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Is Intuitive Eating a Good Idea in Eating Disorder or Dieting Recovery?

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Intuitive eating is a concept that really resonates with me. In a society entrenched with diet culture, a huge percentage of people have lost the ability to trust their bodies, and instead opt for counting calories or macros, or eliminating food groups, or trying out various juice fasts, veggie cleanses, cabbage soup diets…the list of restrictive diets and ways to self starve is endless. The fact that we do not ignore other bodily signals: emptying our bladders or bowels; sneezing; coughing; itching; removing our fingers from a burning surface; blinking; but ignore our body’s signal for hunger and then call it a good thing is absurd. We have decided to stop trusting our biological body; a body built for survival, and instead listen to the multi-billion dollar diet and weight loss industry, our unhealthy thin-obsessed culture, and the media which panders to both (again, to make money). It is nonsensical. It is ridiculous. It is madness. And yet nearly all of us are guilty of listening and responding to it.

Intuitive eating is a nutrition philosophy based on the premise that becoming more attuned to the body’s natural hunger signals is a more effective way to attain a healthy weight, rather than keeping track of the amounts of energy and fats in foods.

This is why I love the idea of intuitive eating (although do remember when reading the above that a “healthy weight” is whatever your body needs to be at naturally, and has nothing to do with BMI). Reconnecting with your body; listening to it; honouring its cues and signals; respecting it and giving it the treatment it needs and deserves…this is exactly the right attitude to have, and exactly the right action to take. However, when it comes to recovering from the effects of dieting, or even more serious, an eating disorder, intuitive eating becomes a little trickier to throw yourself into.

Months or years of damages done to the body through restriction can cause huge issues with the way the body communicates with you, especially when it comes to hunger. Your hunger cues may have become suppressed, and therefore will be unreliable during the recovery process. When this is the case, it means that both hunger for the correct amount of energy and cravings for the right types of foods that the body needs won’t be felt by the person experiencing this, and so intuitive eating would be a disaster for them. It would mean that they would not get the energy that their body needs for daily energy requirements, and would not get the types of food that the body needs and nutrients that the body is lacking in. For these people, intuitive eating would not be something that they could jump into straight away, and would have to be a goal for later on in the recovery process. Those without reliable hunger cues would need to count calories to ensure that they are eating enough (I wrote about calorie counting in recovery here), and also keep an eye on the types of foods that they are eating to make sure that they are getting enough of each food group.

Those with reliable hunger cues will find that they are able to move to intuitive eating sooner, although I would always suggest counting at first whilst you establish if you have reliable hunger cues or not (and I have a video on when to know when you are able to eat intuitively here). Those with reliable hunger cues may find themselves ravenously hungry, or may be hungry for the amount that they need day to day, and then find themselves absolutely starving most of the time. This is normal and expected and in recovery is called “extreme hunger” (I have a video on this here). This is something those in recovery often experience, but not always. Those with reliable hunger cues find that they are hungry for the amount of energy that their body needs each day.

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Some people in recovery go through periods of both reliable and unreliable hunger cues, and during this time it is best to keep counting calories and keeping an eye on what you are eating until you are receiving consistently reliable hunger cues.

For both those who have reliable and unreliable hunger cues it is important to make sure that you are eating all food groups, as they are all important for health. It is important to note for both those with reliable hunger cues and those with unreliable hunger cues that it is normal in recovery from restrictive eating disorders or dieting to crave foods that are high in energy, especially foods with a high fat, sugar, or carbohydrate content. This is because processed food can be one of the best things for recovery, especially during the initial stages. Foods high in energy help to fill the calorie deficit and repair the extensive damage done through starvation, as well as providing energy for the day. Foods high in fat help with regaining your period, aid bowel movements, and most importantly, the brain is made of at least 60% fat which requires eating fat in order to heal and maintain its health. Fat is also most easily processed by the body, which is quite essential to your damaged digestive system. Usually in recovery people crave “junk” food because this is just what their bodies need, and that is okay. If you are eating far more carbs than any other food group, that is okay. If you are eating far more sugary foods than any other food groups, that is okay. What is not okay is if you are only responding to these cravings and not having any other food group. Responding to the cravings is really important, but it is also important that you don’t go without an entire food group. Some people find that whilst their bodies are busy craving foods high in energy, it can end up not sending signals for fruit and vegetables. It is quite common for those with eating disorders or even dieting to have issues with filling up on fruit and veggies, and for these people, cutting down and thinking about it less is the goal, but for others, they can find that in recovery they can have reliable hunger cues for the energy that their body needs, but do not have the cravings for all the food types that it needs. The body, in this way, is being reliable in letting you know exactly what it needs in order to become energy-balanced (by craving foods high in energy), but has made this a priority and is not giving the right signals in order for the body to get all the nutrients that it needs. So if you realise that you are going days without fruit or veggies, make sure to incorporate some into your diet. Don’t become rigid or fixed upon a certain number, but just make sure you are having some throughout your day. The same applies to any other food group that you might find yourself not eating through lack of cravings.

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Whilst many people crave “junk” food, you may also experience cravings for dairy, cereal, and meat/fish. You can have cravings for anything! You may also find that you have cravings for odd combinations of food, and that is perfectly normal too. Just respond to what your body is asking for.

If you are experiencing extreme hunger and/or having intense cravings for only one food group or particular type on food – don’t panic. Appetite settles down when the body is healthier to include cravings for a massive variety of foods: chocolate, milk, fruit, cereal, doughnuts, pizza, pasta, vegetables, fish, steak, cake….EVERYTHING. No foods should ever be off limits, and your body will start giving you more and more reliable hunger cues as your body gets healthier and healthier, until you are able to really connect with it and trust it. Throw out your magazines. Forget the media. Forget diet culture and societies unhealthy obsession with thinness. Trust your body and work with it. There is no wrong way to have a body (and please please please check out weight set point theory, and health at every size under my resources section).

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For some people, intuitive eating can be something that they start doing fairly early on in recovery from an eating disorder or dieting, but for others, it can take time for their bodies to adjust and be able to communicate correctly. Whichever is the case, intuitive eating is a fantastic goal to work towards, but it is important to recognise that it can take time, patience, and perseverance. I would always suggest it be the goal, and would never want anyone to have to return to listening to diet culture – it’s what got a lot of people into a terrible place emotionally and physically in the first place (particularly those recovering from dieting as eating disorders are nearly always a lot more complex . However, recovery is certainly not helped along by diet culture). Listening to your natural, biological, earth-given body is the best thing to do for your mental and physical health when it comes to eating. Not concepts created by society. And always know that food is not just about nurture and nourishment, but about pleasure and enjoyment too. Do what makes you happy and healthy, both physically and mentally. You deserve it.

Digestive Distress in Eating Disorder Recovery

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So you’ve started recovery from a restrictive eating disorder, and suddenly you’re experiencing tummy troubles: troubles you may or may not have been expecting. I know that when I started recovery, I was unprepared for the physical symptoms and did not attribute some of them to recovery process. I wish I’d known more: my mum and I were baffled when I started sweating so profusely at night that I was soaking the sheets through, and I thought I had Chronic Fatigue Syndrome at one point when I was unable to even sit up in bed I was so tired. Both of these are normal recovery symptoms (sweating lots indicates your metabolism speeding up, and exhaustion is your body telling you to rest and repair).

The first set of symptoms to normally occur, however, are those related to your digestive system: gas, bloating, constipation, diarrhoea, acid reflux, indigestion, partly digested food, abdominal pain, and having very frequent bowel movements. These symptoms are not fun, and they are certainly not comfortable. However, recovery is about persistence.

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Restriction has a huge affect on the body, and with the digestive system, if it the body isn’t processing food regularly and consistently, it will stop wasting energy on working so efficiently. The digestive system slows down: a healthy person’s digestion rate is about 1.5 hours, whereas someone who has been starving themselves can have a digestion rate of 4 or 5 hours. This means that when you start to nourish your body with adequate and consistent energy, the digestive system will need a while to catch up. During the beginning of your recovery, because your digestive system will be working slower, food will sit in the stomach or bowel longer than it should do, which can result in abdominal distension, gas, and constipation. Or the body can go I’VE FORGOTTEN HOW TO PROCESS THAT, which can result in diarrhoea.

Restriction also can result in critical bacteria in the gut being reduced, and digestive enzyme levels being not as they should be, which also contributes towards digestive issues.

Wastage of muscles in the abdominal area can also cause distension as the muscles are not strong enough to hold things in more firmly when food is eaten. Do remember though that your stomach will distend slightly throughout the day naturally – the more food, the more your stomach will distend, and this normal and healthy. Those in recovery though will often find that the bloating and distension is far more extreme than that of a healthy person -and that is normal for the recovery process. Remember that your stomach has most likely shrunken during starvation, and will need to be stretched back to a normal size with refeeding. This is not going to be a great feeling, and it is likely to cause pain and tenderness.

The other thing to talk about is IBS and food sensitivities. During your eating disorder, your body can become unused to processing certain foods, for example, carbohydrates could be one. Dairy products could be another. This could lead you to think that you have a gluten or lactose intolerance if in recovery you start to reintroduce foods like bread, pasta, biscuits, cakes, and pastries, and/or ice cream, cheese, chocolate, and milk back into your diet and you get adverse digestive effects. However, this is generally not the case. If your body has become unused to processing foods that you have restricted for a long time, it is logical that it will now have to work up a tolerance again (like babies have to). It does not mean that you will be permanently intolerant. Abstaining from these foods that you are sensitive to will only mean that the body never gets used to processing it again. Refeeding and reintroducing these foods slowly into your diet – with the help of a doctor if the results are severe – will help your body develop a tolerance to them again and heal the gut. The same is true of IBS. Your doctor may have diagnosed you with IBS if tests for other conditions came back negative. Most of the time, sensitivities and IBS are resolved with refeeding, so give it time. Recovery requires patience and perseverance, so bear with the discomfort and keep on going. If after years, certain symptoms have not resolved themselves, then it is time to look for other causes, but this is fairly uncommon. Obviously if you have diagnosed food allergies or diseases/conditions such as Celiac disease, Crohn’s or ulcerative colitis, neuropathy disease, or have any obstruction in the GI tract, or have any other diagnosed medical condition that would be dangerous and cause damage to you if you were to increase certain foods/types of foods into your diet, then the paragraph above does not apply to you.

So, onto gas. This is probably the most awkward of the recovery symptoms. Smelly gas; loud gas; persistent gas; gas that wakes both you and your partner up with a start when you trump in the night (yes, that happened to me). It can feel embarrassing, but it’s one of the most common symptoms in recovery. If it happens in front of someone (which it probably will) just giggle about it. It may even help to pre-warn them if you are happy to let that person know that you are in recovery from a restrictive eating disorder. It means that they will be expecting it and you can laugh about it (which you can do even if it is a surprise). Everyone farts- you’re just going to be letting off wind a hell of a lot more than the average person for a while.

Frequent bowel movements are also normal. This can be a sign of your digestive system speeding up. I went to the toilet to poop up to seven times in a day for a while (yup, really). If your bowel movements are loose, this could be the I’VE FORGOTTEN HOW TO PROCESS THAT from above.

It is important to continue to eat, even when it is the last thing that you want to do. If you are experiencing a lot of pain, then it is okay to give yourself a break and eat when it feels more tolerable, but discomfort and slight pain is normal and it is important to eat adequately and consistently. However, if you are worried about any symptoms that you are experiencing, please see a doctor to determine if there is anything other than the normal recovery process going on in your body.

So how do you deal with these recovery symptoms?

Firstly, if you are experiencing constipation, eating fats can help move things along. Getting some fibre never goes amiss to prevent it from happening, but this is recovery, so doing healthy people things won’t necessarily work. Warm water is also extremely helpful for constipation – I’d never heard of it before but it has saved me a couple of times. If your stomach is not feeling so great, herbal teas can help settle it, and a hot water bottle can help ease pain or discomfort. For acid reflux and indigestion, there are over the counter medications that you could use, or you can visit your doctor for other options.

I know it sucks, but don’t give up – these symptoms do not last forever. Be patient, and stay on course. Keep moving forwards. As Churchill once said “If you’re going through hell, keep going.” You will come out the other side.

Treatment and Support Options for Eating Disorder Recovery

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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

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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.

Shouldn’t I Be Recovered By Now?!

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In recovery, it is easy to become impatient with oneself about the time it is taking. We can often find ourselves wondering if it is not time that we are fully recovered already. Human beings seem to be particularly easy to agitate when quick results are not apparent.

However, recovery takes time. And by time, I mean it could take years. It could mean moving forwards bit by bit over a long period of time, overcoming obstacles at a slow but steady rate. It could mean overcoming many obstacles within the first six months but then finding that certain habits and thought patterns are lingering, and taking the next couple of years working on those leftover aspects of your eating disorder. It could mean mentally recovering within a year but physically recovering within three. It could mean physically recovering within a year but mentally recovering within five.

You have to be patient: patient with your body, and patient with your mind. You have to put all of your determination, dedication and perseverance into your recovery and realise that it is going to be exhausting and time-consuming for quite a long time, but the outcome is going to be worth it.

You may think that you are recovering too slowly and that you should be done with it by now, but you have to let the body and mind heal at its own pace. You can’t force yourself into remission. There is so much to work on, and undo, and repair from. Recovery is a delicate process, and it is a journey. Like with all journeys, it’s not just the destination that is important: it’s also what you learn and discover along the way that makes for a robust and stable remission.

After 18 months in recovery, I was pretty stable, but I still had lingering eating disorder thoughts and habits: counting calories, weighing food, a fear of white carbohydrates, unhealthy exercise habits, and an intense dislike of my body. It felt like these things were never going to go away because they were habits that were persisting even though I kept trying over and over again to challenge and overcome them. I felt like I was bashing my head against a brick wall. Then I tried knocking down the brick wall. I tried climbing over it. I tried driving a vehicle into it. I tried to find a way around it. Nothing seemed to be working, and I was giving up with it. I felt like my recovery had come to a dead end, and that I was going to progress no further.

Sometimes in that time period I felt like going back, because I wasn’t going forwards, and I wanted to be moving somewhere. However, I kept at it, and continued developing and growing in front of that brick wall. Then one day, I realised the wall wasn’t there any more. It sounds too good to be true, but that’s honestly what happened. I had been avoiding white pasta and rice, and continuously choosing wholemeal or wholegrain bread over white bread for a really long time, and had also been spending countless occasions forcing myself to eat white carbs when I suddenly realised that I was now eating them without any anxiety whatsoever. I can’t pinpoint when it changed for me. I just one day recognised that I had been eating white carbs without anxiety for a while, and wasn’t trying to avoid them any more.

The same thing happened with the other habits. One by one, they stopped becoming an issue. What once seemed like an impossible task became something that I had faced and overcome. I stopped weighing my food, I learned to use exercise in a healthy way, I accepted my body as it is naturally, and I stopped counting calories. I had tried so hard to force the wall down, but in the end, it came down in its own time, and the effort was in staying facing that wall rather than turning my back on it and walking back the way I had come.

Be gentle and kind and patient with yourself. You are recovering from something that is very complex, and very severe, and it is going to take time. Don’t pressure yourself or set a time limit as to when you think you should be recovered. Allow yourself all the time in the world. That time will help you.

MinnieMaud: Is It the Only Way to Recover from a Restrictive Eating Disorder?

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I have had quite a few people ask me if I believe that MinnieMaud is the only method of recovery that will result in remission. The answer to that question is not simple, so I have gone ahead and written over three thousand words on the topic.

MinnieMaud (MM) is the name of a recovery method with guidelines constructed by Gwyneth Olwyn, on her site Your Eatopia. Whilst MM has received much criticism, and is seen by some as controversial, many inpatient and outpatient facilities do enforce methods alike to MM, such as similar calorie requirements, and remaining sedentary. Other people find that they end up recovering in a way much like MM without having ever heard of that particular recovery method (for example Caroline, from The Fuck It Diet), and I would argue that that is because this type of recovery is normal and natural for the body.

As I see it, the main goals are:

– To eat minimums, and respond to any additional hunger and cravings
– To not engage in exercise
– To eat whatever you want, whenever you want
– To not weigh yourself (be blind-weighed if needed)
– To accept your body, and anyone else’s body, at whatever size it is naturally, and not try to control your weight, as your body does that for you (weight set point theory)

To the present me, these aren’t particularly controversial ideas, but with diet culture being so prominent in our society, I can see why some find it hard to accept, and in the past, I myself was one of those people doing furious amounts of further research and questioning what I read when I first came across Your Eatopia. I looked all over the internet. I asked other people about it. I relentlessly emailed Gwyneth about my doubts (and she always took the time to reply). I didn’t agree with all of it (and arguably I still don’t agree with some of the content of her blog posts), but I knew deep down that so much of the information was making sense to me. A lot of the posts were talking about things I had experienced during recovery and up until that point had had no idea what it was that was happening to my body. Reading the articles gave me a great deal of relief in finally having a logical explanation for the processes that my body was going through. So much of it clicked into place for me, and in hindsight seemed obvious.

I believe that during recovery it is crucial to eat “minimums”. When it comes to these “minimums”, I find it so important that people should follow them because if you let there be a grey area during recovery, it will be easier for the eating disorder to wedge its way into those cracks and convince you that you require less calories than other people (and less, and less, until you realise you have relapsed). It is necessary for everyone to stick to the “minimums” for at least most of their recovery journey, until they are stable and responsible enough to listen intuitively to their hunger. When this happens, things are slightly different, as appetites naturally vary from person to person. For example, my hunger generally leads me to on average 2800 calories, whereas someone else’s hunger may lead them to on average 3200 calories, and someone else may find themselves eating on average 2900. For older people, calorie requirements are often a bit lower (this is also taken into account with the “minimums”). Gwyn says that minimums are for life, and I interpret that to mean around minimums are for life, leaving room for natural variation. Eating minimums during the recovery process and then eating a slightly lower amount intuitively will not result in more than needed weight gain, as your body will burn off excess calories, or use them for the essential repair of the body. In fact, you are almost certain to experience extreme hunger at some point during recovery, and it is pivotal that you respond to it.

As for exercise, in recovery it is just as crucial not to engage in it as it is to eat minimums. To me this seems extremely obvious now (hindsight is 20/20 after all), but apparently not so to some professionals, and more understandably, those in recovery. If you have a broken leg, you would rest it until it was healed. To walk on it would not only prevent the healing of it, but it would make it much worse. This also applies to a damaged body. Not only that, but physical activity is a massively used and abused technique of the eating disorder’s to burn calories and exercise control (excuse the pun). The eating disorder is also an expert at convincing you during recovery (a vulnerable time) that exercise is healthy and needed, and that you can use it in a responsible way. It is very easy to fall into the trap of denial when it comes to this topic, and this was my biggest issue when it came to my own recovery journey. Just like calorie requirements, in remission it is different. In remission you are in a place where you can make an informed choice to engage in exercise or not, but you should always be extremely aware that you are walking a fine line, and it does make relapse more likely. If you feel you are stable and responsible enough to handle exercise without any problems, then it is your decision to go ahead, but also your job to always remain vigilant and to address and resolve any thoughts or behaviours that could pop up as soon as they do (if they do).

In recovery, I believe that no food should be the enemy, and if it is, this just accentuates an unhealthy relationship with food. I do not believe that there should be any forbidden foods, and I do not believe a distinction should be made between “good” and “bad” foods. I believe that all food is good food, and I also do not subscribe to labelling foods as “healthy” or “unhealthy”. I believe that if we stop associating foods with emotions and morality, we will be able to listen to our bodies and remain healthy by responding to it. From a personal point of view, that is working extremely well. During the beginning of recovery I was very hungry, and I also craved a lot of “unhealthy” food. Looking back, that seems perfectly rational: my body was starved and in need of a high amount of energy, and it also needed foods that it had been restricted from. “Unhealthy” foods not only provide lots of energy, but are rich in fats, carbs, and sugar, which were what my body had been restricted from for a very long time. As my body healed, my cravings and hunger settled down. As someone who is now fully recovered and does not see food as being a matter of morality or emotion, I listen and respond to my body and find that it leads me to a balanced diet. Sometimes I crave cheese. Sometimes I crave bread. Sometimes I crave cereal. Sometimes I crave ice cream. Sometimes I crave apples. Sometimes I crave broccoli. Sometimes I crave chocolate. Sometimes I crave bacon. Ectetera etcetera. I crave a variety of foods, at a variety of times. I trust my body fully to lead me to what I need to eat, and it seems to be working very well in leading me to eat a varied and balanced diet.

Not weighing yourself in recovery seems to me to be the most obvious one of all. So many people with eating disorders attach such great significance to the number that the association is not reversible, and so to weigh oneself opens oneself up to a massive trigger every single time one hops on the scales. The scale is something that does not need to exist in your life. It is an object infused with so many negative emotions that I would highly advise you to take a hammer to it in your garden (it seems to be quite therapeutic for some). However, you may need to be weighed for health reasons. I suggest being blind-weighed by your doctor, or by a partner/friend/family member. They could give you a thumbs up for progress, a neutral thumb for no change, and a thumbs down for weight loss. This gives you an idea of where you are and what you need to change or continue doing without giving you the specific number which is not going to help you in any shape or form.

Lastly, we come to accepting your body, and other people’s bodies, at whatever weight they are at naturally. People come in all different shapes and sizes, and that is the way of the world. Each body has its own weight range – its set point – at which it is at its healthiest and happiest, and each individual is different. To be healthy, and to be happy, you have to let your body gain to whatever that weight is. To try and control it and maintain a weight that is not your set point would be to restrict and to focus on intake all day every day (and that is not being recovered). Our weight is not as in our control as we think it is, or would like it to be. It is our bodies that decide what weight we should be, and we can either accept that or spend our entire lives fighting it (which many people tragically do). Some people are naturally slim. Some people are naturally voluptuous. Some people are naturally chubby. Some people are naturally muscular. Some people are pear-shaped, some are an hourglass, some are an apple shape, and some are other various fruit/veg/inanimate object shapes (still finding these nicknames for body shapes slightly odd). You should never judge or ridicule someone for their body’s weight, shape, or size, and neither should you do that to your own body. Body acceptance, for both ourselves and others, is an extremely important step that needs to be made by everyone in our society. I don’t think people can recover without finding it within themselves to make peace with their body. I don’t expect people to love their bodies (I certainly don’t love mine) but to accept it and move on from hating it and berating it and focusing on it is a crucial part of recovery.

There you have my in-depth opinions and reasoning for why I believe that the key points of MM are needed for recovery.

Do I believe that you can fully recover without those things? No. I do think that you can make a great deal of progress using other methods of recovery. For the first six months of my recovery I adopted the “eating healthy and exercising” method. It helped me a great deal: I was eating enough and eating a far more varied diet, which brought me back from being very, very sick, to being sick. What I noticed from those six months was a vast improvement in the functioning of my brain. Before, my cognitive abilities were impaired, I had severe brain fog, my moods were horrendous, and the only word I can really describe my state at the time is “insane”. I was not behaving in a rational way, and I was not able to think straight. I was not able to make logical decisions, and my brain was just not working correctly at all. Eating an adequate amount really helped with that, and I was able to regain my cognitive abilities, and some of my former self. However, I was far from recovered and I knew that, but I didn’t know how to move forward until I came across FYourED, which then led me to Your Eatopia. I read the information and advice given out there, which gave me a way to continue moving forwards on my journey to living an ED-free life. I don’t think continuing to focus on intake (whether calories or macros, or even just food types without being so specific) and exercising during the recovery process will ever lead to a full recovery, because there are still so many rules and restrictions, which the ED both creates and thrives on. Whilst people without the genetic predisposition to develop an eating disorder are able to try diets, go through phases of exercise frequently to try and lose weight, and engage in acts and thoughts pressed upon us by our diet culture, those with restrictive eating disorders do not have the luxury of doing so, as it will most likely cause a relapse at some point. I believe that to attain a full recovery, diet culture must be tossed out in the trash as well as your ED.

Without the help and encouragement from the wonderful community on the forums on Your Eatopia, and without my own determination to fully recover from my eating disorder, and without the extremely extensive and valuable support network that I have in my life, I don’t think I would have been able to recover, especially not using MM. Most of it was down to being so resolute in my decision not to go back to where I had been, but I had the privilege of having a family that tried as hard as possible to provide me with support when I needed it, but also left me to recover how I saw best without question (and this was the most important part for me). I also had the privilege of my many fantastic friends who all were rooting for me, who stuck by me throughout the entire journey, and who also let me rant and vent whenever I needed to. I also have friends with eating disorders and met other friends through recovery who were also recovering, who were invaluable to me, as we walked the journey to freedom together, and propped each other up when it was needed. I also had a partner throughout the first six months of recovery, who was essential in providing motivation, and in some ways built the foundation of my journey. Our relationship, in both its triumphs and failures, became one of my main inspirations and was always a reminder to keep on moving forwards, so that I may never repeat the mistakes I made again.

This meant that I had something that so many people lack in recovery: a strong support network. and a normal life to go back to once I reached remission. Some people do not have that to look forward to. Some people do not have the support of others. This can mean that recovery is a hell of a lot harder, and sometimes that can mean that the guidelines of MM are unattainable at this point in their lives. It can mean that they are not ready to embark on that journey, which is incredibly difficult and requires a sometimes overwhelming amount of dedication that some people are not able to give right now. It can mean that the anxiety and guilt that comes with recovery is too overbearing without having people close by to help with those negative emotions and experiences. Some people do not feel strong enough to oppose diet culture and the people who subscribe to it. All of these are valid reasons for not wanting to follow MM or a similar method, or not wanting to choose recovery at all (although I would still encourage you to try, because you have no idea how strong and courageous you actually are when the ED constantly tries to overpower you).

I am also aware that some people use the guidelines as just that: guidelines, and I think that is okay too if you feel confident in doing so (although I will always condone following them pretty rigidly as that is the stance I have chosen to take as I am so aware of that “grey area” that I talked about earlier).

In conclusion, I agree with the MM guidelines, and I agree with the general ideas and opinions that Gwyneth is trying to get across. However, I do not agree with everything Gwyneth writes about, and there are lots of things that she says on Your Eatopia that I am unsure of because I have not done further research on them. I prefer not to identify with MM as a singular recovery method (although it seems I have become one of the key spokespersons for MM, on Tumblr at least). This is because I would like to move away a little from just the specific recovery method and would prefer to take on an approach more like Caroline (The Fuck It Diet), where I am not just talking about the recovery method, but also a way of life. However, the two need to still be separated as recovery is more black and white whereas remission has room for experimentation. I also think that those general ideas are for anyone, anywhere, not just those with eating disorders, and as I said, a way of life. It means that I am stuck between being black and white (MM-style) for those who are in recovery from restricting eating disorders, and my own opinions about being less rigid but still vigilant in remission, and also being an advocate for the general guidelines as a way of life for those without eating disorders as well.

I believe that the guidelines at the beginning of this post are needed to reach a full recovery. The label of “MinnieMaud” does not have to be slapped on it, but I personally found my way through Your Eatopia, and through “MinnieMaud”. It provided me with a way to regain my life, and I know it has saved countless others. So whether you recovered by finding those guidelines through Your Eatopia, or whether those guidelines just happened to you throughout your recovery process because you recognised they were part of recovery, I believe they are of paramount importance to reaching remission.

The Portrayal of Anorexia Nervosa in the Media (and the General Lack of Representation of Any Other Eating Disorder)

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There was a time, a couple of years ago, when I expressed interest in a photoshoot that was going to show people of various shapes and sizes in bikinis or “tasteful white underwear”, to accompany an article on the recovery of eating disorders. As a B-eat media contact, I receive emails about research projects, articles, and surveys to do with eating disorders that I could possibly help out with, which is when I stumbled across this article and the request for those who had recovered or were in recovery to contact the journalist who was to be writing the article.

I expressed my interest, and the journalist and freelance writer who was to write the article responded. She explained that the aim of the article was to have a positive and influential impact on the way eating disorders are viewed in the UK. She wanted to eradicate the myth that a full recovery isn’t possible, and also to present a healthy image of women’s bodies. She expressed that she was aware that the media usually sensationalises eating disorders, and portrays the subject is a very negative light, without ever looking at the recovery journey and people who have achieved remission. She wanted the article to inspire those in the grips of an eating disorder. To me this sounded like an excellent idea until I read with unease that my present weight and clothes size was expected to be included in the article, as was a “before” and “after” photograph. It stated within the email that she was not looking for a shocking image, but if that was the case, why on earth was there any need for a “before” photograph at all, showing me when I was sick?

If the intent was to raise awareness for non-disordered people, and inspiration for those who have an eating disorder, then a photograph of someone when they are sick would not be beneficial in any way. Disordered people would only be triggered by such images and most likely put off by the weight gain that they see between the before and after photographs (a comparison between the two would be inevitable), and raising awareness means showing a variety of eating disorders: bulimia, EDNOS (Eating Disorder Not Otherwise Specified), and BED (Binge Eating Disorder), as well as anorexia. People who suffer from eating disorders that are not anorexia tend to be of a normal or above normal weight, and therefore a “before” photograph would not illustrate their sickness. Eating disorders are mental illnesses, and therefore the problem lies predominantly within the mind, not exclusively within the body. A photoshoot portraying people who are recovered in bikinis or underwear would be positive because it would show those in remission being proud of their bodies instead of feeling ashamed and hiding them, the focus should not be on what clothes size or weight they are now. Giving that number significance just defies the point of recovery and draws attention to what these people have been fighting so hard to get rid of: the destructive obsession with attaching such an importance to a number. Why would that number even be given a mention in an article about recovery?

I replied to the journalist, stating my thoughts on the matter, but she never sent me an email back to answer my questions about it all.

The media need to stop printing photographs of these extremely underweight girls day in and day out. Not only does the frequent publishing of photographs of anorexic individuals numb the viewer, but there is a high risk that it will trigger people with eating disorders to push themselves further into the disease, and hinder those who are trying to recover by possibly sparking a relapse. This could also cause the same for those who are recovered, because being recovered does not mean being cured. One of the eating disorder’s most powerful weapons is its little mantra: you’re not sick enough, and so when faced with images of the worst cases of anorexia, those with eating disorders more than likely have that voice whispering persuasively into their ear. Photographs of anorexics at their lowest weight benefit nobody. Ever. At the end of the day the use of these images of very underweight people are there to satisfy the curiosity of the viewer, and not for any beneficial reason for those afflicted with the disease.

Notice that I said “girls” in the paragraph above. The prevalence of eating disorders in men is becoming more and more significant, but articles about men with eating disorders are extremely rare, which furthers the stigma surrounding it and invalidates the many men suffering from the illness. We need to start representing the male population who suffer with eating disorders. It is so important that they get recognition and acceptance, so that more men feel able to ask for help and support which they desperately need.

Another negative to these images is that because anorexia nervosa is the eating disorder most visible to the eye, the media focuses almost entirely on that eating disorder only so that they can publish disturbing images alongside the articles to shock the viewer and satisfy their morbid curiosity. This results in the media neglecting to give equal coverage to bulimia nervosa, BED, and EDNOS, not to mention ortherexia nervosa* and ARFID, which most people have not even heard of, and anorexia athletica. Our society seems eager to gawp at people who are physically different in some way to most others; whether they are exceedingly thin, extremely overweight, showing severe symptoms of illness, deformed, or disabled. Some examples of this are the programs Supersize Vs Superskinny, The Undateables, and Embarrassing Bodies. We are overly intrigued to see those deemed physically unattractive try (and often fail) to lead a normal life, but that has got to stop when it effects those in similar situations in a harmful way, which is exactly what the publication of these types of images does. We are so obsessed with staring at those different to us that it becomes the main focus of articles on eating disorders, and so all the other eating disorders get barely any coverage, which is extremely invalidating and perpetuates the myth that anorexia is the only “serious” eating disorder. All eating disorders are life-threatening and soul-destroying, and it is so important that people receive that message loud and clear.

Because the media focuses chiefly on those with severe anorexia nervosa and ignores the existence of other eating disorders, this only enhances the misconception that eating disorders are about weight, and that people who are not severely underweight cannot suffer from an eating disorder. Eating disorders are judged far too frequently by appearance, and people that are of a normal weight or above normal weight are not taken seriously enough by friends, family, and even doctors. The media only panders to that incorrect judgement.

People need to realise that eating disorders are exceptionally harrowing, extremely serious, and utterly destructive mental illnesses, and not some kind of sick pastime in the form of some “light reading” in a glossy magazine.

We are people, and we are suffering: stop parading us around for the entertainment of others.

*Ortherexia nervosa is not mentioned in the Diagnostic and Statistical Manual of Mental Disorders (DSM) but was first used by Steven Bratman to characterize people who develop an obsession with avoiding foods perceived to be unhealthy. This is something a vast majority of people in recovery from an eating disorder experience a phase of, but it is also very much experienced as a stand-alone mental disorder and should be taken very seriously, as it can result in malnutrition and even death.

What Being Healthy Really Means

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About a year or so into my recovery, I went to the hairdressers. When I sat down for a haircut, my (very awesome, around-the-same-age-as-me) hairdresser said, “You’re looking healthy!”

It took me a while to register that what she had said was a compliment. The eating disorder lodged in my brain saw an opportunity and cried out “Healthy?! Healthy?!What she really means is fatter.”

The above image is me before and during recovery from atypical anorexia. I didn’t even realise that there was a difference in the way I looked then and now bar that I had gained weight until I was at a friend’s house over Easter and on her wall were two photographs that included me: one at a healthy weight and one when I was underweight. I was in shock. I never realised how pale and sick I looked.

My hairdresser had been cutting my hair in Manchester since my first year at university. She saw my drop weight to my lowest, and she saw me restore it again. That’s how I know that her compliment was so sincere.

One thing that I’ve noticed since being in recovery is that even though sometimes I am unable to act on my own opinions, those opinions about food and weight and body shape have become so healthy that they’ve moved way over to the other side, as far away from disordered as possible, and past even most “normal” people’s views. My views have become so healthy that when I am having coffee with my friends at Starbucks, and one of them says “Oooh, do you think I should get a cake with my coffee? It’s kinda a lot of calories…” I look at her disapprovingly and say “Of course! If you want it, you eat it! Stop asking me for validation, that chocolate cake looks so damn good that you should get TWO SLICES.” Another of my friends said that she had eaten loads that day but “haha it was okay” because she would just work out for double the amount of time. To which I shouted “No, no you will not! Our bodies are not mathematical machines that have specific countable amounts going in and our like our diet culture would have us believe. You do not have to double your work out just because you over ate for one day. GIVE YOURSELF A BREAK!”

Having an eating disorder and trying to recover from it has ruined a lot of my life and had me existing in constant misery. What it has done for me though is introduced me to blogs like Fyoured, TheFuckItDiet, and Youreatopia , which opened my eyes to the actual truth rather than the lies that our money-grabbing, body-shaming diet culture would have us believe (I suggest that you check them out). I began to learn that being healthy means making the right choices for you and your body. It means going swimming if you genuinely love going swimming (but not before being in remission, or nearing it). It means having a second helping at dinner if you still want more. It means playing badminton with your best friend if that is what makes you smile. It means sitting down with a friend to watch a movie and sharing a whole tub of ice cream if that is one of your favourite foods. It means eating whole foods if that makes you feel great. It means spending the day in your pjs in bed blogging and watching TV when you want to relax. Being healthy means doing with your body what makes you happy. Genuinely happy. Without that eating disorder voice having any say.

In addition, exercise doesn’t have to be exhausting, or stressful. You don’t have to dread it. In fact you can exercise without even having to take much notice of it, and that’s the way that it should be done. Exercise should not ever be about changing your body. What it should be about is genuine enjoyment. In fact, I have talked about this topic extensively on my YouTube channel (Here, here, and here are my videos on exercise in recovery, and exercise in remission). It does not mean you have to spend gruelling hours at the gym or engaging in high intensity aerobics, gasping for air in your living room. It can mean taking a walk in the countryside with your dog/friend/camera. It can mean splashing around with your mates in the pool. It can mean getting competitive and enjoying a game of badminton in the sun. It can mean getting on the trampoline with your siblings. It can mean walking in the fresh air to town to do your shopping rather than catching the bus. It’s about what works for you.

Health is eating the right foods for you and nourishing your body and your soul. It’s about eating whatever you want, whenever you want. It’s about trusting your body and it’s cravings; whether it is calling for doughnuts or broccoli, you should respond to it. Being healthy is being happy, and the happier you are the more it will shine through your skin and your eyes and in the way you hold yourself. Knowing that is how I overruled the voice of my eating disorder when my hairdresser complimented me with those words: the knowledge that I was shining the most I had done for going on two years.

Recovery, Self-consciousness, and Relationships

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Recovery isn’t the prettiest thing. There are numerous unpleasant physical issues that we can have to deal with as well as the incredibly overwhelming mental aspect of the process: massive water retention (edema), bloating, constipation and/or diarrhoea, uncomfortable and unpleasant amounts of gas, extreme hunger, night sweats…the list goes on. This generally makes us feel not entirely loving towards our bodies, and this can affect the way we think our partners (if we have one) perceive us. We can become incredibly self-conscious around them and feel embarrassed at letting them see us this way.

“I look pregnant!” is a common complaint that I hear from people about their recovery bodies. Well, this is what it would be like if you were pregnant, so if you two are seriously loved up and settled, this will be a trial run (I’m only kidding. Half kidding.).

Your partner is with you because he/she likes you for you. He/she also cares about you. And because he/she cares about you, he/she wants to see you get well. So yeah okay, you’re gassy and swollen and sweaty but so what? It’s not a big deal. I’ve looked after people I love when they are sick and vomiting, or have fevers and are sweating, or are drunk and have thrown up over themselves, or are like “babe I have the worst diarrhoea” – that’s just life. We see our partners at their most unappealing and we love them anyway. So if your body being swollen and sweaty are the temporary side effects to you getting happier and healthier, then he/she’s really not going to care. If he/she loves and cares about you, he/she will laugh along with you at your belly noises and farts (I used to wake myself and my previous partner up in the night on numerous occasions in recovery when I had bad gas). He/she will admire your ability to eat the entire contents of your fridge, and will high five you for it. He/she will give you massages to help you with your swelling and aches. And if it’s affecting your desire to have sex he/she will get over the fact that you don’t really feel like hopping in the sack right now and will just look forward to when you can again rather than begrudge you for it now.

You have to remember that your partner holds your best interests at heart. A mature, loving relationship will not be negatively affected by your physical state in recovery. Your partner should hold your hand and accompany you encouragingly on your journey to recovery. They will be there with unflinching support, however unattractive you may deem yourself to be. How you view yourself is not how they view you. Always remember that.

Shame in Recovery from a Restrictive Eating Disorder

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Those who are watching someone recover from an eating disorder (friends, family, partners) will be overjoyed that their loved one is on the journey towards health and happiness. They will see recovery as an entirely positive process, and objectively, they would be right. However, the fact that they are looking at it with such an objective view can also mean that it makes it more difficult for them to understand why the person in recovery does not always feel the same way. They may become confused as to why the person suffering it finding it so hard to make this journey to remission.

I have a confession to make: when I was suffering with an eating disorder, I felt ashamed when I put on weight because it made me feel like a failure. It made me feel ugly. It also made me feel like people were judging me. I’m not sure why that was. Maybe it was just my eating disorder, which was trying at all costs to get me leave the path of recovery and pull me back into misery, or maybe it was also because our society puts so much value on our bodies and what they look like. Maybe I thought that people saw it as me losing my “self-control”; becoming “weaker”, or that I didn’t have a serious eating disorder any more. Maybe I thought people would think I looked better when I wasn’t eating and would think I had “let myself go”.

People don’t often realise that people feel shame in recovering from their eating disorders. Feelings like “letting their eating disorder down”, losing their identity as a “sick/thin person”, or feeling weak or a failure, is an issue when it comes to recovering. People who don’t understand eating disorders fully, or haven’t experienced an eating disorder themselves, think it’s great when someone gains weight and is working towards getting better – and it is; of course it is. However, there is another side to it too: we have to face all of our demons head on in recovery, and it is scary to say the least. On top of that, we have to face not only our demons but the society that we live in which tells us that thinner is better, that losing weight is good and gaining weight is bad, that the goal is to eat less, not more. Around us people are trying to avoid certain foods that we need to eat in abundance; nearly every magazine has tips on how to lose weight; our friends are on diets; all the menus have the calories labelled clearly next to them; low-calorie options are advertised. Everything around us – not just our eating disorders – is screaming at us that what we are doing is wrong. It is overwhelming, and confusing, and downright difficult.

A lot of the time an eating disorder is also a coping mechanism, and so losing that coping mechanism can be hard. It also means that that coping mechanism may have made the person feel strong, powerful, and in control and in some twisted way, that can cause someone to feel pride. Most people cant understand that. That means that letting go of that coping mechanism can make you feel weak and shameful.

Recovery is such a delicate process. It is full of ups and downs. It is a path constantly moving forwards to health and happiness, but the path itself is full of extremely negative thoughts and feelings. People supporting those in recovery need to be very aware of this, and that even after the decision has been made to get better, it is a choice that needs to be made multiple times a day. The road is hard, and although it looks very straightforward from an outsiders perspective, take the time to recognise that from the inside, it is a maze.