Counterintuitive

One of my favourite talks at EDIC was a sprint though the role of food in eating disorders by Professor Andrew Hill. He began by addressing the infamous cliché attached to eating disorder awareness raising – it’s not about the food – and said that he felt this was a simplistic and not entirely accurate statement. Food, he suggested, could be seen through different lenses of nutrition, health, emotion, identity and control, all of which could influence eating behaviour. During this whistlestop tour he covered everything from the Minnesota semi-starvation experiment – in which 36 healthy young men were fed 1800 calories a day for six months and developed symptoms we would usually associate with eating disorders, thus beginning research into the fact that malnutrition itself can perpetuate anorexia and bulimia independently of psychological processes – to the internal and external cues involved in feeling hungry, the expression of ones identity through channelling values and morals through food choices (e.g. becoming vegetarian), the government-sanctioned demonisation of certain food groups and so on.

The most interesting part of the talk for me was on the regulation of food intake. Professor Hill introduced this by showing an immensely detailed systems map relating to obesity, which included a staggering 108 known variables across 7 broad themes – biology, food production, food consumption, societal influences, individual psychology, individual activity and activity environment – which contributed to food intake and energy expenditure. This map really shows how complex the regulation of weight and intake is on biological, psychological and societal levels. It is not a simple issue and does not have a simple formula attached to address those who wish to influence their weight in either direction. The link to the map is here – I can’t find a version that lends itself well to zooming, but you can clearly see the seven themes and the interlocking paths which link them. The document it belongs to is this one, which is freely available online.

One influence on food intake Professor Hill particularly highlighted was the impact of actual or intended dieting/dietary restriction. This was in the “control” part of the talk, which I originally thought might refer to the fact that so many people think that eating disorders are *about* control, but was happily mistaken. What he was actually talking about was the physiology and psychology of control over food intake. He spoke of study after study which had shown how the dieting mindset actually leads to more episodes of (actual, not just perceived) over-eating, compared to non-restricted controls. This is especially true when the dieter eats food they had previously ruled as off-limits (the fuck it effect – I’ve had one biscuit so I’ll eat them all), if alcohol had been consumed, if other people around the dieter were eating high calorie foods freely or conversely if they were eating alone, if the dieter was experiencing a negative mood, and if they believed the foods they were eating were unhealthy or had a high calorie content. Professor Hill also outlined the mechanisms of cravings: dieters and restrictive eaters have both more cravings overall and more specific cravings for foods they have outlawed compared to non-dieters. When highly palatable foods are outlawed in this way they become more desirable, and if the person either finds this resistance very difficult or fails to maintain it they will often attribute the blame to a property of the food, thereby spawning hundreds of articles about the supposed addictive qualities of sugar, cake, biscuits, chocolate and so on. Hill related this to the well known mind game of trying not to think about a polar bear, and said that at least one study had taken the polar bear concept and applied it to instructing their participants not to think of chocolate – with the result that chocolate overwhelmingly became the subject of their thoughts.

This has also been researched in relation to children. Basically, findings are that children exposed to “pressuring” food rules (e.g. you must eat everything on your plate) are likely to eat less, and those exposed to “restrictive” food rules (you must not eat snacks between meals) are likely to eat more. Either way, imposing food rules either on yourself or others usually backfires in some way: either a large amount of time and energy will be required to adhere to the rules, or a restrict/binge/restrict pattern will emerge, in which a person strongly adheres to the rules for a period of time, becomes overwhelmed or exhausted and lets them slip for days/weeks/months, and after a certain further period of time will reapply the rules and begin the cycle again, ad infinitum. This pattern of behaviour in those not predisposed to anorexia usually leads to weight gain over time.

This is all really interesting in the context of both “normal” dieting, disordered eating and clinical eating disorders. Of course there are some people who, through some quirk of biology, never binge or deviate from their self-imposed rules during restrictive periods, but even this tells us something about the way they differ from the rest of the population biologically and/or psychologically. For the vast majority of the population it means simply this: diets don’t work. Formalised, rule-driven diets which prescribe a certain way of eating seem to make matters worse over time, establishing a chaotic pattern of restricting and overeating which leads to the body increasing its set point in response to deprivation, then hoarding every calorie it gets when the rules break down. From what I gather, dietary decisions made for ethical reasons are exempted from this, with the exception of when a person is fooling themselves over their reasons and actually just wants an excuse to restrict. I never craved meat in 17 years as a vegetarian and most of my ethically-driven vegetarian and vegan friends would say the same, but others I know who have stopped eating meat have struggled immensely when doing it for the “wrong” reasons.

I share Professor Hill’s outlook on this issue: that our society and government have worsened this problem by constantly harping on about certain foods or macronutrients (fats, carbs) being unhealthy, or even somehow immoral. For goodness sake, I feel like I’m committing an act of rebellion every time I eat cake in public. Not that it really affects me beyond finding it vaguely entertaining when people remark on my ability to eat cake and not gain a million pounds (I feel this is related to the fact that I actually allow myself cake, rather than freaking out about it and eating twenty cakes in a spurt of panic as I did as a teenager), but what about all the people who are too ashamed to eat anything but celery in public, only to go home and eat the entire contents of their fridge? Stigmatising various foods, inaccurately labelling them with good/bad judgements and even worse, attempting to shame larger people into losing weight just isn’t going to do a damn thing to help.

It is for this reason that from January 2010 I’ve been steadily learning about and applying to my own life the principles of Health At Every Size and intuitive eating. To begin with I found Health At Every Size a bit of an unfortunate name – after all, I hadn’t been healthy at my lowest weight so I couldn’t quite see the logic – but then I realised I hadn’t understood it correctly. What HAES actually means “is an approach to health that does not pursue the goal of a particular body weight, but rather concentrates on what health benefits and improvements can practically be achieved for individuals” (from the HAES UK FAQ, acronym heaven!). I would really recommend that anyone interested, either from the point of view of wanting to find out more for their own benefit OR because they are sceptical/unsure how it works, reads the first two sections in the FAQ linked: the basics and the justifications. HAES has a growing body of evidence behind it, not just established by the leading experts who have a vested interest in the subject (Linda Bacon is the woman in the know), but also gradually by other interested parties who want to test alternative approaches to weight issues as it becomes clear that dieting just makes things worse.

It’s no secret that I would really encourage people to look into intuitive eating in later stages of their recovery. I started teaching myself this way of eating and maintaining a healthy weight in February 2010, after a year of gaining weight and a month or so at my target. I could have micromanaged my weight forever, adjusting my calorie intake up or down depending on whether the number was trending up or down in general, but I was thoroughly sick of counting calories and obsessing over numbers, and wanted to at least try something different. I started slowly because eating disorders can rob bodies of sensitivity to hunger cues, and I couldn’t reliably identify feelings of hunger or fullness after twelve years of eating disorder. I believe I began by sticking to my general meal plan structure – breakfast, snack, lunch, snack, dinner, snack – and still aiming for the same sort of amounts at each, but without either weighing portions or counting the exact calorie totals. I was sure my weight would rocket (come on, I was a recovering anorexic, we’re all sure our weight will rocket!), but it didn’t, and so I extended my experiment for another week, and another. It held steady, and I have maintained my weight within six pounds (which is what constitutes one BMI point for me) without consciously trying to for the last two years now. I still have to break away from this approach slightly and make an effort to keep my intake up if I’m particularly stressed or ill, but otherwise I eat what I want, when I want, in the amounts I want, and those cues from my body mean I maintain a healthy weight.

One last question to Professor Hill from a lady in the middle of the auditorium: if there are so many different variables which influence our food intakes, from advertising to clock watching to biology gone wrong to stress, how can intuitive eating be a practical solution? Surely our bodies and minds are too confused to work out what they want? I can’t remember his answer fully because by that point I’d put my notebook away in anticipation of the dash for the complimentary cups of tea before the masses started queuing, but I vaguely remember it having a similar feel to my own thoughts on the matter. My answer, had the question been directed at me, would have been that once I was healthy I approached the problem on two fronts: by eating mindfully and retraining myself to be more sensitive to my internal cues, and by educating myself about HAES, intuitive eating and the like, slowly giving up my rules and revising my way of seeing food through the value-driven prisms of good/bad, right/wrong, healthy/unhealthy. It worked for me, and while I respect that different things will work for different people, it’s not just me and it’s not just people in recovery from anorexia. This approach is especially healing for people who have had problems with bingeing, chronic overeating or bulimia, and I would love for more people to give it a chance rather than immediately dismissing the idea on the basis that it can’t possibly work, that people need more rather than less control over their food intake, and/or that it’s too damn scary to contemplate. Actually, it gave me the most genuine and wonderful sense of control and freedom over my life, my body and my food intake, and it has taken all the fear out of eating.

I kind of wanted to kiss Professor Hill after his talk for being so well informed and making so much sense – but I wanted that cup of tea more 😉

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22 responses to “Counterintuitive

  1. I think he might have been embarrassed if you had kissed him, but you never know. It WAS good wasn’t it, despite being on the last day of a very full programme.

  2. First, I must take back my former negative criticism of Andrew Hill. I had previously been put off by his involvement with a weight loss camp for children… But I agree, his talk at EDIC 2012 sounds brilliant.

    I do see problems with ‘intuitive eating’, however… The fact of the matter is that we DO live in an ‘obesogenic’ society where highly palatable, high energy foods are readily available, and the human body is (in general) adapted through evolution to store energy. If many people ate intuitively, they would very quickly become obese, and there is no doubt that obesity IS a health risk. The only counter to this, for many people, is via obesity prevention and avoidance of these foods – because some people simply cannot eat ‘in moderation’ (which is not a willpower thing, but a genuine metabolic drive). Yet, countering the ‘obesity epidemic’ also appears to be fuelling disordered eating… So whether or not the majority of people really can eat intuitively in our society is questionable.

    On a personal level, if I ate intuitively, I would grossly undereat. This is the way it has always been. Long before I developed anorexia as a child I had a genuine lack of appetite that was partly fuelled by food phobias and emetophobia. I HAVE to adhere to a plan that I know contains well over 2000 kcal/day, otherwise I would drift towards undereating, would lose weight rapidly and would quickly fall down the rabbit hole. Basically, I just don’t enjoy eating that much.

    • Yes, this is what most people say when confronted with the idea of HAES and intuitive eating – that our society and environment make it impossible. But increasingly the research says this isn’t so: that HAES outperforms traditional diets for weight loss (this is one of the reasons the post is called counterintuitive – because weight loss isn’t the goal of HAES, and yet if it needs to happen, it facilitates weight loss very well), for maintenance of that loss (this is the big area where traditional diets fall down – keeping it off) and for general well being. Intuitive eating is totally possible for all sorts of people with all sorts of previous eating and weight related problems in our society, it just needs to be approached with the right sort of information and education. You don’t just jump in and start eating ice cream for breakfast, you read about it first and learn what it actually means to eat intuitively. Professor Hill was a big fan too, and like you said he works in the field of obesity…

      I know it wouldn’t work for some people with a very long history of anorexia because hunger and satiety cues are so messed up. But many people with AN, BN, EDNOS and BED have benefited from learning these skills in later recovery. Seriously, even if you don’t think it’s possible for yourself (and I respect that, because like I said I need to make more of an effort when I’m stressed out not to undereat), it’s worth reading those FAQ and checking out the research before just dismissing it as impossible due to the availability of highly palatable foods, because that’s not actually the case.

      • I actually attended the UK’s first HAES conference in the UK in 2006. My friend, who was doing her PhD on the subject, set up the conference and I intended in part to offer her moral support.

        My primary understanding of HAES, however, is that although weight management is NOT encouraged, ‘healthy eating’ is. The dietician from the USA who spoke at the conference emphasised ‘healthy choices’ (fruit, vegetables, low GI carbohydrate foods etc.) and also encouraged mindful eating. So there was no evidence of intuitive eating in the sense of ‘eat how much highly palatable food you want’. Rather, the emphasis was on filling oneself up with ‘healthy’ food to curb hunger and leave less room for the high energy foods. Physical activity was also encouraged, and my friends actually undertook her PhD on the subject of physical activity intervention for obese individuals.

        Given that obesity is not driven by hunger, I still question how intuitive eating can work via HAES. The logic seems feasible on the surface, but metabolic research is increasingly showing that the control of appetite in obese individuals is unusual, with unusual patterns of grhelin and neuropeptide YY secretion for starters. Obese individuals typically don’t feel either extreme hunger or extreme fullness. Rather, they have a constant nagging urge to eat highly palatable foods and never feel satiated. There is also a relationship between childhood obesity and inadequate maternal nutrition during pregnancy, which seems to prime the foetus to favour highly palatable foods in childhood via epigenetic phenomena.

        On a personal level, I can never see intuitive eating working. But my own metabolism and psyche seem to be the polar opposite of the principals on which HAES operates anyway!

      • And I will add that on te HAES FAQ list it is stated:

        “Intuitive eating is about paying attention to internal body signals and eating (or not) in response to them.”

        Yes, but accumulating metabolic evidence suggests that in obese individuals, or people with a propensity towards obesity, these internal metabolic signals are skewed. This is why for some people with morbid obesity (who are NOT healthy), the only chance of ever losing weight to improve health is to have gastric bypass surgery. The latter has been shown to alter metabolic signals from gut to brain and alter intuitive eating in such a way that the person doesn’t crave highly palatable foods.

        Oh, and when I attended the HAES conference I made the very point you highlight in your post. HAES doesn’t apply to AN!

      • But you’re talking about people at both extremes here Cathy, and I never doubted that in some people obesity is driven by powerful biological mechanisms, just as in anorexia. But not everyone falls into those polar opposites – how about people who have become overweight because of shift patterns at work comfort eating, being too busy to look after themselves and other situatio s like that? People stuck in a loop of failed diets or very far along in recovery from an ED who want more from life? I had no hunger cues two years ago and I’ve sort of timed back into them, so it’s not impossible even for some with histories of anorexia. Dieting makes people bigger over time – this is a sensible alternative for many, but that doesn’t mean I think everyone will benefit, and equally that fact doesn’t mean it’s a dead end either.

      • Okay, spelling things right on my phone is tricky 😛

    • No we are not an obesogenic society. The body has a very complex system with various back-ups to ensure that we maintain whatever our body determines is an optimal weight. Any weight control effort in any sense will damage that system.

      Less than 5% of the population actually has the genotype that allows for the extremely effective storage of energy and these individuals are disproportionately from gene pools where their ancestors had to survive unusually harsh environments: aboriginal communities in Northern Canada and across the American desert areas are examples of this so-called thrifty genotype.

      In fact those of European descent are particularly ill-equipped to survive famine in that same way because the relative plethora of food stuffs available to our nomadic ancestors did not evolutionarily select for such thriftiness of metabolic function.

      There is no such thing as an obesity epidemic. On average the population has gained less than 1 lb. per year in the last 25 years and, as mentioned, the weight has disproportionately increased in the 4.8% of the population with the so-called thrifty gene. In the U.S. that weight increased flattened out completely back in 2004. That weight increase could be attributable to the age of Boomers in fact. As a disproportionate group in our population numbers they would have naturally increased their weight (as all adults do) up to about age 65 at which point their weight naturally lowers as they enter their senior years.

      Eating intuitively is to eat without restriction for all human beings whether they are on the restrictive eating disorder spectrum or not. You’ll find all the scientific references to the above data on my blog in the Fat series entitled: Fat: No More Fear, No More Contempt. http://www.gwynetholwyn.com/blog/2011/11/24/fat-no-more-fear-no-more-contempt-part-i.html

      • Thanks for responding to my comment, Gwyneth, but I think you misunderstood what I meant by ‘obesogenic society’. By using the term ‘obesogenic’, I was referring to the readily available provision of highly palatable, high energy food in many developed countries; not the inherent tendency for some individuals to become obese. I, of course understand how the human body regulates energy balance given that this was a primary focus of my PhD research and published, peer-reviewed post-doc research. I agree that the data surrounding the so-called obesity epidemic has been skewed by a sub-group of individuals with a particular susceptibility to gaining weight, and that not everyone is ‘at risk’ of gaining large amounts of weight to the point of morbid obesity. The point I am making is that there IS a sub-group of individuals in developed society who have been shown to have difficulties regulating their intake of highly palatable, high energy foods. If such individuals eat intuitively then they will over-eat and readily store that excess energy which will contribute to health risk. So would you argue that such individuals eat intuitively, especially if they live in an environment where the cheapest and most readily available foods are high energy and high fat?

      • Oh my, I couldn’t possibly hope to compete with a peer-reviewed, post-doc and published understanding on the topic but I’ll humbly wade in nonetheless.

        Thank you for clarifying that you had actually meant to use the term obesogenic as an adjective defining the impacts of ultra-processed, or highly palatable foods. However, as you point out yourself, obesity is not driven by hunger and therefore that fact alone would rule out the possibility that ultra-processed/palatable foods will impact the 4.8% of the population who are pre-disposed to obesity. It does not appear that their ability to regulate their intake of such foods is in any way compromised:

        Statistics from the Healthy Eating Index [Table 10, 1998]: 17% of those eating only 60% of the recommended calorie intake are obese. Only 10% of those eating 120% of the recommended calorie intake are obese. The correlation coefficient is r=0.02594 (p<0.38), and that means that body mass index is not linked to calorie intake.

        I think the recent research investigating the inflammatory capabilities of the endocrine organ we call fat is likely going to have much more bearing on the experiences of the 4.8% of the population prone to obesity, than epidemiological studies that tentatively correlate the addition of ultra-processed foods into the diets of large populations with weight gain.

        Given that the introduction of ultra-processed foods into large populations never occurs without a commensurate increase in the number of people attempting to restrict their food intake (dieting), no on can be confident that the correlations are in any way causative.

        And, in fact, the impacts of dieting (or non-intuitive eating) on the inflammatory responses of adipose tissue is perhaps going to become much more relevant (and ultimately successful) to the treatment of the sub-section of obese individuals who are metabolically unwell.

  3. I totally agree with you that HAES principles are better than dieting principles. And I totally agree that we’re talking about a spectrum of individuals (the population as a whole) rather than the extremes. Also, I agree that dieting DOES increase weight gain over time for the majority. What really interests me in all of this is the science, because science informs practice. But so often in science, theories are conflicting.

    I am not writing off HAES principles whatsoever. I am merely arguing against the idea that they are ‘intuitive eating’ (in an environment where people are surrounded by highly palatable food). I think HAES is a good thing. The health-related data from studies based upon the HAES principle do suggest that overweight people can become healthier in many ways (including risk of developing metabolic syndrome) through increasing their physical activity levels and making ‘sensible’ food choices, yet not starving and not losing weight. But that’s not intuitive eating. It’s a non-dieting approach to health. And HAES doesn’t apply to the morbidly obese or the anorexic individual.

    I also think you’re correct that for most people with restricting AN, hunger cues do return with weight gain. They have for me, but I still tend to eat less than my body needs, unless I consciously ensure that I eat enough. The problem most people with restricting AN have during recovery is an urge to binge. I know I’m an enigma 😦

    • Right, I get where you’re coming from. I’m aware that HAES abd intuitive eating are different things, but many people find them, along with mindful eating, compatible. Also, intuitive eating itself doesn’t mean people really do go around eating ice cream for breakfast, just that by removing food restrictions and allowing oneself to eat when hungry often guards against developing the sort of mindset that leads to diets “failing”

      • Yes, I agree that diet restriction is largely counter-productive. Obesity can be the product of ‘yoyo-dieting’, and ‘yoyo dieting’ is unhealthy in metabolic and physiological terms. And for people with a propensity for developing clinical EDs, dieting is dangerous.

  4. By the way, please NEVER think I am being negatively critical if I produce counter-arguments. I am just really interested in the science, and debating/discussing are really interesting.

  5. loved this post, Katie.
    As you know I was totally not up for IE at all just a couple of months ago. I was looking at my EDs (AN, BN, COE) through the lens of the addiction model and that helped me for a long while. However, as you say, some people further into recovery start to want more freedom, more flexibility and more life in their lives than a very structured food plan allows for. For me it’s been a whole revelation to believe that I may now be able to train myself to tune into my hunger/satiety cues and let my body lead me (with mindfulness too). I don’t think I could have embarked of this part of my journey any sooner than I had. I have probably been chronically undereating without realising it because I was at a healthy weight and didn’t realise. Having read Linda Bacon’s HAES book it just spoke to me and I started to believe (based on the scientific arguments) that maybe I wasn’t “powerless over food” or a sugar addict. I totally credit the 12 step programme I was a part of and the very rigid “abstinence” to getting me this far: ending up at my body’s healthy weight is not something I would have elected for from the outset, but having ended up here it’s allowed me to think further ahead, contemplate being the shape I am without scurrying back down the hellhole of AN, which for me always leads to BN and COE and then back round until I’m in some hideous maelstrom of all three!!

    I’m just over 2 weeks in to my HAES journey and it’s had so much more of a positive impact on my life, mood and functioning way beyond the food!

    Louisa

    • It’s so awesome to read this Lou, I’m really glad this is working out for you! I never used 12 Steps but I know what you mean about it having served its purpose and provided you with the necessary foundations – I would never have managed to start teaching myself how to eat intuitively if I hadn’t had a whole year of constant nutrition via my very rigidly structured meal plan, which I used from March 2009 – February 2010. I needed to learn how to trust food and my body again before I could start experimenting. Best of luck continuing with your journey 🙂

  6. I’ve spent some time reading your post, the stuff on HAES and intuitive eating.

    I’m literally approaching this from the other end of the scale. I do like the way that HAES puts emphasis the health benefits of changing diet, and yes, a overweight person can be healthy. However, the problem I see with HAES, from the point of view of an overweight person, is its exclusive focus on health. I’m sure that if you ask obese people why they want to lose weight, health improvements would be only one of the reasons. To be obese is not just about being out of breath when you walk up the stairs or the risks of type II diabetes; it is also about having to deal with the shit other people give you. Kids shout abuse at me in the street every now and again, but adults are even worse. I’ve spent the best part of five years feeling that people want to avoid being seen with me, or socialising with me (Katie, I should add that none of this is aimed at you, you were the exception). They may not express it in so many words, but it feels like people often take an instant dislike to me because of my weight. I’ve found trying to develop friendships or find someone to date to be considerably harder at a high weight. Yes, you could argue that this comes from prejudice within society or whatever, but that is little comfort if you’re overweight because it is not going to change anytime soon. You’ve got more chance of changing your weight than people’s views (sadly withdrawing from people and seeking solace in food is even easier, as I have found).

    I’m not prepared to accept being overweight and healthy, as it seems like such a miserable compromise because my weight is still a barrier. I suspect most obese people would take a similar view (that said, I do admire obese/overweight people who are comfortable with their size). You are right to highlight the ineffectiveness of restrictive diets and the all or nothing approach which can lead to binging. I’m trying to focus on living a healthy lifestyle, with the emphasis on structured meals and exercise rather than restricting my intake (although I do avoid all the junk I use to eat), this approach does seem to overlap with the principles of HAES but in taking this route, I see weight loss as a goal rather than something I should forget about. Without intending to, I’ve slipped into to something similar to intuitive eating in that I’m now eating in response to my body’s cues rather than my emotional urges, but I feel this has come about because I’ve retrained my eating habits. I’m losing weight more rapidly than I expected and my health is improving; I’m having my cake and eating it (quite literally). Maybe HAES is right, and long term weight loss is not possible in most people (although I’m determined to prove such an approach wrong), but I’m not sure that most obese people are going to want to accept that regardless of the evidence may say.

    I only intended to say that I found your post informative and it made me think, but it turned into a bit of a rant. Sorry about that.

    • As if I never go to reply to a post and then end up on a thousand word rant – it happens! Anyway, I think a common misunderstanding about HAES is that it means total size acceptance and no weight loss at all. Although the goal is not to lose weight, you’ve seen for yourself what happens when you focus on something like increasing activity. That’s pretty much all it is! Some people don’t lose weight as a result and seem to stay healthy yet overweight, but I guess if someone’s weight is artificially inflated by an eating disorder and they then cease those behaviours/exchange them for healthier ones, weight loss would be a logical result.

      I can definitely get behind having ones cake and eating it too, anyway!

  7. Thank you for this post – I really appreciate you sharing the highlights of EDIC and explaining things so clearly! I also find it really hopeful and reassuring that you’re able to eat intuitively…I find that a lot of people in recovery aren’t really willing to try it. I’m not being critical; I realize that for some people rigidity may just be necessary. But for me, that stance has really held me back in recovery. Each time I’ve attempted recovery in the past, I stuck SO rigidly to a meal plan and although I maintained a healthy weight for a while each time, I was still completely ED in mindset (and I guess behaviour if it comes down to it, despite eating a ‘normal’ amount) – and I was not entertaining the prospect of ever allowing a modicum of flexibility into my eating. That’s probably the main reason I have repeatedly relapsed…I feel like there’s no point being weight-restored and eating a healthy amount if I’m still unable to eat flexibly and intuitively. I’d rather just be properly AN and have done with it! (ha, black & white thinking, I guess! but it is helping me to aim for a FULL recovery for the first time in 7 years of AN). So this time (after my worst ever and most ridiculous relapse), I am approaching recovery with the aim of, eventually, being able to eat intuitively. It’s really reassuring to hear that your hunger cues fixed themselves after sticking to your MP for a year and it helps reinforce the realization I’ve already had that I can’t jump into IE too soon, especially while still at a low weight. Anyway totally rambling here…just wanted to say thanks for your post 🙂 I love your blog but rarely comment because I’m shy and never feel articulate enough!

    Oh but to add evidence to your discovery that IE is possible even after an ED: my (amazing) boyfriend had severe AN for most of his adolescence/early adulthood and has been fully recovered for about 5 years now…and he eats totally intuitively and maintains his weight within about 1 BMI point (healthy, normal-slim). (I don’t even want to use the word ‘maintain’ because it seems to imply an active stance, whereas in fact he doesn’t need to try – his body just does its thing when left to its own devices!). If only he could somehow pass this ability onto me…hehe 😉 patience, I know!

    Okay I will stop flooding your blog now! Hehe sorry…

  8. love these posts and sounds like a great talk!

    nosy/slightly facetious question – doesn’t HAES for the obese population have some odd similarities to harm reduction in EDs? 😛 just popped into my head although obviously a fairly flawed comparison, piqued my interest!

    btw diss is finished, am revising tho, but I finish exams at the end of May. what are you up to atm? x

    • Ooh, interesting point! Hmm. I guess it depends on the meaning of “harm”. I keep coming across the idea that up until a certain point, weight itself isn’t the best determination of whether a person will suffer health problems – it’s more to do with activity level and quality of diet. So someone who has a BMI of 32 who looked after themselves could quite feasibly have perfect blood pressure, cholesterol, blood sugar levels, easily beat the crap out of me in a 5K race and outlive me by ten years. I know there will be a point at which health does start to decline as a result of high weight/BMI, but I’m not sure where that point is, or even if it’s a universal point or an individual one. For the obese or morbidly obese populations, the problem is that there’s no better answer. In low weight sufferers of eating disorders, with intensive enough support (from hospital, family, friends, 12 step, whatever works) people who have seemed otherwise hopeless can and do recover (not to mention the existence of oddities like us who did it largely solo). With morbid obesity there just isn’t any evidence-based treatment, and since traditional diets backfire I guess HAES is a good alternative. And finally, HAES isn’t incompatible with weight loss. It seems to me to be based on one of the central tenets of positive psychology – that people are more likely to complete tasks/reach goals if they are doing-things rather than not-doing-things, so walking for five minutes a day and building that up to an hour or so will be psychologically more easy to achieve than cutting out junk food. It’s more analogous to an anorexic attempting to increase the amount of fat they consume in a day, or switch three hours of walking for thirty minutes of gentle yoga, rather than aiming for a specific number of pounds to gain. It’s a good way of getting started, and once people build up some momentum it seems easier to keep going. So yeah, I can see how people COULD compare it to harm reduction, but it just doesn’t have the same feel somehow?

      Hope you are finding some nice places outside to revise 😀 obvs not when it’s snowing though, lol. I’m not really up to much, trying to find a new job and finishing the last few assignments for my college year. Thrilling stuff 😛 Are you too busy for coffee until May?

  9. Jvstheworld

    Katie – the common misunderstanding may come from the HAES website which actively talks down the possibility of weight loss (which, as I said, is a difficult suggestion to sell to overweight people). However, your post makes some very salient points about the failings of conventional diet approaches. An approach which,puts an emphasis on lifestyle change with weight loss being almost incidental is something which I think has merit.

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