Category Archives: eating disorder recovery

Calories: Why You Need More Than They Tell You

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I’ve written about this before, but it’s so important that I decided that it is time for a refresher. It’s important because if you are following the recommended daily allowance of calories, or advice you’ve read on the internet, or used a calorie calculator to try and work out how much your body needs, then you are almost certainly not getting enough energy for your body.

So we all know that currently the RDA is 2000 calories for women, and 2500 for men, but what most people don’t know is that number is too low. Especially if you are under 25. For people in recovery from restrictive eating disorders, it’s wayyyyyy too low. Under-eating is damaging to our bodies and to our minds. People who do not diet and eat by listening to their hunger and fullness cues do not eat the RDA when it comes to calorie intake.

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So let me tell you a story.

In 2009 the calorie guidelines were reconsidered when a study found that energy requirements had been underestimated by 16% (around 400cals). What is telling is how the guidelines weren’t changed to accommodate these new findings. On the NHS website is written

“This news does not mean that everyone can, or should, now eat an extra cheeseburger or its equivalent in calories a day. The advisory committee makes it clear that the revised energy intake recommendations do not mean that people should increase the amount they eat and that, if people do eat more, they will need to do more exercise to avoid being overweight or obese.”

What we have here is science telling us that the current calorie guidelines underestimate the energy REQUIREMENTS, yet we are being told by our medical community and our government to not eat the amount that our bodies need. Regardless of the fact that studies found that we need more energy, the government put this on its website in 2017:

“The new campaign, due to launch in the spring of 2018, aims to help people be more aware of and reduce how many calories they consume from the 3 main meals of the day, in particular when eating on the go. There will be a simple rule of thumb to help them do this: 400:600:600 – people should aim for 400 calories from breakfast and 600 each from lunch and dinner.”

There the government are advising 1600 calories as a rule of thumb, and cited obesity as the reason for this. “As we are the sixth most overweight nation on the planet, we believe it is a sensible thing to do.” A sensible thing to do? To deny scientific findings, which have, by the way, repeatedly shown that the calorie guidelines are inadequate? To me that sounds like irrational fatphobia, and a complete misunderstanding about health, which is a pretty scary thought since this information comes from the government itself, not to mention our health physicians. It shows very clearly how our entire society including the medical community and our government is indoctrinated in diet culture and fatphobia, so much so that they will dismiss actual science in favour of advising that people restrict to stay thin. Even when this is unhealthy. Even when it harms us. How can we accept this?

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So what do we do about providing our bodies with enough energy? As stated above, evidence shows that adult women need around 2400 calories and adult men 2900 calories. This is extremely similar to the calorie guidelines shown on The ED Institute website run by Gwyneth Olwyn, who developed the Homeodynamic Recovery Method (formerly known as the MinneMaud Guidelines). Olwyn has always promoted 3000 calories for men over 25 and 2500 calories for women over 25. Under 25 the recommendations are 3500 and 3000 calories respectively, due to the fact that our bodies continue to grow and develop until around that age. Those who exercise or have children need more energy to cover this. On her website you can read an extremely detailed blog post on why the government approved calories guidelines are entirely inadequate, with far more scientific evidence than this simple refresher.

In remission you will have learnt how to listen and respond to hunger and fullness cues and your body will give you signals in order for you to provide it with the right amount of energy, without counting calories. Until then, it is advised that you keep track of calories in order to ensure that you are getting enough energy for your body (I wrote an entire post on this here). I urge you with all my heart to take note of the science, and take care of your body accordingly. Nourish your body. Respect it. Listen to it. Provide it with what it needs.

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On that note, it is also totally normal for someone in recovery from a restrictive eating disorder to eat far more than the calorie guidelines. This has been coined “extreme hunger” in restrictive eating disorder recovery. Extreme hunger is where you are eating above and beyond the calorie guidelines by quite a bit (e.g. over 4,000 calories). Eating between your guidelines and 4,000 calories is additional hunger but not classed as “extreme”, however the following explanation also applies. The reason you might find yourself eating an extreme amount of calories is because your body has acquired significant damages during your restriction and engagement with disordered and harmful behaviours. Your body needs energy for the day (actual daily guideline amounts – NOT the inaccurate government approved guidelines) but it also needs energy on top of that in order to heal the internal damage done to your body. Some people need more, and some people need less. Some people will find their bodies are calling for a more extreme amount for a shorter period, and some people may find that their bodies are calling for a less extreme amount but over a shorter period. This is something that will taper down in time to settle more around the guidelines, but whilst your body is damaged, it often will need more, and whilst it can be terrifying, it is normal. I always compare it to when burns victims are in hospital and put on a high-calorie diet in order to give the body enough energy to heal the damaged skin and flesh. It is a similar concept in that your body will need more energy on top of daily energy expenditure to restore itself to good health internally. You can read several of my blog posts about extreme hunger that include much more detail here and here. also I have my very own YouTube video on the subject, which you can watch here.

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It is a sad, and frankly terrifying fact that we can not always trust our own government or medical communities to ensure our good health. It is frightening how diet culture and fatphobia are so prevalent in every single area of our society, so much so that we can’t even escape it even when we turn to those whose responsibility is to provide us with accurate information in order for us to be as healthy as possible. What we must do is look for ourselves. Research for ourselves. Critical review the information that is given to us, and then take care of ourselves, and if we can, take care of others by enabling the science to be available to others. And most of all, heal the relationship between ourselves and our bodies, and then listen to them – our bodies have the most reliable information on how much we need to eat, and they share that information with us via hunger and fullness cues. Listen.

You can read my original and more detailed blog post on why we need more calories here.

5 Tips For Coping With January’s Diet and Weight Loss Talk

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It’s January, and we all know what that means: a total inundation of diet talk. It’s EVERYWHERE. TV advertising is filled with diet promotions, “healthy” eating, exercise equipment, gym memberships, and low fat yogurts (although hell, when do those NOT appear in the ad breaks?!). Friends, family, and colleagues are on a mission to lose weight, tone up, or get super heallllltthhyyyyyyy (god, pleeeeeease make it stop). “Lifestyle changes” are being broadcast from the rooftops (it’s still a diet, Susan, don’t kid yourself). It’s really difficult trying to deal with all this talk when you are trying to recover from an eating disorder or dieting, and/or are on a journey towards body acceptance. It can be downright triggering. So here are some tips on how to deal with the diet culture disaster that is January:

1. Set boundaries

I know that this can be really tough for a lot of people, but it is so important. If someone is talking to you about their diet/lifestyle change/new workout routine/how many pounds they’ve lost since only eating lettuce for the past two weeks, or god forbid are trying to offer you “advice”, tell them that it is making you uncomfortable. Hell, tell them that it downright harms you when you are trying so hard to explore a different path. Let them know that diet and exercise talk is not appropriate or helpful for you and that you would appreciate if you engaged in conversation about other topics instead. If they are commenting on your own body or eating habits, let them know it’s entirely not their business.

2. Use facts as a weapon against disordered thoughts

When you are feeling the insidious pull of temptation leading you towards to some sort of restriction, consider the facts:
* Diets don’t work. 95-97% of people who lose weight on diets regain the weight within 2-5 years (if not sooner). They also often end up gaining more weight due to the body trying to protect itself against “famine”.
* Chronic restriction can push people’s set points (their natural, healthy weight that is individual to each person) higher, because the body becomes damaged by getting less energy that it need, and can alter its set point in order to protect itself from harm.
* The metabolism slows as a response to not getting enough energy, and this makes it harder and harder to lose weight – which if you have an eating disorder or have ever been on a diet, you know already. Leptin levels also drop when our fat levels decrease. Leptin is a hormone produced by the fat cells in our bodies. It exists in the body in proportionate amounts to our weight. Our bodies want to compensate for this loss in leptin and respond by increasing hunger urges, which makes not eating enough super unpleasant – as you know already. Your body does not want to lose weight, and it is going to fight to keep it at its set point.
* Studies show that weight cycling (losing/gaining/losing/gaining) is much more unhealthy than just staying at a higher weight. It increases the risk of developing major illnesses such as cardiovascular disease.
* Restricting often leads to binging, and that’s a signal from your body that you are not getting enough energy on a regular basis. Binging also leads to emotions that are really not fun to experience, and can lead to even more unhealthy behaviours as compensation. Restriction also leads to obsessing over food, and that means less time for doing things that are important, productive, and enjoyable. In addition, restriction leads to increased cravings – again, not fun to feel, and again, often leads to binging.
* Any type of restriction is a slippery slope. It could easily turn into a full-blown relapse. Don’t risk it.
* Losing weight won’t make you happier. It won’t. We’ve all been there before, ladies and gentlemen. Who’s life was super awesome with an eating disorder/chronic dieting? I’m betting no one at all.
* Did I mention diets don’t work?

3. Unfollow or mute people on social media who are triggering you

This is advice for anytime of the year, but if people are going on about losing weight, cutting out certain foods, restricting their intake, or exercising then unfollow them. If anyone is making you feel bad about yourself, triggered, or is causing you to compare yourself to them, then unfollow them. If they are a friend or family member that you want to keep on your social media, you can mute their posts, or you can let the know that their posts are negatively impacting on your wellbeing (see tip number 1).

4. Fill your social media feeds with body positive and food positive people

This has helped me so much in the past few years, and is definitely one of the things that gives me ongoing support and a sense of community, hope, and positivity. Start following people who are body positive. Start following people who love food and have a healthy relationship with it. Start following people who are fat, trans, disabled, of other races than your own, etc. Fill your feed with people who are diverse. Fill your feed with people who look like YOU, and people who don’t. Just stop filling it with thin white women (or if you are a guy, muscly white men). Stop looking at people who you want to look like or be like, just because our diet culture told you that’s who you should look like or be like, and start looking at people who celebrate who they are. Start celebrating who you are.

5. Write down reminders of why you made the choice to try something other than dieting/restricting

There’s a reason that you are in recovery for an eating disorder or chronic dieting. There’s a reason you chose to try going down a new pathway; why you decided to give another option a try. I bet there are quite a few reasons. Write them down somewhere where you can always see them if you need to. If you need any help with thinking of reasons not to relapse, you can check out my blog post ‘Repel the Relapse: 8 Tips for Staying on Track in Recovery from an Eating Disorder‘ or watch my video ‘Reasons to Recover and Reasons Not To Relapse‘ on YouTube.

I know that it sucks to hear the constant chatter about diets, weightloss, exercise, and the body-shaming that comes with it, but you know it’s all for nothing. You know that diets don’t work. You know that it is extremely bad for your physical and mental health. You know it won’t improve your life, or make you happier. Remember remember remember. Grit your teeth, and do your best. You can do this.

Repel the Relapse: 8 Tips for Staying on Track in Recovery from an Eating Disorder

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It happens to us all at some point in our journey from sickness to health: we hear a comment, see a magazine article, or wake up with rose-tinted glasses that throw us back into a tirade of insidious thoughts, ideas, and what if I just‘s.
What if I just exercise more?
What if I just restrict a little bit?
What if I lose just ten pounds?
What if I just cut out xyz?
What if I just…?
And of course: I’d feel so much better if I was thinner.

STOP.
The answer is you won’t. You’ll feel worse. You will always feel worse.

Engaging in eating disordered habits will mean spiralling down right back into the hellish Pit of Misery. You can convince yourself that you won’t end up there, but you will. And even if you don’t, engaging in any kind of eating disordered habits isn’t exactly taking a vacation to Disney World. It’s dark and dangerous, and it is joyless.

Here are some things to think about when you can feel the pull of a relapse:

Ask yourself this: what did your eating disorder give you? How did you benefit from it? Okay, I know it made you thin, but what did you actually gain from being thin? Did it give you stable, healthy relationships with friends, family, and romantic partners? Did it find you a fulfilling job? Did it buy you a nice home? Did it contribute towards your education? Did it make you feel better about yourself? Did it bring you happiness? I imagine the answer is no. Eating disorders help us feel in control (which is only an illusion), but beyond that, they don’t give us anything real.
Think about your own personal reasons for recovery. Write them down and think about them. Is it worth abandoning those goals for the sake of losing weight? Your reasons might include the things mentioned in number 1. They might also include decreased anxiety, trips out with friends, being present in your day to day experiences, keeping your body healthy in order to have children, being involved in your hobbies and passions, being able to enjoy social events, being able to enjoy food, improved sleep, having time to do the things you want to do, dedicating your energy towards enjoying life, being productive and fulfilled by doing things that matter to you and are important, physically feeling a million times better, and regaining your identity.
Use your support network. Friends, family, partners, doctors, therapists, helplines, online support forums – USE THEM! They are there to help you and are often crucial in remaining strong and continuing on in your journey. You may feel ashamed or like you have failed, but that isn’t the case – we all slip backwards at one point or another. It’s all part of the journey. Don’t suffer in silence: seek support.
Eliminate negative influences. Get rid of those triggering gossip/women’s magazines that spout diet culture bullshit. Unfollow those accounts on social media that make you feel like you are doing recovery wrong. Stop looking at that vegan paleo raw blogger who survives off smashed avocado and vegetable juice and works out 7 days a week because it makes her SO HAPPPPPPY (it doesn’t). Follow people who are crushing their eating disorder, eating fear foods, and resting. Follow people who are body positive and food positive. Follow people don’t set rules for what health looks like – because it is different for everyone. Cut toxic people out of your life. Assert your boundaries with your loved ones who comment on your body/food choices/lifestyle/exercise habits or who won’t stop talking about the diet that they are on. Motivate yourself to move forwards by using the positive influence of those who truly push you onward.
If you find yourself missing food here and there, make yourself a schedule. Ensure you eat regularly and consistently. If you find yourself making excuses not to eat, then you may just have to put yourself on a more rigid plan until you are able to go back to eating intuitively. Three meals, three snacks. Adequate amounts, and no excuses not to eat them.
Know your warning signs! If you find you are:
– Finding reasons not to eat/avoiding situations involving food
– Increasing your exercise
– Weighing yourself again/more regularly
– Worrying about food/weight/exercise
– Changing the way you dress/hiding your body
– Body checking/spending time scrutinising your body in the mirror
– Cutting out certain foods or thinking about cutting out certain foods
– Desiring control
– Withdrawing
– Hiding disordered behaviour from others
– Feeling like you NEED to change how your body looks
– Feeling guilt after eating/resting
then any of these could mean that you are approaching a relapse or in a relapse. If you know what your own warning signs are, and are able to recognise if you find yourself doing/thinking those things, then you will be able to address and resolve the problem a lot quicker. This will enable you to bring yourself out of a relapse/prevent a relapse before it snowballs into something more ingrained. It may also be a good idea to tell your partner, friends, and family what these red flags are so that if you are unable to see them in yourself when they happen, they can point them out and support you in getting back on track.
Remember that recovery isn’t linear, and every setback is an opportunity to learn and take bigger steps forwards. Some of my most important lessons learnt were during the slip ups that I made during my recovery. Pick yourself up, dust yourself off, and don’t let the tide sweep you up and carry you back. Keep wading upstream, and take the knowledge with you for next time.
Keep busy and use distraction techniques. This list is not exclusive but here are some ideas of what to do when you are sitting with anxiety/guilt/relapse temptations:
– Watch a movie
– Read a book
– Write
– Paint or draw
– Blog
– Collage
– Knit or sew
– Research something you are interested in
– Play XBOX
– Play games on your phone
– Do fun internet quizzes
– Play computer games
– Call a friend or family member
– Meet up with someone
– Watch a documentary
– Play a musical instrument
– Do homework
– Tidy your room
– Do some internet shopping
– Take photographs
– Do puzzles

Write these tips down. Save this article to your bookmarks if it helps. Make a reasons to recover/reasons not to relapse poster or screensaver. Watch my YouTube video on that topic here. Remind yourself how strong and brave and beautiful you are. You’re gonna be okay. You’re gonna make it through. Keep on trekking on, and you can and WILL beat your eating disorder.

Our Bodies and Us: The New Years Revolution

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Artwork by Marie Boiseau

It’s approaching the New Year (another one already?!), and a lot of people will be suffering with those all-too-familiar post-Christmas blues. And a lot of those negative emotions will be coming from the shame and guilt so many of us feel for eating what we wanted and eating more than we usually would. Our cupboards are filled with leftovers: chocolates; biscuits; crackers; cakes…not to mention the mountain of cheese in the fridge. We are slumped in front of the remaining Christmas TV and we are being inundated with advertisements. Diet advertisements. Like, seriously, they are really shoving it in our faces this year. Every time I turn on my TV there’s a woman with dead eyes smiling at me, talking about her calorie-controlled diet and how much weight she has lost. Her mouth says “this is great!” but her face says “help me I’m starving!”

The diet and weight loss industry raked in $66 billion in America in 2016, and in 2014 the British diet industry was worth £2 billion (and as far as I am aware that hasn’t changed). The UK has a £20 million laxative industry, and almost two thirds of Brits are on a diet “most of the time”, even though research has showed time and time and time again that diets do not work and that 95% of the time people regain the weight that they lost within 2-5 years (and frequently end up gaining more on top of that). In short, these corporate assholes are making money of our self-hatred, and they will feed into it (excuse the pun) as much as they can so they can continue bringing in the big bucks.

Their biggest secret? IT. DOESN’T. WORK. If it did, everyone who has been on a diet or restricted their intake (which if we are honest is pretty much all of us) would be thin, and we would be thin forever, because that is what a success is: reaching a goal and staying past the goal posts (obviously this is not what I view success as, but in that context that is what people on diets are aiming for). But we aren’t staying thin – if we even get there in the first place. Those who go on diets lose weight, then gain it back again, then find another diet to go on, and then regain the weight (and so on and so forth). Or they don’t lose weight at all. If we want to stay thin, we have to punish our bodies and our minds every single day; something that most people cannot sustain, and something that is extremely damaging. Those that can are nearly always the victims of torturous eating disorders – and some of us will die trying to reach an unattainable goal with ever-moving goalposts.

So this year, let’s go into the new year with a different motive. Let’s choose life. Let’s choose happiness. Let’s choose self-love, and body-acceptance. Let’s see food as just that – food. Let’s see how it brings us together. Let’s eliminate the use of labelling foods as “bad” and “good”, and let’s eradicate the words that send a shudder down my spine “I’m being good” or “I’m being naughty” (oh god I’m shuddering just typing it eaugh). Let’s choose to nourish our bodies with adequate and consistent energy. Let’s face our fear foods and overcome them. Let’s stand in front of the mirror and challenge all the negative things that we feel about our bodies. Let’s support our sisters and brothers in body positivity, and let’s make the promise to ourselves and each other not to waste time on diet and weight talk, and self-deprecating comments. It will take time, and it will be hard, but let’s make this not just a New Year’s Resolution, but a New Year’s Revolution. Let’s fight to end body hate, not be a part of it, even if that means taking it one small step at a time.

Coping At Christmas: A Rough Guide For Those With Eating Disorders (Take 2)

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I have pretty much copied and pasted my article from last year on this topic, except for some tweaks, so if you recognise this article, that’s why!

Christmas is looming (how is it tomorrow already?), and people are preparing for Christmas with food, wine, presents, decorations, and of course, advent calenders. This time of year is always filled with trepidation for those of you with eating disorders. It’s a holiday focused around alcohol, food, and family, and at least two of the former bring on that familiar rising panic for lots of people suffering with or recovering from eating disorders.

If you are someone who is living with an eating disorder, and you are approaching Christmas Day with dread, you are not alone, and you can get through it. It is probably going to be a tough day, but there are steps you can take to make the most of it, and to protect yourself from at least some of the stress and anxiety that the day might hold.

Here are my suggestions on how to get through the day:

Focus on Family

Food is a big part of Christmas for most people, but you don’t have to let that be your main focus. Prioritise your family and/or friends and/or partner and enjoy their company. Catch up on the gossip, take part in the board games, and sing along to the carols with grandma. Spend time doing what is enjoyable for you. If your family can make this easier for you, let them know how. Maybe it means trying to keep the topic of conversation away from food. Maybe it means keeping food in the dining room and having the lounge as a food-free zone. Maybe it means going out for a walk with your siblings to get a bit of fresh air and space. Whatever you do, try to keep the focus on the company of those you love, and enjoying the time spent with them.

Set Boundaries with Loved Ones

This is a day that everyone should be able to enjoy to their very best, so do take the time to talk to the people that you will be spending your time with and set your boundaries for the day. This could mean asking them to refrain from talking about New Year’s diets, making food-moralising remarks, or reminding them not to comment on any of your eating habits or your weight. Do not be afraid to voice your needs, and do not be afraid to emphasise how crucial it is that they respect your boundaries. It is important to make clear what you need from them in order for you – and everyone else – to enjoy the day.

Use A Helping Hand

Have a chat with family and identify one or two people who you could use as a “safe person” during Christmas day. It might be good to have two people so that they can share the responsibility (one in the morning, one in the afternoon for example). These family members can look out for warning signs that you are not coping (or you could devise a signal), and are people you can take aside for reassurance and support. If you don’t have a family member that can help you get through the day, then make sure you have a helpline phone number available on your phone that you can call if any situation gets too overwhelming and you need someone to talk to in order to get through it.

Challenge Yourself…But Not Too Much

A huge part of the anxiety of the day is that there will be a lot of delicious food around that you will want to eat but also will not want to eat, and that’s the fight between you and your eating disorder. For a lot of people, this battle is going to go on all day, and that can make the day extremely stressful and anxiety-provoking (see Focus on Family for ways to minimise this). This is also a great time to challenge yourself, but a time to not push it too far: you don’t want to make the day even more stressful by pushing yourself to the limit. One way to go about using this day as a manageable challenge is to make rough plan of what you might eat that day. This will give you a guideline that might help you feel a little more contained, but could involve trying something new or facing a fear food. Try not to restrict yourself as much a you can, but it’s okay if you need to feel safe for a day that is so difficult already. Remember that you deserve to enjoy yourself and you deserve to be able to eat the foods that you like.

Take Care of Yourself

You may be around people this Christmas that will not respect your boundaries or may be insensitive or ignorant to your recovery. They may talk about the triggering topics which I mentioned in the “Set Boundaries With Loved Ones” section above, such as complaining that they have put on weight/are going to put on weight, lamenting that they have eaten “too much”, are being “naughty” or “bad” because they are “indulging”, or moaning that they need to go on a diet because of that. Please ignore them. They are battling their own insecurities and are looking for reassurance that what they are doing is okay and that other people feel the same and that they are not alone. This is really, really sad, and something that no one should have to feel. Enjoying the Christmas food is part of the festivity, and no one should have to feel guilty for it. Know that other people’s worries are not a reflection on you, and you should keep in mind that it is not something positive that they are experiencing, but guilt, anxiety, and insecurity. So instead of letting their negativity impact on you, empathise with them, as guilt, anxiety, and insecurity are emotions that you are likely experiencing also (albeit on a much grander scale to those who do not have eating disorders). Then turn your thoughts to yourself and keep moving forwards towards your goals. Keep moving forward on your journey towards health and happiness. Keep in mind your motivations, and remember that the way you respond to others affects you primarily.

Leave the room for a bit if you need to. Take yourself off for a relaxing bath or a nap or to read a book. Go for a stroll. Have a quiet word with that relative who keeps calling the chocolate yule log “bad”. Just take care of yourself and do what you need to do, for you, to have the best day that you can. Do not be afraid to speak up. You need this. You deserve this.

If you are someone who has an un-supportive, highly triggering family, do know that it is okay to decide not to see them at all. If you want to spend Christmas with yourself, your partner, your partner’s family, your friends, or your pets, do it. Do what is best for you. Do what you need to do to continue moving forwards. Do what you need and you deserve to continue working towards health and happiness. Make positive choices, and don’t feel guilty about them. This is what you need. This is what you deserve.

Move On

Christmas is unfortunately never going to be an easy time for those with eating disorders, and it often means that those people go into it with anxiety, and leave it with guilt. It is okay to experience those feelings: you are not alone and those feelings are not your fault. However, you have to keep remembering that these negative emotions are caused by your eating disorder and the control that it has over your life. Keep fighting the war against it, and don’t respond to those negative feelings. You are going to be okay and you can get through this. Christmas will be over in a blink of an eye, and then it is time to put it behind you and move on from that day. Don’t carry the stress from it with you. Let the day go. Remember that it is absolutely, 110%, super okay to eat more than usual, go outside your meal plan, eat “normally”, or respond to extreme hunger (this applies for always, of course). It is okay to put on weight. It is okay to enjoy yourself. The guilt of going against those eating disorder rules can be overwhelming, but it is important to remember that this is part of recovery. Going against your eating disorder and doing what you deserve is part of fighting the battle inside your head. Eating whatever you want, whenever you want, is the goal, and so if you were able to do that for a day, or two, or more, or even if you were able to eat a little more than normal, you are making small steps towards achieving that outcome. That is a wonderful thing.

If the anxiety is becoming overwhelming, check out my article on anxiety management here.

Original article can be read here.

So Now We Have to Lose Weight to Get Surgery

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On Sunday I read the news that obese NHS patients will not get non-urgent surgery until they lose weight.

It made me want to cry. I’m a recovered anorexic who is very active and eats a varied and balanced diet and because of that I am both fit and healthy. I also happen to fall into the “obese” BMI category. In order to lose weight I would have to restrict my food and exercise to the extreme, leaving me both hungry and exhausted; pushing my body below the weight that it sits naturally at. This is unhealthy, and it would mean that my physical and mental health would be in decline. I would also end up spiralling back down into a very dark and dangerous place, with even more devastating and continual effects to my physical and mental health. If I required non-urgent surgery, I would therefore have to force my body into a place where it is not at its healthiest, experience distressing physical symptoms, and in the process would be triggered into a life-threatening mental illness that could leave my physical health in such a bad way that it could kill me – if the torture of living with an active and consuming eating disorder didn’t tempt me to end my life first. In short, I would be put in a life-threatening situation in order to get non-urgent surgery. For me, it wouldn’t be worth the risk.

Artwork by Francis Cannon

BMI is bullshit. All health professionals know this. And if they don’t, then they should: there’s been so much indisputable evidence that shows us that using a basic BMI chart to tell us whether we are healthy or not is ridiculously primitive, simplistic, and inaccurate. To think that I might not have access to the same healthcare as someone thinner than me after working so incredibly hard to get to this healthy and happy point in my life both physically and mentally makes me feel sick.

We all have individual natural and healthy weight ranges that our bodies choose and we maintain when we have a healthy lifestyle. We don’t get to choose that weight. No one else gets to choose that weight. Our bodies determine it. And those people who don’t fit into the “socially ideal” weight category (that literally wasn’t EVER intended as a way to measure health) get punished for it (whilst those who push the “obesity epidemic” and reinforce the stigma and myths around “obesity” profit from it). There is so much overwhelming evidence that it is possible to be healthy at most weights, shapes, or sizes (depending on yourself as an individual and what your own personal healthy weight is), and it is nauseating to think that people will be forced to make a choice that could cause them both physical and mental distress.

Even regardless of health, “singling out patients in this way goes against the principles of the NHS,” says Mr Ian Eardley, senior vice-president at the Royal College of Surgeons in The Independent.

The article also reports on more details:

Patients with a Body Mass Index (BMI) of over 40 will not be referred for routine surgery unless they are able to reduce it to under that number over a nine-month period.

Alternatively they will be required to shed 15 per cent of their weight, according NHS Herts Valley Clinical Commissioning Group (CCG) and NHS East and North Hertfordshire CCG.

Whichever achieves the greater weight loss will then allow them to be considered for surgery.

Patients with a BMI over 30 but under 40 will also be required to reduce that figure to under 30 or lose 10 per cent of their weight before they are considered for surgery.

This decision is yet another discriminatory act against people in larger bodies in the UK, and I’m so tired of it. I’m tired of being told everywhere I look that my body is “wrong”. I’m tired of watching my category of bodies represented by images of men and women with protruding stomachs and their heads cut out of the shots as if they are nothing but their size (for example right now I typed in “obese patients will not get non-urgent surgery until they lose weight” into Google and the majority of the images are fat people with their heads chopped off – seriously, I’m so done). I’m tired of things like having a “World Obesity day” following the National Mental Health day – which if it wasn’t so revoltingly ironic, would be laughable, without even addressing the fact that there is literally a day to tell us all how bad and unhealthy our bodies are if we are over a BMI of 30.

Artwork by Frances Cannon

Despite that, I’m someone who exists in a body that is fairly “average”. Even as an “obese” person, I have an amount of thin privilege. I can fit into clothing at regular stores. My friends laugh as if it is absurd when I say that my body fits into the “obese” category. My booty is the UK’s “average” size (although this booty is anything but average, just saying), and my top half is below the UK’s “average” size (and just so you know the average clothing size for women in the UK is a size 16, which is a US size 12, and in the U.S. the average size is between a 12-14, which is a UK size 16-18). I have only had one health professional (physiotherapist) mention my weight in a negative way (AFTER I had told him all about my previous experience with an eating disorder and described to him my active lifestyle and balanced diet. And boy, did he receive an educational six-page feedback letter on eating disorders and health at every size? Yes he most certainly did). The discrimination that I face is significantly less than those who live in bigger bodies than I do, and it can have devastating effects on mental health.

I don’t want to be fighting to be seen as equal to other people because of my BMI. I don’t want to fight for those bigger and smaller than me to be treated the same. I don’t want to fight to get rid of negative associations with certain body sizes. I just want it to BE like that. Right now. I will, of course, keep fighting this fight, but man, am I exhausted of having to argue with at least one person every time I say that to be obese is okay and that someone who is obese can be just as healthy as someone who is not. And now we have our healthcare to fight for, too.

Hopefully, one day, we will all be at peace with our own bodies, and each other’s, and regardless of our weight, shape, or size, we will be treated equally and our health considered individually. Until then, let’s keep being angry, let’s keep speaking up, let’s keep pointing out the evidence, and let’s never give up.

Artwork by Francis Cannon

A Balanced Diet: What Do Those Words Really Mean?

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We hear it everywhere: in order to be healthy, you need to eat a balanced diet. But what does that really mean? I’m scrolling through Google images right now trying to find an appropriate picture to go with this article, and at least half of the images only show “healthy” foods. You know what I mean: your greens; your grains; your fish; your eggs; your cheese; your meats (the latter four tiny splodges at the top compared to the large array of fruits and breads). A large percentage of the pictures are only of fruit and veg. I mean, come on: I have my own “cheese corner” in my fridge, and no one is ever taking that away from me. Especially not a food chart.

For the most part, the food triangle often used to demonstrate balanced eating is a fairly accurate rough guide, and looks something like this:
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It is a rough guide to the way our diet will look if we listen to our bodies (when energy-balanced and healthy in themselves – not in a state of recovery or beforehand) and follow its cues – and we do not have to do any counting or checking or weighing or recording to trust that this is what our bodies will naturally lead us to do. Our bodies are extremely intelligent and I urge you to listen to them over most external influences.

I also like this pie chart, apart from the wording of “treats”, as these types of foods should just be another part of the pie chart rather than being labelled with a word that holds so many negative connotations.

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What I do like about this pie chart is that it shows that 10% of your diet in a day should include foods deemed “unhealthy” by society. Foods like cookies, sweets, chocolate, cake, biscuits etc. Now this chart shows a representation of your daily diet. If you start to think about it, that means that you can eat these foods every day – something that I have seen demonised in countless magazines and online articles. I have often seen or heard advice that you should only eat “treats” a few times a week, and no way am I giving up my daily dose of baked goods, however much you tell me it’s not good for me, Karen.

The thing is, a lot of us believe the words “balanced diet ” to exclude those yummy foods that are so often seen as the devil. The thing is, these foods are an important part of a varied, balanced diet. They are part of our mental health – because we should not deprive ourselves of anything. They are a good, quick energy source for our bodies, and they are especially helpful to our bodies in recovery because of this. Eating a balanced diet means eating bits of everything. It means not restricting any food types or specific food items, unless you have a food allergy, food intolerance, or you have an illness that requires you to cut out certain foods or monitor them. It means varying what you eat and not eating the exact same thing every day (yeah, I’m talking to you, ED). It means eating foods and consuming liquids that you enjoy. It means getting in those nutrient dense fruit and vegetables. It means providing yourself with an adequate amount of carbohydrates so that you have enough energy for the day. It means having that coffee and cake with Ann, and getting takeaway with Heather, and digging into ice cream and popcorn in front of a movie with Sam. It means changing up your routine. It means being flexible. It means trying out new things. It means going back to old favourites. It means hearty meals, light bites, snacks, and puddings. It means not overthinking it and letting your body lead the way.

So often these wonderful foods like crisps, pizza, and cake are associated with feelings of shame, greed, and overindulgence, and there can be judgement from others when eating them. However, this is only because they also have been made to feel those negative emotions when eating those foods themselves. The thing is, food is not a moral issue (and you can read my article on that here). You are free to eat what you want, when you want. You are free to be as healthy or unhealthy as you want – and that is not anyone’s business. And if you want to be healthy, follow the lead of your body (yes, I will repeat that until my death). If you want to check that you are eating a varied, balanced diet, do a quick valuation of what you eat on an average day or an average week, but don’t overthink it, as this can very quickly descend into a spiral of obsession. As long as every food group is incorporated into your diet, that’s a good sign. And when you’re uhmming and aahing in the cafe with Susan, just get the damn cake.

Are You Listening? How We Hear the Things that People Say About Our Bodies When We Have An Eating Disorder

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My partner and I are lying in bed. He’s got his arms around me and we are a tangle of limbs beneath the sheets. Then he speaks.
“You’re so soft,” he says.
He says this a lot. He also says things like “you’re so huggable” and “you’re so squeezable”.

I wonder what your reaction was reading those words. Imagine hearing them said to you. How would you feel? What would you hear? I know what my reaction would have been a few years ago. I know that I would have heard “you’re fat”.

The thing is, we listen to what people are saying and then we apply our own filters to the words; filters which have been created from a whole myriad of experiences. That is what our minds do, and when it is someone with an eating disorder, that filter is especially pervasive, vehement, and antagonistic in the most negative of ways when it comes to comments about our bodies. People’s words go through this filter and it gets translated, so that what we hear is not necessarily what was said.

In this instance, I did a little laugh as I realised that his words went through my “ED translator”, and then carried on through my “recovered translator”, meaning that it went through two stages: “you’re so soft” turned into “you’re fat” and then into “he means your skin is soft or maybe he does mean your body is soft and so what Sarah, a lot of it is, and that’s nice, and it is nice to hug soft things that’s fine stop acting like he told you that you look like a naked mole rat that went through a blender.”

Sometimes my partner even puts his hand on my stomach and gently squeezes the squishy bit. Yeah, you can see my face now:

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If it was me three years ago I would have had a meltdown and engaged in some drastic and incredibly harmful behaviours, and it would be something I would probably remember forever as a trigger point for self-loathing. However, I am not that person anymore and I am – thankfully – now not in that torturous place. Instead I asked (slightly incredulously):
“Are you squeezing my fat?!” to which he replied: “Yeah, sorry.” Again, three years ago I would have heard that answer as “yes you remind me of a beached whale and I am poking fun at your fatness and reminding you that you should probably do something about it because it is gross.” But instead the translation that finally came out of my little two-staged system was “You have fat on your body and he squished it because he had his hand there and it is a part of you and it it something that squishes and that’s okay; he still finds you attractive and wants you to be naked 100% of the time.” Because I suffered from an eating disorder for ten years, and because I live in a society that highly values diet culture and thinness, my brain will always automatically put the words through a negative filter. But because I was able to fight tooth and nail for my life and succeed in claiming it back from my powerful and evil mental illness, and because I then went on to reject diet culture and embrace body positivity, I have a wonderful second filter in place that allows me to pause, rationalise, and try to really hear what people are saying when it comes to my body (and everything else).

The important thing in these situations is that the outcome is totally different depending on where your head is at and on your ability to hear what is really being said rather than putting it through your own personal filter. You want to be able to really hear what the speaker of the words means rather than ending up reflecting back your own insecurities as a response. If we hear things through a negative filter of our own, it can then lead to negative situations with that person or people, because we think that they are insulting or hurting us. It also leads to a spiral of negative thoughts and possibly subsequent harmful behaviours. It is important not to hear the words that people say as confirmation of our own insecurities. Your eating disorder is always looking out for ways in which to validate itself. Don’t let it cause distance and destruction towards others or yourself.

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If you are struggling with something someone is repeatedly saying, or even a one-off comment that affected you, then talk about it. Be calm; be open; be honest; and try not to use accusatory language. Instead use “I feel” or “my eating disorder hears it like x” as opposed to “you are doing x/you are making me feel x”. People’s defensive barriers go up when they feel that they are being attacked. Often what is being said is actually okay to say and is not intended harmfully, but it is the eating disorder that translates it into something else and then causes harm. Because of this it is more productive to talk about how the eating disorder is at fault rather than them, or you. Of course I am perfectly well aware that there are those who are disrespectful, insensitive, and malicious and do intend to cause damage or do not care enough not to, but I am for now talking about those who we assume are not saying the wrong thing per se, but are saying things that are triggers for the eating disorder, which then rears it’s ugly head and translates for us.

It is not an easy thing to change the patterns within our brains, but it is possible. It takes time, and patience, and perseverance. It takes determination. It takes persistence. It means having to challenge negative thoughts every damn minute of every damn day. It means working towards liking and respecting yourself as a person. It means taking steps towards accepting your body as it is at its individual natural and healthy weight. It means screaming “NO” to the eating disorder and fighting for your health and happiness. It means recognising that the people who love you are not out to hurt you. It means remembering that you might at this point in your life feel hatred towards your body and self-loathing towards who you are, but that that is not how other people feel about you. It means recovery, and it means going on a journey to the place you want to be; to the life you want to live; to being the person that has been suppressed by the eating disorder. It means taking the path that leads to being free.

Recovery Does Not Mean Compromise

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Recovery from an eating disorder is a fantastic thing. A long, arduous, torturous, fantastic thing. It is painful and it is terrifying and it is tedious, but it is the most rewarding thing anyone with an eating disorder will ever do, because it gives you your life back. It gives you back your freedom, and it gives you back your health. However, all too frequently I am seeing what looks like compromise in those who claim to be recovered from an eating disorder.

I want to state right now that the recovery journey in itself does often entail some compromise as we navigate our way from disordered to healthy. It does frequently mean swapping things in and out, finding that with challenging one behaviour another pops up more strongly, transferring fixations and focus from one thing to the next, and other such struggles as we learn how to overcome our sickness. That is perfectly okay. That is part of the journey. It is part of managing the initial trauma of recovery. But there comes a certain point where you have to challenge how you are recovering, and you have to move on from compromising with your eating disorder. There comes a certain point where you have to be aware of all those things listed above, and start to do something about it, because although at the start recovery may include it, recovery cannot be about compromise. Recovery has to be about getting rid of the disordered habits, not switching them up for more socially acceptable ones and calling it healthy.

I get it: it is easy to fool the world and it is easy to fool yourself that eating “clean”/detoxing/eating only “healthy” foods/being vegan/going Paleo/etc and going hard at the gym/training for marathons/attending multiple aerobics classes/etc is living a recovered life, but those sneaking eating disorder lies and manipulations only prevent you from living the life that you deserve to live: one free from the shackles of your eating disorder. We as a society can praise the woman who “recovered” from anorexia nervosa and became a bodybuilder all we like, but it doesn’t change the fact that she still has an eating disorder. We can applaud that man who went from having bulimia nervosa to being a fitness instructor whose muscles ripple and glisten in the sunlight, but that doesn’t alter the fact that he has just switched up one eating disorder for another. We can use the woman who “beat” her eating disorder and now stocks her kitchen with protein shakes, quinoa, and lentils, and exercises an hour every day as inspiration, but that doesn’t change the fact that her life is still dominated by rules and routines and fear.

Recovery means breaking free of that suffocating cage. It means tearing down the walls that keep you from dedicating your time and energy to your passions, hobbies, interests, and relationships. It means not worrying about your calorie or macro intake. It means engaging in physical activity that you actually enjoy when you want, not in a fixed, rigid routine. It means resting whenever, but especially when you are sick, tired, or having any intrusive eating disorder thoughts, however small (because being recovered does not mean being cured). It means throwing off the shackles of guilt and anxiety by challenging and overcoming every negative, controlling eating disordered thought and behaviour. You know what they are. Push away the convincing eating disorder voice, and listen to your gut. Do you feel free? Think about the life that you want to lead. Is this it?

It’s Summer Soon and Surprisingly, Fat People Get Hot Too