Recovery After Weight Restoration – 1

As with the rest of my DIY recovery section, everything that follows is just my opinion. I can be quite an opinionated person 😉 but I do know that recovery is different for each individual. Some aspects of recovery are universally important, such as cutting out all ED behaviours and reaching a healthy weight – but other things will be subjective and dependent on the type of person you are.

I split this section into two pages. The first deals with parts of recovery after weight restoration which are specific to eating disorders, such as learning to eat intuitively and finding your set point weight. The second page could be about life after any sort of mental health problem, because it focuses on topics such as sorting the rest of your life out, untangling your identity and the illness, and the choice you have as to whether you try to leave your past behind or use it in some positive way, as I do with my voluntary work.

On this page:
Reaching target weight
The first few months
“Intuitive” is not a four letter word!
Exercising healthily
Coping with lapses

On the second page:
The rest of the iceberg: putting your life back together
What to do with all that baggage?

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Reaching a healthy weight and/or ceasing all eating disordered behaviours is essential to recovery, because without this necessary first step your brain and body will have no chance to heal. But what happens next?

Reaching target weight

I got to my target BMI in last week of January 2010, and my immediate feeling was one of pride. I floated around on a little cloud for the first day, feeling so happy with myself for having managed to beat the odds and get myself back to a healthy weight. Then the inevitable backlash set in and I spent the rest of the week hiding in a pair of enormous dungarees, feeling utterly confused and horrified by the amount of weight I’d gained over the past ten months. I might not have experienced body dysmorphia during my eating disorder, but that didn’t mean that being a healthy size didn’t scare me! During my illness I had associated being underweight with a feeling of safety and control over my mind, and now I was healthy I felt like the whole foundation of my personality and view on life had been fundamentally changed. Being healthy meant that my appearance no longer matched my mental state, and that was terrifying.

After sternly telling myself that freaking out was to be expected and that it was absolutely not a reason to go back to restricting I calmed down a lot and started feeling better again. This is something I’ve noticed time and again – during previous attempts at recovery, whenever I felt panicked about something and allowed myself to entertain thoughts of relapsing, the urge to relapse would increase exponentially. Just giving myself the option virtually guaranteed that it would happen. Conversely, telling myself that I was choosing to stay in recovery no matter how anxious I got decreased the urges and the anxiety. It was weird but it worked for me, so I’m not going to complain! If you experience a lot of distress on reaching your target weight, do try to hang on. It is normal, it will pass, you need to give it time. Distract yourself and try to talk to people – but be wary of obsessively talking about how *insert negative word about your body* you feel, because focussing on that will just intensify the feeling. Try to work out what you’re actually scared of, because chances are it won’t be the weight gain itself, but what that represents to you. I think understanding your triggers and fears about health/life is an important part of recovery – probably as important as getting to a healthy weight in terms of protecting against relapse.

One issue which was flagged up when I asked for comments on what to include in this section was accepting the need to set your target weight at a level which was appropriate for you as an individual, rather than sticking to the bare minimum deemed technically healthy. I wrote a bit about the reasoning behind my choice of where to set my target this page, under “Issues around target weight”, but I think working out where your set point is is a slightly different issue to picking a target weight, so it deserves some space here.

These are the criteria that I feel need to be fulfilled before you can say that your weight is truly healthy for you as an individual:

* For women: you get your period. Getting your period is not a definite sign that your weight is healthy, because some people get theirs at medically dangerous weights, but equally you absolutely cannot say that your body is healthy if you don’t get your period. Even a friend of mine who recovered from anorexia after thirty years eventually got her period (for the first time in her life!) during recovery, so in most cases no period = more weight (/higher body fat percentage/less exercise) needed.

* You do not use ED behaviours to maintain your weight. If you can only maintain your current weight by restricting, b/ping, using diet pills or laxatives, exercising to the point of injury and exhaustion, skipping meals, going to bed hungry or anything else of that sort you are probably maintaining too low a weight for your body.

* You are not obsessed with food. This is a bit controversial, because some people are genuinely interested in food, and it’s certainly not true to say that all chefs or bakers have eating disorders! However, if thoughts of food are occupying your every waking minute it is most likely that you are still underweight, exercising too much or restricting. My obsession with food died down a lot when I got my periods back about two thirds of the way through weight restoration, but it still persisted to a lesser extent until I had been weight restored for a few months.

* You don’t get overly hungry before meals or go to bed hungry (sure signs of restriction)

* You have the energy and interest to engage in hobbies/academic work/relationships

* You are capable of strenuous activity (I’m not talking about running marathons, just normal stuff like moving house or going on a long walk with friends/family) without getting tired before everyone else does

* Along the same lines, your body doesn’t over-react to small changes in routine. For example, during weight restoration my blood sugar used to go absolutely crazy if I delayed a meal by an hour! I would get really shaky, cold and confused. That hasn’t happened to me in response to normal variations in routine since about a month after I reached my target weight

* Your weight remains stable regardless of small fluctuations in your intake from day to day

* And finally, you do actually have to be at a medically healthy weight.

All of those statements are true for me, and I would see any changes in that to be a relapse warning sign. It’s not an exhaustive list, but this is what I see as the bare minimum requirement for health without referring to BMI.

Fulfilling these criteria basically translates to finding the weight your body naturally seems to want to maintain – your set point. This might well mean that you need to gain beyond what you see as an acceptable target weight. Lots of people with eating disorders get hung up on the idea that once they reach the minimum medically acceptable BMI/weight they will be totally healthy, even if they don’t get their periods and they have warning signs screaming at them from all angles. If you don’t accept the need to be at a healthy weight for your body you cannot recover totally. It sounds harsh but I mean it in a factual rather than judgemental way. Whether you decide to recover fully or hang on to part of your eating disorder is entirely up to you, but from experience I would say that not reaching your set point is a recipe for relapse, especially if you are still experiencing physical problems like amenorrhoea.

The last point on this issue to note is that up to a point, people are supposed to gain weight as they get older – at least into their mid 20s. One of my sisters is a great example of this. She was naturally very thin and energetic as a child and teenager, and is still slimmer than the average adult – but her BMI is around 20 now. Being naturally slim as a child does not necessarily mean that your set point as an adult will be in the underweight range! I tried to convince myself of this a few years ago, and having seen many other people do this and relapse (including myself) I am convinced that it is not beneficial to recovery to rigidly stick to a target weight more appropriate for someone in their mid-teens. Letting your weight move into a range healthy for your age group is scary at first, but the long term benefits far outweigh (pun not intended!) the ED-related anxieties.

The first few months

Another thing I can see in retrospect was that despite all my best efforts to mentally prepare myself, I had a bit of an unrealistic idea of what life would be like after I’d reached my target weight. I was so proud of myself for achieving this that I imagined in comparison nothing else could feel all that hard, and the rest of my life would just sort of fall into place once I was healthy. Wrong! Two months after reaching my target weight I fell into a bit of a depressive hole, because although I was physically stronger and I wasn’t obsessed with food any more, very little else had changed. I still suffered from anxiety, was lonely, had no idea how to talk to people or make friends, didn’t know what I wanted to do with my life, my cognitive function was a mess, my moods were all over the place – the list was endless. I suddenly realised that gaining weight was not the be all and end all of life, and that despite making myself all better physically I was still going to have to live and die like everyone else. It sounds obvious, but you get such a feeling of power from saving your own life in this way that you can feel invincible for a while afterwards. When reality hits you again it can be really difficult to cope with.

I don’t think there’s really any particular way to deal with this – I used all of my general anxiety management techniques, like talking to people, mindfulness exercises, distracting myself, blogging – but in general terms, if it happens to you too you really just have to wait it out. I started feeling better again within a couple of months, which is a lot better than the 6-18 months that my full-on depressive episodes used to last.

Of course, although weight restoration didn’t solve those other problems, without getting my health back the anorexia would have continued to make all of these things worse. Weight restoration was the essential foundation for sorting my life out. A year on from reaching my target weight my concentration and memory are much better, my moods are more stable and my anxiety less overwhelming (although they both still kick my ass sometimes 😉 ), I have a plan for my future, a university course for this autumn, I’m living independently without self destructing, I have a partner and more friends…things did get better, slowly.

Several people have asked me what I did about the more practical aspects of recovery after I reached my target weight. For the first couple of months I weighed myself every fortnight, because maintenance was new to me and I wanted to make sure I wasn’t losing. One year on, I weigh myself maybe once every 4-6 weeks – I don’t plan when, I just realise I haven’t done it in a while and hop on the scales to see what’s going on. My ability to cope with this without freaking out is probably linked to the fact that I monitored my own weight all throughout my recovery, and so am desensitised to seeing the numbers I’m at now. I also implemented a rule during the start of my maintenance that if my weight went up I would NOT decrease the amount I was eating unless I gained more than one pound every week for three weeks in a row, in the absence of obvious reasons like Christmas. This never actually happened! That rule stopped me from panicking and restricting when my weight naturally fluctuated (usually due to hormonal stuff), and also taught me that my weight does not just randomly go up for no reason. I’ve been more or less the same weight for the whole year now, despite moving from a concrete maintenance plan to intuitive eating – my next topic – very early on after weight restoration.

“Intuitive” is not a four-letter word!

The next big challenge I faced was self-imposed: I wanted to stop calorie counting and move to eating intuitively.

Intuitive eating needs a bit of explanation because there is a lot of misunderstanding around it. The idea is that you learn to listen to your body – you eat when you are hungry, you eat the types of food that you want to eat, and you stop when you are full. The theory goes that if you impose rules on your diet you are more likely to break them, fall into the “oh f*k it” mindset and binge (or add increasingly restrictive rules if your disorder inclines in the other direction) – whereas if you are listening to the cues which are genuinely coming from your body you will be able to maintain your genetically determined set point weight, because your body will naturally tend towards the point at which it is most healthy.

I think this is something that you really need to be ready for, because if you try it too early on you might still not have much in the way of hunger cues, and could find yourself unintentionally restricting. But equally I don’t believe that people in recovery need to cling to their meal plans forever. They are a brilliant tool for teaching your body what “normal” eating feels like, but once you are at a healthy weight and have a good idea of portion sizes, don’t let fear of the unknown hold you back from at least giving intuitive eating a decent trial period.

For me the process was surprisingly quick and painless compared to my eating disordered fears. It started when I went to stay with a friend in London one weekend with the understanding that we were going to be doing a lot of eating out. At this point I had been weight restored for a few weeks and my body had gotten used to eating a maintenance intake (no point in including numbers, it varies wildly from person to person). I realised on the first evening that I could either drive myself crazy trying to estimate calories or I could just relax and try to look at the experience as an experiment. I chose the latter option, and ate lots of new foods of unknown calories in unmeasured portions, trying to use the way my body felt as a way to gauge whether I was hungry, full or in between. When it was time for my Monday morning weigh-in back at home I was shocked to discover that my weight hadn’t changed in the slightest. I extended my experiment for another week – not weighing or measuring any of my food, and not making even rough guesses of my calorie intake. Surprise surprise – my weight remained the same, within a pound or so. In this way, I gradually gained confidence that I could eat whatever I wanted whenever I wanted and my body would take care of itself.

The concept which is probably the hardest for people with EDs to get their heads around – it certainly was for me – is the idea that you eat whatever you want, whenever you want it. Surely that’s just a recipe for becoming overweight! I think the mistaken assumption a lot of people make is that their bodies would just make them eat junk all day if they didn’t keep tight control of their intake. This CAN happen – if you are restricting, using food to deal with your emotions, over-exercising or maintaining your weight below your set point. None of those things are compatible with intuitive eating, and so there is no reason for someone who is genuinely eating intuitively to gain weight beyond their set point. I tend to naturally want to eat three meals (of a good balance of carbs, protein and fat) and two snacks each day, and I eat dessert after both lunch and dinner. Despite eating chocolate at least once a day I don’t ever binge – although I did when I was a teenager, so I definitely have the potential for it under the right (wrong!) circumstances. A recent analysis of research into “sugar addiction” found that there is no evidence for it, suggesting that it is not sugary foods themselves which compel people to lose control, but the way those people are using sweet foods to change their emotional state. There is a place in intuitive eating for all types of foods – meat, foods with a lot of carbs or fats and dessert as well as the less demonized types of foods such as protein-heavy foods, fruit and vegetables.

At first, trying to work out what the hell a hunger cue felt like was really hard – I’d spent more than a decade training myself to ignore the things, so trying to get back in touch with them was confusing to say the least. To begin with I went by what I recognised as alternative signs of hunger: I might not feel it in my stomach but I knew when I had to eat because I would start feeling cold, shaky and confused. Using the signs of low blood sugar is not exactly the best way of gauging your hunger, but I didn’t have anything else to go on in the beginning. As time went on I became more and more sensitive to how my body felt, and learnt to distinguish earlier signs of hunger. Now, I *think* I can just about work out what stomach hunger feels like – but to be honest I don’t pay much attention to my stomach, because my IBS makes it give out completely confusing signals. Instead, I just somehow seem to know when it’s time to eat, and what I want to eat, and the result of this is that my weight remains stable. I’m certain that people who have never experienced eating disorders wouldn’t find this surprising at all, but to me it seems magical and I love it 🙂

This also became another sign for me that I was at a healthy weight for my body, because my weight has barely changed during my 12 months plus of eating intuitively. It fluctuates about an average, but that average is constant.

Exercising healthily

Another question I faced was this: given that I had problems with compulsive exercising in the past, should I give up on the idea of ever running or using the gym again, or would I be able to somehow cultivate a healthy relationship with exercising? I can’t tell you the definitive answer because like everything about recovery, it will vary from person to person – but I can give you my solution to the problem.

First of all, when I tried to return to the gym when I was only 5lbs shy of my target weight, it all went wrong. I’ve described this on another page so I won’t go through it again, but basically I got compulsive about it and injured myself quite badly. So once I had recovered I abandoned the gym and switched to just running outside, with the goal of doing the Great North Run – and again, within weeks I was feeling as if I HAD TO run, regardless of how I felt or the state of my blood pressure/palpitations on any given day (which were giving me hassle at the time!). When you feel as if you have to run even though you are worried that you’re about to randomly drop dead you know you don’t have a healthy relationship with running!

At this point I decided to give up for a while and stick to walking. I enjoy walking and find it easier to control in terms of avoiding compulsivity. So for the next six months I did no formal exercise and determinedly avoided getting into a rut of walking for certain distances or times every day – I made it functional and always made sure there was a purpose to it, like walking to the shops for some eggs, or going on a nice walk along the river in Durham with my boyfriend.

Then one day a month or so ago I really felt like going for a run. The weather was warming up and I just really missed the hypnotic quality of running. I thought about it carefully and decided to give myself another chance to try and create a healthy relationship with running. The rule I set myself was that there would be no plans or goals involved: no count of calories burnt, no mapping my distances, no attempts to improve my time or stamina, no progressive training plans. I would just warm up, set the timer on my mobile phone for 30 minutes and run out my front door. So far it’s working well 🙂

This leads on to another question that someone asked me – after weight restoration, how do you know if a behaviour or desire comes from you or from your eating disorder?  The ED doesn’t go away with weight restoration – I’ve found that the thoughts decrease in frequency and intensity, and are easier to fight because I am mentally more stable and resilient now, but they still catch me out sometimes. For example, when that urge to take up running again appeared, I seriously questioned my motives before I decided whether or not to act on it, and I only did so when I was sure it wasn’t a trick and had a firm plan of how I would keep myself from veering back into compulsive territory. There are other issues which lie on rather dodgy territory like this – a sudden desire to “clean up” your diet or impose restrictions on it (my friend who asked the question said she had considered going vegan for lent, before it was pointed out to her that her motives might not be entirely healthy) is another classic. When you have recently recovered from an eating disorder, trying to cut out foods or exercise more is often not the best idea, because these things tend to escalate. Chances are, your diet is probably just fine as it is – it brought you back to health, why change it now? The only changes I’ve made to my diet since recovering is to add foods that I was previously scared of back in – taking them out would not be a good idea, because once I start taking things out I tend to have trouble stopping! So please treat these sort of ideas with caution. There is nothing wrong with trying to recapture a healthy relationship with exercise and food – that’s a great goal – but be really, really careful about how you go about it. I tend to know deep down if I’m doing something for healthy reasons or restrictive reasons, but if you’re not sure about a particular issue, run ideas on changing your diet or exercise habits past a parent, close friend or health professional.

Coping with lapses

So far the sections on this page have gone something like this: I came up against a problem; it was hard!; I got over it. I don’t mean to make it sound as if recovered life is all roses, and that everything falls into place once you are healthy, because it’s not that simple. For example, although I got through it quite quickly, that horror I felt when I reached my target weight was intense and had me in a week-long panic attack. And intuitive eating scared the crap out of me before I got the hang of it.

Another potential obstacle that I anticipated but underestimated was what would happen to me if I couldn’t eat enough for reasons out of my control. When I moved from Dorset up to Gateshead I was under a lot of stress, being pretty active (lifting boxes and walking everywhere now I didn’t have a car to use), and then from July to about September I came down with no fewer than four stomach bugs, one after another. I wasn’t actually sick, but I felt horrendous, and as I am phobic of being sick I found it extremely difficult to eat for genuinely non-eating disordered reasons.

This is dangerous. It is pretty much accepted now that eating disorders develop when someone who is biologically predisposed begins to eat less or chaotically for whatever reason. It doesn’t have to be bad body image (it wasn’t in my case) or even stress, it can be something as simple as a physical illness. Anorexia is fairly common in people with digestive disorders or other chronic conditions which affect the digestive system, such as coeliac disease. This is because when vulnerable people become malnourished it affects their brain in such a way as to lock them into the pattern of eating less and less (or bingeing and purging, or whichever other type of eating disordered behaviours they fall into). By this same token, stomach viruses or periods of prolonged stress which lessen a person’s appetite can very, very easily cause a relapse in someone who is recovering from an eating disorder.

This very nearly happened to me on several occasions during my first year after reaching my target weight. For very vivid examples of this, see these posts in July 2010, October 2010 and January 2011. These were not fully-fledged relapses, they were periods of a few days or maybe a couple of weeks in which I slipped from not eating enough due to stress or illness into deliberate restricting. Each time I managed to catch myself and back myself out of the dead end before things went too far – but it was always a close call and it wouldn’t have taken much longer before I had found myself in real trouble.

It’s hard to explain exactly how I stopped myself from turning the lapse into a relapse. The first thing I always did was write about it. Eating disorders thrive on secrecy, and talking about those lapses helped to snap me back out of denial. Secondly – and I fully accept that this sucks – the only way to pull yourself out of a lapse or relapse is to force yourself to stop using the behaviours again. So once I had realised and admitted that I was beginning to slip back into dodgy territory I absolutely could not just sit on my butt and hope that things changed of their own accord, I had to make myself increase my intake back up to normal levels, check if I had lost weight and gain it back if I had. In some ways it felt like starting over, but on a miniature scale – I often felt horrifically anxious about eating more for the first few days, but that phase was fairly short lived and nowhere near as terrifying as when I began to gain weight for the first time.

In that last paragraph I am NOT suggesting that eating disorders are entirely under the control of the person who is affected. When you are very ill you are more or less under the control of the illness – your brain is deeply biologically affected by malnutrition and that makes it extremely difficult to change things. Not impossible – I still don’t really know how, but I did it, and several of my friends have too – but close to it. Pulling yourself out of a lapse is different. As long as you catch yourself quickly enough, force yourself to be honest with yourself about what is happening and where the behaviours are going to lead, it is nowhere near on the same scale of difficulty as pulling yourself out of a severely eating disordered state. Things can escalate so quickly where eating disorders are concerned, so time is of the essence when it comes to lapses.

It is a good idea to make a specific contingency plan for how to cope during times when you can’t eat enough through no fault of your own, to add to any general relapse prevention plan you might (hopefully!) have. Liquid calories, not weighing yourself for a week or two after a stomach bug (to avoid being swayed by the inevitable weight loss), talking to people about what’s going on in your head and making a list of your emotional/behavioural signs of relapse and checking it regularly can all help.

Finally, please don’t feel guilty or ashamed if you do have to deal with lapses or relapses. They happen. I’m not going to be a prophet of doom and say that they happen to EVERYONE, and that people who have eating disorders will never be entirely free of the prospect of relapse, because I am not a fortune teller and can’t tell whether I will be safe from them one day. But they are common occurrences, and beating yourself up over them will just make things worse.

Click here for part two!