Part One: Reclaiming "Health" in the Eating Disorder Field

And how to stop getting stuck in diet rebellion

This is a somewhat difficult blog for me to write. I have put it off for far too long, but I feel it’s time. I fear being misunderstood and upsetting people who are already marginalized. Please know, that this is not my intention. I need to address a problematic pattern I have witnessed in the field of eating disorder treatment. We have begun to become overly cautious, afraid even, of providing education on what is healthy for our bodies. “Healthy” has long been a trigger word for our clients, but it has also become a loaded word in our field. Being “healthy” can be interpreted as orthorexia, restriction of intake, and often, disordered exercise. Health is a concept that many of our clients take too far, that society tells them is their personal responsibility and even reflects moral character. To protect our clients from healthism we have been cautious to use healthy in our vocabulary. We do not want to further trigger diet behaviors or promote fat phobia.  But have eating disorder clinicians unintentionally created a fear of healthy eating and healthy lifestyle behaviors? Is recovery from eating disorders now almost synonymous with rebellious eating and abstaining from exercise? 

It is true and important that after painful, damaging bouts of restriction, we need to rest and eat with complete abandon. Our clients have rediscovered their power by giving the proverbial middle finger to their eating disorder rules and to our toxic diet culture.  This rebound eating, which, might even look like bingeing, is making up for all the deprivation that has been there. Allowing all foods that were previously off limits is very important. The temptation as weight potentially increases is to begin controlling intake again. A common, recovery-delaying mistake I see people making here is going back to restriction or compensation to make up for what they perceive as failure and fear that the “out of control eating” will never stop. This phase just really needs to be trusted. It needs to be allowed. It needs the space and time to just be so that the mind and body get the message that they are not going to be deprived again. Yes, you can have anything and everything. By truly surrendering, it eventually organically subsides. The rebound eating eventually ends. That is, if we allow ourselves to reconnect with our bodies and listen.

However, I am noticing that some folks in recovery seem to be getting stuck in this rebound place. There seems to be an almost equally painful stagnation where clients who began with an assertive and necessary rebellion are unable to move beyond it. They are quite literally stuck in their anger and rebellion against diet culture, so much so that they have removed their bodies from the equation and stray away from the very thing they believe they were fighting for. They are not eating intuitively. They are eating as if they are on a constant battlefield, fighting society’s insidious influence, only to ultimately betray themselves, and yes, their health. Many of our clients describe that it is easier to not think about food and to avoid exercise. But this only leads to disconnecting from the body in much the same way the eating disorder did.

We owe it to ourselves to listen to our bodies and take health into consideration. When I hear clients describe an inability to consume fresh fruits and vegetables out of fear that they are returning to diet culture, we have a problem. When people are afraid of eating foods that are typically considered healthy out of fear that they will somehow be labeled for “not doing recovery right”, we have a problem. I see the same issue with exercise. Clients yearning to move, but fearful that if they allow exercise back into their lives, it means that they are immediately giving in to ED.  My clients have grown fearful of working up a sweat and eating foods that nourish them. Though it is completely understandable to fear going back to the hell of restriction and the torment of ED, this fear is not the freedom of recovery.

We don’t throw the baby out with the bath water. We do go back to movement. We do go back to food that our bodies are craving and that are good for us.  But we do so in a way that is not diet culture, that is not deprivation driven, that is not restriction. We do so in a way that is on our terms. That balance is one that can be found. For some people it organically evolves, and they go from this refeeding phase to naturally slowing down and being more in touch with hunger and fullness cues. They find their way back to something that was innate before dieting began and return to engaging in what feels intuitive and normal. There are also those clients that legitimately have more of a compulsive eating presentation that are not served by constant reminders to “just go for it.” This type of overeating is not necessarily deprivation-driven but more habitual, more emotional, and maybe more addictive in nature. These folks also really need to be understood and listened to.

I propose that we don’t shy away from reclaiming health with our clients. I think we need to address in a shame-free way and with curiosity the over-consumption as much as the under-consumption of food, the lack of movement as much as excessive movement.  Besides giving clients permission to eat, we also need to give our clients permission to stop eating. As eating disorder dietitians, we are uniquely qualified to assess both the presence of over and undereating and to assess what is inadequate and what is excessive. If we are only addressing the undereating side of the coin out of fear of aligning with diet culture, we do our clients a disservice and miss the support we can give them with what is a very real struggle for many.

Click here to read Part Two of this blog with tips on how to reclaim health on our terms.