In making a post weight-restoration recovery plan, I find it helpful to envision what full recovery will look like for this particular individual, and then break it down into small steps to help her achieve these ends. In my opinion, full recovery from AN involves all of the following:
• Ability to feed oneself the appropriate quantity, quality, and balance of nutrition.
• Ability to maintain one’s optimal body weight with an age-appropriate level of independence.
• Ability to accept and tolerate one’s body size, shape, and weight.
• Complete absence of eating disordered behaviors such as fasting, food restriction, binge eating, and purging.
• Ability to enjoy regular physical activity without compulsion.
• Engaging fully in all aspects of life, including school, family life, social life, and recreational activities. For older patients, this may also include employment, dating and romantic relationships.
• Freedom from constant preoccupation with food, weight, and body image.
• Mindful awareness of one’s predisposition towards AN and ability to avoid or manage potential triggers.
In my opinion, full recovery from AN does not necessarily involve any of the following:
• Ability to eat intuitively
• Ability to eat spontaneously
• Ability to eat sweets or “junk food”
• Return to the eating habits one had prior to the onset of the eating disorder
• Loving one’s body
• Not caring about one’s weight at all
• Complete absence of eating disordered thoughts
• Freedom from monitoring (for example, going for long periods without being weighed)
Of course, it would be wonderful if a person recovered from AN could do any or all of the above. If one of my patients does one of these things, I view it as a very positive sign, an indication that a person has reached a new level of freedom from AN. Parents of recovering kids often long for them to walk into the kitchen and grab a handful of chips, eat candy with abandon, or ask to go out for ice cream.
If a person in recovery does these things, that is fantastic, and it should be celebrated! Often, these things happen naturally after a year or two or three of weight restoration. But these things may not be realistic for some people with a history of AN. And if these things never happen, that is OK.
What is most important, in my opinion, is for a person in recovery to do whatever it takes to live a rich, happy, healthy, fulfilling and productive life. This is what recovery means to me.
Sometimes parents and clinicians worry that a patient’s avoidance of sweets, or inability to eat intuitively, or adherence to a structured plan of meals and snacks is “part of the disorder.” This may be true. But this is not inherently a bad thing.
Some recovered people may never want to be weighed again, because it reminds them of what it was like when they were ill. Some recovered people may resent having to eat three balanced meals every day, or not being able to diet like their friends, or not getting to participate in fasting for religious reasons like their families. Sometimes they just long to be “normal.” These feelings are completely understandable. However, this does not change the reality that people recovered from AN often have special needs which require them to be careful about their health in ways that other people are not. We cannot rewind time to the days before the illness began. We should not pretend AN never happened.
I find it helpful to assess a person’s stage of recovery using the following question:
“Can this person maintain good physical and mental health, and live a meaningful, productive, independent life, while _______________________.”
Then, fill in the blank with the issue in question to help determine whether it is in the patient’s best interest to accept it or change it.
• Can this person maintain good physical and mental health, and live a meaningful, productive, independent life, while also getting weighed every week at the doctor’s office? YES
• Can this person maintain good physical and mental health, and live a meaningful, productive, independent life, while being 5 pounds underweight? NO
• Can this person maintain good physical and mental health, and live a meaningful, productive, independent life, while never eating dessert or snack foods? YES
• Can this person maintain good physical and mental health, and live a meaningful, productive, independent life, while restricting dietary fat or carbohydrates? NO
• Can this person maintain good physical and mental health, and live a meaningful, productive, independent life, while being tormented by frequent thoughts about food and weight? NO
• Can this person maintain good physical and mental health, and live a meaningful, productive, independent life, while wishing she had thinner legs and having occasional thoughts about restricting food? YES
• Can this person maintain good physical and mental health, and live a meaningful, productive, independent life, without being able to eat intuitively or spontaneously? YES
Keep in mind that accepting something is not the same as liking it, and acceptance does not mean abandoning hope that things will improve. Rather, acceptance is about acknowledging reality and embracing it without judgment, while doing what works, in this moment, to maintain wellness.
5 Replies to “After Weight Restoration: Envisioning Recovery”
Very nice post! I like that you avoid the sometimes back and white thinking one can encounter in treatment philosophies that does not allow for individual variation.
You explain this very nicely. This approach gives space for the person to get on with their lives and for time to do its healing.
At the same time I as a parent would want to keep being on the lookout for any fears or behaviours which are restricting my child’s freedom and I would want to keep reassessing which can be tackled at any time. Your final paragraph addresses this concern very nicely for me.
I completely agree with periodic reassessment. It is important, as you mention, to keep an eye out for behaviors that are impeding your daughter’s quality of life, distressing thoughts, and potential threats to her health.
Reassessment is important because strategies that work in early recovery are not necessarily the same strategies that work in later recovery, or in post-recovery maintenance and relapse prevention. For example, blind weights may work better at one stage of treatment whereas open weights may work better at another stage.
Love this. I think recovery is usually presented in such black and white terms, that it’s easy to feel you’ve failed at recovery when you can’t manage intuitive eating and have to rely on some amount of external structure for eating. The irony is that the ED community seems remarkably tolerant of letting sufferers remain slightly underweight and see it as no big deal.
Thank you for this piece, you’ve put into words what I have been thinking about lately, full recovery doesnt mean perfect. I’ve realised that my daughter is never going to be the same person as before, she has been very ill and that is part of who she is now. I can see she is doing well leading a full life and though she may struggle at times I can also see that she know AN is a part of her and that she has worked out her own ways of coping when she needs to.
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