the end, we enjoyed a lovely meal at dinner, and a refreshing drink just after unclipping from our pedals.

Hannah’s Story. The Tale of the First Reported Anorexic

Blogging should have been far from my thoughts, as I sat in Temple yesterday, the first day of our High Holidays. But food and eating and Judaism seem inseparable, and so my thoughts turned to Drop It and Eat. At this time of introspection, at the start of the Jewish New Year, a time of re-creating, what’s the chosen text we read each and every year? A tale of a woman named Hannah, who by my interpretation is clearly struggling with anorexia. Is it me and the lens I view life through?  Perhaps. But I don’t think so. 

Read the full, (translated) passage from 1 Samuel 1, dated from before 600 BCE. online if you‘d like. http://www.mechon-mamre.org/e/et/et08a01.htm

Here’s the synopsis, relevant to this blog topic, as I see it.

There was a man, who had two wives, one named Hannah, one named Peninah. Peninah had children, Hannah was childless. Hannah was his favorite, although God had closed her womb. Her rival, Peninah, to make her miserable, would taunt her that God had closed her womb. Year after year this happened. Every time she’d go up to the House of God, Peninah would taunt her, so that she wept and would not eat. Her husband would say “Hannah, why are you crying and why aren’t you eating? Why are you so sad? Am I not more devoted to you than ten sons?”

After they had eaten and drunk, Hannah rose. In her wretchedness, she prayed to God, weeping all the while. And she made this vow. (To paraphrase—look upon my suffering and remember me and if you give me what I want (a male child) I will dedicate him to your service.)

To make a long story short, she began praying silently,  “in her heart; only her lips moved, but her voice could not be heard”.  And the priest took her for a drunk, and told her to “sober up”. And what does she do? Does she shut her mouth in shame? And close her heart as well? No! She finds her voice in a big way. She replies, “I am a very unhappy woman. I have drunk no wine or other strong drink, but I have been pouring out my heart out to God. Do not take your maidservant for a worthless woman; I have only been speaking all this time out of my great anguish and distress.”

In response, she was apologized to, told to “go in peace” and “may God grant you what you have asked for”. Yes, an apology and a blessing. Pretty impressive, for a woman of those times. So she left, and she ate, and was no longer downcast.

After relations with her husband, Hannah conceived, and had a son and the story goes on. And for the record, Hannah became a model of prayer, with her silent but heart felt communication.

So I’ll reiterate the obvious. Here’s a woman, seemingly depressed, taunted, yearning year after year for a child. Her husband doesn’t seem to get it, or likely to understand her or her sorrow, as he naively asks her “isn’t my devotion as good as ten sons?” She manages to eat and drink something, then finds her voice. She takes control of the situation, by bargaining with God to get what she wants—take note and give me a son, and I’ll dedicate him to your service. She expresses her pain to the priest and makes herself understood after being accused of drunkenness. She leaves, eats, and is no longer downcast. And then she is able to conceive.

The text doesn’t tell us if she had amenorrhea. We don’t know if there is a genetic component to her fertility problems, or to her eating disorder. We know nothing of her thoughts about food and eating, about her preoccupation with anything other than conceiving. And I doubt she calorie counted. We certainly don’t know her weight, BMI or how medically stable she was. But we see a link made over and over in this text—She ate, she found her voice. She didn’t eat, she was infertile. And I have learned that when things are repeated in these texts, it is never accidental, but for emphasis. After expressing herself, pouring her heart out, she was able to eat and drink, resulting in her ability to conceive; a connection, causation even, suggested between not eating and infertility, between eating and conceiving.

Hmm. Seems like perhaps the earliest reported case of anorexia to me.

What’s the significance for you?

From my read, I see hope. You can be stuck year after year in the same bad place, but then something can change—YOU can make something change, and get to a better place. It takes nourishment to find your voice, to petition to get your needs met. But isn’t it worth it if you can finally be heard? And even if you don’t get blessed for your outspokenness, I suspect you’ll feel much better. Getting things off your chest—whether through personal expression (writing, journaling, silent prayer, meditation) or speaking up to your significant other or those who really don’t get it—is crucial. Yes, eating helps you find your voice, and expressing yourself helps you eat—but pregnancy will not necessarily result.