When people think of eating disorders, they picture the starving 15-year-old girl or the college student throwing up after a cookie binge. I’d like you to expand your definition. The 40-year-old woman about to undergo gastric bypass and the successful businessman who is 80 pounds overweight are both wrestling with eating disorders that are no less harmful and debilitating than anorexia and bulimia.
Unfortunately, these particular eating disorder sufferers are more likely to encounter a physician than a therapist. The sad truth is that most physicians are woefully under-trained in nutrition or the psychology of over-eating. Many doctors write prescriptions for obesity-related ailments but have neither time nor expertise to address underlying causes. Many feel helpless and frustrated with overweight patients, viewing them as “awkward, unattractive, ugly, and non-compliant” (Obesity, Research Journal, 2003). Since physicians report having “lower respect” for their overweight patients, it’s not surprising that many of these patients, sensing this disdain, avoid the health care system altogether (Journal of General Internal Medicine, 2009).
Recently, I’ve seen an increase in overweight clients entering therapy. Some are verging on diabetes. For others, this is their last stop before bariatric surgery. Still others arrive after surgery, stating, “I know I need to get my head on straight if I’m going to keep the weight off.”
So many people want quick, simple solutions to this complex problem. I’d like to share just a few of the themes that come up in our work together so you’ll understand why a diet, a pill or even surgery often won’t do the trick.
Growing up as an overweight child who was teased and bullied for her weight, Jan’s self-worth is in the gutter. She’ll need to learn to separate her "Worth" from her "Weight," no easy feat in this culture. By developing compassion for herself, taking better care of herself will start to feel right. (How can you take care of something you hate?)
Uncovering and resolving childhood trauma is crucial. As a child, Danielle used food to both punish and nurture herself after she was sexually abused by her stepfather. She unconsciously kept on extra weight as protection from unwanted sexual advances growing up. As she works through this trauma in therapy, she’ll learn to establish healthy boundaries so it will feel safe for her to live in a body that attracts attention. Therapy will also help her become more accepting of her own sexual needs and desires.
As a teenager, Tom gained 50 pounds after his mother died from cancer, soothing his feelings of loss and sadness with food. He’s been unable to shed the weight through dieting. Allowing himself to grieve will free him of the need to numb through binge eating.
Abby alternates between Denial and Panic. She refuses to look at pictures of herself or gaze into a mirror. Whenever she really sees her body, she becomes overwhelmed, angry, helpless and despondent. Abby is learning to see herself accurately as well as manage her anxiety about her weight. Until she faces and accepts the reality of where she is in this moment, she will continue to use food as soother, comforter and numbing agent.
Gary is learning Patience. Now that he’s got his eyes open, he wants the weight off fast. He must resist the siren call of “Lose 30 pounds in 30 days” lest he follow that with “Gain 40 pounds in 40 days.” It will take time to re-wire his brain since it has followed the same neural pathway (i.e. bad feeling=go eat) for decades. It may take a year to lose those 30 pounds forever, but more important than looking good at the reunion a month from now is being able to dance at his grandson’s wedding 20 years from now.
When you look at Sarah, you would not guess that she is a Perfectionist. But this is the most common attribute shared by every person struggling with an eating disorder. For binge eaters, the logic goes, “If I can’t follow my diet to the letter, then I might as well eat whatever and however much I want!” It’s All or Nothing, Black or White, On or Off. I remind Sarah that the goal is Normal eating, not Perfect eating. Normal eating is flexible and probably averages out to about 80 percent healthy, 20 percent not-so-much. This is a formula that a person can live with forever.
Ken is intrigued when I suggest he start listening to his body. He realizes that he has tuned out the signals in his gut for decades. He ignores his satiety signals and barely recalls the last time he experienced hunger. As we explore his fear of hunger, tears accompany his memories of childhood neglect and loneliness. Ken is surprised to discover that connecting to this sadness actually helps him feel more alive and whole. Discovering his ticket out of his eating disorder lies in his gut and not his brain is a new and exciting (and scary) concept.
Amanda is learning to recognize the Voice of her eating disorder. It says “I love you and I can make you feel better right now.” It comes from the primal part of her brain focused on immediate pleasure. But she can learn to shift into her frontal cortex where she has the capacity to think of the Big Picture. In a different part of her brain, she can imagine how she’ll feel after she’s overeaten, how she’ll feel in the morning when she wakes up stuffed, how this binge will impact her health over time. Her challenge is to stay conscious, awake and connected to the big picture when the Voice whispers, “Worry about all that stuff later…”
At age 60, Brenda is finally learning to say “No.” Her life-long pattern of taking care of everyone else’s needs only led to resentment, angry blow-ups and debilitating guilt. Over-eating had been her way to take care of herself. She’s learning that saying no to others frees up time and energy for activities that are truly fulfilling (and not just filling!).
Recently a YouTube video from Britain’s Got Talent went viral. It features Jonathon Antoine, an overweight teen who sings like Pavarotti. Before he sings, you see disdain and disgust on the faces of audience members. Then he opens his mouth and we discover he is gifted, vulnerable, sweet and courageous. Our harsh judgment is suddenly transformed into a rush of compassion.
Perhaps we can hold onto this little moment of insight when we step away from our computer screens. We might all feel a little lighter.