This post may be triggering. Iām about to talk about being fat, and my eating disorder, and an exchange I had with a new therapist at my treatment center. Itās an assumption that has become so common place it hardly phases me anymore. But it should. It needs to. Because itās an example that even within a treatment facility with a weight set point mind set and a health at every size governing philosophy, when the staff see me, and see my body, and my size, thereās an assumption that I either have binge eating disorder or compulsive eating disorder.
Iāll share the interaction, and then why itās so important. I sat down to an orientation for a new group Iām joining. The therapist and I have met in passing, but have had no direct interaction before this. She asked how my recovery was going. I told her Iāve had a lot of set backs over the last six months, but Iām four weeks in to eating AND sleeping, which is a huge accomplishment. Iām really starting to feel true hunger and my dietitian is thrilled that Iām actually eating. And the therapist said, āOh, so, you mean feeling hunger and eating in a good way?ā
And I just stared at her for a moment. Iāve gone for so long not knowing what actual hunger felt like, doing anything and everything to busy myself the moment my body twinged in that direction, suddenly becoming desperately busy and oh look, itās too late now, Iāll just eat at the next meal, or perhaps the nextā¦
When I first entered treatment, I was nauseated all the time. The amount of food on my meal plan felt impossible. Every meal was a nearly unbearable experience. My meal planās been raised multiple times since then. Now, I wake up hungry and cranky until I feed my body. Itās still hard to eat. But Iām doing it. Every day. Ā So many things have changed.Ā
But not that Iām fat.
Every now and then, I get to forgot that Iām fat for a little while. Itās usually not long before Iām reminded, before an assumption, or a seemingly innocuous question brings it back to the forefront. Right. I exist in a large body. There are a lot of assumptions that go along with that.Ā
Ā And my answer was a laugh, and a clear explanation, because Iāve had to do it so many times before, ticking off each thing on my fingers. āOh! I have a restrictive eating disorder. My behaviors are restricting, purging, starvation, diet cycling, and using exercise as a way to punish my body. My meal plan is a minimum I have to eat each day, going over that is great but I canāt go below. And I have restrictions on water, because I have a history of water loading.āĀ
Ā "Oh!ā was her reply.Ā
I followed immediately with the example I always use, preempting the inevitable bingeing question. āWhen I started here, I thought I binged. I was like, āI totally binge. Iāll eat an ENTIRE cheeseburger!ā And the staff was like āā¦Thatās not a binge.āā
And she stepped in and finished the sentence with, āā¦right, thatās a portion.ā
And suddenly we were back on the same page. She had adjusted her internal diagnostic criteria of me, and what I struggle with, and the rest of the orientation went great. Iām excited about the group, and I think sheāll be a great facilitator. I do feel a bit heartsick though that she didnāt take a moment to look at my file, or speak to my current treatment team before our orientation. It would have saved me from that moment, where I have to explain, again, that while yes, Iām fat, the disorder that Iāve been struggling with for over 30 years is restrictive, based in control, anxiety, and trauma, as well as genetics and a solid dose of disordered modeling. The reactive eating Iāve done, what feels like bingeing to me, falls squarely in the realm of a portion, or at its most extreme, a large meal.Ā
Now thereās some great stuff over at www.youreatopia.com and @bigfatscience & @everythingeatingdisordered if youād like to understand how you can not lose weight, and even gain weight, while being in a restrictive state. This is especially true while diet cycling, which has been my path in between ED behaviors for the past 15-ish years. To quote @heavyweightheartĀ āIt turns out human bodies are a little more complicated than lawn mowers.ā Weāre not just fuel-in, energy-out robots. There are all kinds of processes that occur making us very different than, say, a carās engine. And each of us has unique needs.Ā
Ā And hereās where we veer into the why: Why these underlying assumptions matter so very much, why they must be examined and challenged, and why there needs to be more open and honest dialogue around the reality of eating disorders occurring in individuals of all body sizes.Ā
I went to my neurologist recently to discuss the increase in my migraines in both frequency and severity. I told him in clear and blunt language that Iām in the early stages of eating disorder treatment for a restrictive eating disorder and on exercise restriction. He asked why. Not kindly, or with compassion. But very bluntly. āWhy?ā And I explained.Ā
He then went on to bring up weight loss three times and walking an hour a day four times in the remaining time of the appointment. Did he say these things over and over because he thought this was what was best for my overall health, taking into consideration the serious damage Iāve done to multiple organ systems with my decades of starvation and purging? No. He said these things because of the theoretical damage that could occur based on correlation between these issues and obesity. My blood pressure, pulse, blood sugar, and other metabolic measures of health look pretty damn good for someone with as many health issues as I have, none of which are weight related, but many of which are ED related.Ā
Itās so ingrained.
Youāre fat. Get healthy. Lose weight. Exercise. My psychiatrist put it really well. She said,Ā āIf you had gone in for a well check, checking in and making sure youāre eating a variety of food and getting some exercise makes sense when discussing migraines. But itās like you went in and said,Ā āIāve been through hell. And Iām still there.ā And his response was,Ā āLetās get some walks in!ā He didnāt actually listen to you, or hear you.ā
I was asked recently whether I thought there was any point when inpatient treatment would have been appropriate. And I said yes. When I was 19, and passing out daily in class, and my movement teacher told me I couldnāt return until Iād seen the doctor. They diagnosed me as hypoglycemic. I was at a ānormalā BMI, the smallest Iād ever been, but still not underweight. I had never missed a period, and the fact that I worked out 2-8 hours a day showed how really dedicated I was to my health. I used the diagnosis as an excuse to become a vegetarian and cut even more food out of my diet, and learned how to eat just enough to not pass out in class. 19 years after that, I finally sought treatment.Ā
We say it over and over and over. Eating disorders impact all manner of people. Eating disorders are mental health disorders first, and cause a myriad of health issues, further psychological issues, and relationship and social issues. And not everyone who has them is underweight. Yes, the pictures of skeletal women are the most shocking, attention grabbing, and likely to get people to raise both money and awareness, which ED treatment desperately needs. But the cost is that the rest of us, those in average size bodies, and yes, those of us in fat bodies, are receiving extremely dangerous messages, repeatedly, about our bodies, and our health.Ā
Iām not referring to our theoretical some day health, that health that my neurologist is so focused on. Iām talking about our health right now.
My biggest wake up call in treatment was when my dietitian sat me down, looked at me seriously, and said, āWe need to talk about your weight.ā I flinched, sure that she was going to say that Iād gained a huge amount of weight adding in more food, that I was messing up my meal plan, that I was failing at recovery.Ā
Instead, she said, āYouāre losing weight alarmingly fast. You have to start eating again. Everyday. Your full meal plan. All that long term damage you thought you wouldnāt have to worry about?ā She pulled out some charts and showed me some very scary things. āYouāve been doing this for 30 years. Itās now. The long term damage is happening now.ā I was shocked. Wasnāt I supposed to lose weight? Wasnāt I supposed to shrink away into nothingness? Or at the very least, into aĀ ānormalā BMI?
My restriction, dieting, and exercise addiction were supported and even recommended to me by my doctors. And whatās so scary is that when I tell doctors outside my treatment team Iām in recovery, and on exercise restriction, itās still being recommended. My dietitian was horrified. My therapist was furious. My psychiatrist gently but firmly suggested I find a different neurologist.Ā
Itās hard enough to confront that what youāre doing is hurting yourself. Itās excruciating to confront that your eating disorder also hurts the people you love, and who love you. Thereās no break from recovery. Thereās no day off. And when youāre fat, you also deal with a daily onslaught from every direction suggesting, prodding, lecturing, even screaming at you that you are invalid in your body. That you are not worthy as a human being until you reach a certain weight. And that your well being is dependent on you losing weight. Ā
We live in a culture where being thin is so closely aligned with being healthy, that that goal is worth anything. Itās worth a doctor telling me to actively do things that will harm me. Heās not the first. Heās just the most recent this month. Not this year. Not this season. This month. It causes assumptions so deeply ingrained that even amazing, supportive therapists at the front line of this work still catch themselves making a judgment based on the size of the body of the person sitting in front of them. Ā
Iām having to unlearn a lifetime of information while itās still being forcefully given to me by doctors, friends, biological family, the media, random strangers on social media, random strangers on the street, and every single packaged food loudly proclaiming it has less fat, less calories, and more all natural ingredients!!! I have had to narrow my focus. I listen to my treatment team. I do my own research. I trust the chosen few who are supporting me with everything they have.Ā
Iām fat, and I have a restrictive eating disorder. These things can, and do, exist in the same body, at the same time. If you take anything away from reading this, know that I am not the only person who exists in a large body who has a serious eating disorder. And it may not be the kind you think.
This is so important
Thank you for sharing your experience, it will help so many people, including me.