318: The Problem With Maintenance And Stopping Recovery Early

Chris Sandel: Hey! If you want access to the transcripts and the show notes and the links talked about as part of this episode, you can head to www.seven-health.com/318.

Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist and a coach and an eating disorder expert, and I help clients to fully recover.

Before we get started with today’s show, I have an announcement that I’m currently taking on new clients. So if you would like to reach a place of full recovery – and I know that can sound like a very scary thing; it can sound like something that is very far off, but if that is something that you would like, then I would love to help. This doesn’t matter how long it’s been going on, if you have been living with an eating disorder for the last couple of months, the last year, or many decades.

So if you’re wanting help, you can send an email to info@sevenhealth.com and in the subject line, if you just put the word ‘coaching’, then I can get over the details of how we can work together, and we can arrange an initial chat, a discovery call for us to decide and figure out if working together is the right thing for your recovery.

00:01:18

The problem with maintenance

So, on with today’s show. What I want to talk about today is the problem with maintenance and stopping recovery early. Like a lot of my recent podcasts in terms of these solo episodes, it’s come about because of some things that have happened with clients in the last couple of weeks.

With one client in particular, just to start this off, we started working together fairly recently, maybe in the last month, and in that time she’s made a huge amount of progress. She’s made lots of changes to her eating, she’s really hit the ground running. And as part of making those changes to her eating, she’s actually noticed a lot of changes in terms of herself. She said that she is feeling clearer in the head, she has less anxiety, she’s able to be present with her kids. She’s actually relieved at being able to eat more and eat more regularly and just feels better for it. There was this real improvement in a very short amount of time with her making changes. We also made changes in terms of her movement. But yeah, it was great to hear about all these changes.

She then went and saw her other support through the NHS, and when she was talking about the changes that she had made, the person basically said, “This looks like a programme or a thing you’re doing to try and gain weight, and really you just need to be doing maintenance at this stage” or something basically to that effect.

This is someone who’s been struggling for a really long time, has been working with these people in the NHS, hasn’t been getting anywhere in terms of the changes, and yet she’s now said, “Hey, I want to do something different. I want to be eating more food. I recognise that the place I’m in is not working for me, and what I’ve been doing isn’t working for me” and is taking the initiative, is starting to do this. Really, this is a real slap in the face for someone who has made the decision to start to do things that really go against the eating disorder, to be told “Hey, I don’t know if this is the right idea. Maybe you should just be doing maintenance right now.”

The reality is that eating disorders happen all across the weight spectrum. Just because I know what someone’s weight is, I have no idea what their level of restriction is. I have no idea how much exercise they’re doing. I have no idea the depths of the eating disorder. I only find those things out by starting to have a conversation with that person and saying, “Tell me what’s going on. Tell me what’s happening in terms of the thoughts, what’s happening in terms of your behaviours, what’s happening in terms of your symptoms.” That’s the information that is going to tell me how someone is doing.

So for her to be told basically, “I think what you’re doing is wrong, this isn’t the right kind of thing to do” – that can create a huge amount of fear in someone, and it creates a huge amount of confusion in someone. And yes, on the surface she can notice, “Hey, I’ve been doing these things and it’s really improving things for me.” But it doesn’t take much for the eating disorder thoughts to really start to ramp up and for little bits of information like that to really start to get into someone’s head.

I have this real hatred of this idea of maintenance, and maintenance based on someone’s weight or someone’s BMI, that you cross some line – or maybe someone even starts on that line. They never got their weight low enough to be below some threshold. So basically, what they’re always told and what they’re always offered is just eating like a normal person and “You’ve just got to get over this.”

What I said to her was, “I would love you to ask the person that you’re working with, ‘How are you expecting me to get over this eating disorder? How are you conceptualising this eating disorder and what is going on?’” Because from my perspective, the way I’m conceptualising it – and look, eating disorders are complex; there are many different components to it. but from a biological standpoint, she’s not been getting in enough energy, and this has led to the kinds of thoughts and feelings and behaviours that have arisen because of the eating disorder. The way that she gets out of that tis by bringing in more energy so the body can repair, it can start to make changes to all the systems and the organs and to her brain, and in a sense, by doing this for long enough, it turns off the eating disorder.

So I said, “That’s my outlook and how I understand this and why you are noticing these improvements in making these changes; I would love for you to ask them. What’s their concept of this? How are they expecting you to get over this by doing what you’ve been doing?” I’m waiting for a response on that at this point.

00:06:03

The order of repair during eating disorder recovery

I think it would be useful to explain here – and I’ve done this in another podcast, but if we’re looking at the order of repair with an eating disorder, it doesn’t work in the way that most people would want this to happen. If I’m looking at what happens when someone starts recovery, the body at the beginning preferentially stores weight. If we bring in more energy – and I’m just going to use some percentages; these percentages aren’t necessarily accurate, but it makes it very easy to explain it this way.

If someone increases the food that they’re eating and they’ve been in a pretty depleted and malnourished state – and when I say ‘depleted and malnourished’, again, it doesn’t mean that their BMI is very low; it just means they haven’t been giving their body what it needs to be able to function and to now do all the repairs that need to happen as part of the recovery process. But if someone starts to bring in more energy, in the beginning, all of that energy, the vast majority of it – and it could be 100% of it – it just stored as weight gain. Rather than the body spending this new energy, it just stores it as weight gain.

And this makes sense because the body hasn’t been getting what it has been needing, so it is very conservative. It doesn’t know, “Okay, is this just happening today? Is it just happening this week?” The body needs to be convinced that it can trust you with the energy that is coming in. So in the beginning, whatever extra comes in, a very high percentage of that – maybe even the whole lot of that – is just stored for weight gain.

What I often hear from people is, “If my body’s already gaining weight on this small amount, why don’t I just stay in this place? Why do I need to be increasing even more?” The answer to that question is: because you want to get over the phase where the body is just storing extra weight. And that’s not because I have anything against weight gain; it’s because to truly recover, we need that extra energy to be going towards the repair processes within the body.

So what happens is as the body receives more energy and does that for long enough or does that in a way that allows the body to start to trust that this isn’t a temporary situation, that more energy is going to be consistently coming in, then it starts to use more of that for the repair. For example, in the beginning, maybe it was using 100% that it was just storing as part of weight, but as time goes on, it becomes that it’s storing 75%, and 25% is now going towards that recovery process. Or it’s storing 50%, and now 50% is going towards that recovery process.

What starts to happen as you keep going is that a higher percentage is now going towards recovery because the body is now not needing to store as much weight, because one, it’s already done some of that, but two, it now knows this is a consistent thing that happens.

So the reason why you can be gaining weight and I would say you still want to be increasing your calories is you want to get through that phase of “I’m just storing energy.” You want to get through that as quickly as humanly possible so that the body can actually start to repair and notice benefits through this.

I’m just mentioning this because I think this can be a trap for a lot of people, and especially if someone has started their recovery journey not in a very low-weight body, so not in the stereotypical view of what an eating disorder or someone with anorexia looks like. I have to say that of all the people I work with, it’s a pretty low percentage that actually fit that stereotype. Yes, I do have some of those clients, but the vast majority I don’t have of those clients. Their weight is along the weight spectrum.

The reason why this is important is because what can happen otherwise is someone can do that, and in a very short amount of time be told, “You just need to do maintenance now” – despite the fact that all this extra energy that has come in hasn’t been channelled towards recovery; it’s been channelled towards this first phase of weight gain, because the body still is in this conservative mode because it doesn’t know what’s going to happen next week.

If someone is then told at that point, “Let’s just do weight maintenance”, maintenance typically doesn’t mean “Let’s hold steady in terms of what you’re eating”; maintenance often means “Let’s now reduce what you’re eating. Maybe we need to have less of that snack or we don’t have that snack, or maybe we go back to having low-fat products”, which is just, again, absolute insanity from my perspective. This is not the kind of advice that you should be giving, from my perspective, to anyone, but let alone someone who is in recovery from an eating disorder.

But this is why this whole concept of maintenance is such a problem, because people are being told to do maintenance even though they’re not anywhere near recovered. And just because some number on the scale says something, doesn’t tell us anything about it.

00:11:06

The problem with reducing eating after starting recovery

Another client that I’ve had recently has been making a huge amount of progress. She’s made a huge amount of progress over a period of 5 months and has drastically changed what she’s eating, has drastically changed her movement, and has really made a massive difference in terms of what her eating looks like. If I compare what her eating looks like now versus when we started, it’s completely different.

What has happened with her more recently – and this is something that actually comes up a lot, because when I was reflecting on this, this has happened with a number of clients – is that they’re in this stage where there’s been a lot of improvements, but we’re not there yet by any stretch. There’s still recovery to happen from a physical standpoint, but there’s still a lot of recovery to happen from a mental standpoint, an emotional standpoint. There’s still lots of coping skills that need to be developed more, so that’s what’s reached for when things get difficult instead of going back to exercise or restriction.

But she’s had a number of challenges recently connected to her personal life, and what has happened alongside these challenges with her personal life is there’s been some times where her eating has dropped down. What has happened is that there’s been then a lot more eating disorder thoughts, there’s been a lot more insecurities, there’s a lot more body image concerns.

What can often happen in these situations is the fact that the eating has taken a little bit of a downturn really gets missed, and all of the focus around “This is so hard” and all the challenges are connected just to what’s going on in someone’s life. The problem with this is that we’re only focusing on coping skills or we’re only focusing on looking at the meaning around certain events or whatever it may be, and we’re missing the fact that a lot of the challenges going on now, it’s not that those things in someone’s life aren’t hard, but what’s making it exponentially more difficult is the fact that their state has started to change because their eating has taken a downturn.

This then has a huge impact on someone. What often happens in this scenario – and again, I’ve seen this happen many times before – is when someone’s eating gets a little worse – and by ‘worse’ I mean they just start eating less – and it doesn’t have to be that total meals have been dropped or there’s this significant change, but by the fact that we’ve taken a little bit off the dinner here and a little bit off the lunch here and this snack got a little smaller, when you add all of those things up, it does start to make a difference.

The other piece connected to this is that by going through all the recovery processes, and we got through that stage where all the body was doing was just prioritising weight gain, the body’s now prioritising using that as part of repair, the body has upregulated. The body is now using a ton more energy than it was using before. So when someone then starts to take these things away, whether that’s intentionally or unintentionally, the body is now getting less. And the body often is still spending a huge amount, but now it’s getting less.

What often happens is people reflect and say, “This can’t be creating a problem for me, because previously I was eating half of what I’m eating now. So the fact that it’s gone down a little bit shouldn’t affect me very much.” But the reality is, your body’s now using a lot more. It’s now expecting a lot more. So when you now have this drop down in intake, you feel it a lot more because you’re missing out on this. Your body’s spending all of this extra energy, so you now feel it so much more than you were feeling it before. This then creates a real problem.

00:15:00

Psychological symptoms due to stopping recovery early

But the other piece that I often see alongside this is that a lot of the time when there are these changes that occur, there isn’t actually a lot of changes in terms of physical symptoms. Maybe occasionally someone’s sleep might get a little bit worse at this stage, but often – and this is where it gets tricky if there are a lot of symptoms that start to come back in terms of if someone’s digestion starts to get a lot worse, if they start to get a lot more tired, if they start to feel cold again, if they start to get all of these things, it can then be really obvious like “Oh okay, this is connected to the fact that the energy intake I’ve had coming in has dropped down because I’m getting all these symptoms again that I used to associate with my eating disorder.” So it becomes a lot more obvious for someone to say, “Okay, I need to prioritise the eating again” and start eating again and things get better.

But what can often happen is that a lot of those physical symptoms don’t actually start to happen to begin with – and again, this is because the body is prioritising doing recovery and spending a lot of this – but what happens is a lot of psychological symptoms that come up. There is then a lot more of the body image problems. There’s a lot more anxiety that starts to occur. There’s a lot more of the eating disorder thoughts that come up.

So in that scenario, it can be hard to think that this is about the energy intake, especially if there are all of these other things that are going on in someone’s life that make them think, “No, this is just about what’s going on in life and how hard life is.”

I remember with another client where we hit a similar kind of thing. In this situation, we were further along in his recovery, and at that point we were actually starting to bring exercise back in. We were doing this in a very gradual fashion, but we were bringing it back in, and around the same time he started wanting to get back into dating. He was starting to get into the dating process as part of that. Work got busy; things were going on in his life, and again, there was this downtick or reduction in terms of his eating coupled with the fact that he was starting to do a little more exercise.

He had all of this body image stuff come back out of the blue. It had felt like he’d been in a really strong place and feeling really good, and then all of this stuff came back. It would’ve been very easy for him to just chalk all this up to the fact that he was wanting to date again and all of the uncomfortableness that was coming along with that. He was then in a really tough spot.

I looked at what was going on and I was saying, “I get that there is this dating that’s going on, I get that there’s these challenges at work, but actually, there’s been a change in your energy balance. You’ve started to do a little more exercise and you’ve started to eat a little less. This is the thing that we need to focus on. We need to pull back on the exercise; we’re going to put that on hold for now, and we need to get your energy coming back up.”

It took a little bit of convincing for that to happen, but once he did that, it was pretty immediate. We’re talking in a matter of days, a couple of weeks, for him to then start to notice this shift again in terms of his thinking, and for him to be able to think more clearly, for the body image stuff to start to improve again.

00:18:22

Why this is a crucial point in recovery

The reason I’m mentioning this is that I think that this happens really frequently. In this scenario with these people, I’m able to work with them. I’m able to talk them through and hopefully get them to make those changes and get on track, or get back on track in terms of their recovery. But what can happen for a lot of people is this is the point where things stall and then they relapse, and then the narrative that they remember around this time is “I did recovery, I gained a bunch of weight, didn’t really work, and then I had the worst body image. Recovery just doesn’t work for me. I didn’t get any benefit from doing recovery.”

It’s that last little piece that gets remembered. It’s that last really challenging time that then led to the relapse, and then the story is “It was just too hard. I wasn’t noticing a benefit, and that’s why I went back” versus you actually making it through that hump and then having that realisation of “Oh, even though I’m a lot further along in recovery at this point, I’m still fairly susceptible and I’m still at a point where if my energy balance takes a downturn, this has a really big impact on me.”

This is then the difference between someone who goes on to fully recover versus someone who may go back into the eating disorder, and it could be another year, could be another 5 years, could be another decade before they even contemplate doing recovery again and getting out of that place.

So when I’m working with clients, I always think about there are these very crucial points in recovery where there’s these pivotal moments of “This could go in two directions very easily.” One of those directions is going to take them back into the eating disorder, and not just in a neutral way, but in quite a bad way in terms of the story that is going to be built up about that thing. Or this is that place where someone had a rough couple of weeks and then they were able to get better and were able to fully recover.

I think as someone who’s done this for a long time, being able to notice where someone is at those really pivotal points, and being able to call it out and just say, “Hey, I just want to say this to you, I want to let you know that this is one of those times that is really important for you to make it through because if you don’t, I think it’s going to create a real big problem.”

So that is why it is such a problem with stopping recovery early. It’s not just “Oh, there was just a little blip here.” This is the thing that could then send someone back to an eating disorder for a really long time. This is why I want to work with people, and I want to be able to help them through that rather than someone saying, “You’re now at a phase that you should just be doing maintenance” or “Yeah, I get that there’s a lot of stuff going on in your life and that’s the reason why you’re having all of these things come up.”

It’s not that life can’t be having an impact, but I also think we need to be looking at what’s going on with someone’s energy balance because that has a huge impact on someone’s state and how they’re feeling and how they think and how they perceive and their beliefs and all the memories that are coming up. All of these different things are all state-dependent.

So that is it for this week’s episode. I hope you found it useful. As I said at the top, I’m currently taking on new clients. If you would like to recover and you’d like 2025 to be a completely different year for your eating disorder and your recovery, then I would love to help. And if you’re listening to this in the future and it’s 2026 or 2027, then this still stands. Please just send an email to info@seven-health.com and put ‘coaching’ in the subject line, and then I can get the details over to you.

That is it for this week’s show. I will be back with another new episode next week. Until then, I will see you soon. Bye!

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