Numbers – a Catch 22
I read this post on Dads and Daughters With Eating Disorders: Eating Disorders – Weights & Scales
To summarize:
Because her health is directly related to her weight. Measured by scales.
Her recovery is directly related to her weight. Measured by scales.
Her life is directly related to her weight. Measured by scales.
Weight matters.
And scales matter because they measure weight.
I posted a comment on this post, which hasn’t been approved yet, but I decided that I wanted to discuss the issue on Grey Thinking anyway.
Yes, weight is inexorably tied to health and to recovery. Weight restoration is vitally important to recovery. You can’t be recovered and still be below the healthy weight range. Professionals need to monitor weight. Some treatment decisions need to be made based on weight. In short, I am not at all arguing that weight is unimpotant for recovery.
With all of that said… I find a lot of diagnostic criteria and treatment approaches to be contradicting and frustrating. In therapy, you’re told that you are not a number. That you are lovable regardless of what the number on the scale says. That coping with food / weight is not okay. That eating should be mindful and emotional eating is unhealthy. You don’t have to be sick to deserve care.
But think — how is your health measured?
- weight, BMI, % of IBW
- calories, exchanges, % of meal plan completed
- heart rate, blood pressure, potassium, electrolytes
- # of binges / purges, # of laxatives, # of diet pills
- hours exercised
… see my point? Everything is measured in numbers.
I have an issue with your mental health being measured in numbers. From this point of view, gaining weight = a good week and losing weight = a bad week. That has just never been a linear relationship for me. I have bad weeks and gain weight, and vice versa. Sometimes I follow my meal plan and lose weight, and other times I restrict and gain weight. The system reinforces the necessity of communicating through your eating disorder. If you’re feeling crappy but follow your meal plan, then obviously you weren’t really feeling bad — if you were, you would have restricted. Plus, when you are at a healthy weight — ta da, end of treatment! You’re all better! Even if you feel as crappy as ever, you’re not sick anymore, so…..
Thankfully not all professionals practice this way, but measuring your progress in recovery by numbers is not unusual. I feel strongly that weight is just a piece of the puzzle… and while weight and eating are core components to eating disorders, by basing treatment on just these factors you are really limiting treatment. There are people who will stay sick because the system inforces that they need to be to get help. And that’s unfair…
well said. thanks.
Sadly true. Stupid BMI charts. Anyone hear of standard deviations???
Thanks for this response. I read this posting yesterday and had a lot of thoughts about the validity of using weight as a measure of health and recovery for eating disorders. To some extent I understand the need to have some sort of measure of success, but weight and other test numbers are just partial measures. They don’t capture the despiration and empty feelings that people with eating disorders face when thinking about their weight and their life.
Although I am new to the offical label of, “someone with an eating disorder”, I have spent a lifetime being judged both internally and externally by the nnumbers on the scale and it has left me feeling hollow, lonely and a total failure. I would hope that professionals and family members would begin to understand that in order to fully treat a person with an eating disorder you need to deal with the person rather than her (or his) numbers.
Thanks.
When I was a teenager living at home, my parents measured my ED progress purely by weight and numbers, and thus it was extremely easy for me to manipulate my way out of treatment by meeting enough quantitative goals, without really changing thoughts or even many behaviors in the long term.
I totally agree.
Of course you need weight/nutritional rehab to recover. Fixation on the number doesn’t help.
What about a person whose weight should be slightly higher than the charts suggest? I’ve watched friends fight their bodies in early recovery– feeling like they would gain/be hungry forever all because their set point wasn’t the number assigned to them. Sure, fighting to stay at a ‘normal’ weight is better than being fully anorexic, but not much….and I think it totally sets people up for relapse.
I work with a nutritionist, but she doesn’t weigh me. We go by hunger cues & other indications of whether I’m eating enough.
I have a metabolisn that’s nearly double that of your average, active person (and that’s not the ed perception!) and when I’m eating this, I feel full, have energy, sleep well & my weight stays exactly the same. (A few times a year I get curious….)
I guess my point of that is, having hard numbers can keep people sick. if you’re not eating enough for you & at your set point, your life is going to be rife with ed thoughts. I wish more people understood this.
if I stuck w/ the standard maintenence plan, I’d be hungry all the time & lose weight, but to most professionals I wouldn’t be restricting.
I’m really grateful that I’ve had a team who was willing to work with me on this issue. It was a hell of a lot easier to gain weight with the hope that my body knew what it needed & would level off. I couldn’t stomach the notion of IBW- it seemed the worst of both worlds, to me. Gaining the weight without losing the obsession over an ideal #.
Thank you for this. This has been a big issue for me, so much so that I’ve stopped seeing ED specialists since I moved a couple years ago, because I don’t want to be weighed–even a blind weight reinforces the importance of the scale for me, and although I recognize that I’m engaging in black and white thinking (the scale has to matter or not matter at all), that’s where I’m at right now, and I haven’t been able to find a medical professional here who will honor that and not pressure me at every session to let them weigh me. I had a very positive experience while actively in a recovery program in my former state, where I obviously had to be weighed because it was part of the guidelines, but afterwards my team listened to my concerns and worked with me. I’m EDNOS, and there’s no question of me being underweight, so they agreed that other medical indicators were what mattered for me–things like blood pressure and heart rate, and bloodwork, etc. The therapist at the local ED center here was not so understanding. She told me I was “tying her hands” by not allowing her to have objective information to refute my subjective impressions about my body, which I can see, but all of a sudden put my weight at the center of my therapy instead of my emotional responses to my body. I want to feel like it’s okay no matter what I weigh, not be reassured that I’m in the “normal BMI” range, and thus not “objectively” overweight now that I’m following my meal plan. So I went back to my previous therapist because he understands and respects my position–we’re doing sessions on the phone, and it’s made my life a lot better. I miss having a nutritionist who advocates intuitive eating though. I didn’t realize at the time how fortunate I was.
This is one of the things that I struggle with the most. For the past several years my weight has been normal (the higher end of normal, nonetheless) yet I was still really struggling with eating disorder thoughts, and was also not eating in a normal way (alternating between binging and restricting). However, it was just assumed that I was recovered because my weight was normal. For as much as I had been told in inpatient that “it isn’t about the food or weight” I felt like once my weight wasn’t dropping, I was told “oh, so you must be fine.”
Beyond that, I have never ever felt like my weight reflected how I am doing. I gain weight from binging and purging, sometimes I restrict and don’t lose weight, sometimes I eat ok and lose/gain. From years of having an eating disorder my metabolism and body signals are so screwed up that I know my weight doesn’t adequately reflect my thoughts and behaviors, and I know that restricting is a problem whether my weight goes down or not.
I agree that weight restoration is an essential part of recovery, but is important to remember that eating disorders are mental illnesses, and thus you can’t measure recovery by physical parameters.
It is almost one of those necessary evils….I don’t think that I could have made any progress had some numbers not increased, and others not decreased. Although, I don’t think I made any real progress until myself and my therapist stopped focusing on the numbers…..I was able to really talk and really be more honest when we weren’t measuring things by numbers…althougth, ironically, I have been totally open about everything! Who knows! At the same time, I was talking to a friend about this the other day, we both look “normal”–so the weight #s and such don’t really reflect our inner battles.