Tag Archives: exercise addiction recovery

Extreme Hunger in Eating Disorder Recovery: Why You Are Not Binging and Other Fears Explained

anxiety 3

Recently I have been inundated with questions about extreme hunger. This is not unexpected, as extreme hunger is one of the most terrifying aspects of recovery, and one that the eating disorder will latch onto; screaming all of your/its fears into your brain and how they have/are about to come true. Extreme hunger is probably the most common topic that comes up in messages to me asking for information and advice, alongside digestive issues. Recently though, the questions have become even more unrelenting: I could answer five questions in a row about extreme hunger and then within hours receive five more, even though their question was answered in the previous messages. Either the senders of these messages did not take the time to read them (or my FAQ), or, as is understandable, they see themselves as the exception to the recovery process (the “I am a magical unicorn” thinking process).

unicorn 2

Our anxieties and our eating disorders tell us that what we are experiencing isn’t the normal symptoms of recovery; that we are different; that our experiences with an eating disorder do not warrant the symptoms of recovery; that we were not sick enough for this; that somehow we need less food; that somehow our weight gain is not normal; that unlike everyone else the numbers on the scale will increase forever more and we will gain into infinity. And I get this entirely, because I was the same, but there is only so many times that I can repeat the same things over and over again, especially when they are in messages that come directly after one another. And so I decided to create this article to address the fears and doubts that are the most common: the ones that come up in those messages time and time again. The first part of this issue is to talk about the main fears of those with extreme hunger. The second part is a collection of experiences from those who have gone through extreme hunger and come out the other side.

Without further ado:

You can experience extreme hunger regardless of what weight you are or how much weight you lost.
If you restricted your intake, your body experienced an energy deficit. This energy deficit causes damage. This can result in extreme hunger.

Extreme hunger varies in severity and length of time.
It often lasts longer, or is more extreme, in those who have restricted for long periods of time, or those who have restricted very severely. Combining the two is therefore likely to double the chances of this. However, everyone is different, and the severity of extreme hunger is down to how much the damage the body has to repair. If you have extreme hunger, you have it for a reason.

Extreme hunger can come at any time.
Extreme hunger can come and go, be constant, start on Day 1 of recovery (or even during your ED, hence “binging” episodes), come during the middle of the recovery, or the end, or not at all, and it can last for varying periods of time.

It is totally normal to crave what you may call “unhealthy” or “junk” food.
High carb, high fat, and high sugar foods are foods that you are likely to have restricted during your eating disorder, which is why your body craves them now. It is deficient in those things and also in energy, and these foods tend to be high in energy and are easier to process by the body. Basically, this food is easy energy for a starved body. Your cravings for these types of foods will calm down in time as your body gets healthier and your mind recognises that you will not deprive it of these foods again. As a side note, just remember, that there is no “healthy” and “unhealthy” foods; “good” or “bad”, there are just foods that have different nutritional and energy values. Food is food, and also food is not a moral issue.

Extreme hunger is normal, natural, and expected.
If you starve your body, it is going to need more calories than a healthy, energy-balanced body, in order to get back to its balanced state. You can read more information about extreme hunger, why it happens, and how to cope with it here. I also have a video on the topic here. You are not alone in this experience.

Extreme hunger will not lead you to gain forever.
If you starve and lose weight, you will gain that weight back when you start eating more (and possibly more if your body is still growing and developing as your natural weight is not static until around 25ish when you have grown fully  into your adult body). However, extreme hunger is more about internal repairs. So yes, some energy will go towards gaining weight, but lots of energy also goes into healing the damage done to your insides, which means it is used up doing this and is not part of weight gain. When your body is not so severely damaged, your appetite will taper down.

Extreme hunger will stop.
Extreme hunger is there for a very good reason: because your body is severely damaged and needs energy in order to repair this damage. When the body is healthier and not in need of so much energy, it will stop giving you signals for so much energy. Trust the body. It wants to heal you. It wants you to be happy and healthy. Your eating disorder wants to kill you. Put your faith in the right one, even though handing over control feels so scary. Remember that the illusion of control is scarier, and that with your ED you were never in control at all. You were controlled by something that wanted you as miserable and as sick as possible. It’s ultimate goal is your death. Take back control by working with your body, not against it. By giving over control to your body, you will be more in control than you ever have been, because you are reclaiming your health and happiness.

Your eating disorder will try and tell you that you are using extreme hunger as an excuse to eat, but that you were “not sick enough”, “didn’t restrict enough”, “didn’t lose enough weight” to warrant experiencing extreme hunger in recovery.
This is manipulation and bullying by your eating disorder. It can feel that it is losing, and it will try anything to have total control over you again. P.s. you never need an excuse to eat whatever you want, and if you can eat amounts that are “extreme hunger amounts”, then there’s a very good reason for it, and that reason is that the body needs it.

What you think is extreme hunger might not be extreme hunger.
2,500-3,500 calories is a very normal appetite. 3,500-4,000ish is more of a grey area. It is a larger appetite than most people with a healthy, energy-balanced body (although can be reached by energy-balanced people, usually by eating lots at a restaurant, or a buffet, or a night out drinking lots of alcohol and mixers), but it is not exactly extreme. 4,000-4,500+ is when it would start to be more in the extreme hunger range. All of these ranges can be experienced by a person in recovery from a restrictive eating disorder.

You are not binging and you do not have BED.
It feels very very much like binging, but it is not BED, and here we can look at the criteria for Binge Eating Disorder:

DSM-5 Diagnostic Criteria
  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
    • a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
  • The binge-eating episodes are associated with three (or more) of the following:
    • eating much more rapidly than normal
    • eating until feeling uncomfortably full
    • eating large amounts of food when not feeling physically hungry
    • eating alone because of feeling embarrassed by how much one is eating
    • feeling disgusted with oneself, depressed, or very guilty afterwards
  • Marked distress regarding binge eating is present.
  • The binge eating occurs, on average, at least once a week for three months.
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

You will probably read these and think but this is what I am experiencing! Let’s go through it point by point:

  • Yes, you will eat food that is larger than most people would eat in that time because you have a starved body that needs loads more energy than most people.
    You will absolutely feel a lack of control because your eating disorder (which gives you the illusion of being in control) is not driving this: your body is, and therefore your ED will feel out of control.
  • Yes, you will probably eat rapidly because your body wants to get energy is as fast as it can because it is desperate for it.
  • Yes, you will feel uncomfortably full because a) your stomach is shrunken and b) this is an amount of food that your stomach is not used to at all.
  • You may not feel physically hungry because extreme hunger can be experienced in many different ways. Extreme hunger can be the feeling of hunger and tummy rumblings etc, but for the most part, from talking to people and experiencing it myself, it comes in the form of feeling empty and/or intense urges to eat/mental hunger.
  • Feeling embarrassed, disgusted, depressed, and guilt, along with marked distress, whilst and/or after eating a large amount of food, is quite obviously going to be experienced by someone with a restrictive eating disorder.
  • Again, it can be experienced every day, or on and off on some days and some not, or once a week, or not for a week and then constantly for weeks, etc etc.
  • Now if we take a look at the last in that category, I want to draw your attention to “does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder“. You are in recovery from one of these eating disorders (or OSFED/EDNOS). This means that you still have that eating disorder, because even though you are moving forwards from it, it is still active for you, until it is inactive and you are in remission. Meaning that you do not have BED. You have anorexia, bulimia, OSFED, or ARFID, and your body is trying to recover from the physical effects that this has had on you.

eating 4

Personal Experiences With Extreme Hunger : Those Who Have Come Out The Other Side

Extreme hunger was definitely the most daunting part of the recovery process for me. Mine began about 1 week into recovery and lasted non stop for approximately 3 months and then fairly regularly for the next 9 months with only the odd day here and there after that. It was emotionally traumatic and I was, like many people who go through it, certain that I had developed a binge eating food addiction. I had not… it was exactly what my body was screaming out for and all I had to do was listen to it and respond appropriately without compensating through exercise or attempts to restrict afterwards. I would eat thousands of calories in single sittings, often after a meal is when it would hit me. For example I’d have a normal lunch and would then suddenly feel like a bottomless pit, like my insides were desperate for more. I’d eat several family packs of biscuits, boxes of cereal, whole boxes of magnum ice-creams, share bags of salted nuts, loaves of bread, you name it. It was terrifying but I battled through the fear and the hatred my ED would scream at me and allowed my body to do the healing it so desperately needed to do. Over time the episodes of EH would become fewer and further between and now I simply couldn’t eat as much food as that in a single sitting- now I look back on it and know with confidence and experience that it was essential for my recovery and pivotal in my battle of overcoming my eating disorder. – Emily, 22

eating 3

I developed an eating disorder when I began restricting calories in order to lose weight. It got out of hand and I then developed bulimia. I wish I had known that my binging (extreme hunger) was a normal reaction to the restriction. Eventually I realised the only way to end the bulimia cycle was to just go all in and let my extreme hunger run its course. It was really really REALLY hard, and scary, with many slip ups, and I recommend building a good support system around yourself. I didn’t count my calories at the time, but I’m sure they went to at least 4000-5000 most days. I think on average I would have hit 4000 calories a day. But there were definite days where it could have easily been 8000 calories. What I remember most is eating entire loafs of bread with butter in one sitting. Definitely entire large icecream tubs were in there. Just complete freedom. It was the best decision I have ever made. It meant I could enrol into university and study. It took the better part of a year for the extreme hunger to completely subside, and then another year for me to be completely rid of disordered thoughts around food. I know I’m so lucky to have gotten through it. I’ve tapered down to a weight that has stayed stable for months without any effort. I now have the brain space to focus on things I actually love doing. I wouldn’t have gotten here if I didn’t let extreme hunger run its course. – Ira, 24

eating 3

Before I experienced extreme hunger, I had tricked myself into thinking I wasn’t sick anymore, because while I was eating the minimum amount of calories recommended for me for my body weight (which turns out is less than half what I should have been eating to live a normal life) and experiencing extreme orthorexia, I was still, in my mind, eating. I thought that I was well enough to go back to work as a chef. In the six months that followed the years and years of starving myself overwhelmed me and extreme hunger kicked in. I had no idea what it was and was terrified I had developed BED. I would eat cake until I felt sick, throw it away in tears, and then feel the need to eat it so badly that I’d get it out of the bin again. I would eat entire loaves of bread and cheese and all of the food I’d told myself I wasn’t allowed to eat, and panic until I had anxiety attacks. I was terrified and felt so wildly out of control that I started making myself sick again. After months of this, although it was incredibly difficult, I stopped being sick, I stopped counting calories, and I tried really hard to eat what my body was telling me to eat. I threw away my scales. I didn’t look in a mirror for months. I just told myself that it was going to be okay, and that I had to let my body do this so that I could live my life without spending every waking moment thinking about fat and weight and diet plans. I just wanted to be able to live like normal people lived. Obviously I put on weight, because my body was starved and was desperate to hold on to the calories I was putting in to it, but after a few months of extreme hunger, my body began to calm down. My appetite lessened, and my weight evened out. I learned how to eat normal food again, how to eat without calorie counting, and how to eat meals like normal people at normal times. Extreme hunger terrified me because I didn’t know what it was, but I needed to go through it not only to let my body recover from all of the awful things I’d put it through, but also to learn how to eat again.  Anonymous, 24

eating 3

My experience with extreme hunger was a scary one. Going from eating so little to so much in such little time was a shock both mentally and physically… and was actually kind of terrifying at times. My extreme hunger began very soon after embarking on a ‘3000 calories a day’ meal plan. After a few days of this plan, it was as if my body completely took over my mind and wouldn’t rest unless it was well fed. For the first few days of extreme hunger, there was actually very little fear or hesitation involved when it came to eating. I felt FREE. I ate pretty much everything I’d been restricting by the bucket load. If an award could be won for the most chocolate consumption in one sitting I’d definitely win them all (are these awards a thing? I hope so). I’d say that my consumption started at around 5000-6000 at the beginning for around 2 weeks and then crept up to around 10,000 calories a day which I’d say lasted for around 4-5 weeks. Can I just add that it sounds WAY more terrifying than it actually is. Yes – it is scary, but it is also the most freeing thing you could ever experience. After eating around 10,000 calories a day for 4-5 weeks, my hunger began to taper a little; week by week my intake lessened slightly until I was eating 3000-4000 calories naturally and comfortably a day.
Body wise, I gained weight quickly. I had the whole puffy face, slightly pregnant belly thing going on. At the time, I honestly didn’t concentrate much on how I was looking. The feeling of freedom was completely overwhelming and overshadowed the physical effects of what I was going through. That being said, extreme hunger didn’t come without its discomfort. My body was obviously not accustomed to digesting this volume of food, which meant that I experienced fairly severe stomach cramps. I ensured that I stuck to easily digestible food at this time and after a couple of weeks, they passed.
My extreme hunger diminished completely at around 7 months into recovery and I am now 3 years in! Extreme hunger helped me break down so many barriers in recovery and it has enabled me to build a far healthier relationship with food. – Emmy, 22

eating 3

I was meeting with a nutritionist about once a week at the beginning of my recovery. She would give me a meal plan, calorie goal, etc. It was extremely difficult at first because I had to not only eat, but keep in, the calories I was consuming. Once I was on this meal plan for a few weeks the extreme hunger started to kick in. The biggest issue I had with extreme hunger is that in the beginning you don’t trust your body or think that it’s accurately telling you the things that you want. But one day I just said “fuck it” and tried a different approach. Whatever I was craving I ate, no matter the amount I wanted. The extreme hunger lasted for six months, and was one of the more difficult parts of the recovery process but it is so, so worth it, and is exactly why I can be typing this right now while enjoying ramen with my roommates and knowing that yes, this can be overcome. – Natalia, 21

eating 3

Last year, I used MinnieMaud to recover from anorexia. Extreme hunger hit me like a truck, and I was a ravenous beast for a solid 4 months. I went from about 90 lbs to 150 lbs, and once I hit that weight, my appetite normalized, which was pretty awesome and relieving. It was a rough and scary road, but having confidence in the principles of MM, and especially the Minnesota starvation study, and TRUSTING my body, helped immensely. – Anonymous, 30

eating 3

During the early parts of recovery my hunger was huge. I was CONSTANTLY hungry/craving large amounts of food. I would eat blocks of cheese, chips, sandwich after sandwich and still feel hungry even though my stomach felt so full and bloated. It was scary to think the hunger would never end and I’d just keep on eating and eating. BUT, I trusted the process and resigned myself to allowing myself grace during this period knowing many other people had experienced the exact same thing with good results in the end. I knew the key was to not limit myself when it came to food and cravings. It took awhile but slowly I started noticing myself eating and craving smaller portions and feeling satisfied with those portions. The body just needs all those calories and nutrients after being in the negatives for so long. Give yourself time to make up some of the deficits without freaking out too much! You can do it! – Shannon, 34

eating 3

My extreme hunger started before I even chose to recover. My body eventually decided that after seven years of restriction that varied from minor to severe during that time span, and one year of severe, unrelenting starvation, it was going to have to do something about it. My body would put me in what I can only call “trances”, where I would go to the kitchen and eat loads of porridge oats, then “wake up”, and chaos would ensue, both in my mind and my reactions to what I had eaten. A month or so of this ensued: with my body taking over, and then my eating disorder reacting to it and making me compensate. Then I chose recovery, and tentatively gave myself permission to respond to the hunger and cravings that I was experiencing. During extreme hunger I would eat whole cheesecakes; pints of Ben and Jerry’s; bowls of cereal; whole big Thornton’s chocolate boxes…I was terrified that I had developed BED; that I was using recovery as an excuse to binge; that I would never stop eating so much…but it did. It stopped when I was healthier. My appetite tapered down. It stopped demanding so many high carb and high fat foods. My days of experiencing extreme hunger lessened and grew farther apart. During the second year of my recovery, my appetite was generally normal, with a couple of days of eat around 4,000 calories (in the grey area between normal appetite and extreme hunger, but then again some days I probably didn’t eat enough for my body and therefore ate more on other days). Now my weight is stable, my appetite has normalised, and I haven’t experienced extreme hunger for years. It was terrifying to go through, but it is not endless. It does stop. And it is so important to trust that your body is that hungry for a reason. – Myself (Sarah Young), 25

I hope that this article answers most of the questions related to extreme hunger and gives some reassurance that this is normal and does end.

 

Advertisements

Extreme Hunger – What Is It, Why Is It Happening, and How Do I Handle It?

hunger

It has come to my attention that I have not yet addressed one of the biggest topics of recovery from a restrictive eating disorder in any of my articles on this website (shame on me!). I’m not sure how I managed to miss it but it may be because I have a comprehensive video on the subject, and also refer to Your Eatopia’s articles about it. It was, after all, Gwyneth Olwyn who did coin the term “extreme hunger” (as far as I am aware). But let’s get started.

Extreme hunger is a rather controversial subject in the recovery world. It is rarely recognised by professionals regardless of the clear logic that shows us that it is totally normal and expected to experience a surge in hunger after a period of starvation, not to mention the sheer amount of people that talk about extreme hunger being part of their recovery (or “binging”, which is actually the same thing, but we will get to that later).

Extreme hunger is a very rational experience when you look at the facts. A body that has been starved has a large energy deficit, and therefore calories that are needed for daily expenditure are not going to be enough to get an energy-deficient body back to its energy-balanced state. This is because it will need calories for daily expenditure and calories to make up for the energy deficit. This energy deficit in itself will have resulted in damages to the body, and it can also result in weight loss which also causes harm to the body – and frequently the more extreme the weight loss the more severe the damage. Damages like that require energy to heal, and that has to be energy on top of daily energy needs, as that is expended in – you guessed it – the energy that you use up in your daily life.

balance

So if you imagine that energy-balanced is the number 0 – a neutral place with a healthy body, and let’s say you need around 2,750 calories to stay in this energy-balanced place. Then starvation brings you to -10 on that scale, which means that you are in an energy-deficient place. Let’s say you now enter recovery and bring your calories up to 2,750 again (after increasing gradually because of the risk of refeeding syndrome). Your metabolism is probably very suppressed, so for a while, 2,750 may cause weight gain either slowly or rapidly as your body will store as much energy as it can rather than burning it, to get you to a healthier weight. The metabolism will then speed up and you might a) experience hypermetabolism and end up dropping weight or maintaining a fairly low to low BMI (or a BMI too low for your personal body), which will mean that you will need to increase your calories until you are gaining again or you may b) find that you maintain a certain weight or that your weight gain slows down. This does not mean that you need fewer calories. This means that your body is now able to maintain its weight on those calories. It does not mean that it is done healing the many internal damages done through starvation, so if you experience hunger or cravings for more than the 2,750 your body (theoretically) needs, then it is really important to respond to those signals and eat. Your body is your team mate; your best friend; your rescuer. Listen to it. It if it telling you that it is hungry, then it is hungry. I know – this is ridiculously difficult, and I will talk about that in a moment.

Now let’s say you are recovering on a sub-optimal amount of calories and have stopped gaining weight. My body must be recovered! I hear you say. It must only need this amount of calories! Wrong. Let’s say that you are recovering on 1500 calories. Your body is maintaining a weight that is not its natural or healthy weight because it needs more energy to repair and gain weight. In order for it to gain to its set point and heal the internal damages done to your body, it needs adequate and consistent energy, and that is much more than 1,500 calories (or whatever your sub-optimal is). Let’s say you are recovering on a sub-optimal amount of calories and are gaining weight. Well clearly I don’t need any more calories if I am gaining weight on this! I hear you shout. Wrong. Giving your body an inadequate amount of energy means that it is extremely likely to keep your metabolism suppressed and therefore will continue to store more energy as fat rather than burning it like it would if it had a normal-speed metabolism. To find out how many calories you need (base level, without extreme hunger), check out my recovery guidelines here. Remember that activity level also factors into being energy-balanced, and that if you are engaging in excessive exercise, this will put you in an energy-deficient state too. It is also important to note that whilst your body is healing, any energy put into exercise will put a strain on a body that is desperately trying to heal a multitude of damages, and exercise will eat into much-needed energy for repairs. This is why it is important to rest during recovery (and for more on that  herehere, and here are my videos on exercise).

You may be experiencing extreme hunger right now. It may be something that you will experience in the future. It is something that most likely makes you feel terrified beforehand, and extremely guilty after. It is something that may be heavily weighing on your mind (excuse the pun). You may think that you have lost control; that you are spiralling into a different eating disorder; that this is binging and you are never going to eat like a normal person ever again! You are not alone in those fears. I had them too. Extreme hunger is utterly anxiety-provoking. It feels as if it will never end, and it evokes a multitude of negative emotions and thoughts, including shame, terror, and disgust. The eating disorder will scream and scream and scream at you inside your head. It will do anything to stop you eating what you need to eat, and the more you eat, the louder it will usually scream.

This is an extremely chaotic time inside the mind of someone recovering, and you are not alone if you feel completely overwhelmed by your hunger and your eating disorder’s reaction to it. The eating disorder hates anything that goes against its cruel, life-threatening rules, so for something like extreme hunger to hit and be responded to is something that will enrage it. People also have fears that it is binge eating disorder – and these fears are understandable, given the volume of food that might be consumed. Yes, you will be consuming a large amount of energy. You might eat anywhere from 4,000 calories to 10,000+ (although the latter seems to be quite rare – but again, not unheard of and if you are experiencing this you are not the only one). This would be a lot of food for an energy-balanced body. But you do not have an energy-balanced body. You have a starved, damaged, energy-deficient, nutrient-deficient body that needs far more energy than a healthy, energy-balanced body, to get it back to that state of equilibrium again. This is okay. This is necessary for your body. You are not alone.

You may experience extreme hunger at the beginning of your recovery. You may experience it in the middle, or near the end. You may find that it comes and goes throughout your recovery. You may never experience it at all – and that is okay too. This could be because you may need less energy to repair internally – this does not negate your need to recover. It may be that you may have repressed hunger cues and find that you struggle to even eat your calorie guidelines let alone have any desire for more. Extreme hunger may come to you later, or it may not come at all. It may be that you are someone that finds that you eat a little more than what your body needs as an energy-balanced body for a long time and your healing is done more slowly.

It can also be that during extreme hunger you find that you are eating a certain type of food: sugar, carbs, and fats are generally the types of foods that are most highly restricted, and because of that, the body needs and craves foods high in these things. It is also easier for the body to quickly process and get energy from these types of foods. Those who are highly lacking in fats may find themselves eating jars of peanut butter – this seems to be quite common so don’t freak out if you are eating whole jars of peanut butter, nutella etc, and strange combinations also seem quite frequent during extreme hunger or recovery in general. You may find yourself chomping on lots of meat or iron rich foods. You may find yourself digging into ice cream, milk, cream, and cheese because you are deficient in fats or calcium. There is a reason for the foods you crave. Listen to your body and respond to it.

balance 2

The message that I want to get across is that if you have been through a period of restriction, experiencing a raging hunger is totally, absolutely, 100% normal. I want you to know that it is not forever, even though it feels like it could be, and even though that is your greatest fear. Your body will become energy-balanced (or close to energy-balanced) and the intense hunger will dissipate as your body gets healthier. Your extreme hunger may taper down, or it may vanish from one day to the next, but you will not have extreme hunger forever. Everyone I know who has gone through the entire recovery process has experienced extreme hunger, and they have come through it and out the other side. They have eaten whole cakes for breakfast, or pints and pints of ice cream, or whole cheesecakes, or whole large Thortons chocolate boxes (that one was me), and they have all been horrified; ashamed; fearful. They have all been scared witless that it would never end. They have all questioned whether they had gone from one extreme to the other and developed Binge Eating Disorder. And they have all, in one way or another, either come across information on the topic and been a little soothed until the hunger calmed down, or have freaked out and then, in time, found that the hunger normalised. If you (unsurprisingly) need help with anxiety management, check out my article on it here.

Why more research has not been done into this topic, I don’t know. I have talked to thousands of people in recovery since I began my journey over four years ago; on the Your Eatopia forums, on my blog, on this website, on my Youtube channel, and on my Instagram account, and one of the most frequent topics is extreme hunger. I don’t know why it has not been researched or recognised by many health professionals, and it is one of the most frustrating and saddening things for me when people are told not to respond to these very natural, obvious signals from the body. But I can say with conviction that if you are experiencing this, you are far from alone. You are okay. You are healing. Work with your body, not against it. Be strong, and patient, and kind to your body and your soul. What you are experiencing is normal, and expected, and you can get through this.

Celebrating the Day that I Chose to Live

2

TRIGGER WARNING.

This article contains before and after photographs of someone who has previously suffered with an active eating disorder, and also names eating disordered behaviours that they previously engaged in. This article could be triggering for vulnerable people, those with eating disorders, and those recovering from eating disorders.

Today holds an extortionate amount of significance for me: four years ago today I made the decision to make the first steps towards recovery from my mentally and physically destructive and severe mental illness: atypical anorexia. It didn’t feel like much would come from the vague, half-hearted decision, but it was a monumental moment that put me on the road to recovery. That moment has gotten me to where I am now: a healthy, happy woman who has been in remission from an eating disorder for over one and a half years, after an intense two and a half year battle in which I emerged victorious.

I’m well aware that I wrote a post last year which will probably be very similar to this one, but the topic isn’t an insignificant one: this day four years ago saved my life in many ways, and celebrating it is, in reality, celebrating the day I decided not to die slowly, and to fight tooth and nail for my health, my happiness, and ultimately, my life.

1

Four years ago today I was entirely, unequivocally, weary of being sick and miserable. I was weary of being in a living hell. I was weary with the despair and the darkness and the anger and the devastation. I was weary of watching my hair fall out in clumps in the shower; of watching it become thin and dry and brittle; of being dizzy; of living in a grey world where my senses were dulled as if my brain was smothered in cotton wool. I was fed up of the insomnia; of the nightmares; of the calories circling around my head all day and all night, leaving little space in my mind for much else. I was tired of counting down the minutes until I was “allowed” to eat; of the starving and compulsive exercising, and eventually, the purging; of the intense fear I felt at going anywhere near food; of the absolute and utter desolation of my mind and body that meant that I lived in a starving shell that could not function, and a mind controlled by  a single focus: lose weight lose weight lose weight. A focus that meant I could not think about anything else; could not deal with anything else. A focus that meant that I did not have to confront the emotions and experiences that had caused my eating disorder in the first place. A severe mental illness caused by a combination of genetics and my environment was my way of handling the world and myself, but finally, after 8 years, I had decided that this could not go on. At first, I viewed death as the only escape from the torment my eating disorder wreaked upon me, but moments of clarity started to push their way to the forefront of my mind, until the possibility of recovery developed from rejected thoughts to cautious actions. And over time my strength grew, and grew, and grew.

8

I know: you’ve heard it all before. You’ve read my posts or the posts of others, you’ve watched a loved one battle an eating disorder, or you’ve experienced it first hand. But today I also want to talk about where my recovery took me and how it might differ from that of others.

I have come across a lot of people who live under the title of “recovered”. It may be a title they have given themselves or a title a professional has given them. It doesn’t matter. What I see are a lot of very slim people who use the word “recovered”. Some of those people will be naturally slim – people whose natural, healthy weights are down the lower end of that “healthy” BMI category. And that’s great! All weights, shapes, and sizes are fab, as long as the person is at their natural, healthy weight and is healthy and happy. However, I tentatively would suggest that there are those that maintain a certain weight by closely monitoring and restricting their intake and controlling their exercise. And if that is where you end up at in recovery because you are unable at that point in time to go any further or feel that that is all you can manage, then I applaud your progress and your strength and bravery in getting to that point – you are amazing and strong and wonderful. Some people will manage their eating disorders and live with it in a state halfway between being free of their eating disorder, and being utterly consumed by it. That is absolutely okay, and if you want to call that full recovery, who am I to decide that it is not by your own personal definition? But I also want to stress that that is not where you have to be if you want to choose differently. You can push further. Whether that is now, or in the future, there is the option to press on forwards to a life where you live pretty much entirely free of your eating disorders influence. I know, because I decided to take the path to that place.

I decided to reject the idea of an “ideal” body. This took me a very long time. It took years of research into health at every size and weight set point theory. It took getting involved with feminism and the body positivity movement. It took learning about the impact of diet culture and how the diet and weight loss industry intentionally make us hate ourselves for profit. It took deciding to be as healthy and happy as I could possibly be in both body and mind. It took deciding to let go of the importance that I had placed on being a certain weight.

I turned out to be one of those people who naturally have a higher body weight than others. It can mean dealing with increased stigma around weight and size, and comes with knowing that I am at a weight where some people will look at me and decide that I am unhealthy/lazy/greedy, whilst knowing nothing about my lifestyle, or indeed myself as a person. Some people will look at me and see me as a weight/shape/size. I am also aware of my own weight privileges in that there are people at far higher weights than me that suffer a hell of a lot more stigma and discrimination. I am aware that although I am far from society’s “ideal” body weight, shape, or size, I still wear “acceptable” clothes sizes (as in, the clothes stores that I shop in cater for my size, even if it is a size some feel shameful about). It is also a size that I maintain effortlessly eating a balanced diet (and by that I mean I eat what I want, when I want, which leads me to eat a wide variety of foods from all food groups), and with physical activity that I do for enjoyment rather than to alter my weight, shape, or size, or any other disordered reasons. It is the size that I can live my life as a healthy and happy person. If I wanted to be smaller, I would have to focus on calorie restriction and possibly an excessive amount of exercise, and we all know where that would lead. Don’t misunderstand me: I’m not going to lie and say that if I had to option to do all this at a smaller size, then I would choose not to. Because of the importance society places on our bodies, being at a smaller size would mean not having to think about or deal with the discrimination of being at a higher weight, and I would rather choose not to deal with that. But my body and its weight/shape/size is not at fault for those stigmas, and nor am I. I accept my body. It is everyone else accepting my body as happy and healthy and beautiful that is the problem, because not everyone does. But that’s okay, because I choose my health and happiness over the approval of others. I choose me.

9

To get to where I am now, I chose to reject the ideas and ideals that are so entrenched in our culture and our society. I chose my actual health over the idea that you have to be a certain weight, shape, or size to be healthy. I chose my happiness over the absolute lie that you have to be a certain weight, shape, or size to be happy. Those lies are fed to us all day, every day, everywhere we look, but I just don’t buy it any more. I’ve seen enough evidence of all kinds to call bullshit. And I have decided to live my life in a way that means working with my body and letting it be whatever weight, shape, or size it needs to be to enable me to be healthy and happy. I will not change that for anyone. I choose me.

Orthorexia Nervosa: The Invisible Eating Disorder

veggies.jpg

Orthorexia Nervosa. Have you heard the term before? Many haven’t. “Orthorexia” is a word that is not yet an official eating disorder diagnosis, but is used to describe a particular set of eating disorder behaviours that are distinguishable from other eating disorders, although can be experienced in conjunction with other eating disorders (usually anorexia nervosa). It is also an eating disorder that is easily overlooked in a society obsessed with “healthy eating” and exercise.

Those suffering from orthorexia have an unhealthy obsession with healthy eating and healthy lifestyle, so much so that it becomes extremely rigid and restrictive in regards to food, and can also include compulsive and excessive exercise. Orthorexics can be obsessed with feeling “clean” or being “pure”, and generally fixate more on this than on body weight as a motivation for behaviours. Orthorexics can also feel morally superior for the choices that they make in regards to their lifestyle, and the way they view themselves becomes entangled with the way they live their lives and what they put into their bodies or do with them. Orthorexics can find that their diet becomes so restrictive in both calories and food variety that it can become extremely physically unhealthy as well as mentally. This can also be the case in regards to excessive exercise. Like other eating disorders, it will end up becoming a top priority for the sufferer, and they can end up isolated.

In a culture that celebrates weight loss, calorie and food group restriction, and exercise, it is easy to go unnoticed if you have an eating disorder at a “normal” weight, but even easier if you have orthorexia. In a society that focuses so much on health, those with orthorexia will more likely than not be congratulated for their “healthy” life choices, determination, perseverance, and motivation. Others may aspire to be like them because they appear to work so hard at being healthy, whilst in reality they are driven by a relentless and miserable force that has nothing to do with being healthy and more to do with being mentally ill. That mental illness will be driving that person into the ground both mentally and physically with its extreme rules and restrictions, and that may go unnoticed in amongst the admiration of others.

Eating disorders are terrifyingly common, let alone the phenomenal amount of people living with disordered eating (issues with food, weight, etc, that are not a mental illness but are a problem). Our preoccupation with a “healthy” lifestyle and our celebration of “healthy choices” is misplaced. Living a healthy lifestyle is great, but we are missing the bigger picture: so many people are utterly miserable trying to achieve goals that are usually more about being thin than being healthy, or are driven by guilt and shame about not being “healthy” enough. In trying so hard to be physically healthy, we are sacrificing mental health, which is just as important – if not more so. With our food/weight/exercise/health obsession, and the equation of “health” with morality, no wonder so many eating disorders go undetected. It is a culture for eating disorders to thrive in, and that horrifying truth is something that we need to recognise and address.

So could you recognise orthorexia? Do you think you may have it yourself? The Timberline Knolls website talks about orthorexia and how to recognise it particularly articulately, so I have put it below. If you want to read more information on it, just click the link above.

Orthorexia is the term for a condition that includes symptoms of obsessive behavior in pursuit of a healthy diet. Orthorexia sufferers often display signs and symptoms of anxiety disorders that frequently co-occur with anorexia nervosa or other eating disorders.

A person with orthorexia will be obsessed with defining and maintaining the perfect diet, rather than an ideal weight. She will fixate on eating foods that give her a feeling of being pure and healthy. An orthorexic may avoid numerous foods, including those made with:

  • Artificial colors, flavors or preservatives
  • Pesticides or genetic modification
  • Fat, sugar or salt
  • Animal or dairy products
  • Other ingredients considered to be unhealthy

Common behavior changes that may be signs of orthorexia may include:

  • Obsessive concern over the relationship between food choices and health concerns such as asthma, digestive problems, low mood, anxiety or allergies
  • Increasing avoidance of foods because of food allergies, without medical advice
  • Noticeable increase in consumption of supplements, herbal remedies or probiotics
  • Drastic reduction in opinions of acceptable food choices, such that the sufferer may eventually consume fewer than 10 foods
  • Irrational concern over food preparation techniques, especially washing of food or sterilization of utensils

Similar to a woman suffering with bulimia or anorexia, a woman with orthorexia may find that her food obsessions begin to hinder everyday activities. Her strict rules and beliefs about food may lead her to become socially isolated, and result in anxiety or panic attacks in extreme cases. Worsening emotional symptoms can indicate the disease may be progressing into a serious eating disorder:

  • Feelings of guilt when deviating from strict diet guidelines
  • Increase in amount of time spent thinking about food
  • Regular advance planning of meals for the next day
  • Feelings of satisfaction, esteem, or spiritual fulfilment from eating “healthy”
  • Thinking critical thoughts about others who do not adhere to rigorous diets
  • Fear that eating away from home will make it impossible to comply with diet
  • Distancing from friends or family members who do not share similar views about food
  • Avoiding eating food bought or prepared by others
  • Worsening depression, mood swings or anxiety

You can also read my article ‘Food Is Not A Moral Issue’ here.

 

Exercise (pt 2): Exercise and Eating Disorders

exercise addiction

This is the second part to the article I wrote last time, which talked about exercise in general and the way that an unhealthy mindset around exercise has infiltrated our society as a whole.

Today I want to talk about exercise and eating disorders.

Like I spoke about two weeks ago, nearly everyone views exercise as something that is healthy, regardless of how it is used. During my recovery from my eating disorder, I told a friend about my compulsive exercise and about how I was trying to challenge it because I was doing x amount of exercise a week because I felt that I had to, and hadn’t been able to stop myself from doing it even when I didn’t want to. She genuinely replied with “Yeah but that’s fine because exercise is good!” Because we have such a warped view about exercise, many people don’t seem to understand how detrimental it is to those with eating disorders, especially when it doesn’t appear to be severe.

Some people with eating disorders push themselves to the extreme when it comes to exercise. Some people exercise for five hours a day, and some more. Some people never let themselves sit down – ever – except when sleeping (and I’ve even known someone to sleep standing up). It is easier for people without eating disorders to understand why this might be a problem, but when you are someone with an eating disorder who exercises in a way that people might perceive as inspiring and healthy; in a way that people might see as #goals; in a way that people aspire to, you may end up with congratulations rather than concern.

For those who have exercise addiction, you can’t just stop when you want to, or give yourself a day off (unless you already have a “scheduled” day/time, and then it must be that day/time and none other). You will miss social events if it coincides with your sessions. You will feel incredibly anxious before exercising, and after the exhilaration of finishing a workout has subsided, you will feel the dread of knowing that in less than 24 hours you will be repeating the same monotonous and exhausting work out. You will continue with your exercise routine however much you don’t want to do it, however tired you feel, or however sick you are. It is not enjoyment that drives someone with exercise addiction: it is the perceived need to do so.

As well as being mentally draining, compulsive exercise (also known an obligatory exercise or in extreme cases, anorexia athletica) can have a negative effect on the body. Firstly, by working out intensely every day, the body is being put under a lot of strain, and is not being given any time to recover, which is needed. Those addicted to exercise will work out even if they are ill or injured, which could have serious consequences to their health, including damage to tendons, ligaments, bones, cartilage, and joints. When injuries happen and are not given enough rest to heal, this can result in long-term damage. If the body is not getting the nutrition that it needs, muscle can be broken down for energy instead of building muscle. Girls and women could disrupt the balance of hormones in their bodies, which can change menstrual cycles and even lead to the absence of them altogether. It can also increase the risk of premature bone loss, which is known as osteoporosis. The most serious risk is the stress that excessively exercising can place on the heart, particularly when someone is also restricting their intake, or using self-induced vomiting to control their weight. Using diet pills or supplements can also increase the risk for heart complications. In worst case scenarios, restrictive eating disorders and compulsive exercise can result in death.

The reasons behind exercise addiction can be complicated when it comes to eating disorders. For many people it is an additional means of furthering and/or quickening weight loss, or it could be the main part of someone’s eating disorder, in order to get “fit” or muscular (anorexia athletica). It could be about control. It could be, like the rest of the eating disorder, a form of distraction from feeling or thinking certain things. It could be part of orthorexia (an obsession with eating “healthy” or “pure” foods and leading “healthy” or “pure” lifestyle). Athletes, dancers, wrestlers, gymnasts, and other people who are fixated with keeping in shape and keeping their weight down for their careers are also susceptible to developing exercise addiction.

Although it is not listed in the Diagnostic and Statistical Manual of Mental Disorders, exercise addiction is a serious and potentially life-threatening obsession, and needs to be taken extremely seriously. It is not just a strain on the body but a strain on the mind. It is absolutely exhausting, and completely miserable to experience. It can take up a huge amount of your life and a huge amount of your thoughts, and is extremely unhealthy for your physical and mental health. Whether it  is the main part of an eating disorder, a lesser part of an eating disorder, or a disorder on its own, compulsive exercise is serious. It is something that must be challenged and overcome as part of recovery from an eating disorder, and must be ceased until the unhealthy relationship with exercise is broken and remade into something healthy. Only in remission can someone make an informed and healthy decision about whether to restart exercise and how much/what to do in regards to moving their body. Even then, it’s a fine line.

I talk more about a healthy relationship with exercise in part 1.

If you think you may be developing/have developed an addiction to exercise, seek medical help from your GP.

Signs that you or someone you know may be suffering from compulsive exercise include (but are not limited to) the following:

  • Not enjoying exercise sessions, but feeling obligated to do them
  • Seeming (or being) anxious or guilty when missing even one workout
  • Not missing a single workout and possibly exercising twice as long if one is missed
  • Seeming (or being) constantly preoccupied with his or her (or your) weight and exercise routine
  • Not being able to sit still or relax because of worry that not enough calories are being burnt
  • A significant amount of weightloss
  • Increase in exercise after eating more
  • Not skipping a workout, even if tired, sick, or injured
  • Skipping seeing friends, or giving up activities/hobbies to make more time for exercise
  • Basing self-worth on the number of workouts completed and the effort put into training
  • Never being satisfied with his or her (or your) own physical achievements
  • Working out alone, isolated from others, or so that other people are not aware of how much exercise is being done
  • Following the same rigid exercise pattern.
  • Exercising for more than two hours daily, repeatedly

(sites used for reference and more information: 

http://www.brainphysics.com/exercise-addiction.php
http://addictions.about.com/od/lesserknownaddictions/a/exerciseadd.htm
http://kidshealth.org/parent/emotions/behavior/compulsive_exercise.html
http://en.wikipedia.org/wiki/Exercise_addiction )

Treatment and Support Options for Eating Disorder Recovery

support

Recovery will be the best choice you have ever made for yourself. You will be choosing life over death. You will be choosing health over sickness. You will be choosing happiness over misery. However, recovery can be daunting. It can be terrifying and extremely difficult and immensely challenging. It can bring with it feelings of anger, guilt, sadness, shame, anxiety, and pain. It can leave open wounds that you were trying to cover by using your eating disorder as a band aid. It can uncover truths and experiences and memories you were trying to suppress. Because of this, it is important that you use all opportunities given to you in the form of professional support. This can be harder in countries where you have to pay for all professional help and do not have the NHS, but it is still possible to find help and support even if you are strapped for cash.

In this post I am going to go over some of the treatment and support options that you might want to consider.

Inpatient/hospital 
Inpatient treatment would be provided in a hospital setting. The main aim of inpatient is to medically stabilise the patient and get them back to a healthier weight, before discharging them. In most cases they would be discharged to a residential setting for continued care.

Residential
People using these services reside at a live-in facility where they are provided with care at all times. This means that they are under constant medical supervision and monitoring of both physical and mental health. Treatment programs within residential facilities are usually very structured, and they provide an environment in which the client can focus solely on physical and psychological healing with a great deal of support from their treatment team.

Intensive Outpatient (IOP)
Intensive outpatient is suited to those who need more professional support than outpatient treatment but still need flexibility to continue their education or job. IOP Programs generally run at suitable times for the participant, ranging from 2-5 days a week. Treatment usually includes therapy, nutrition consultation, topic focused groups, and/or family support groups.

Outpatient
Outpatient is much less restrictive than inpatient, and is good for those who have a job or are attending school or any other form of education. It is also an option for those who do not have the insurance to cover higher levels of care, but still really need a moderate level of support to aid their recovery. Those in outpatient programs may see a therapist, nutritionist, and other recovery professionals around 2-3 times per week.

Therapy
For those who don’t want to consider inpatient, outpatient, or residential, or who cannot get a placement for any reason (and that will be the majority of those with eating disorders), there are many options where therapy are concerned: Cognitive Behavioral Therapy (CBT), Medical Nutrition Therapy, Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT),  Art Therapy, Dance Movement Therapy, Equine Therapy, Exposure and Response Prevention Therapy (ERP), Family Therapy, Interpersonal Psychotherapy (IPT), Cognitive Analytic Therapy (CAT), The Maudsley Method (also knows as Family-Based Treatment), and Mindfulness-Based Cognitive Therapy (you can find out more about these therapy methods here, here, here, and here).

For those who cannot afford therapy and are in education, see if your school, college, or university has counsellors on site that may be able to provide you with free support. You may also be able to find therapists at reduced costs who have been fully trained but have not clocked up sufficient hours yet.

Support Groups
If you cannot afford any therapy, cannot get any using the NHS, and are not in education or have none in your educational institution, check out if there are any support groups near you that you can utilise.

If you cannot find a therapist or support group, you could ask the NEDA Navigator service to help you find support in your area – wherever you are from – or just to vent to and get some support from. (Beat also have a HelpFinder).

Doctors
If you can, do make sure you are seeing your doctor regularly, or at least semi-regularly, to get updates on your health. Again, I know this can be a money issue for a lot of you, but it is really important that you know where you are where your health is concerned. Doctors can also help you find support groups, and give you referrals for therapy, inpatient, or outpatient programs.

Helplines
If you are struggling to find any support, do know that there are many helplines available. There is NEDA’s information and referral helpline (there is also a Click to Chat option so you can instant message if you would prefer to do it that way), there is BEAT’s 1-2-1 Chat Online service, BEAT’s online services, and BEAT’s helplines.

Forums
I would advise being careful with forums, as they can often lead to triggering discussions, but if you are going to visit forums (and they can provide invaluable help and support) I would advise BEAT’s forums, NEDA’s forums, or the forums on Your Eatopia (the latter has a tiny fee but I would say it is really worth it – personally it helped me more than anything during my time in recovery).

Self Help
There are self help options such as books on certain therapies (like CBT workbooks), anorexia and bulimia workbooks, other eating disorder workbooks, online resources etc that can help you work through your issues with the help of workbook exercises, challenges, and reflection.

I hope that if you struggling and don’t know which way to turn, this comprehensive list enables you to find help and support during your recovering from your eating disorder.

If I have missed any that are important, do let me know!

Men Get Eating Disorders Too

eating-disorder-mirror-drawing

Eating disorders are stereotypically seen as an illness that young, white, females develop. Whilst this is obviously an outdated myth and anyone of all ages, genders, and races can experiencing eating disorders, there are still a huge amount of people ignorant to the fact that many men suffer from eating disorders too and it is just as serious when men suffer from them as when women do.

Studies suggest that eating disorders are on the rise in men. However, it is also theorised that this may be because eating disorders in men are becoming less stigmatised and more men are coming forward and seeking help and treatment for their illness. Out of those with eating disorders, it is reported around 10% of sufferers are male, although again, these statistics are unreliable due to the fact that so many men do not come forward for treatment, and a recent study on a large university campus found that the female-to-male ratio of positive screens for eating disorder symptoms was 3-to-1 (Eisenburg, Nicklett, Roeder, & Kirz, 2011). As it says on the website MGEDT:

“Conflicting and poor quality data is one of the biggest problems in pinning down the full extent of eating disorders in the UK and indeed the world. According to Beat information from the Department of Health only shows how many individuals received inpatient treatment. This only captures only a very small percentage of cases, since as much as 50 per cent of treatment is provided by private clinics and only the most severely ill will receive inpatient care.”

Through large scale surveys it was found that in the past thirty years, male body image concerns have increased severely, with 15% to 43% of men being dissatisfied with their bodies; rates that are comparable to those found in women (Garner, 1997; Goldfield, Blouin, & Woodside, 2006; Schooler & Ward, 2006). In adolescent and college samples, between 28% and 68% of males of normal weights saw themselves as underweight and reported that they had a desire to increase their muscle mass through dieting and strength training (McCabe & Ricciardelli, 2004; McCreary & Sadava, 2001).  (Statistics and sources taken from the NEDA site)

So why do boys and men get eating disorders? Just like with girls and women, the reasons are vast and complex. Bullying, abuse, dieting, feeling pressured whilst engaging in sport, having a career that demands thinness (such as modelling or acting), and diet culture can all be a catalyst in the develop of an eating disorder in men (and these are just a tiny selection of the things that can trigger an eating disorder). It is also shown that the media is having an effect too, and that exposure to male body ideals are causing men to compare themselves to these ideals and this is positively correlated with the drive for muscularity in men. The fact that we are living in a society that still places importance on gender roles and traditional masculine ideals means that males have negative attitudes towards seeking psychological help. In addition to that, we are not identifying eating disorders in boys and men:

“Doctors are reportedly less likely to make a diagnosis of eating disorders in males than females. Other adults who work with young people and parents also may be less likely to suspect an eating disorder in boys, thereby delaying detection and treatment. A study of 135 males hospitalized with an eating disorder noted that the males with bulimia felt ashamed of having a stereotypically “female” disorder, which might explain their delay in seeking treatment. Binge eating disorder may go unrecognized in males because an overeating male is less likely to provoke attention than an overeating female.  This inferior image, among other things, contributes to the reality that 1 in 10 cases of eating disorders involve males. Particularly, for the disorder anorexia, up to one in four children referred to an eating disorders professional is a boy.” (ANAD)

Even though the stigma may be dissipating, it’s still there, as illustrated by the experiences I have been hearing about. One male wrote to my blog to tell me that his doctor told him he could not have anorexia because he could not experience amenorrhoea as he had no menstrual cycle to lose. Another man told me his doctor thrust a leaflet about eating disorders into his hands and offered no other information or support. It is extremely worrying to hear that even professionals are dealing with males with eating disorders in a way that is so dismissive and also shockingly ill-informed.

Men also find it extremely hard to talk to other people about it, because of the sense of shame they may experience in relation to having an eating disorder, and again, this is down to stigma in our society. They are afraid of being judged, and they are afraid of the negative reactions of friends who might laugh it off and dismiss it or make fun of them for suffering from an eating disorder, because it is still to some extent seen as a “girl’s illness”.

Eating disorders can also be harder to spot in some men because it is more likely for women to have dramatic weightloss, whereas in men their eating disorders can expressed through “bulking up” and hitting the gym, which is not seen as particularly suspect in a society so keen on advocating exercise and showing male body “ideals”. as lean and muscular.  It is important to note that if an individual is taking performance-enhancing supplements in their attempt to become more muscular and then engages in weight lifting, they are at increased risk of suffering a heart attack or stroke.

It is of paramount importance that we recognise eating disorders in boys and men as much as we recognise them in girls and women. It is of paramount importance that we start treating them just as seriously and it is of paramount importance that we continue to reduce the stigma surrounding males and eating disorders so that those suffering will come forward for help and support, from their doctors, from their friends, and from their families.