I’ve Gained Weight. Now What Am I Gonna Do?

Perspectives for those with bulimia, anorexia and those with no eating disorders at all.

"How much weight have I gained since we started working together?", “I want to know." That was the pressing question.

Ellie has been seeing me for several years, for periods at a time. She presented with severe bulimia, purging 3 times per day, every day, after each of the three times per day she allowed herself to eat. Back then, eating and keeping food in was simply not an option. Over time, her purge frequency decreased and she normalized her food intake, ultimately giving up her bulimia. 

Beyond her initial and modest weight increase, her weight has remained stable within a 2-3 pound range over the past many years. And that initial increase can be attributed to two things—no longer living in a dehydrated state and better nourishment.

To me, the better question for Ellie to ask would have been " how much better off am I since I’ve changed my eating?" In spite of the modest weight increase that she had no interest in, what did Ellie get in return?

When confronted with this question, she appropriately retreats from her disordered thoughts which periodically reemerge and readily acknowledges just how far she has come, how much better she feels. She remembers that there's no way she could've taken care of her newborn grandchildren in the state she was in then, or be trusted driving back and forth to their home. No, the price she paid, the few pounds gained, is nothing given what she's getting in return.

Gaining weight is rarely seen as a positive in our culture. Advertisements fail to praise us for outgrowing our jeans.

But for some, that is exactly what needs to happen. Staying at the weight you were at when you were 12  is hardly appropriate when you are 16, 20, or 40 years old. And even if your weight is objectively 'within the normal range' for the population, it may not be in range for you. It drives me crazy when doctors tell their patients that their weight—a  weight that has never been maintainable without an eating disorder because it's too low—is fine, because they are basing it on the charts for populations. Why the double standard? Because if you've always been a healthy larger size and you've lost weight through unhealthy measures, that 'normal range weight' may be anything but normal. Perhaps given your build, your genetics, your muscle mass, your history of athleticism, your body needs to be at a higher-than-average weight. And fighting it to be at a place you've never been will only contribute to unhealthy ways of eating and thinking. For your mental and physical well-being, weight gain may be just what's needed.

Gaining weight without an eating disorder?

Not long ago—a couple of months, maybe—I noticed that snugness around the middle. No, my jeans hadn't just been dried at high heat for too long. And really it was not in my head. Everything was fitting a bit too tightly. (Yes, even the bras.) Not one to weigh myself with any regularity, I suddenly jumped on the scale. I felt the need to reality check, to verify what I was feeling.

Yup. My weight was up.

Save your rush to judgement, please--it has nothing to do with the cupcakes, the chocolates and my homemade, full fat lavendar ice cream. Ok, let me clarify. No "I told you so's" necessary, because I ate all those foods before. But over the months of summer, the balance wasn't perfect, and so my weight crept up. 

Could it be that I was super active through the end of June, training for my fundraising ride, only to reduce my activity precipitously with the heat wave and awful humidity? Perhaps. Could it be that I've been socializing more, sipping on wine with dinner more nights than previously. Perhaps.  Could I have possibly joined my husband for an after dinner snack—just because it looked good and I thought I'd keep him company—more often than I really needed from a nourishment standpoint? Likely. Like you, I'm not perfect.

But the bigger question is what to do about it. If you were me, would you:

1. exercise a couple of hours each day to make up for the previous reduction in activity?
2. reduce your food intake to compensate for the extra calories consumed?
3. seek the guidance of a Registered Dietitian?

Ok. So I'm the RD so  I'd better come up with a fix.

But if you don't fall into the categories described above--those truly needing to gain weight, or those who've gained appropriately as a result of releasing yourself from disordered behaviors--and you find you've gained some unnecessary weight, here's what I'd suggest. Intuitively, it may seem appropriate to make up for any overeating in the days or weeks which follow. But don't do it! Instead, refocus. Get back to the basics, particularly if you've found yourself slipping into old patterns. Have you forgotten the basics? For starters,

Sit. No eating as you walk around the kitchen emptying the dishwasher. No eating standing at the fridge. And no, don't sit at the fridge; seat yourself at a kitchen or dining room table.

Separate. Eating and distractions,  (other than your family which you can't get rid of) should be separate activities. TV watching, texting, reading--these should be separate from eating. (Unless, I'll add, you are struggling to get food in and find that being less mindful is actually helpful--which it often is!)

Eat with your senses. Are you seeing your food and acknowledging what you're eating? Are you experiencing the textures of what you're eating? Are you tasting your food? Doing so will allow you to slow the pace and to feel more satisfied with what you're eating. You'll enjoy the food so much more!

Choose what you enjoy. Are you giving yourself permission to eat what you like, or holding on to rules about what's allowed vs forbidden, in your mind?

Tune in to  your hunger. Don't wait  until you are at the extremes of hunger--if you're starving you are more likely to struggle to eat as described above, and overeat.

Re-explore fullness. Are you eating until you are stuffed? Might a modest adjustment in portions be appropriate? That said, if you start with smaller portions, do give yourself permission to eat again later--after about an hour--regardless of what you you ate before.

Don't panic! And don't take radical steps to 'fix' the problem. Restrictive eating, denying your body's signals and needs, does nothing positive in the long run. It will only perpetuate an unhealthy cycle and make you feel like c!*P!

Breathe. It won't take long to get yourself back on track. But be realistic--if your eating was off course for some time it will certainly take some time for you to be back to your former, healthy self. Radical dietary changes can have radically negative consequences, so do be patient and appreciate the modest improvements as they happen.

Weighing In: Can't Bear to See it or Can't Tolerate Not Knowing?

You might imaging all kinds of things are happening
to your body if you don't have the facts.

It's time to hear from you. That is, if you have an opinion on knowing your weight. Does anyone not have strong feelings on this topic? I'm prompted to write this post having recently debated the merits of having clients see/not see their weights. And among us eating disorder professionals, opinions are pretty strong about what's the best approach. And we don't all agree.

On the one hand, whether you're dealing with anorexia, bulimia, or binge eating disorder, seeing your weight early in treatment can be a disaster. It can distract you from trusting the benefits of eating better, of listening to your body, and of nourishing yourself, shifting the focus simply to the number and all you associate with it. It can derail you from staying the course and normalizing your eating--because your preoccupation with the number stops you in your tracks. Often I address the relative change in weight--whether it increased, decreased, or stabilized, is in range, is 'where it needs to be', is 'as expected'--whatever language we've decided would be tolerated, patient by patient.

That of course can lead to use of your very creative imagination! If I say 'things are going well, we don't need to make a change this week' you might jump to conclusions and imagine that you've gained ten pounds or so. Or you might assume that since you've gained--while eating less than you were supposed to--that you'd better cut back this week. Or it might provide reassurance that your worst fears didn't come true, that all is safe--as long as you trust my feedback.

Some providers approach it completely differently. They tell patients their weight, and then they spend time debriefing about it in a very therapeutic way. It removes the 'what if's', because you know exactly what happened. But it can also cause panic and halt your progress; it may make it challenging to continue to stay on course with your eating.

Ultimately, as providers I believe we need to assess where each individual is at. Are you at a place where you can take in information about your weight? Are you able to look at weight change in perspective, or will it cause a set back?

What's your thoughts on knowing your weight as you change your relationship with food? What would you recommend to your provider about weighing and giving you feedback about your weight?

Thanks for taking the time to comment.

Thinking the Work is Complete Now That Your Weight Has Changed?

Lessons from co-writing Food to Eat: guided, hopeful & trusted recipes for eating disorder recovery.

Last week I saw a new patient, a 50 something year-old overweight woman who presented with the stated goal of improving her health—and taking control of her escalating weight. Her body language and her attitude shouted ambivalence—or more accurately, defensiveness—and within the first quarter hour she had me on the defensive, too. Not too much rocks my boat, given 26 years seeing patients, including those who'd rather not be there. But the accusatory tone in which she asked about my weight history startled me. While not speechless (imagine what it would take for that to happen!) I was certainly at a loss to articulate my credentials to help her in a way I thought she could hear. Perhaps even expecting that she would hear was setting an unrealistic goal.

Can I ever REALLY know how difficult his life is? Or what he's thinking?

What could I possibly know about her weight struggle, was what she implied. How could I—a slim appearing, seemingly confident person — know about her challenges? Who am Ito be giving advice? Well it wasn't the first time I had heard such questions, but for some reason her's threw me off guard. How do I begin to explain that my weight has nothing to do with my knowing, and with my ability to help? (Do I need to share my personal struggle with weight—which I openly discuss in my new book, Food to Eat, coauthored with Cate Sangster—which should have no place in our session about her?)  

What does weight have to do with it?

And if I had been a fat nutritionist, would that have validated my skills in guiding her on her recovery path? I suspect not, as I have heard many a criticism of dietitians' weights that has made me cringe over the years. That is, unless they were able to look past size and weight bias and hear the value of my words, as the Fat Nutritionist proves worth doing.

For those of you struggling with an eating disorder, you may feel similarly. Just because you are weight restored or nearly so, doesn't mean your disordered thoughts have abated. My co-author Cate, even when in a physically healthy place, is no stranger to these intrusive thoughts. And she shares them so openly with raw emotion—exposing her fears and her wishes relating to food and eating. But what does the public know when they see Cate or you on the outside? No, it's not just the stereotypical 60-pound-anorexics that suffer from eating disorders.

And what assumptions, what projections do you make, about what they are thinking about you? Do we have any idea what anyone struggles with unless their appearance is extreme? Would people know I live with MS when I am not wheelchair bound nor walking with assistance? Do they know about your closet eating? Your food hoarding? Your bulimia? Your obsessive calorie counting and weighing and body checking?

Being exposed.

In a similar way, completing the book leaves us both vulnerable. How will it be received? Will it look good? Will it be criticized and viewed as flawed? Will it be taken seriously? Will it have been worth the struggle to do the work? Will readers, like last week's patient, wonder what we could possibly know about the struggle to improve your relationship with food?

Can you even see the distortions?

I think not. Cate and I have been painfully honest, sharing—perhaps for the first time—about our own histories and relationship with food. We are not naïve enough to believe that this one book will solve your eating disorder—your bulimia, anorexia or compulsive overeating.  But we believe deeply that it is immensely valuable in changing your thinking and getting yourself eating with more peace. In spite of our fears, we've put ourselves out there and have taken the risk of exposing ourselves.

Quite frankly, I never dreamed that experts in the eating disorder community would take the time to thoroughly review our book. And then to provide valuable criticism that would really enhance it. I certainly didn't expect to receive the praise we got. Really, I am humbled and flattered beyond words.

I owe thanks to Laura Collins, author of Eating With Your Anorexic and a leader in supporting families living with eating disorders, for pointing out our blatant omission of families—both as a target audience for the book, and in their role supporting those struggling to prepare food and to eat.

And to Dr. Lydia Shrier of Boston Children's Hospital Adolescent Clinic and Harvard University, for highlighting our need to think more broadly about genders and partners and spouses in the book.

To have virtual strangers and mere professional and cyber acquaintances—Dr.Cynthia Bulik, the well-published researcher, author and public speaker; CarrieArnold, author of Decoding Anorexia, known to me from her ED Bites blog; Dr. Suzanne Gleysteen, with whom I've shared so may eating disorder patients; Dr.Therese Waterhous, a dietitian at the forefront of the eating disorder field; Dr. Wendy Oliver-Pyatt, from Oliver Pyatt Centers; and MEDA, the Multi-service Eating Disorder Association—think enough of Food to Eat to write fabulous, glowing reviews, exceeded all of my expectations.

Getting exposure?

Flying high, but feeling rather vulnerable.
Won't you provide the safety net?

I believe in Food to Eat and its value like I believe that recovery is possible. I regret that, due to its beautiful printing is full color, it needed to be priced to cover the large costs of production and distribution to Amazon and bookstores. (Purchases of the print version outside of Create Space and Amazon yield a shared profit of $.04, for the record!). We do not expect to get rich on this project, which has taken the two of us almost a year to complete. But we do hope to make a difference.

Can you help? If you buy a copy via Kindle or Amazon, will you kindly write a review? And if you buy it through Create Space please add your review to our comments page on food-2-eat.com.

Can you demonstrate the power of social media, and share a link or a comment on Facebook, or Twitter, Pinterest or Google Plus? Or even on your blog if you write one?

And please contact me or Cate with feedback on the book, any feedback. Yes, we all need to be prepared for criticism!

Thanks for listening!