350: Overcoming avoidance, losing the ED identity, calorie requirements in recovery and much more…

Chris Sandel: 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 people to fully recover.

So we have a really good show today. It’s a Q&A episode. This is Episode 350, and I’ll get into that part in a moment, but as part of this one, we’re going to hit lots of different topics.

There’s overcoming avoidance; depression and eating disorders; navigating doctors and health professionals when dealing with an eating disorder; recovering into a bigger body and how to deal with that; advice for parents or children or loved ones who are suffering with eating disorders; how to take action when it feels so wrong to do so; going all-in for recovery and is this the right approach; eating disorders that don’t match up to the stereotype of wanting to be thin; how to cope with losing the eating disorder identity; how much to eat in recovery; why so many calories are required as part of recovery; and then taking a break in recovery versus keeping up your regular life.

Those are some of the topics that we’re going to cover, so hopefully they’re of interest to you. No doubt if you’re living with an eating disorder that there’s going to be a lot in here that is going to be really relevant.

As I said, this is Episode 350 of the podcast. I don’t know how many of you who are listening were there since Episode 1. It’s been – I think this is the 10th year of doing this, so it’s been a very long time. I know the podcast has evolved a lot over that time. I know I have definitely – when I started this, I had a full head of hair and I didn’t have a child and I wasn’t married, so a lot has happened over the last decade. But I’m really thankful for all the listeners, for people who are regularly getting in contact and saying how much they enjoy the podcast. I love getting to do this. I do this most weeks. Sometimes I’m not quite as diligent with it, but yeah, I’ve loved being able to do this over the last decade and I will continue to do that for many more, hopefully.

So as part of this episode, as I said at the top, it’s a Q&A episode. I put out a post on social media; I’d asked people on my mailing list what they wanted to cover. And I got a lot of questions. There was like 17 pages’ worth of questions when I copied and pasted them all in. I’m not going to be able to answer every single question that was asked today, but I do have all of them in a document, and the goal is that over the next little while, I will continue to do Q&A episodes where I will deal with a bunch of them at a time. Because this is really useful. It gives me an idea of what people are struggling with and wanting to know about.

So yeah, if your question is not answered today, it will be answered at some point. Just know that I will be getting to it; I just couldn’t answer 17 pages of questions in one day.

What I’m going to do is I’m going to read out the question and then I’ll obviously answer. Some of the questions were really long, and a lot of them were a lot of praise for me at the beginning, so I’m just going to lop off all of that. I’ve read all of them. Thank you so much for all the lovely comments. But I’m going to just read the part of the email or the comment that pertains to the question that someone wants to have answered.

00:03:41

Avoidance as part of eating disorders + recovery

Nicole says, “If eating disorders are anxiety disorders and it’s all about avoidance, does this mean I need to stop avoiding all things (i.e., socialising, overbearing work tasks, any form of commitment, etc.)? And where does it start or end?”

Great question. My honest answer is, yes, it does mean that you do this in all areas of your life, because if we look at eating disorders, but even if we look outside of eating disorders, if I look at people who are psychologically healthy, where things are going well in their life, typically they are not avoiding things. They are able to deal with what happens in their life, and they’re able to notice that “there are things that are challenging and I’m still going to find my way to navigate that.”

So I think it is really important to then be noticing, where are all these areas of avoidance and where I feel unsure about doing this thing, and how do I then address it?

But if I’m thinking about this purely from a recovery standpoint, there are things that are going to be more important at some points and less important at others. So if someone is in the early stages of recovery, the most important things that they should be working on in terms of not avoiding are about how to get the body out of the depleted energy state that it’s in. So it would be connected to doing things with food or doing things with movement that allow that energy balance to start to change for the body.

From a food standpoint, I think I’ve referenced this on the podcast before; I very much think about things from the RAVES method. RAVES is an acronym for Regularity, Adequacy, Variety, Eating with others, and Spontaneity. Basically, these are a lot of the things that need to be tackled as part of recovery, but we don’t need to do all of them at once, and in fact, doing them in a particular order makes sense because certain things are more important at the start.

And regularity and adequacy are the most important things. If you’re not eating enough food, if you’re not eating it often enough, you’re not really dealing with the main thing that is driving so many of the symptoms. So if I’m thinking about the avoidance piece, that’s where I would be starting. How do we get out of that piece?

Then the next piece – and this can be happening afterwards or it can be happening alongside – the thing I always think about is if something’s happening alongside, it can’t be detracting from the thing that is most important. In the RAVES example I just gave, it’s not that people aren’t allowed to add in variety or they’re not allowed to add in eating with other people until much later on. You can be adding that in from the beginning, but only if it is then in service of helping you to eat more food and eat more often. If I’m bringing in more variety but that then means that I’m not increasing my energy intake, then that’s not actually helpful at that point.

So we can be doing all of these things at any point as long as the things that are most important are actually happening. As I said, the next things to be working on would be things that are pulling you towards recovery and are reminding you why you’re doing recovery.

I think it can become very bland and life can become pretty boring if all I’m focusing on is recovery because you’re constantly doing all of these hard things, and it can then feel like “What is the point? There is no upside to this.” So challenging things or going against avoidance for things that “I’m really glad that I actually did this. It was really nice to be able to do this”, whether that’s “Hey, I got to see some friends that I hadn’t seen for a while” or “I went to the movies and sat and watched a movie on a Sunday afternoon for the first time in forever, and that was so enjoyable to do that.” So you’re having these reminders of “Oh, this is why I’m doing recovery.”

I think that would be part of the next phase with this. Or at the same time, working on things that are blocking recovery. If there are things that are getting in the way of recovery, then that could be really important. This could be, for example, connected to things with body image. If I’m really struggling with that aspect of it and that’s actually preventing me from eating more, how are we challenging some of the stuff that’s connected to body image or weight gain that then, once we can start to loosen some of those things and for those to be not feeling like as big a deal or “I’ve realised I’m able to tolerate that thing better than I thought I could”, then that allows other things to start to change.

And then finally, I would be looking at all of the other areas of life. Like, where does it then start to add to the quality of your life, or where does it add to how you’re able to feel and function? If you’re talking about socialising, getting social contact could be really important for you. It could lead to experiences where it’s like, “Hey, I’m recognising that I’m able to laugh more than I was before, or I’m just feeling more like myself. It was really lovely to be able to see these friends.”

I’m thinking of a client as I’m talking about this, and a lot of what we’ve worked on through her recovery is seeing friends and seeing people. She’s someone who is younger; she’s in her early twenties, and really being able to have her have more of these experiences of being a 20-year-old has then really helped her as part of her recovery. Having those experiences is great.

You talked about overbearing work tasks. If this is then getting in the way of you having good energy or you’re just feeling depleted all the time because you’re in this very busy, busy, busy work type mindset, then yeah, that’s something that I would be addressing.

So just to summarise in terms of recovery or even being a human with good psychological flexibility, I would say the name of the game really is “How do I tackle all the things that I’ve been avoiding?”, but doing this in an order that makes sense for recovery.

00:10:14

Relationship between depression and eating disorders

Then the next question is by Bibi, and she says, “Based on your experience with clients, how do you see the relationship between depression and eating disorders or eating disorder behaviours? I’ve been in a state of depression for many years, sometimes worse than others, depending on general circumstances in my life. At the same time, I’ve struggled with eating disorders and exercise compulsion. If possible, please elaborate on the relationship between eating disorder universe, if I can name it that way, and depression. P.S. My eating disorder history goes back to my teenage years, with periods of temporary recovery and quasi-recovery. I’m now 65 years old.”

Thank you for that question, and I’m sorry that this has been going on for this length of time for you and to have the eating disorder, but also to have the depression. That’s a lot to be dealing with.

So how do I think about this? There are lots of things that can predate an eating disorder. Often, people can have depression before an eating disorder occurs, or they can have high anxiety before an eating disorder occurs. They could have bad digestion before an eating disorder occurs. And then the eating disorder makes things worse.

The eating disorder, if I’m thinking about this from depression, the two of them feed off each other. If there’s restriction going on, if there’s compulsive exercise going on, if someone has binge/purge cycles that are going on, this can change the brain chemistry. It can change the available energy that’s coming in, and this can either create or worsen a low mood.

Depression can also then drive a lot of the eating disorder behaviours because it then becomes someone’s way of coping. You can use the restriction or the overexercising or the binging or whatever as a way of numbing or distracting or creating a sense of control or using this – I mean, we talked in the earlier question about avoidance. It becomes one way of being able to avoid a lot of these things.

Malnutrition has a really big impact on your depressive symptoms. I very much think of the Minnesota Starvation Experiment. If you look at the guys’ mental health as they went through that – and just as a note, I’ve done a whole podcast on this; I will put it in the show notes if you want to check it out. There’s a later question where I make reference to it as well, and I will have the show number for you or the episode number for it. But yeah, when we look at what happened in that, as the guys got into a more depleted state, they had lots of different mental health issues, and depression was one of them.

In a sense, if you get into a lower calorie state, there can be lots of reasons why it leads to depression, but you’ve got lower neurotransmitters. It can lead to this lower mood. It can lead to hopelessness and apathy and irritability, obsessional thinking. All of these things are psychological, but they’re also physiological. They’re being driven by that state.

Being in a depleted state really flattens a lot of emotional resilience because when you’re in that state, everything does just feel harder. It does feel just “I don’t have the spoons. I don’t have the capacity to be able to deal with this.” So things then just feel more unmanageable, and again, this can either lead to a depressive state or there is that depressive state that is already there; it just starts to make it worse.

The opposite of that is recovery then does start to improve mood. It won’t happen on Day 1, and there can be lots of other aspects of life that maybe have been ignored or have fallen by the wayside that can then lead to things like grief and having to deal with all of those aspects that, again, in their own sense can then feel like a form of depression or it can feel really challenging. And by going through recovery, it does improve your mood. It does improve your capacity to deal with those things.

You mentioned about being in this quasi-recovery state. I’d say that that then also really plays into the depression piece as well because if your body is still in this energy debt, even if it is less, it hasn’t done the full repair that it needs to do. And a lot of the time, your body is then still staying in this fight-or-flight, shutdown type state, which has an impact on the kinds of thoughts and feelings and sensations and things that naturally arise within you.

The other piece I would say, to use your vernacular, the ED universe can really become someone’s home, or it can become your home and you get so used to the structure and the rules and the identity and the rituals, and it can become – it can feel safe even though there is this feeling of depression that is going on.

I will just say that despite the fact that you are 65 years old and this has been going on since you were a teenager, so multiple decades, I still believe that you can fully recover. There is nothing that prevents that from occurring. If you do the things that are required as part of recovery in terms of making changes from a food and exercise standpoint, in terms of getting past a lot of the avoidance that I made reference to in the previous question, that is how you get to that place of recovery.

So I just want to give you some hope with this. It doesn’t mean that just because it’s gone on this long, that you can’t get better. And I mean that both for the eating disorder but also for the depression as well.

00:16:17

Tips for dealing with health professionals

The next question is from Minal, and she says, “How to speak to health professionals about being okay with weight gain and not seeing the number on the scale? E.g., last time I spoke with one about having an eating disorder – undiagnosed, though – he wrote it down as ‘dietary restriction’ and I found that to be dismissive. Another time, I asked not to see the weight number on the scale. She wrote it on a piece of paper right in front of my eyes, in kilos, not pounds, so she said, ‘Don’t worry, it’s not in your English.’” I’m sure you’ve heard many stories.”

Minal, I’m sorry this has been your experience with this stuff. I really wish that health professionals, doctors, nurses, all the people working in the health field that have so much contact with people were much better trained in this and that they weren’t within a system where weight loss is sort of the number one fix-it-all for everything that is getting recommended. I think this is getting worse in terms of the age of the GLP-1s. It seems like this is the number one recommendation no matter what is going on.

The things that I would say connected to this is that you are not alone with this experience. And I know this doesn’t make it any better for you, but the reason I want to mention it is so that you can understand this isn’t a you problem, this is a them problem. This is about the training people have got, this is about the ignorance and the misunderstanding that people have. So it’s not saying anything about you, even though I know it can feel very personal when that happens.

I also know that many clinicians are either uncomfortable with or just have a complete lack of knowledge about weight-neutral care, and just don’t know how to adapt or don’t even think that they need to adapt. And again, this isn’t about you. This is about them.

Really, when someone is saying something like “Oh, don’t worry, it’s in kilos”, this just shows a real lack of understanding. And again, it’s not about you. It’s about their lack of understanding of how much of an impact that’s going to have on you, and that these things do harm, but someone just doesn’t really know.

A few things that could be useful. One, being direct and pre-emptive. For example, “I’m working on recovery from a long-term eating disorder. Discussing or seeing my weight is harmful for me. I need a blind weigh-in or I don’t consent to hearing the number.” So being really clear and firm in your language removes some of that ambiguity. And I know it sounds like you’ve already done this before and they didn’t follow through, but I would say that with every appointment that you have, starting off from that place of “I want to be really upfront about this and I want to be very direct with it.”

Another one would be stating it in practical terms instead of emotional ones. Often, health professionals respond better to this function-based explanation. For example, “Seeing the number disrupts my treatment progress or it leads to behaviours that undermine my health.” The reason for this is it can change it from being framed as like just a preference to “No, this is a really important clinical need.”

You could even make reference to “My eating disorder team has told me that seeing the number has a really big impact on my treatment” so someone is then understanding this in mor practical terms as opposed to it just being a preference.

You can then name the pattern if you feel like you’re being dismissed. For example, “When it’s labelled as ‘dietary restriction’ instead of an eating disorder pattern, it minimises the severity and affects the support I receive.” Again, sometimes people just don’t understand the language and the impact that that language can have, so being able to point this out.

And I want to just add, I know with all of these things it can be really hard to do this. It can be hard to be in a doctor’s office where there is this power differential just being in that situation. Especially if you’ve had a history of having appointments where you did feel shamed and you did feel very uncomfortable and “it did feel like I was being attacked” and all of those things, again, that can be really hard to speak up. So I’m just saying all of these things of these could be helpful, with the understanding that I know it’s not always easy to do this.

The next one would be give them the alternative you do want. For example, “If you need the weight for clinical reasons, that’s fine. Just don’t show or tell me the numbers. Please document it without sharing it and let’s focus on the symptoms and the labs (or whatever it is) instead.” You can even ask, “Hey, I want to know where this number is going to be placed” because I’ve heard of clients – and I’ve had discussions with clients – where they’ve said “Hey, I don’t want to know the number” and someone said, “That’s fine, I’m not going to include it”, and then they get sent over their medical records and it’s like the first thing on top.

So asking, “If I’m looking at my medical records or if I’m going to be receiving these test results, is it going to be on there?” to be really explicit of like, “It’s not that I don’t want to hear it just now in this moment; I don’t want to see it ever. I want to work out a way that that’s going to happen, and I want to find out where are all the areas where that might break down because you have included it, so I know all this in advance and I’m not going to be blindsided by opening a document and it stares me in the face.”

The next one would be bringing in a note if needed. Writing it all out. I think sometimes that’s a lot easier, to just say “Hey, I want to hand this over to you.” You can write it from your treatment team, again, trying to create this higher level of this person’s working with a professional, just so you’re reaching someone on a level that they may respect more. “Hey, here is a note from my treatment team and this is why we’re not able to talk about weight. This is why I don’t want to be weighed”, etc. It helps it be taken more seriously. It means that you’re more likely to get the message across, because I think sometimes in the moment it can feel hard to actually say what you want to say. So I think that can be helpful.

You’re also allowed to say when someone has crossed a boundary. So “Hey, I just want to flag, I asked not to see the number and you just showed me the number” or “I’m here because of strep. I don’t need or want to talk about my weight right now.”

And again, I know these are difficult things to do, especially if you have been blindsided just there by seeing the number that you’d asked not to, but you are also able to be saying, “Hey, I actually explicitly asked for this and this has not happened” because that shouldn’t be happening in a session with someone. If you’ve explicitly started the session saying, “Hey, I don’t want this to happen as part of it” and then someone does the exact thing you’ve asked them not to do, that’s a real violation. I think it is worth being able to, one, let them know about it, and two, you can then take some action based on that.

Hopefully that’s given you some ideas and things that you can use.

00:24:10

Advice for parents/carers of someone with an eating disorder

The next question is from Melanie. She’s got a daughter who is suffering with an eating disorder. It’s been going on for the last 10 years. She said, “In your podcast, could you possibly include any advice for parents or carers of a loved one who has struggled with an eating disorder for over a decade? It’s hard to get the balance right when you’re wanting to be independent but at the same time are so dependent for emotional and food support on the carers too.”

This is a really tough situation, and I feel for you hugely, Melanie. It must be a horrible situation to see your daughter going through this, and especially to see it going on for so long.

When I’m working with clients, I will have a session with their parents or their partner, whoever is that person for them so that we can have a conversation about this and I can explain certain things about eating disorders. I can answer their questions that they have. The client can then tell me things, “Hey, I’d really like you to be able to address this with my mom or with my partner”, so that’s something I offer for people because I think it’s really important. The client is always my client, and I don’t divulge anything that they don’t want me to divulge, but being able to figure out how this person can be the best support.

One of the things that I always say as part of these conversations is, for you and that other person – if it’s their daughter or their partner or whatever – to have a conversation about, what are your roles and responsibilities for each of you?

I say this because different people want and need different things as part of recovery. Some people do want, “I want you to be there for every single meal, I want you to be making every single meal. I need you to be that role”, and for someone else, that’s not what they want. It may be difficult where you feel like “I want to do these things or it’s important to do these things”, but especially if someone is already 24, it’s really hard for you to then say, “Hey, I’m going to do these things against your will. I know you don’t want me to do them, but I’m going to do them.”

So being able to have that honest conversation about, where are each other’s roles and responsibilities, and what am I meant to be doing here? Because if your daughter’s then saying, “Hey, I do want you to do this thing” and then when we get closer to mealtime and that’s now changing, you can then be saying, “Hey, I know everything’s coming up right now, and we also had that conversation about this is how you’re wanting me to be able to support you.” I think it’s a lot easier to be having those conversations away from mealtime and away from triggering times where you can map out, “What are you wanting me to be helping you with? How involved am I going to be with this?

As heartbreaking as it can be – and I know this from doing this work – you can’t force anyone to do anything. Someone has to want to make the changes and has to want to get better. And of course there are definitely things you can do to support and that can be helpful, but really understanding, what is my role as part of this?

So really understanding that you can support without taking over. You can be offering balance, you can be offering co-regulation, you can be offering structure as part of this so that you can be eating meals together, you can be gently checking in, you can be providing predictable routines, you can be the healthy role model for someone to be able to see, “They do eat on a regular basis. They are able to rest. They are able to eat these kinds of foods.” So being able to be that role model.

I think you can name the duality that you talked about in the question. You can say, “I know you want your independence, and I can also see that you also need this support” – maybe support at mealtimes or whatever it is. I think being able to say that out loud really reduces the tension between both of you.

And also being able to acknowledge that this isn’t just a stage of life thing. This is true for all of us. There are going to be points in all of our lives where we need to lean on friends or family more because we’re going through something. We’re going through grief because someone passed away, or we’re in a tough spot because we got made redundant from work or something’s going on with our relationship or our marriage or whatever, and “Hey, I am now needing friends or family more than I was before.”

So being able to explain that that’s a normal part of being a human, and that at some point, when she’s better, you’re not going to be needing to offer that support to that same level and she’s not going to be needing that support at that same level, and maybe she can then be offering that support to someone else. So just being able to talk about this so that it’s not this elephant in the room that no-one’s naming, and being able to really normalise it. This happens for lots of people at different stages of life.

I would also say that you need to hold on to your wellbeing. This I know is a tough thing, because, if I imagine my son, Ramsay, who’s eight, going through an eating disorder, I would want to do absolutely everything in my power to deal with this. And knowing that this has gone on for a decade, that also is taxing on you. So being able to know that “Hey, I need to support myself as well.”

And I don’t think that this is then you being selfish. This actually helps both of you, because when you’re completely depleted and drained, you’re not your best self. You’re more likely to be argumentative as opposed to being that safe, calm person that your daughter needs, to have those cues of safety when she’s with you. So I think it’s important for your wellbeing but it’s also important for your relationship and you being able to help in that.

So I would say it’s definitely not selfish – because I know for other parents that I’ve talked to, so much of their life has changed, and I think this can often have to be the case. But I don’t want it to be in a point where you’re now really suffering and that suffering is then having an impact on your daughter’s ability to actually recover.

I would also add making sure that recovery is not the only topic. I think what can often happen is it can become the be-all and end-all, and that then becomes a problem because, especially if there’s a lot of resistance from your daughter, especially if there’s a lot of ambivalence, it means “I’m not sure I want to spend as much time with Mum because every time I’m with her, all that we talk about or all we’re dealing with is the eating disorder.” So it is really important to then be bringing in these other facets of life so that it’s not just completely all-consuming.

As I said before, just remembering dependence is not failure. Even if she’s in her mid-twenties, there is a lot of gaps that then are created when someone has an eating disorder for that length of time. There’s a lot of emotional regulation gaps that are created as part of that. There can be gaps in terms of her socialisation or friendships or having hobbies or these different things. That means that it is going to take some time for those things to be rebuilt, and being able to offer support to fill those gaps while your daughter is rebuilding these things is really important.

I think often, when I work with clients – it’s quite interesting; especially clients who are in their mid-twenties, late twenties, early thirties – there can be this real feeling of “Life’s just passing me by. I’ve wasted opportunities.” Very much feeling like “My life is over at this point”, and I don’t want that to be felt from her from you in terms of like “She should be further along than this, I shouldn’t be having to provide so much support for her.” And I’m not saying that that’s what you are making her feel like; I’m just wanting to mention it. It makes sense that there’s going to be more dependence on you because there are going to be these gaps that have built up over that time.

So hopefully that answers the question. As I said, I really feel for you to be in the situation that you’re in with this.

00:33:36

The realities of recovering into a bigger body

The next question is “I’d love for you to discuss the realities of recovering into a bigger body – for argument’s sake, a body that falls above what the NHS calls the healthy range.”

This makes me really angry, is my first impression with this question, because I know what the NHS is like in so many of these situations. I think it is really heartbreaking that just because someone’s not underweight and matching up to some stereotype that the NHS has, people either get no support at all or they lose the support that they were getting because they’ve now crossed some arbitrary line and now BMI is not as low as it was before.

That just shouldn’t be the case. It should be that irrespective of the size and shape of your body, you should be able to access eating disorder care. There shouldn’t be this gatekeeping that is going on. There shouldn’t be this idea that if someone’s in a smaller body, they’re obviously so much more in grave danger than someone who’s in a larger body. It just is not true like that.

I think it’s very valid for you to have grief or for you to have anger around this because recovering is really hard. It’s hard physically, mentally, emotionally. And then doing that in a body that professionals then stereotype and either say, “Oh, you’re good now. You’re recovered, obviously. You’ve put on weight. You’re good” – that’s just not helpful at all. So it makes sense that there’s anger or grief or a whole range of negative emotions connected to this.

What I want to offer and suggest is compassion here. I have a huge amount of compassion for anyone who’s finding themselves in that situation, and to be bringing in compassion for yourself. And I know that can be a difficult thing to do, but recognising, like I said earlier on in the question around dealing with professionals, this is not a you problem. This is a them problem. And that sucks when it’s the NHS and that is your way of getting help, but this is not about you.

With all of that said, someone’s body does not change recovery and what is required for recovery. So if I’m working with someone, my treatment isn’t based on what is their BMI and now we have to do things differently because of that. It’s based on what’s going on, what’s happening in terms of their behaviours, what’s happening in terms of their symptoms, what’s happening in terms of their thoughts. We’re working with the eating disorder. The people who are in larger bodies, the people who are in thinner bodies, we’re doing the exact same thing. There isn’t some magic BMI that someone gets to where I’m like, “You’re good.” It really is about what’s happening in terms of all of these different things – thoughts, feelings, behaviours, symptoms, etc.

So if you’re getting this impression of like “I should be recovered by now because of my weight and I’m not”, then you’re just not recovered by now. The weight that you’re at or the amount of recovery you’ve done means that you still have more to go with this.

The unfortunate part is that this often means that you may need to then seek support that is not provided on the NHS. And that’s hard because not everyone has the financial means to be able to do that, but unfortunately that’s the reality of the situation. And I wish I had a better answer to this.

I’ve had a number of clients that I’ve worked with who were either working with the NHS or who had worked with the NHS – and it’s hard for me to say this because I do have a lot of respect for the NHS and what it can be, but I haven’t seen a lot of good experiences from people who have been there. The throughline that often is the same with all of them is “This is as good as it’s gonna get.” At some point, they get to a place where they’re told, “Look, you’re just going to have to deal with this. This is just how it is for someone who’s had an eating disorder. This is a lifelong thing. You’re always going to have this.”

And that is not the message that people need to receive because it’s just not true. People can fully recover. It’s a matter of doing the things. The reason why someone hasn’t got there is typically because we’re packing up shop before we’ve fully done the things that need to be done.

So that’s my thoughts on this, and I do have a huge amount of compassion for you, because it’s not easy to be doing this in a body where you’re being told that “You’re too big for the services that we offer.”

00:39:03

Taking action in recovery when it feels wrong

Then the next question is from Georgie, and she says, “I don’t know how to phrase this as a question, but I feel like what’s kept me stuck for actual years is, how do you do recovery actions (e.g., eat more, rest, accept weight gain) when your eating disorder makes those things feel like the most fundamentally wrong thing to do, like jumping into traffic? I have all the reasons and the desire in the world to recover, but every day it feels like the only right thing to do is to follow what the eating disorder wants, and I go around the same cycle over and over and over again.”

Thank you for asking, Georgie. I would say that this is where lots of people get stuck. There is this intellectual understanding of “I know I need to do certain things in recovery. I can even recognise this isn’t the life that I want to be living. This isn’t leading to the things that I actually want to be doing. I don’t want to be spending my time on these things.” I think there can be people where it’s very much “But I love the exercise” or “I love the healthy eating” or whatever it is, and then there is also a lot of recognition of “Hey, I don’t actually want to be doing any of these things, and this isn’t enjoyable. This is just about compulsion. And yes, I have these fears, etc., but I also know that this is not the life I want to be leading.”

The thing that I would say – and I always want to get this across with clients – is the ‘wrong’ feeling that you’re describing is the eating disorder. It’s not you. The eating disorder wires your brain, it wires your nervous system, in a sense to mis-predict or miscatalogue different aspects of nourishment or rest or weight changes, etc., as a threat.

And that panic, that threat response, is real. You feel it within your body. I often use the example when I’m talking to people to explain what an eating disorder is like, it’s the equivalent of having a meal but I’m bringing you into a room and on the floor is snakes and spiders and scorpions and then I’m saying, “Hey, just eat the food. It’s just a sandwich.” You’re looking around and your whole nervous system is reacting to all of these things in the room, and that’s the response that is going on.

In the eating disorder, as I said, there’s this misattributing of these things. There’s this threat response that is occurring that shouldn’t actually be occurring.

I’m mentioning this because this is what is going to happen. There is no way of doing recovery where that doesn’t occur. It will stop occurring as you keep going, but in the beginning there is no way around that. And I’m saying this so that you can manage your expectations so there isn’t the feeling of “I’ll do recovery on the day that I wake up and it feels normal to actually have that breakfast or it feels normal to add in that snack or it feels fine to stop that exercise.” Those things aren’t going to happen in advance. So expect that wrongness feeling. Expect that “It feels like I’m jumping in traffic” to be there every time, and recognise, “Actually, I can take action even though that feeling is there.”

I think that’s the distinction that people then learn as they go through recovery. The thing I regularly say is you don’t think your way into acting differently, you act your way into thinking differently. It is by taking the action that you then retrain your nervous system and you retrain your brain to recognise that “This thing isn’t actually a threat.”

A lot of the time when I’m working with this on clients, I very much focus on this concept of running the experiment. Your eating disorder brain is going to tell you lots of things that may happen as part of making this change, and what we want to do is figure out what actually does happen. Because so much of what the eating disorder tells you is not actually true; it’s just a prediction of what it thinks will happen.

And often, either, one, the thing doesn’t even come true in terms of “I thought if I did this thing I’d be overwhelmed for days after doing it” and recognising “Oh, actually I made that change and I wasn’t overwhelmed for days afterwards.” So starting to recognise, when I do the thing, I actually get to deal with the reality of the situation as opposed to just the eating disorder’s version of it.

But two, you often learn, even when the things do happen – that thing happened and it was so scary – “Oh, I can actually tolerate this.” Because I think that’s the part that the eating disorder convinces you of. Like “If this thing happens, you won’t be able to tolerate it” and the reality is, actually, you can. “I can start to recognise that I can do these things that are hard, I can have these thoughts that come up, I can have these feelings and sensations that arise, and I can still take the action, and I can notice that it was an hour later or it was an hour and a half later and then that started to dissipate of its own accord.” Recognising, “Oh, there is a rhythm to this. It gets hard and then it comes down.”

So being able to recognise that by taking the action, you get in contact with reality as opposed to just the stories the eating disorder is telling you. And connected to this is pairing those changes with other ways of supporting your nervous system. This is a lot of the work that I do with clients. We’re now having this breakfast and that feels really new, and afterwards or before, I want you to do these things that are going to support your nervous system to help you to make that change and help you to stay grounded or be able to manage the emotions that come up afterwards.

There are different tools in terms of guided meditations or journalling or breathing or other ways of moving one’s body in terms of pushing certain things or rocking or different ways of regulating the nervous system. That’s often the way that I’m focusing on it. I know that this thing is going to create this reaction within you, and we still need to do it because that’s the way you get out of the eating disorder, and what we’ll do is pair it with these other things that then help you to be able to support and manage that.

Again, on top of that would be you’re having support and accountability with this. So when I work with someone, I’m providing that support and accountability as well as other people in their lives if they have that. So that would be the other suggestion with this: having someone who’s able to support you with this if that’s possible, so that they’re able to sit and eat that meal with you or whatever the change may be.

But I really want you to understand that what you’re experiencing is completely normal and it is just the eating disorder, and the way that you get over it is by retraining your body and mind to see and experience things differently, and that comes through action-taking. You can’t do all of that work in advance and then start taking action. It just doesn’t work that way.

00:46:47

Staying motivated in recovery

Then the next question was from Christie. She says, “How do you get motivated to stick with recovery when I’ve failed so many times before? It feels hopeless to succeed and be motivated.”

I’m not going to answer this question now; I’ve done a whole podcast on motivation. It’s Episode 337. So I’m going to suggest that you just listen to that episode, because I go into motivation and motivation in recovery and navigating the different points of recovery and how to deal with the motivation piece at those different points. I go into it in a ton of detail. It’s Episode 337, and I’ll put it in the show notes as well.

00:47:28

Does going all-in on recovery help to improve metabolism?

Jessica then asked, “Does going all-in help fix metabolism quicker than slowly increasing and gaining weight at a slower pace?”

Yes is my general answer to this. When you are feeding your body fully and consistently and you’re getting more rest, this gives your brain and gives your body clear signals that “We’re safe, food is coming in on a regular basis”, but it also gives the energy for your body to then be able to start to do the repair work, so it’s then able to speed up your metabolism and normalise your hormones and improve your digestion and really do repair work on all of the different systems.

When you’re doing it at a slower rate, especially if someone’s doing really teeny-tiny changes, your body just doesn’t get out of that place. Your body still feels like “We’re in a famine.” It doesn’t really want to be spending a lot of what’s coming in on increasing your metabolism or on doing the repair work because it doesn’t know what’s going to happen tomorrow or next week.

So if I’m looking at, from a physiological standpoint, what is the best thing that someone can do, it is bringing in as much energy as possible and taking as much rest as possible – with the caveat of yes, there is refeeding syndrome, and there is this specific window when that is more likely to occur, which is within the first couple of weeks of someone starting to refeed. There are certain things that make it more likely to occur or less likely to occur. It’s not something I take lightly; it is a real thing, and it is deadly. And it’s a very short-lived window that it can occur. So once someone is out of that window, then yeah, we can start to increase things.

As I said, it’s through this that the body is then able to ramp up digestion and temperature and hunger cues and energy and all of these things that are so important.

The big ‘but’ that I’ll say with this piece is – and this is after doing this for such a long amount of time – I no longer believe that there is this one way that everyone needs to do it and if you’re not doing all-in, you’re not really doing recovery. I don’t believe that’s true. The best plan is the plan that someone will follow, and that someone will follow through the long term. That does not mean at all that someone should be going really slowly in their recovery and that that’s the best plan. You want to be making meaningful changes. But you can be making meaningful changes without going all-in.

And I just say this because I think there can be this very black-and-white barrier that gets created where “If I’m not doing all-in, I’m not doing recovery, so I don’t even know if I can even start recovery.” My thoughts are, no, you can start recovery without going all-in and you can just start making more meaningful changes as part of this.

00:50:31

Eating disorders aren’t always about weight or body image

The next question is “My 13-year-old daughter is in anorexia recovery and I find all the information is skewed to calorie counting, body image, being scared of gaining weight, and none of this applies to her. She doesn’t worry or do any of this. I’d love some other discussion around maybe the small percentage of people who are still struggling, but these fears are not driving them, or adolescents who can’t articulate the thoughts and feelings supporting them.”

I want to make it abundantly clear that not all eating disorders are about weight and size and all of that. And not even everyone who’s suffering with anorexia, which is supposedly meant to be all about this, is because of this. I would say that it’s not a small percentage, either, and that it’s actually quite a lot of people.

When I work with clients, I do discover that either, one, this wasn’t what was driving it to start with, or two, even in the depths of the eating disorder, it’s not what is keeping it going. So often, there is neurodivergence or sensory issues. There can be anxiety. There can be loss of appetite due to stress. There can be someone eats less food because they were fasting for Ramadan or they were fasting as part of Lent. There could be a need for control. There can be all of these different reasons why someone develops an eating disorder in the first place, and then continues to have that eating disorder.

The brain, when it is in a starved state, behaves in the same way. There is obsessiveness, there is shutdown, there is withdrawal, there’s inability to really explain what’s going on. We have a very stereotypical idea of what eating disorders are or why they occur, and I just don’t believe that to be true.

If I was to think about, what’s going on in terms of an eating disorder, what happens is someone gets into a low-energy state, and if you have the biology, you have the genetics, then this, in essence, turns on the eating disorder. Then there is this, as I talked about earlier, miscataloguing, this mis-predicting of what will occur, and that then changes the reward circuits in the brain, it changes the fear circuits in the brain, and this now means I start to have this different relationship with what happens when I eat or what happens when I move or what happens when I rest.

Someone can get into that state for a multitude of reasons, as I talked about a moment ago. It could be fasting for Ramadan, it could be because “I went on this det because I was being bullied at school”, it could be “I’ve got really bad digestive issues and we’ve been trying to do all these different elimination diets to figure out what’s going on.” There are many roads that get people to that point, and then the eating disorder gets turned on – and it’s at that point that we then try and explain why this is going on.

It feels weird if we think about, “Why would I be afraid of a sandwich, or why would I be afraid of stopping exercise, or why would I be afraid of not being productive?” or whatever is going on, so I need to come up with an explanation of why that would be the case. And often what we lean on when coming up with these explanations are “What’s been going on in terms of my upbringing? What’s been going on in terms of the culture around me?” So given the culture that we live in today, yes, so much of it gets blamed on diet culture or beauty standards or all of those usual things. If this was the 1600s, in medieval times, it would be blamed on celibacy, godliness, holiness, all of the reasons that the starving saints used to justify doing what they were doing even though they were living with anorexia.

I’m saying all this because I think it’s really important that so much of the reasoning behind an eating disorder – it’s not that it’s untrue, but we often tell ourselves stories, and we try and make sense of the world. We are meaning-making machines. We want to understand what’s going on. And the person who’s got into that state through dieting versus the person who’s got into that state through elimination diets because they had digestive issues, they all end up with the same kinds of thoughts and worries and concerns.

I know you said that her thoughts and worries and concerns aren’t around counting calories or body image or any of those things, but there’s going to be explanations about why it’s going on, and those explanations are things that get in the way of why I can’t make a change. So instead of “I can’t possibly eat more because I’ll gain weight”, it’s fill in the blank. Could be connected to anxiety, could be some other reasons that is then given.

The other piece I would say with teens is teens aren’t often very good at articulating what’s wrong, and this is true even before an eating disorder or even without an eating disorder. I think most adults aren’t very good at being able to articulate what’s going on in terms of their emotional world, in terms of how they truly feel or think or any of those things.

So if you’ve got a teenager, obviously that’s going to be a lot harder to do because they don’t have as much experience in this world. They also have a brain that isn’t fully developed. And then when you add on top of that a nervous system that is overwhelmed because of the eating disorder, language centres that just can’t keep up with all this, the silence isn’t a refusal; it’s just like, “I don’t have the capacity to be able to do this. I don’t even understand it properly myself.”

I’m just saying this so that you’re aware it’s not denial or it’s not that someone’s refusing to talk about this. In a lot of cases they just don’t even understand what’s going on properly themselves to be able to articulate it.

So often, what is most important, especially for your role – your role isn’t as a therapist or having that kind of role in your daughter’s life; it is more of how you can provide the structure that is needed. How can you be that cue of safety for them? How can you provide consistent meals or predictable routines or that calm adult leadership and reassurance that are so important for regulating one’s nervous system and for being able to change how that is, which then has an impact on thoughts and feelings and other things that naturally arise within.

00:57:45

Grieving your old identity + creating a new one

Then the next question is, “How do you cope with losing your identity as someone who is very underweight and eats little? I’ve had anorexia for 20 years.” Amy, thank you for asking that question.

The first thing I would say is, one, it’s very normal to grieve this identity. If you’ve been living this way for 20 years, the eating disorder has become very familiar to you. It’s often a lot of structure for you. It can be strangely comforting; even when someone can recognise “I don’t want any of these things”, at the same time, it is a security blanket of sorts.

So letting go of that can in a lot of ways feel like you’re losing a part of yourself, and I know for a lot of people there can be this feeling of like “What are people going to think?” or “What if I do get better and then I now don’t have this as an excuse for why things in my life might not go the way that I want to?” This can be really the case when people developed an eating disorder in their teenage years, where they haven’t developed these other skills. It can really feel like “I just can’t lose this thing.”

The suggestion that I would have around this is to recognise that this will change as part of the process. I think there can be this feeling of “I’ve got to figure this out before I make any changes, and what’s my identity going to be, or how am I going to cope with this?” Really, the identity piece – your new identity – will grow as the illness shrinks, and you don’t have to know all this first.

If I’m thinking about identity and where it comes from, it is a byproduct of how you spend your time. If someone says – and I’ve used this example for myself – a huge part of my identity is music. Why is that a part of my identity? Because I spend a ton of time listening to music. I’ve been fascinated by music since I was a teenager. I’ve gone to countless concerts and festivals. I spend, I don’t know, probably 8-10 hours a day working while listening to music. All of my friends, I’ve met through going to festivals or going to clubs. They know a lot about music. So that’s why it’s a big part of my identity, because I spend so much time on it.

It’s the same if your whole life has revolved around your food and your exercise and all of these eating disorder behaviours. It makes sense that that becomes your identity, and the way that stops becoming your identity is “I started to spend more time on different things. I’m now spending more of my time being creative and doing art or going out to this thing, or I’ve got into this hobby.” These things then become your identity because now I’m spending so much more time on those things.

And you can’t do that in advance, in a sense. That becomes your identity because as time goes on, you’re spending more and more of your time doing it.

What I would then suggest connected to this is in the beginning, instead of focusing on your identity, focus on values. This is something I use a lot with clients because even when someone is in the depths of an eating disorder, when we go through particular exercises and talk about this, people can normally say, “My values are…” What they claim their values are can be different to how they’re living their life, and there can be a recognition of “I know my life doesn’t look like this at this point, but actually, these are the things that I do value, and this is how I would like to live my life. I want to live in alignment with those values.”

If you can then map out what your values are, that can be that guiding principle. So “Even though I’m a little unsure of my identity, I really do know that integrity is a really important value for me.” Or “I do actually know that compassion is a really important value for me” or whatever it may be. With clients, I have them figure out what are their top 5 values. You can have more values than this; it’s just an easy way to start.

The thing I also say with this is you get to pick your values. It’s not that these are then set in stone. You can then use values for a particular season of life. So “Hey, it makes a lot of sense for me to really value growth during this recovery stage, so that’s going to be my value.” I get clients to then explicitly write out what those values mean to them, and then as part of that, they can use it as a way of guiding their action-taking.

So if I say that I value compassion, how would a person who’s compassionate act in this moment? Or I say I value growth; how would someone who values growth deal with the discomfort that is coming up here? So using values instead of identity, with the recognition that “If I keep living in alignment with my values, my new identity is going to grow out of that.”

The other piece connected to this is just recognising there is going to be this transition period. There is going to be this messy period where you’re trying to figure this out, and that’s completely okay. It’s normal. I often think of recovery as like going through being a teenager again. This can be true, often, from a physical standpoint in terms of people getting their period back and hormones coming back online, but it is very much like being a teenager. And most people I speak to, being a teenager was not fun. I would not want to go through being a teenager again. If I have to do that as part of something really important, then of course.

But it can be a useful way of framing it, like “Of course this period feels hard. I’m learning this new way of being, and it’s going to feel awkward and it’s going to feel different, and that’s fine.” The other analogy is going through a breakup after a long-term partner, and really rediscovering who you are and finding out who you are after going through that breakup. It’s the same kind of process.

So I would just say you’re not losing yourself or your identity; you’re losing the cage of the eating disorder that has really kept you confined, and you’re leaving that so that you’re finding something that is bigger and richer and more whole. And I understand that can be terrifying at first, and there is a real payoff from that.

01:04:27

How much should one eat in recovery?

The next question is, “I continue to struggle with knowing what a realistic amount to eat for recovery is. I know that it may vary from person to person and what you might recommend for one client may be different from another, but perhaps you might be able to speak about a ballpark range or some kind of aim for how much one should be eating in recovery.”

Thank you, Russell, for asking this. The first thing I would say is it’s more than most people think, especially if you’re either one, listening to the eating disorder, or two, “Let me look around first or let me look around with certain friends and see what they’re eating and then I’ll make a decision.” The thing with this, yes, it is very individualised, and there are certain minimums that I tend to recommend.

When I’m working with someone, my goal to start with is I want to get them to around 3,000-3,500 calories as a baseline. And this is a starting point, and then let’s see what’s happening at that point. For many people, they will then eat more than that, especially if the eating disorder has been going on for a long time, especially if we’re in the early stages of recovery. But this is a minimum of where I want to get people to because the reality is, you’re not just giving yourself food for today; you’re giving yourself food for all of the missed repair and all the breakdown that has occurred within your body.

I also add that consistency matters much more than perfection, so being able to eat enough each day and doing this on a regular basis is really important. If you’re having a really good week and then the next week you’re stopping, and then “I did a couple of good days and then I really pulled back”, that’s not sending your body cues of safety and that food is consistently coming in. It also means that you’re having days where your body’s clearly not getting what it needs.

So really prioritising consistency with this and recognising that hunger is just not a reliable guide early on. This is why I set goals with people, this is why we’ll often have a structure with their eating where it could be “I want you to be eating three meals and three snacks” and we’ll outline what this is.

This is different to the eating disorder and someone having to be rigid and structured with it. The way I always describe it is this is the minimums. If you want to add in more, you can add in more. If you want to have a bigger size meal, you can have a bigger size meal. But we’re just creating a structure that means that there is going to be this consistency so that we’re not having to rely on hunger. Because at this point it’s just not very dependable. So instead of using hunger, we’re going to just follow the plan.

And you can notice hunger, you can notice fullness. I want you to start to notice these things; we’re just not using them as a decision-making thing at that point.

What I’ll say is I’ve got a free mini course, and in that free mini course I go through this in much more detail and talk about how to start to make changes with your eating. I give even examples of different meals. So if you haven’t signed up for the mini course, I highly recommend that you do. Once again, I’ll put it in the show notes so that you can get access to it.

01:07:56

The need for additional food after a prolonged calorie deficit

Then the next question is from Cindy, and she says, “Hi Chris, could you please address a concept that doesn’t land as scientific? The idea of making up for a prolonged calorie deficit. Using a different example, say you’re sleep deprived for months with a brand new infant. Your body is sleep deprived. You have friends/family who cover for you and you’re allowed to get two nights’ rest. The body is then alert, ready, back on track despite the deficit of months. How can a calorie deficit be any different? Once the body has been fed, I don’t know how this need for additional fuel is necessary to make up for all the deficit. That certainly is not how the body seems to operate with other functions. Love your insight and thoughts.”

Okay, the first thing that I would say is sleeping for one or two days after months of prolonged not getting good sleep doesn’t actually repair everything. Yes, you may feel a little sharper, but in terms of the deeper things that sleep does in terms of hormones and immune function and processing things, this takes a lot longer. And people don’t often recognise the sleep debt that they’ve accrued. The brain adapts to that chronic lack of sleep by normalising that fatigue, so you can feel fine, but your performance and your health are still impaired. And there’s lots of studies that look at this.

So while sleep in some ways can give you a little bit of a quick rebound, it’s not a complete rebound. Just recognising that “Hey, I do feel better, but I don’t actually feel completely healed.” And it can be really hard to recognise this. There’s a book by Matthew Walker called Why We Sleep that I highly recommend checking out because he’s got lots of research and studies connected to this that really do demonstrate that if you’ve been sleep deprived for a month or a couple of months, it’s not just one or two nights of sleep and you’re out of that.

But what I would also add is that the energy balance in the body is different to sleep. Energy balance is a long-term system that involves every system and organ within the body, and it just doesn’t reset quickly. So when you’re having months or years of a deficit, it does, for example, shrink your gut lining or suppress your hormones or weaken your heart or alter neurotransmitters or reduce muscle mass or slow metabolism. These systems don’t just bounce back after one or two days, and they need time and sustained fuel to be able to do that.

Maybe it’s the analogy of paying back debt that gets in the way here and means that it doesn’t land properly, because it’s really about repair. If you have injured tissue, if you have depleted hormones, if you have stressed organs, this requires energy for them to be able to regenerate, and they don’t just regenerate overnight. This is why there is this energy need, because in essence, you’ve missed out on lots of repair. Your body has also started to break things down and deplete things in a way that it wouldn’t normally do, and that then takes time.

In terms of your sleep analogy, you mentioned a few months because of an infant. If someone has been restricting for a few months, obviously the repair is a lot quicker. If it’s only been a few months of restricting, in a fairly short amount of time, it could be a matter of weeks that someone is repaired because that’s how quickly it can repair. But often, people are living with eating disorders for multiple years, multiple decades. So that’s going to be very different. If, for example, someone’s in their mid-fifties and they’ve been living with an eating disorder since their teenage years, that’s a long time. And that’s why it’s going to take more than a few nights for things to get better.

This is where a lot of find themselves. This has been going on for years and decades, so of course the body’s not going to bounce back. Your bounce-back is a lot quicker than how long it’s taken. So if it’s been a couple of years, yea, maybe within a handful of months things are better. But if this has been decades going on, we can’t expect the body to bounce back that quickly.

I would also say – you said it sounds unscientific. The Minnesota Starvation Experiment, which I’ve recommended many times, I’ve done a whole podcast or multiple podcasts on it – I’ll put it in the show notes – that was incredibly scientific and explored this thing in real great detail. These guys were starved for 24 weeks, and they then followed them in terms of the repair process, and it takes time. They didn’t bounce back after one or two days. That was a very rigorous study. Ansel Keys wrote – I think it was two books that had like 1,300 pages. There was a huge amount of science that went into that.

This is why it takes longer to heal, and this is why there is this idea of we have to pay off this calorie debt.

01:13:24

Keeping busy vs complete rest in recovery

The next is from Billie. Billie says, “I know you advocate maintaining life pursuits, career, family, obligations, social events while in recovery, but do you ever support clients’ decision to take time off and allow for complete rest and honouring of extreme hunger? To explain why I asked the question, I will let you know that I have loved all your podcasts and emails, except for the ones that emphasize staying busy not with exercise, but with life stuff. That part of your message baffles me because the eating disorder is in every part of my doing. Productivity, even in the form of a positive, like helping a friend look for an apartment to rent, for example, feels like migrating to me. And I find eating around and through even the small ‘have to’s’ and ‘shoulds’ very difficult if not impossible. Therefore, I’m always, always yearning for a complete break in which I can feast and fully rest. I find it troubling that the better path to full recovery is to hustle and eat at the same time. Your note about the client who recovered working as an ER doc comes to mind. I cheer her on, but I can’t conceive doing that myself. Then again, I’m 55 and pretty worn out in general.”

There is no right way of doing this. Do I think that people can take complete time off and complete rest and do all this? Absolutely. This is why when I’m working with someone, I figure out, what is the best thing for that person? Some people do genuinely need this full period of rest and reduced demands. If someone’s nervous system is fried and every form of doing just triggers the eating disorder, stepping back is definitely essential as part of this.

The ER doctor that you referenced, that’s just one version of recovery. It’s not the template. Many clients, especially those in midlife or with longstanding eating disorders, yeah, they do need more space or more calm or fewer obligations. So your age and your long history matter. If you’re 55 years old and there’s decades of burnout, that’s going to be different to someone who’s in their twenties and has had a shorter illness. So yeah, I’m definitely not against this.

Why I typically recommend not putting everything on hold – there are a few reasons. One, what I’ve noticed is that there are people where they’re like “Hey, I just want to put everything on hold and I’m just going to focus on my recovery”, and then they do this and there’s a huge time void, and what happens? The eating disorder just comes in to fill that. “I thought I was going to do recovery and now I just find that I’m spending all my days walking and doing exercise and doing eating disorder behaviours, and all this extra time has just been given over to the eating disorder.”

So for a lot of people, having structure is important. Having these huge gaps of time does not work for them.

I also want to have people remembering and being reminded of why they’re doing recovery. And if everything gets put on hold and all I’m doing is recovery, sometimes that then just becomes so detached. It’s like, “I don’t even understand why I’m doing this anymore. There’s nothing going on in my life. There’s nothing meaningful going on. All I’m doing is sleeping or sitting on the couch” or whatever it may be. So there can be this feeling of “The eating disorder, in a sense, is all I’ve got. It’s the only thing I have to fill my time and distract myself.” When all of life falls away, it can feel like “The eating disorder is the last thing that I have.”

So my recommendation, then, is if you are going to put a total pause on things, great. Make sure that these two things don’t happen. Make sure that, “Hey, I am finding ways to fill my time and it is recovery-based, and two, I’m not now getting into this depression where it feels like everything has fallen away and I’ve got nothing that is meaningful going on in my life.”

If you can avoid doing those two things and really truly give yourself the rest and repair that you need and the food that you need as part of recovery, have at it. I’m all for that. It’s just, as I said, my recommendations are because I’ve seen when that hasn’t worked well for people.

01:17:47

My favourite podcast episodes

Then the final question that I have for today is, “In 350 episodes, which has been your favourite and most memorable? What is one piece of recovery advice you would give to everyone and have stood by since the start of your practice?”

If I’m thinking of podcasts, there are a few that come to mind. I already made reference to the Minnesota Starvation Experiment. The most recent one that I did on this and the one that I recommend is Episode 226. It goes into a ton of detail, and I loved having the time to go into that one. I’ve just been fascinated with this study for – must be nearly 15 years since I first found out about it. So I highly recommend listening to that one. I enjoyed putting that together.

I did an episode from a long time ago – it’s 112 – it’s all about free will. This was back when I had a lot more time on my hands, and I spent a ton of time putting that together. In a lot of ways it can feel less like eating disorder and less what I focus on today, but I’m fascinated by the idea of free will and whether we have free will. My landing point on this is we don’t. And I explain why I’ve come to that conclusion and why that’s actually not defeatist and it’s actually a really useful thing to recognise. So if you haven’t checked out that episode, I would recommend it.

In terms of guests, maybe there’s some recency bias with this one, but the ones that stand out most – the episode I did with Sasha Gorrell. It’s 246. This is where we talk about eating disorders being anxiety disorders. She was the one who helped me really be able to name this and talk about this. I’d understood it in some ways or fragments of it or pieces of it, and she really helped me to understand it. So that one, for sure.

328 with Abbie Attwood. I really like Abbie. There’s something about her. Unfortunately, we didn’t have a huge amount of time. I didn’t get the full two hours with her, but yeah, she’s someone who I think is doing incredible work, and I really enjoyed that conversation and I want to have her on the show again to talk more.

I’ve also enjoyed so many of the interviews that I’ve done with past clients. I’ve been less doing them of late, but yeah, there’s definitely some good memories of that. The one that comes to mind more – and again, there could be some recency bias with this – is Kate Ely. Kate was a past client of mine, and what I got out of that episode was she was a client that I worked with for a year, and I found out so much more about her from that episode in terms of her backstory and what she’d been through and her life. I’d known some of it, but not anywhere to the detail that she explained it. It was really one of those recognitions of like, this is someone who did recovery in the most challenging of circumstances. She’s incredible. She’s now gone on to be a therapist. She’s working with people for eating disorder recovery. So yeah, that was a really good episode. That was 291.

So that is it for this episode. I loved getting to answer all these questions. I hope it was useful for you. At the moment I’m taking on new clients, and I’m taking on clients now for people starting in January time. I fully believe in recovery and full recovery and that everyone can get there. And after 15+ years of working with clients and doing this work, I feel very good in my ability to work with people and to get them to a place of full recovery, and hopefully this episode has been a demonstration of my knowledge around this stuff.

So if this episode has spoken to you or resonated with you, if you are wanting help, I would love to be able to support you. Send an email to info@seven-health.com, or you can message me, send me a DM on Instagram. It’s @sevenhealthcompany. And I can then send over the details.

That is it for today’s show. I hope you enjoyed it, and I will catch you again next week. All right, take care!

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