Caveat: when I say that intuitive eating won’t work, this is in the context of an eating disorder recovery.

Why I like intuitive eating

I’m a big fan intuitive eating and I’d say that the way I eat is pretty intuitive: I eat what I like and what feels right at the time. Sometimes it’s more nutritious than other times, but I trust that my body can cope with that because it did before I got ill, and it has done it ever since I have recovered.  Often when people come to me, they tell me that they want to be able to eat “normally”, a bit of everything and without guilt, which sounds a lot like intuitive eating. “I wish I could just go to a café and order something I like without fearing the consequences. Other people do it all the time, why couldn’t I?”

Why I don’t recommend intuitive eating to everyone

The answer to this is that you can eat intuitively but not straightaway. Intuitive eating is marathon and both your legs got broken with the ED, so right now you’re having to relearn how to walk.

Intuitive eating is seductive, but one must proceed with caution. Is it seductive because it would confer you with more brain space and that you’d finally be able to eat normally? Or, is it because the ED sees it as a way to restrict?

You see, intuitive eating is a great idea for someone whose physiology is “normal” i.e., the body responds to given and predictive cues. Anorexia, however, implies a pathophysiology i.e., things aren’t as they should and so we can’t imply the same principles as we would with normal eaters.

What does eating intuitively mean anyway?

The main principles of intuitive eating are as follows:

1. Eat when you are hungry and stop when you are full.
2. Eat Slowly.
3. Pay attention to the tastes and textures, as well as the sensations in your body.
4. Take time to appreciate how good the food is.
5. Eat without distraction, away from screens.

Let’s review them and see why they can’t apply to anorexia recovery.

Eat when you are hungry and stop when you are full.

People in recovery from anorexia, especially at the start and if they are on a structured meal plan, will almost never be hungry and always feel full. This is because their digestive system has slowed right down, this is called gastroparesis and 98% of my clients present with this when they first come to see me. When we restrict, we don’t just lose fat, we also lose muscle. Muscle doesn’t just mean biceps, quads etc., it also means our smooth muscles and that includes our digestive tract.  Our digestive system becomes less active and therefore doesn’t move the food as fast as it normally would. There may also be an attempt from the digestive tract to slow things down so that it can mop up the little nutrients provided in the diet. Restriction also leads to a slowing down on the metabolism and this isn’t to be annoying but to save you.

Your metabolism will slow down to save you

You see, if you, let’s say, need 2,000kcal and that you eat 2,000kcal, the body is happy and it does what it’s supposed to do metabolically. If it needs 2,000kcal but that you only give it 1,000kcal, you lose weight because of the deficit, but the body will also start to panic a bit “thinking” that if it carries on, you’re going to disappear into thin air. That’s not ideal as far as the body is concerned, the body wants to live, that’s its main job. So, it will react by slowing down the metabolism and that means doing things more slowly (perhaps not doing things at all, like periods) to spend less energy. Calories are energy by the way, so the body will try to do what it has to, spending less energy doing so. Of course, there are very important things like the heart and brain that it will try to protect for as long as possible, so this is not where the slowing down first happens. The digestive system, however, is important but not as vitally tuned so it can afford a bit of slowing down. So, the combination of the loss of muscle tone and your metabolism slowing down leads to a digestion that has slowed right down – gastroparesis means paralysis of the gastrointestinal tract. It’s obviously not a complete paralysis.

You are going to feel full all the time

So, it takes you ages to digest and on top of that you are required to eat a fair amount of food because you need to restore the weight that you have lost (or at least some).  That’s the irony of this illness: the more weight you lose through restriction, the more food you will have to eat to get better. The effect of this is that you are going to feel full all the time. It’s not uncommon for people to tell me that at lunch they are still full from their breakfast and morning snack and I believe them. Regardless, lunch needs to happen. No, you can follow the intuitive eating principles at that moment because listening to your body would get in the way of your recovery. Worse, those cues would in time be giving free rein to the ED to restrict.

Eat Slowly

Slow eating with careful mastication is something nutritionists often recommend, it’s a way to help with digestion, a way to properly taste your food and a way to make your meals last longer. “It would help my digestion!!”, I hear you say. You are not wrong there but that’s not enough to turn a blind eye to two problems with this idea of eating slowly.

The longer you are at the table, the more time you are having to face what scares you the most. If the last thing you want to do is eat that plate of macaroni cheese, is it really a good idea to spend 2h looking at macaroni cheese gradually congealing on your plate? Get it over and done with. Yes, it’s going to be hard and yes, the thoughts after will be loud but let’s be real for a minute: as far as anorexia is concerned any food is bad/too much, so if you’re going to be shouted at, it may as well be for something. You can’t recover from anorexia without eating enough, you can’t talk yourself out of this I’m afraid.

Satiety isn’t your friend right now

Did you know that feeling satiated normally takes around 20min or so? This is because this sensation of satiation relies on a dance of hormones and hormones take a bit of time to do their jobs. The thing is, as far as your brain is concerned, feeling full is the same as feeling fat and when you feel fat what do you want to do? Eat less. Can you see, therefore, why spending ages to eat might not be the smartest of moves?

This is why, by the way, meals usually cannot be longer than 30min in in-patient settings. It’s not just because they want to clear the table.

Pay attention to the tastes and textures, as well as the sensations in your body

A starved brain is a scared brain. Normally, when we eat, a small part of the brain, called the insula, is in charge of telling us whether this feels good and whether we should carry on. With anorexia, the insula is quiet and that triggers another part of the brain, the amygdala, to panic. Textures become slimy, gritty, yucky etc. You’re not lying, this tastes disgusting.

Also, since you are going to feel really full, paying attention to your body’s sensations is going to be like having someone repeatedly shouting in your ears with a megaphone: THIS IS ALL WRONG! Not a good move. Eat mechanically, get it done.

Take time to appreciate how good the food is.

As seen above, this isn’t going to be possible in your case. Food isn’t going to taste good. Even the food you used to love won’t taste good, it’s just not. Not yet. Everything will feel wrong in recovery. It’ll come back though. All of this will come back when you are renourished and that your brain isn’t panicking constantly.

Small caveat here, if food does feel good or at least some food, you’re not doing anorexia “wrong”. It probably just means that your brain is trying its best to save you by giving you glimmers.

Eat without distraction, away from screens.

This is something we get told all the time, isn’t it? And yet I disagree. I disagree even, to an extent, for normal eaters. When we have a conversation with someone at the table, are we really mindful of all the tastes and textures? Nope and yet how many memories were created around animated dinner tables?

Anyway, let’s go back to anorexia recovery. Eating on your own at the table might feel like being thrown in a pit full of spiders when you have arachnophobia. It’s going to be horrendous. The very thing you need is distraction, so eat with people you feel comfortable with, listen to a podcast, or eat in front of your favourite series. Your only job is to put the food in your mouth and to swallow it.

Intuitive is great but only when you are ready. You’re not ready for a marathon yet. First you need rest, then physio, then training and then you can give it a go.

I know we are often extolled the virtues of intuitive eating: eat when you are hungry and stop when you’re full. There’s a lot of sense in that, but it’s not always that simple and, as always, there are many nuances.

A couple of weeks ago, I posted something in my stories about me “forcing” myself to have lunch and why. That afternoon, I got a lot of DMs thanking me for talking about this and asking me lots of questions, so I decided to create a post to expand further.

Intuitive eating doesn’t always marry well with busy schedules

Let me paint the scene first if you didn’t see that story. It was circa 12.45pm, a time around which I normally take my lunch break. I took the break but just wasn’t hungry for lunch. The reason being was that I had had breakfast circa 8.30am that morning (not late but not early either), and my breakfast was rather substantial. In all honesty, I cannot remember what I had but I know it was a good breakfast because I was really hungry that morning after my yoga session. I was then faced with a dilemma: it’s lunchtime but I’m not hungry, what do I do?

Do I:

• Skip lunch and wait for the hunger to come?
• Have something small, like a snack, and then see whether I need more during the afternoon?
• Have lunch anyway?

To be totally honest, I didn’t ask myself these questions, by now I know what I should be doing but I know such questions do arise in my clients.

Intuitive eating when you are working full time

Intuitive eating would have you skip lunch and wait for the hunger to come but that’s not always practical. I normally work in the afternoon; what if the hunger comes when I’m in the middle of a session with someone? Sure, I could have something after the session since I’m in the fortunate position of working from home. But what about if I have back-to-back appointments? I can’t eat in sessions and not eating is likely to cloud my thinking, which would be pretty unprofessional.

What happens if you are not at home?

It just so happened that I had taken the afternoon off that day to go watch my youngest son play football with school, and this is at the core of the story. I had to leave the house an hour later to get to the match and I knew that I wouldn’t be home much before 6pm. Having a meal by the side of a football pitch isn’t exactly practical, unless we’re talking a sandwich of course. From having done this before, I know it can be hard to fit in a sandwich on the side of the pitch when there are lots of parents there. I don’t mind eating in front of them but it’s hard to have a conversation when you’re the only one eating.  I could have brought some snacks, I hear you tell me, because they’re small and easier to eat. Sure, I could have. However, snacks such as cereal bars, nuts and fruit aren’t exactly filling. They might be yummy, and even nourishing, but if I’m hungry a cereal bar isn’t going to do the job. That would mean me being slightly uncomfortable all afternoon with latent hunger and that doesn’t appeal to me. Another issue with having a later lunch, in the form of a meal or a string of snacks, is that you may then not be hungry for dinner and then you end up with the same conversation and dilemma.

Eating when you are not hungry is sometimes the smartest choice

If your relationship with food is a bit shaky, this could be dangerous territory. This is when the disordered eating voice might creep in telling you to skip dinner. It can also pipe up again the next day telling you that if you start having lunch now, that’s greedy because yesterday you managed without etc… To round off my point, there was also the option of skipping lunch altogether and hoping for the best but again, personal and professional experience have shown to me that “hoping for the best” in that situation would be rather foolish. Hunger will come because it always does and you’ll find yourself with no food, getting more and more irritated, not concentrating and probably demolishing the kitchen on your way back.

Intuitive eating and recovery don’t mix

Let me say this first of all, when you are in recovery, scrap intuitive eating. You simply need to follow your plan, full stop, no questioning or bargaining (you can read more about this here). That aside, if you are recovered, or even if you are a normal eater, you may also benefit from not always being intuitive with food. Bear with.

If you are hungry, of course do eat, that’s fairly simple. If you’re always hungry, though, you may need to question why that is. Are your meals too small? Disordered eaters sometimes are so entrenched in their habits that they can’t see that what is a normal amount for them, might not be for other people. Are your meals lacking something important? Protein and fibre are pretty filling while starchy carbs and fat are satisfying; are they absent from your meals? Could it be that you never finish your meals? I often see that, people having all the right meals and snacks but never finishing anything (because they got distracted, it got cold, they had to work etc., i.e., delaying tactics) and then wondering why they are hungry all the time. I’ll try to write something on that at some point.

Eating has to be practical

So, back to my point. Sometimes, I think it is wise to eat “now” because you won’t be able to “later”. You might not be hungry “now”, but the hunger will come, it always does, and if you know that “later” you won’t be in a position to eat for whatever reason, “now” is the right time to eat, despite the lack of hunger.  This will prevent: the sneaky temptation to skip a meal (hello, potential relapse), surviving on “tissue paper snack” i.e., without substance, or getting really hungry and bingeing when you get back home.

What to eat when you are not hungry then?

• Something that is appropriate for the meal for you: breakfast things at breakfast, lunch things at lunch etc. Work with patterns.
• Known, classic, combinations: porridge, yoghurt and fruit, eggs and avocado toast, soup and bread etc. Work with habits.
• Things that you normally like. Work with memories.
• What people around you are eating. Work by mimicry.
• What you have learnt to be “right”: protein, carb, fat. Work systematically.

Spoiler alert, it won’t be the most enjoyable meal, but it will do the job, free some space in your head and ensure that you don’t completely derail.

How did I fare?

I had roasted vegetables, black rice, hummus and avocado, I seem to recall. Did I enjoy my meal? Not particularly. I liked all the elements of the meal, and I know that in other circumstances I would have loved it (I decided to work with memories) but that day it just ticked the box and did the job. Not all meals have to be amazing, it’s just food, it shouldn’t be the most important part of your day.

This meal enabled me to get on with my afternoon freely. I ended up talking with a dad most of the time, so having to feed myself would have been tricky. I wasn’t hungry so I could be present and concentrate on the match (7-nil to them, since you’re asking) and even attempted to learn what off-side actually means (don’t ask me now).

By the time we got home, I was ready for some food and luck had it that I had already prepared dinner, so all I needed to do was reheat it. Obviously when I say “luck” I mean preparation and organisation… Anyway, this was another cunning strategy in place knowing that we’d all be hungry by then and that starting dinner would be the last thing on my mind.

The cult of wellness or the cult of disordered eating?

I often come across the expressions “cult of beauty” or “cult of fitness” and in as much as I understand the message conveyed by those expressions, I can’t help but wonder whether the word “cult” is exact here.

I have long been fascinated by cults and sects; name a Netflix documentary on the subject, I’ve watched it. I’m fascinated because from the outside it is so obvious what is happening and yet those involved are totally blindsided.

But back to beauty and fitness for a minute. Those two “cults” are in fact enmeshed, aren’t they? Often people want to be fit to be attractive (fit and attractive have even become synonyms) and you’d be hard pressed to find someone deemed attractive by all who is not also sporting a fit (as in athletic) body.

What is a cult?

Why don’t I think they are cults? Because the definition of a cult is as follows: a relatively small group of people having beliefs or practices, especially relating to religion, that are regarded by others as strange, or sinister, or as imposing excessive control over members. A lot of it fits but not sinister, to me; and bear with me on that one.

Is it a bad thing to want to be in good shape or attractive? No, I don’t think so. It might not be important to everyone but, equally, it should be ok for it to be important to some. To me the confusion over the fitness and beauty industries being cultish lies in the fact that they, indeed, have tribes whose practices, sometimes punishing, tend to require commitment. They echo the same concepts and can be a little be evangelistic about whatever it is they are preaching.  There’s there’s an alikeness to their flocks and, more often than not, what that congregation is after is a sense of belonging.

Take me to church

I have lost count of the number of girls in their twenties I have come across at the yoga studio I frequent who are donning matching tight high waisted shorts and bikini-like sports tops, usually in taupe colour. The look wouldn’t be complete without a messy high bun and an Oura ring dutifully positioned on the index finger. Nothing wrong with any of that, they are visually sign-posting which church they belong to. I am there too; my place of worship is “the pod” and my yoga mat is the altar upon which I sweat several times a week; but I belong to a slightly different denomination.

Regardless of your faith or denomination, I believe that what makes people keep to their practices is a yearning for connection, acceptance and belonging. We have, seemingly, never been so lonely that in this world where we can connect with anyone in the world in an instant. Together but apart, we are collectively lonely. Loneliness is perhaps the greatest ill of our society and so it is not surprising that we seek solace in group of like-minded people. This is a good thing.

Religions are good and even perhaps needed. It doesn’t matter who or what you believe in, believing is what matters. Can there be hope without faith?

When things become sinister

I know what you’re thinking: how can religions be good given all the wars? How can we condone faiths after the atrocities perpetuated by so many religious leaders? And I’d agree with that. There is a dark side to religion that we cannot ignore, and this is where things get murky and that the lines between religions and cults become blurred.

You see, most of the times, cults start as innocent enough small religious groups but before you know it, in the shadows cast by their somewhat excentric beliefs, the practices become sinister.

I sometimes wonder if my fascination with cults has anything to do with the fact that I deal with them every day. Or perhaps it is the other way round, who knows?

Religion is to fitness and beauty what cults are to eating disorders. One is an order, the other a disorder.

Me, you and the eating disorder

There are always at least three of us in the consultation space: me, the client and the eating disorder and, boy, does it become clear when I start asking the “wrong” questions.

The way I see it, a person suffering with an eating disorder is like a person trapped in cult. In case you didn’t watch any of those documentaries, you should know that leaving a cult is hell and usually can’t be done overnight. First there is denial and anger, then there is doubt, fear, guilt, shame, clarity and a desire to escape, followed by more guilt and shame, perhaps even wanting to go back to the safety of what you know even if it hurts you.

Vulnerability exploited

Cult leaders always operate in a similar way: pick someone who is vulnerable, someone who is either at rock bottom or someone who is figuring out who they are. It is no surprise that eating disorders afflict so many teenagers but also people experiencing transitions in their lives: breakups, pregnancy, menopause, injuries, ending of sporting or professional careers, sexual changes etc.

Then you promise to these lost souls that you can provide them with a solution to their “brokenness” and that by becoming a follower you can be part of an enlightened community. You are chosen because you are special and if you follow the advice, you will receive unconditional love.

Ecstatic, you might start cutting out UPFs and instead consuming reems of materials on the benefits of “real food”. You will listen to the same sermons coming from that community and will accuse those who are refuting those dogmas of being corrupted by “big pharma” . This echo-chamber will soon enough turn into propaganda with more and more bizarre practices to follow. It’s not just UPFs you need to watch out for, food needs to be organic, low sugar to avoid insulin spikes, you need to eat thirty plants a week for your microbiome, you need protein but also fermented fibre, you need to sleep but you also should carve out time to work out and lift weights because “sitting is the new smoking” etc.  

There is truth and there is dogmas

You see it always starts with a nugget of truth and then it escalates to dogmas. Of course, cooking from scratch and eating protein and fibre is important. Of course we should move our bodies. Do we need to spend hundreds on glucose monitors, anti-spike supplements, trackers, etc.? No. Do we need to feel guilty because we fed our kids fish fingers? No, it’s flaming fish for Christ’s sake!

Ok, back to you. You have now fallen down the rabbit hole and that’s when things turn sinister. So, you gradually detach yourself from your loved ones. Now, you go out less with friends and don’t spend much time with your family. That is a tried and tested technique: isolate the victim and make them think that you only hold the truth. Then ensues the rules and rigorous rituals but also the repercussions for failing. “You have eaten some cake? Then thou shalt do a hundred sit-ups”. Ecstatic turned into acetic.

Notice how someone in the throes of a cult always ends up having to work unpaid for hours on end for a salvation that they will only know when they are dead. The eating disorder is always asking you for more, but does it give you what it promised? Are you more popular, happier, pretty enough, thin enough? No, it will never be enough. The eating disorder wants you hollow so it can inhabit your space entirely. It is a type of parasitical terrorist if you wish.

Time to escape

In time, you might become tired of the rules, and you might start to doubt that this is right. Oh, but if you listen to your loved ones or your team, the eating disorder will not be happy.  The eating disorder will get angry at those profanities and shout that the advice you are given is pure heresy. “Three meals and three snacks is way too much, they don’t know what they are talking about! They don’t love you; they just want you fat so that they look better!”

As I said, leaving a cult is hard. Something at some point must give for someone to break away and there will be hurt, shame and perhaps even regret following that decision. The same goes for an eating disorder. I believe that you can’t make someone want to recover. Something must give; something must happen intrinsically for someone to be willing to put themselves through a different type of hurt. They don’t have to be ready, but they must be willing to endure that stress. There will be pain (physical and mental), there might shame (the body changing) and there might be regrets (things were easier before).

The good news is that people do leave cults and people also recover from eating disorders.

The problem isn’t faith; it’s the abuse of power.

The problem isn’t wanting to be fit or attractive; it’s sacrificing your mental health for it.

Amen

An eating disorder is a crutch to make you feel more stable

The question of “why” often poses itself. Why did I/ my child have an eating disorder? Finding the exact answer to this can be useful but, over the years, I’ve come to realise that the general answer tends to always be the same. At some point in the person’s life, something rocked them enough to make them unstable on their feet. And what do you do when you become unstable? You reach for something nearby to stabilise you. An eating disorder is a crutch to help you feel more stable. That seems fair, doesn’t it? But. This is based on a lie.

Surprisingly perhaps, I’m not about to launch into how the eating disorder lies about thinness and food or, how the goal post will always move and that you will never be enough. You know this. The lie is that you should always be stable and that wobbling means you can’t stand on your own. The lie is that you need a crutch when you don’t. The eating disorder offers to fix a problem that isn’t truly one. We all wobble in life, some more than others because life presents us all with different challenges.

However, you never needed a crutch

I don’t know how much you know about yoga but try to picture someone doing a balancing pose in yoga (say warrior three). Now imagine someone comes along and pushes them, they are going to wobble and, almost certainly, fall. That’s similar to life dealing you with a bad hand and something really hard happening to you. You couldn’t predict it and it wasn’t your fault.

Imagine the person is wobbling simply because it’s their first try at yoga, they don’t really know what they are doing and, really, they just need more practice. I find a lot of young teenagers are in that category. They come to me at the age of 14/15, anorexic, telling me that they put lots of weight on when they were 12/13 and that they are now terrified of this happening again.

Hormonal changes during puberty is often a factor here. That aside, I’d say that those tweens simply didn’t know what they were doing with food. They had more freedom, stopped at the corner shop, perhaps more often than is reasonable, but it’s not a big deal. It doesn’t mean they needed their eating disorder to make them better, most young teens do that. There was no real problem, nothing that needed to be fixed. They just needed to grow into themselves both physically and mentally.

When being the best makes you miss the woods for the trees

Another configuration is someone who has strength and who could easily hold the pose. However, they don’t quite get that no one is going to give you a medal for lifting your leg the highest. They will want to showcase their athletic prowesses without giving too much thought to the value of stillness. So, they will push and push and might check the clock to see how much longer they have to hold. These people are likely to wobble and fall too. Pursuing the “best diet” at all costs is precisely likely to cost you a great deal, as you will have lost sight of your overall health.

Now imagine a person who is quite versed at yoga, it’s not their first time. They are more than capable, except that they haven’t quite got the principle of yoga, which isn’t based on competition. There’s only you and your practice, what the others are doing is irrelevant. So there they are, in their poses, but they want to check what everyone else is doing. They want to make sure they are not doing anything wrong, or they get distracted by the shiny Lulu lemon leggings over there. No doubt about it, they will wobble and perhaps come out of their pose. In yoga, like in life, you have to do your own thing instead of comparing yourself to others. The moment you start comparing your diet, or your body, with those of others, you’re in trouble even if you’re normally quite solid.

Your drishty is what keeps you stable

What’s the secret then? Well that’s your drishty. It means “focused gaze” and in yoga we use to hold still. You pick a point in the room and you stay focused on this while in a challenging pose. This enables you to withdraw into yourself and concentrate solely on you and your practice. This, I find, we tend to acquire when we age. We become less bothered by what the others are doing and we are more able to tune out the noise around us telling us to be blonder, younger, thinner etc.

Yet even those who are seasoned “yogis” are always at risk of wobbling because you never know who might come and push you. We all have bad days and the noise can sometimes get too much for all of us. That’s ok, it doesn’t mean you’re rubbish at yoga or even at standing, you don’t need a crutch. You might just need to sleep it over, to gather yourself, to rest etc. You might need to talk it over with someone so you can understand that the fault was in the person who pushed you and that you are still more than capable to hold still unaided.

Finally, I have come to notice that the people who wobble the most are those who just haven’t found their drishty in life just yet. It’s not always easy to find and you might need several attempts. They may struggle to find their purposes and their values preferring for now to look around at what others are doing and being swayed by popular opinion. Perhaps that explains why so many teenagers are falling prey to eating disorders? They don’t know who they are and what they want yet, so finding that point of focus is going to be harder.

Wobbling is part of your life practice

Know that it’s ok to change focus. You may wobble along the way. Remember, there’s no rule dictating that you have to keep the same focal point at all times. People also get their drishty wrong thinking happiness will come from doing that successful job, or earning that amount of money. However, if that doesn’t truly resonate with them, they will wobble. I often see people with no hobbies who are unstable. Usually, they either haven’t yet found what makes them tick, or they have found it but think it’s not cool enough. So, they don’t pursue it and instead chase something that society will more readily validate. If your thing is carp fishing and that’s what’s going to make you happy, then do that.

You know the saying: those who mind, don’t matter and those who matter don’t mind. Allow yourself not to mind because you are the only person who really matters.

Should our weight be kept in check?

Weighing was at the centre of one of my sessions this morning and so I decided to write some more about it while my memory was still fresh.

Should we or should we not weigh ourselves? That is the question.

As always, the answer isn’t clear cut, in fact would there even need to be a question if it was clear cut? My answer will depend on whether we’re talking weighing someone in general (“normal eaters”) or weighing someone in recovery. I would never suggest that people who are struggling with food are abnormal but they have different needs in my opinion, hence the needs for some differentiation.

On a very basic level, I can see why weighing “in general” might be useful. It’s common practice, for example, to frequently weigh newborn babies to make sure they are eating enough and that they are growing properly. If you are to receive general anaesthetic, the doctors might need an indication of your weight, as the dose needed won’t be the same if you are 7st or 22st. So weighing for functional reasons makes sense.

Should we weigh ourselves to make sure we are healthy?

By the way, have you ever wondered why weighing scales are kept in the bathroom? Isn’t the subtext here that it is to keep our health in check? I think this has something to do with painting the scales as a health tool in the same way as vitamins and medications are. Yet, we know that weight doesn’t equate health. They can sometimes overlap (being underweight can be damaging to your health and carrying an excessive amount of weight can lead to co-morbidities) but most often they are not linked.

ED diagnostic criteria are not based on weight per se but on the amount of weight lost/gained in respect of time, and, mostly, on the importance the person gives to their weight/shape. You can be very unhealthy at a “healthy” weight and you can be totally healthy while clinically under or over weight.

If the scales aren’t a measure of health, why do we keep them in our bathroom?

Because that’s where we take our clothes off? We also do that in our bedroom, don’t we? In fact, wouldn’t that make more sense? Isn’t our checking our weight more about appearance than health? Should it therefore not be where we keep our other appearance relating stuff like our clothes?

Anyway, back to whether we should, or not weigh ourselves.

Do I think people in recovery should be weighed? Yes. Do I weigh myself? No.

Weighing can be useful in recovery

Let me explain. I think weighing is useful and, often, even necessary in recovery but that depends on the person and diagnosis/problem. 

I mostly work online these days, so I don’t weigh people, this is done by their GP/nurse/hospital and the number is then relayed to me. Why is it important? To keep people who are restricting safe. We need to know what is happening to them weight wise, so that we don’t realise months down the line that they have been losing weight and are therefore at risk medically. I also often use the number on scales to show people that the food they are eating and fearing isn’t having the impact they thought it would on their weight and this can greatly help them move forwards in their recovery.

The optic here isn’t: “look, you can eat and not get fat”. It’s more: “see, the way you have linked food to your weight is somehow skewed, as it doesn’t seem to work like this from the evidence that we have. What else might you have heard that is holding you back in your recovery?”

Do I think we should weigh people for fear they don’t gain too much weight? No. What about to check they are losing the correct amount of weight? Well, I don’t work with weight loss clients, so the answer is still no.

Some people might come to see me and want to lose weight, but that is never the focus of my sessions. If they do, they do but I’m interested in their relationship with food, not the number on the scales.

In recovery, it is my opinion that the best way to weigh someone is blind i.e., the person taking the weight sees the number but not the person being weighed. It’s important to keep track of what’s happening but it’s also important for people to reconnect with how they feel as opposed to being a slave to a number. I want them to start as they mean to go on i.e., not using a machine to measure their worth or happiness, and once they’re out of the woods, weight wise, once the person is weight restored, the weighing can stop. 

I’m not scared they are going to gain “too much weight”, I trust their body to do the right thing. If they have gained weight, it’s probably because they needed to; it’s not my role to set an acceptable weight for an individual. It would be wrong and potential harmful because our weight is genetically programmed in the same way as our eye or hair colour are, it’s not for me to arbitrarily decide.

There are brackets but once someone is above a certain threshold (the “healthy” range), I know the next bracket is pretty far away so I’m going to let the body decide where it needs to settle.

The reality is that some people will naturally be at a BMI of 26 and that will be healthy for them, while some will settle around 20; we are all different.

If someone is in the healthy range but that they still don’t have a functioning endocrine system (no period, no sex drive, erectile dysfunction), that’s a pretty sure sign that they are not where they are supposed to be and that they need to carry on.

Ok, so weighing can be functional and it can be to check a person isn’t losing weight or that an underweight person is regaining enough weight for them to reach a biologically appropriate level.

Weighing for reassurance

Some people tell me that they still like to weigh themselves for reassurance but I worry that this still maintains weight at the centre of it all.

Reassurance from what exactly?

Surely you can see whether your clothes fit or not? Do you really need a number to orient you towards your next step in life? Most often it’s not about the weight but about the meaning you attach to the weight. I’m more or less than I used to be/than I expected to be/than I wanted to be/than my friend etc. Weighing is always comparing and isn’t comparing pretty much always despairing? To me, stepping on the scales is still saying: my weight is a measure of my worth.

I also worry about the conclusions people might draw about their ability to trust themselves if they still use weighing for reassurance. Imagine that if you feel good in yourself, that you step on the scales and that the number isn’t what you expected, what will that do to you and what will that mean about you? Are you likely to conclude from that that it is in fact ok to be bigger since you felt good 10 min before, or are you likely to conclude that your feelings can’t be trusted since the number is evidence you are not good? I’d rather let myself feel ok and sometimes not ok and letting the feeling glide on me knowing it will soon dissipate and that I can use other measure for my worth such as my career, the love from my family and friends, my abilities etc.

I was weight obsessed as a teenager, I don’t know where it came from but I had what I call a “magical weight” a weight at which I thought my life would be perfect. Of course I went lower than that because the goal post always moves with anorexia, it’s never enough because you’re chasing a perfect life, which will never happen. I remember refusing to be weighed at the rheumatologist but then seeing the number and being horrified. I remember the shift from being ok before the consultation to wanting to rip my skin off after seeing that number. That was a crucial day for me, that was a spark for anorexia (which clearly was already simmering in the background) to light up and start burning me thin.

As I was reflecting about my personal relationship with weighing something struck me. We didn’t have scales at home, so instead I would go in the attic and weigh myself on an old fashioned pair of scales intended for animals and goods.

Let that sink that: I was using a device used to assess the weight and therefore price of goods to assess my own worth. That makes me so incredibly sad. I wish I could rescue that poor teenager from this dark abyss.

Scales are a clinical tool not an everyday item

Nowadays I have scales but I don’t use them and I’m not tempted to. They live in my office, they are not in the bathroom or bedroom and they are not intended for the family’s use. They sit on the floor next to my desk and I almost don’t see them, they could be a plant pot for all I care, I don’t need to interact with them. They are just an old tool left from when I used to see clients face to face. Given that last time I used them was to weigh my suitcase before going on holiday, I will probably dispose of them – more floor space.

I don’t weigh myself because I don’t need to: I can tell I’m fine weight wise and that my clothes haven’t changed for years. It doesn’t mean I stayed at that weight all those years by the way. I probably have gone up and down by several kilos over the years but not enough to require my attention so why should I care about the number? I also worry that I won’t totally be neutral about it when that number used to mean so much.

Not wanting to weigh myself is about limiting the potential harm it still could do, even if I don’t realistically think seeing the number would induce a relapse. I don’t want to change my body, I don’t think there’s anything wrong with my weight but what if seeing the number could rekindle the fire?

If I was at a higher weight than expected, I know I wouldn’t diet my way down but I also know I’d have a reaction to the number and I’d therefore have to unpack that, work through it temporarily to neutralise it and move on and I’d rather not do that because it’s easier that way.

It feels like being on top of a building, getting slight vertigo and having the desire to jump.

I won’t.

I would never jump but I still have the giddying desire to because I know it’s possible.  

Saving your calories for later is also called “banking” your calories, like you have a tight budget to respect and allocate wisely. If you want to save time and not read the full article, let me just say that your body isn’t a bank.

The end.

What does banking your calories mean?

Saving your calories for later is the practice of eating very little during the day, or delaying when you will first eat, in order to be able to eat “more” in the evening. Some people do it occasionally, if for example they are going out and that they are worried about what they will be eating/drinking that evening. Some people do it all the time and that for many reasons from sleep, shame, fear of being out of control, habit, wanting to eat highly palatable foods etc.

This may seem strange to some but I’m guessing that if you have landed here, it is because the concept isn’t totally alien to you. If it is you, know that you are not weird; this is in fact common practice in the eating disorder world.

Saving your calories for later is a solution people have found to their problems but this is also a practice that comes with its own problems. Let me break them down for you.

Fullness and bloating

The first one is purely physiological: if you bank your calorie allowance during the day and spend it all in the evening, it supposes that you eat a larger amount then. This means you are going to feel really full and probably bloated because your digestion can’t go from 0 to 100. This would be true for most people but it’s all the more true for people with an eating disorder because their digestion is likely to have massively slowed down because of restriction – this is called gastroparesis and I will do a post on this another time. So your digestion is slower than average, you have had nothing, or not much during the day, and bam, you dump a load of food in your system! This is going to feel heavy.

This sensation of fullness and bloating will send your brain into panic mode: “I have eaten too much! I’m out of control! I’m addicted to food! I’m a pig! I must do better and restrict tomorrow!” This is basically adding fuel to the fire; this is priming tomorrow’s restriction…

This is setting you up for a binge

Another problem, which is also physiological, is that saving your calories for the evening sets you up for a binge. This is because you’ve allowed hunger to rise, rise, and rise during the day and so by the time you actually let yourself eat, you’re ravenous and your brain struggles to hear the message from your stomach telling it that you’ve had enough and need to stop.

It’s also likely that banking your calories for later will lead you to crave highly palatable foods, which you have no doubt labelled as “bad”, thereby reinforcing your belief that you’re out of control and bad for caving in. This has nothing to do with control but everything to do with survival. Your body thinks you are starving (which is technically true but it is not for lack of food availability) and if that was the case, eating a carrot or two would be a shit survival technique. What your body is going to go for at that point is fat, sugar, not much fibre and not much protein. It wants more bang for its buck, it wants easily digestible, yummy, energy dense food that won’t require too much chewing. You’re not out of control, your body is just trying to save you.

If you do end up bingeing it’s likely that you won’t feel hungry the next morning (this is called morning anorexia) and that will once more start the cycle of restriction and later on, bingeing. Not being hungry in the morning could also be because you are unable to recognise hunger cues after weeks, months, or years of teaching yourself to ignore them. Not feeling hungry does not necessarily equate to not needing food.

I do appreciate that not everyone who saves their calories for later ends up bingeing and that’s a shame because bingeing at least gives you some energy. People always look at bingeing as a problem when it is in fact a solution. I didn’t say it was THE solution but it is one of them and a clever one too. It gets trickier and more dangerous when you don’t and what I often see is people who end up restricting twice.

You’re going to end up restricting more than once

Let me explain. The person decided to save their calories for later, “later” finally comes but the ED voice is so loud that it tells them they probably should restrict then too because [insert some hypothetical reason], or because they have eaten “too much” that day. How can it be too much when the person has restricted? Well, because any food will always be too much as far as your eating disorder is concerned. So if you restrict before AND that you restrict “later” , then you are restricting twice. I even see people restricting three times: I must restrict because I’m going out, I mustn’t eat because I’m drinking alcohol, I probably drank too much yesterday so I should eat even less today.

But I like saving my special food for the evening!

People often tell me that they like to save their calories for later so they can have something to look forward to in the evening, “my evening snack/meal is my favourite”.  I’m likely to respond in several ways to that. First I believe we should like all our meals and snacks and I would question whether some foods are only ever allowed at certain times in the day. Why not allow ice-cream at lunch time? What is the rule there?  

Yes, but what if I eat my special food at lunch and that I still end up eating it in the evening?! Then I’m eating way too much! Is that what you are thinking? Well, let me tell you: even if you have eaten something unplanned or more than you are used to during the day, chances are that you can still eat the same amount as you are used to in the evening, especially if you are in recovery. You need more food than you think.

Food should also not be the highlight of your day. If it is, it’s probably because it is constantly on your mind, which probably means that you are under-eating (we always come back to this, sorry). You might also need to build other things in your evening to look forward to: a series, a routine, a hobby, something that has nothing to do with food or exercise but that reconnects you to yourself.

Finally remember that you thinking that you “won’t cope without having that big meal/special snack to look forward to” is a disordered thought born out of restriction and panic. When you are recovered, your body won’t be in panic mode anymore and you will therefore not be thinking like that anymore.

I starve myself now so that I won’t be hungry later

Some people do eat but they delay their eating for as long as possible, they starve themselves in order to ensure they won’t be hungry LATER. They also have the perfect excuse and don’t have to call this “starving” or “banking calories”, but “intermittent fating” or “time restricted feeding”. This sounds more scientific and it also happens to be a trendy, socially accepted form of restriction, so no one questions it.

You have to admire how clever eating disorders are sometimes.

Think about it though, whether you are hungry before or after the meal, the result is still the same: you are hungry. If you can cope with hunger during the day, you can cope with it in the evening too. The idea isn’t “to cope with” hunger but this is just to drive my point home. The constant here is hunger and that’s what needs addressing, not the timing.

What if you ate before and that you’re still hungry later? Then you need to eat, sorry. Will it be too much? Again chances are that you are eating too little even if you are eating, so if you are experiencing hunger it’s because you need food and it is therefore not too much.

Eating more in the evening helps me sleep

Saving calories for later is also a way for some people to help them with sleep. Some people tell me that unless they eat a big meal at night they just can’t go to sleep. I get that because who can sleep when they are hungry? Plus did you know that carbohydrates help you make melatonin? However, this feeling of being satisfied relates to overall eating, not to what you have just eaten. Eating enough throughout the day would have the same effect. In some cases people can experience night eating syndrome and they require to eat in order to sleep but it’s relatively rare I would say.

Evening hunger is just hunger. I think some people are more scared of it because binges often happen at night, and even if you have never binged there is a part of you that thinks that you might. Binges often happen at night but it is usually because people have more time and privacy and because their hunger has been rising throughout the day. If you feed yourself adequately during the day and that you fill your time with activities that feed your soul, there is no reason to think you will binge at night. Evening hunger is only “dangerous” if it has arisen out of daytime restriction, otherwise it is just hunger.

Letting go of the control

I know you are worried that if you allow yourself to eat during the day you will end up losing control but the reality is that restriction is what is likely to increase the chances of you being “out of control”. Plus have you ever considered this: if you can’t stop yourself from saving your calories for later, then are you really in control?

If you pull too hard on a horse’s harness, it will bolt. This isn’t because the horse is out of control and the answer isn’t to pull harder. The answer is to relax your grip.

Food has always been part of my life

I have always loved food and cooking and I come from a family where food was celebrated. We often had people over for dinner parties and my mum cooked pretty much everything from scratch.

I was interested in doing dietetics in my early teenage years but I got dissuaded from going this way because my maths grades weren’t high enough – in France, where I grew up, the system can be quite rigid. It’s not like you need to use algebra on a daily basis these days… 

Too much and not enough

Those teenage years were quite difficult for me: there were problems at home, I had just moved to secondary school, I was trying to find who I was while also trying to fit in, look cool etc. I had this sense that I wasn’t good enough, my family seem dysfunctional and I felt awkward, too big, not pretty enough.

Basically I was both too much and not enough. I had a friend who was everything I wanted to be: slim, blond with blue eyes, perfect parents, a beautiful house etc. All the boys liked her and I felt I was just tagging along. I now know that my friend had an eating disorder but at the time, I just thought she was perfect.

One day I went shopping with my friends and we all bought the same fashionable skirt. I wore it to school, conscious that perhaps it didn’t suit me as well as the others but still proud to be wearing something fashionable – for once I was flirting with being cool. That day my friends all lined up and one by one they came to tell me that I couldn’t possibly wear this skirt because “I didn’t have the legs for it”. It crushed me.

I confirmed what I had suspected all along: I was disgusting, worthless and unloveable.

I hated my legs for years after that and in all honesty this is still the part of my body that I’m the least confident about.

I decided to become “healthier”

So, I decided to lose a bit of weight by eating a bit less. Then I decided to become “healthier” by becoming vegetarian – clearly, the subtext here was that losing weight would be healthier, which turned out to be untrue. Over the weeks and months, I melted and people congratulated me on my weight loss like my weight had been what was dragging me down all along, even though I was never anywhere near clinically “overweight”. They told me I looked good so I figured that losing a bit more weight would make me look even better and so I did… Those boys who had never noticed my existence were suddenly very interested in getting to know me. I was no longer just “the fat friend of the pretty one”. It felt amazing.

Except that it didn’t last. I can’t pinpoint the exact moment when it all went wrong but at some point I lost control. I couldn’t stop restricting and I was petrified of the very thing that had brought me so much joy in the past. I started cooking for myself so that it would be the least calorific possible, I baked lots but I wouldn’t eat any of it. The others could but I couldn’t.

I was tired, cold, hungry, miserable and socially distant. I had to stop dance lessons because I had no strength. The boys didn’t fancy me anymore and the girls were confused by who I had become.

Aside from my mum who tried to intervene, I received no professional help and so it lasted for quite a few years as a result. I just spent my time studying and not eating. I think this lack of help was a reflection both of the time (the late 90s) but also the culture of thinness in France.

I wasn’t ill, I was chic…

I sometimes feel ashamed of admitting I received no help. What will people think? Will they think I can’t possibly be recovered if I haven’t talked it through with a professional?

I think it’s quite rare to recover without help and frankly I wouldn’t recommend it. Clearly it’s possible and I’m not the only one but it could go wrong and it probably will take longer.

How did I recover then?

Out of tiredness and sheer stubbornness I think.

Eventually, I grew tired of it all and I decided enough was enough. I needed to get better, so I did. I didn’t start eating lots but I made tiny little changes (“atomic habits” as some would say). I created my own behavioural experiments: what will happen if I do that? What about this? Little by little I started eating more but it wasn’t really enough for my weight to massively change and that was good because I was still very much attached to the number on the scales and my appearance. This allowed me to relax around food and to see that many of my “rules” were based on nothing but sand.

I moved to London at 19 and it could have broken me but instead it made me. I loved how different everyone looked and also how nobody cared who you were or what you looked like.  The tube became a source of amazement and inspiration: I could see people in larger bodies wearing fashionable clothes and looking sexy. That blew my mind, I grew up thinking that if you’re not thin, you need to cover yourself up and be invisible. I never saw cool clothes in larger sizes before moving to the UK, I always thought that was only reserved for the thin ones.

Being a student in London opened my eyes, I could see there was a world out there that I couldn’t explore if I kept restricting, so I relaxed and tried new foods: biryanis, noodle soups, bagels etc. It also helped that no one really knew me as “the anorexic girl”, so I could reinvent myself and become just Anne, or “French Anne” as people now call me.

Over the years, I regained some weight but it was so gradual that I had plenty of time to get used to it, plus I stopped weighing myself so I wasn’t fixated on the number anymore. I bought new clothes and gave the old ones away. I ate out, laughed, had boyfriends etc. My periods finally came back and I felt elated.

I found myself walking amongst nature

I was now working in publishing but I had a sudden quarter life crisis while trekking in the Canadian Rockies. I wanted more from my job than just make money, so I decided to retrain as a nutritionist. I wasn’t interested in weight loss or eating disorders but simply to show people that food is a friend and that it can help us feel better.

I retrained, quit my job and started my family. Starting a family was also something that helped me recover, I’ve always known I wanted children and I also knew that it wouldn’t be possible if I didn’t get better.

After working for a couple of years I realised people who were coming to me all wanted to lose weight, even though they hadn’t originally come to me for weight loss, and even though there was no issue with their weight. I also noticed that many people displayed strange food habits, habits that were very reminiscent of the things I used to do when ill. I realised eating disorders and disordered eating were ubiquitous and so I decided to train further in that field.

I don’t believe in faith, I don’t believe it was my path but I believe the eating disorder strengthened me somehow. It was tough and it had the power to completely destroy me but it didn’t. There was something in me that said no, I’m not going to let you destroy me. I haven’t lived it yet and there is more to me that this illness.

I didn’t talk to any professional along the way but I reflected a hell of a lot and I have had many chats with myself over the years. I learnt to be curious about my emotions and not run away from them. I learnt that I’m both strong and fragile. I learnt to weed out people who are not good for me. I learnt that I’m flawed but so is everyone else and all we can do is our best and apologise when we make mistakes. I learnt that I’m enough, that my legs are fine legs that allow me to do stuff. I learnt that what I look like doesn’t really matter, who am I is what counts. We are all unique and that’s our strength.

You need to want it even if you’re scared

So, yes what saved me was tiredness and stubbornness.

I think that even with the most amazing team behind you, if you haven’t had enough of being ill, you will not be ready to recover.

You need to want to end this more than you want to be thin.

I can promise you that it will be scary and hard but I am yet to come across someone who regrets recovering.

Trick or trick

Every October I am reminded of the frightening reality of banning sugar at Halloween. It’s always the same thing: my Instagram feed is flooded with posts about the danger of sugar and how society has tricked our kids into becoming ill.

I am reminded of the daily sugar recommendations for children, of dental health, which “candies” are the best for blood glucose control or even hormone balance. My-fitness-not-so-my-pal, loves nothing better than detailed info-graphics on the sugar content of sweets. I even saw this woman advising to start taking electrolytes in October so we don’t crave sugar. Like people eat sweets at Halloween because they crave it!

Then you have the camp of people who let their kids trick or treat but then witchcraft takes place…  Either the sweets disappear overnight and are replaced by raisins and pumpkin shaped tangerines (nightmare), or the kid is allowed one handful and the rest is “donated” (i.e., dad eats it at the office). The worst case scenario, and I have heard it from many people, even an ED practitioner: you tell your kids to eat as many as they want on Halloween, to the point of them being sick, and then throw the rest away, that way they, apparently, understand that sugar is bad for us and that we shouldn’t be eating it. How messed up is that?!!

Tricks or traditions?

I didn’t grow up with Halloween, not least because I lived in the sticks and I would have had to walk for miles on muddy roads to get anything and it probably would have been some toffee that tasted like socks. When I left France, bars were starting to get on it and decorate for Halloween but that’s it. For me Halloween only really started when I had children, or more exactly when my oldest was old enough to walk and not get freaked out by it all. We’re talking knocking on a few neighbours’ doors with a sheet with eye holes here; nothing much and it was all very age appropriate.

When they were little I never bought sweets as part of the weekly shop but I also didn’t ban them. They happened at parties and special occasions and that’s because sweets aren’t things we need on a daily basis but they are fine to have in small quantities. I didn’t buy the kids sweets to give a chance to their taste buds to develop a certain range: try and tell a kid a carrot is sweet when they have only ever been used to Haribos. It wasn’t part of their daily diet but it was also not excluded or put on a pedestal, they were just things we ate sometimes.

It never occurred to me to ban my kids from trick or treating. I don’t see it as begging for sweets, especially since we give plenty out too. I see it as fun: those who want to partake, partake by putting a pumpkin out and those who don’t, just don’t. I have loved getting to know people in my neighbourhood thanks to trick or treating and I’m looking forward to bumping into friends this evening and seeing the kids dressed up and having fun. This for me this is what Halloween is all about: a celebration of the dead that is full of life. Like spiders we have created webs of memories based on traditions such as Halloween and I wouldn’t miss it for the world. Yes kids are hyper but it’s not just a “sugar high”, it’s mostly the fact they are allowed out in the dark (when you’re seven, you’re never out at night!), that they bump into their friends and that everyone, even some silly adults, is dressed up. They are hyper because, unlike silly adults, they embrace the moments and they are feeling it all in and screaming it all out. This is perfectly healthy behaviour to me.

Trick or teach

We all know sugar is something we can overeat and that overeating sugar in the long term can be detrimental for our health but is the solution banning sugar? Of course not, it’s teaching kids how to eat sugar, how much and why.

I encourage having a meal before we go, not make sure they have some goodness to offset the sugar but because it’s much easier to regulate your intake of sugar when you’re not hungry. Let’s face it, they won’t feel like eating broccoli when they get back and I certainly won’t feel like cooking anything when we get back – old witches need their sleep. So we’ll eat before, something warming and satisfying.

If my kids come back with 2 kilos of sweets they will know it’s not a good idea to polish it all off in one go, not least because they won’t have anymore after.  They will eat too much sugar on Halloween but it’s one evening and it’s very much time limited (sweets stay in the kitchen; we eat don’t eat in bedrooms). After that, I will put some sweets in their packed lunches, and they will eat some with a snack or after dinner, little by little.

I want and need to allow sweets in my house even though I’m a nutritionist, because not giving them sweets is saying there’s a problem with sweets and there isn’t. There can be a problem with too many sweets too often but guess what’s most likely to lead to that: restriction and no boundary with no explanation given to the kids.

You will never learn to self-regulate if you are restricted, it’s by eating the stuff on a regular basis that you learn what you like and don’t like and how much is too much. By not throwing away their sweets, they have learnt there is no need to gobble them all up. By allowing sugar you remove its mystic power, it’s just food and we eat sometimes because it’s fun, not because we need it.

I think it’s healthy to explain to kids that they can’t have as much sugar as they want in the same way as we would explain to them they can’t watch as much TV as they want. They also need to read, play and go outside. It wouldn’t be great parenting to give no framework to kids and it wouldn’t be great to allow nothing either. By explaining to kids that it’s fine to have those foods because they taste yummy but that objectively we need fewer Maltesers than broccoli for a strong and happy body teaches kids to be neutral about food and their bodies.

Sweets aren’t a treat but guilt shouldn’t be a trick either.

Trick or blip

My approach to sweets is a bit like my approach to swearing. Excuse my French but, for fuck sake’s the key isn’t to pretend swear words don’t exist but to teach kids that there’s a time and a place for this.

This post on low level movement will most pertain to anorexia nervosa, or to people who are restricting their food intake in a way that it affects their physiology. This is because there is a physiological reason for lower level movement.

So what is lower level movement?

Well, it is a term used to describe a type of physical activity people with anorexia engage in. It often starts involuntarily without the person realising they are doing it but then the Voice takes over, the rules start and it becomes an activity the person feels compelled to do.

Compulsive exercise is well known in the eating disorder world and I shall write about this in more details in my next post. Briefly, however, it is when people engage in frequent, long and arduous exercise sessions. It can been seen as a form of purging, as it is often a way to compensate for the food eaten. It’s quite overt, you see people running, always in their gym wear, constantly at the pool etc.  Well think of lower level movement like this but hidden, like a workout under an invisibility cloak.

Lower level movement is sneakier that blatant compulsive exercise. It often goes unnoticed because people around you don’t see the extent to which you are moving. You are not wearing gym clothes, you are just being helpful, kind to the planet, a good dog owner etc.

Lower level movement encompasses different types of movement that you traditionally don’t think as exercise such as: walking, standing, or fidgeting.

Walking

Walking the dog is a good example. If you have a dog, you need to walk it, it’s only right for the animal to be comfortable and healthy, right? What I see though is people who walk their dog several (many) times a day, more than the dog really requires. It’s not just a decent walk and then a quick wee round the block. It’s getting up at the crack of dawn for a long walk, coming back home at lunch for another one by the beach, then one before dinner and one before bed. Before you know it your dog is exhausted because you have walked 10 miles.

Walking

Then there is walking the longer route, everywhere. This is certainly something that I did when I was a six former when I had to walk to and from the bus stop in time to get to school. I only ever went to quickest, and normal, route when I was with other people because I didn’t want to look weirder than I already was. Towards the end, I could engage in my crazy walking because I had no friend and there was no pretending I wasn’t weird, I was the anorexic vegetarian girl. Everyone knew this.

People wrapped up in lower level movement take AGES to shop. Most people with an eating disorder take ages to shop because they are scrutinising the labels but this takes another dimension. That’s because people will walk to the further shop possible and they may even visit several shops to check the different items they need to buy. Only then will they decide where they will buy the items from, possibly ending up in the first very shop. They will never just pop to the corner shop, they will go to the one that is three miles away at the bottom of that big hill. Conveniently, because it takes them so long to get there, they probably don’t have much time for lunch…

More walking

Another common feature of lower level movement is having rules about the route you take (always the same, or longer). Or, it’s having rules attached to how the walking is done: you have to go round the school grounds twice before you can walk home, for example. The result is the same, it’s about distance and it’s about not being deserving if you don’t comply with the rule.

I remember a language trip to Brighton when I was really ill actually (I looked a fragile twig on the cliffs of Eastbourne). I remember walking everywhere and not often buying a bus ticket because “it was cheaper”. It was, but the real reason was that every little step counted, I walked, walked and walked by myself when I was supposed to speak English, make friends and kiss boys.

People also walk whatever the weather “for the environment”…

Engaging in lower level movement means always taking the stairs even though lifts are available. It is racing people up the escalator (even though those people have no idea a race is taking place). It’s never siting on the tube – why sit when you can stand? It’s getting off the tube or bus several stops earlier, so you can walk the rest of the route home and “get some fresh air.”

Standing and fidgeting are also very common forms of lower level movement.

I see people, influencers or worst perhaps, health professionals, only ever using a standing desk because “it’s better for you.” They even go as far as installing a treadmill under their desk so it becomes a walking desk.

People watch TV standing, sometimes pacing around the room. I have had clients refusing to sit down for our sessions, constantly fidgeting instead.

Some people clean obsessively; people wrapped up in lower level movement never have a dirty house, it’s always immaculate. I saw a programme the other day when a lady was getting up every day at 4.30am to clean her place! She lives in a one bed flat on her own, how much cleaning could there possibly be?! Given other aspects of this woman I would be ready to bet that she is suffering with anorexia.

Certain persons sometimes go as far as picking jobs that mean you will stand and walk all day long: nursing, bar tending, harvesting, farming etc. The number of people I have seen working in the hospitality industry is unreal.

Moving to run away from ourselves

Moving is a way to distract you from the noise in your head and from the voice telling you are not good enough. It’s a way to fill the void and break the awkward silence between you and yourself, so you don’t ask yourself the important questions. So, yes, it is a way to run away from yourself. Eventually, movement is also a way to make it harder for you to eat. You don’t want to make crumbs while also cleaning the house, do you?

What matters isn’t what you do really because walking the dog, cleaning the house, not taking the bus are all valid things. What matters is how strongly you have to do those things. Anything that feels compulsive and that will induce guilt if you don’t do it is likely to be deleterious for your mental health.

The physiological side of lower level movement

One often assumes that lower level movement is just a sneaky way to burn calories but it isn’t just that and that’s what differentiates compulsive exercise from lower level movement. It is common for anorexia to start from compulsive exercise: people get caught up in the number game and need to go faster/further, to do better, and/or lose more weight. Lower level movement seems to be different in that it seems to be the consequence of under-eating. In fact it was already seen in the Starvation Study conducted by Ancel Keys: when starved the men started to fidget and want to move more.

On the surface of it, it makes no sense at all. If you don’t receive energy from food, why would you feel compelled to expand it through movement??

The answer to this is physiological. When someone loses weight due to a restricted diet, their level of leptin decreases. Leptin is a hormone directly related to the amount of fat we consume and store. If leptin is low because our diet is poor in fat and because we don’t have much body fat, it suggests to the body that it is starving. Evolutionary speaking, if we were starving we would have had to move to greener pastures, so low level of leptin therefore urges the person to move in order to find food.

Of course, evolution hadn’t anticipated mental health. It hadn’t anticipated that a person might “voluntarily” restrict their food intake even though they are surrounded by food. Nonetheless, the body responds in the same way and starts to move. Then comes the ED voice, recognising that this is a rather good idea to keep moving in the hope that more calories will be burnt.

How to get better

The only way to get better is by resting and eating.

The body needs rest to heal and it also needs food to rest.

What is volume eating?

Volume eating is essentially eating large amounts foods. Mind it’s not any type of food, here we are talking of low calorie foods. I suspect that if it wasn’t low calorie, diet culture would be quick in calling it overeating or binge eating but as long as there aren’t too many calories, that’s legit, isn’t it?

I think volume eating has also been referred to as the volumetric diet and perhaps this term encapsulates well my views on this practice. It’s not a bad idea to have volume on your plate, but if it’s called a diet I smell rat somehow.

Why it could be a good idea

As a nutritionist, I think it makes total sense to eat food that satisfies you and makes you feel full. Firstly, that usually means you have eaten enough and that you have enjoyed your meal. Secondly, despite the fact that I love food and made it my job, I don’t want to be thinking about it, and more precisely what I’m going to eat next, every five minutes. Volume eating allows you to do that: eat a nice amount and forget about it for a few hours until your stomach tells you it’s time to eat again.

Tissue paper food

There are some foods that I categorise as “tissue paper food”; note it’s neither good nor bad. Imagine, you go to the shop and buy something nice and valuable, the shopkeeper may wrap it in tissue paper to protect it and to make it pretty (I’ve never been handed a light bulb or a saw in tissue paper, it tends to be fabric, soaps, flowers etc.). The tissue paper doesn’t need to be there but boy, it’s lovely to unwrap and hear the rustle of the sheets!

Well it’s the same with food, there are some stuff we don’t really need and on their own they don’t do much but boy, they are nice to eat sometimes. The thing with tissue paper food is that there isn’t much to it. You would want to only get the tissue paper (you want the soap or the fabric) and if you only ate “tissue paper food”, say biscuits or crisps, it would take a while to fill you up, so you’d have to eat quite a lot of them and that might not be great for your health. 

Sure eat the biscuits and crisps but including some fish, meat, eggs, vegetables, fruit etc. would be a smart move for your health and for your satiety too. That’s because protein and fibre are nutritious and filling.

So at first glance volume eating seems pretty sound and like a reasonable nutritional strategy. However, can you feel the “but” coming? There’s one coming of course…

What is the link between volume eating and eating disorders?

But! As almost always with nutrition trends, practices, or good ideas, things can be taken too far. We often refer to “grey areas” as things we don’t really know about and there tends to be negative connotations attached to this but in nutrition it’s the opposite. The best place to be is in the grey zone, we don’t want black or white. Some may agree that restriction is bad and they may argue that volume eating is its anti-thesis so there’s no need to fret but 1) it’s not quite true (bear with) and 2) that sounds very black and white to me.

Ok, restriction is bad so I’ll eat but I want to lose weight, so I’ll eat foods that contain the least amount of calories possible – that’s still restrictive, hence why not the anti-thesis of restriction.

Slightly different scenario: I don’t want to gain weight but I want to feel full, so I’ll eat food with the least amount of calories possible so I get more bang for my buck – this is still restrictive because it makes abstraction of everything that isn’t filling and low calorie. Nutrients, sustainability, enjoyment etc. don’t matter anymore provided the food is filling and low calorie.

Embrace the grey!!

What can happen with volume eating when it is seen as a diet, is that instead of people filling say half their plates with vegetables, the rest with protein, and carbs and having some tissue paper food for dessert, they get rid of the fat, the carbs, the sugar and some of the meat, fish, eggs, cheese etc. People eat, they eat large amounts, but what they eat just chaff and water: leaves with no dressing, steamed vegetables and fish and perhaps some diet puddings made with artificial sweeteners and gums. People tuck into massive meals that take ages to eat and make their jaws ache by the end of the day.

Volume eating can quickly lead to a socially accepted form of disordered eating and to an eating disorder. It can descend into cutting out most carbs aside from fibre, and all fat leaving you with a form of low carbohydrate diet, not quite keto, not quite paleo, just low carbs.

The problems with it

There are lots of problems associated with volume eating: social, nutritional, digestive and emotional.

What happened to me is the same as what happened to my clients: our social life shrunk because we just weren’t eating like anyone else around us. By that I don’t just mean we couldn’t go out but we also couldn’t eat like the rest of our household. Going out was always having a salad, it didn’t really matter what restaurant we were going to, I was always having the salad when the others were having pizza, a curry or a paella. At home people end up eating differently to their partners or children, it’s salad, chicken or white fish, vegetables and fat free yoghurt.

Eating isn’t just consuming nutrients, it’s an act of sharing and we could even go as far as saying that it’s an act of communion, whichever religion you belong to. What does it mean about you and what does it do to you to always be the one not having the cake, the bread or the sauce?

The nutritional limitations of volume eating

Nutritionally it’s a bit of a car crash: we need fat for hormonal function, for brain function, for skin health, to absorb fat-soluble vitamins etc. We need starch so the body can get a readily available source of glucose and to get minerals such magnesium, iodine and selenium, and let’s not forget choline and B vitamins. Many women end up eating mostly vegetables and massively under-eat protein, leading to a decrease in muscle mass.

I saw this guy once on Instagram eating a shocking diet. There were lots of good things (fresh fruit and vegetables and some protein) but what he was eating barely resembled meals anymore. His egg-white omelette looked like a doormat, his salad was so large he ate it from a mixing bowl and his puddings were all artificially coloured and flavoured. It took him two hours to eat his lunch and two third of the way through he looked like was genuinely struggling to finish his 1.5kg salad (1.5kg?!!) but he soldiered on because it was “better than being hungry”.

Forcing your stomach to hold such big volumes for fear for becoming hungry isn’t good for you. I’m ready to bet that with all the fibre he had eaten the next day wasn’t “pretty pretty”.  Fibre is good but we are not ruminant sand shouldn’t just consume vegetables. 

How it could worsen body image and disconnect you from your body

The irony in abusing volume eating so you don’t get hungry in between meals is that by eating exceedingly large portions of low calorie food, you are stretching your stomach more than usual thereby potentially messing with natural satiety cues. What that means is that you are getting your stomach used to having a lot in so that next time it has less, say a regular meal with more calories but smaller in density, it will feel like you haven’t eaten enough. This may cause you to eat more (even though your body doesn’t technically need it), or just to panic leading to the confirmation that higher calorie food is indeed dangerous.

Eating lots of fibre and diet food could also lead to bloating worsening your body image and driving you to eat less.

How eating more to reduce hunger may not reduce cravings

Finally bear in mind that feeling full doesn’t eliminate cravings. I have seen plenty of people who had gastric procedures limiting the amount of foods they could ingest but who regained weight because they still craved certain high calorie food (because they taste good) and who were regularly just consuming ice-cream (tissue paper food). Their weight problem, in all likelihood, wasn’t driven by their stomach, which had too much hunger, but by the brain, which needed to learn other ways of being emotionally soothed than by eating.

Feeling full doesn’t mean being nourished; you could feel full after drinking lots of water even though you haven’t actually eaten anything.

Sure, eat fruit and vegetables, include some fibre in your diet but, please, remember the emotional role of tissue paper food.

If you are struggling with volume eating, get in touch here.