All Food Fits: A Lesson in Moderation
Being in recovery for my substance abuse disorder is rough. There are days where the drugs still call me, beckoning me to come back to the dark side. But my complete sobriety is too important. My sobriety means my life. It is worth the rough patches here and there. When it comes to bulimia and other eating disorders, however, there is no ‘complete sobriety’. Every single person has to eat to survive, so unlike substance abuse recovery, you can’t just quit food to recover from an eating disorder.
The spectrum of eating disorders range from eating almost nothing (anorexia nervosa) to consuming huge amounts of food in single sittings without purging (binge eating disorder) and everything in between (bulimia nervosa, EDNOS, etc). This wide range means that there are issues with under eating as well as overeating. This doesn’t include the compensatory behaviors like over exercising or purging. In eating disorder recovery, one must learn to eat food in a healthy balance. Learning moderation when it comes to eating is one of the key aspects of eating disorder treatment. It is important to regulate the eating so that the body and mind can start healing as you go through psychotherapy and then cognitive-behavioural therapy.
Recalibration of a person’s eating is the first step the dietitian takes during treatment at the Bulimia Anorexia Nervosa Association (BANA). My dietitian has me following the ‘Herrin Food Plan for Eating Disorders’. It is a seemingly simple meal plan that includes three meals a day with three snacks. It can also because the ‘Rule of Threes’ because on top of having three meals and three snacks, you should not go more than three hours without eating. All of the meals include all food groups and offer ideas on what you can have to eat in a balanced manner. Two of the meals even include what is called a ‘fun food’. When people get immersed in their eating disorder and strict dietary rules, food often becomes labeled as ‘bad’ or ‘forbidden’, so because “all food fits”, these foods now get the name of ‘fun food’ to take away the harmful label. In order to desensitize and de-stigmatize these ‘bad’ foods, BANA patients are told to eat them at then end of a meal as a ‘sweet ending’. This gets people used to eating these foods apart of their daily intake, which helps them see these foods as just food, not something that is good or bad. This also helps in preventing binges because when the body and mind are satisfied and are given permission to eat these ‘fun foods’, it is less likely to crave them. Without the craving and hunger, binges are less likely to occur. That being said, however, binges may continue for a while as patients start to learn new coping skills for their emotions.
Eating regular, balanced meals and incorporating ‘fun foods’ to my daily intake is easier said than done, but I can honestly say it works. Since I have started eating more regularly, I am not starving by the time bedtime rolls around. For me, the night is my worst time for binging and purging. This is usually because I had been starving myself all day and was ravenous by nighttime. If I’m starving at night, I will be more inclined to binge and purge than if I had been sated. This cycle needs to be broken with moderation in order to feel sated throughout the day so that binges aren’t a risk at night. Moderation is hard because I am so used to either eating nothing or eating huge amounts of food and then throwing it up. However, eating in a balanced manner is the only way to break the eating disorder cycle and behaviors. It is the only way my mind and body will start to heal enough to be fully recovered.
BANA also teaches its clients the idea of a ‘set point’. Set point is “a reference point around which the body tries to keep a stable weight.” The human body’s ability for homeostasis not only applies to its ability to maintain PH levels, temperatures, etc. but also applies to stabilizing weight. The idea is that recalibration of the body will allow it to achieve its natural set point. Finding set point can take up to a year or two and can be calculated roughly by looking at one’s parents. When someone is at their set point, their weight should remain fairly stable, only fluctuating about ten pounds. The body should be able to compensate for some overeating and some under eating, however, only in small amounts. Your set point will be affected if you diet or are starving, binging, or purging. By calibrating the body, it also begins to reboot hunger and satiated cues, which help you, become an intuitive eater rather than a dieter. It is healthy to eat when hungry and until full, rather than to eat just because. The long-term goal with the Herrin Food Plan is to become an intuitive eater.
Even though I may need to follow this plan for a year or two before this happens, but it will be worth the time. One of the worst aspects about an eating disorder is the unhealthy relationship I have with food. I no longer really enjoy eating; it has become more of a chore. Binges are more about soothing my fears and anxiety, instead of about enjoying whatever I’m eating. Through learning to eat in moderation, I am starting to actually enjoy food again. It wasn’t pleasurable before because there was so much anxiety and fear of weight gain surrounding the act of eating, so it is nice to take pleasure from good food again. It is nice to eat something because I am hungry or because it tastes good, rather than because I had to eat it to lose weight. It is also really nice not eating something because I simply don’t like it or am not hungry, rather than not eating it because I don’t want to get fat.
Treatment cannot just be following an eating plan, there also has to be treatment for all of the underlying, core issues. In order to recover, both the mind and the body must begin to heal. At BANA, there are three different stages of treatment. There is psychotherapy education, cognitive-behavioural therapy (CBT) and a body image group. In the first stage, psychotherapy education, the group learns about portion sizes, emotional regulation techniques, health consequences, how to meal plan/grocery shop, motivation, coping with the media, the eating disorder voice/identity, etc. I am currently in stage one of treatment so I have yet to discover what is taught in the CBT and body image groups. CBT typically teaches people to be aware of their thoughts and feelings and how to interrupt and change these thoughts and emotions. The body image group is about learning to love your body regardless of the size or shape. All three of these groups teach clients how to cope with their emotions better and how to change the negative eating disorder behaviors. ‘SMART’ goals are set each week to help clients incorporate what we have learned into our eating behaviors at home.
On top of group therapy, each client works with a one on one counselor who also teaches him or her how to stop the eating disorder behaviors. The dietitian works with everyone independently and also teaches a few weeks of psychotherapy. She informs us about portions sizes, set point, proper nutrition, and the meal plans without mentioning calories. Her biggest requirement is that “all food fits.” She helps us break the thought patterns that lead to thinking that any food is bad for you. In moderation, all food is
good for you. It is important to treat yourself because it is good for your mental wellness.
She also does weigh each of us, but you can choose not to know your weight. She does not weigh you in an attempt to help you gain or lose weight, but simply to show you that eating in moderation will not make you fat. It is personally really helpful to track my weight because it is important for me to see concrete evidence that eating in moderation doesn’t make me gain weight. Since my mind and mirrors trick me, it’s essential that I have some sort of proof that treatment is working and not working against me.
I often wondered how we’re supposed to learn to just eat in moderation when that is what we have been struggling with the whole time. It does seem like an overly simplistic treatment plan, but it really works. I had to just take a leap of faith and start trusting my counselors/dietitian and my body. It is terrifying to finally trust that your body will take care of everything, but it is such a relief as well. I no longer have to worry about every single calorie or gram of fat. I simply just follow a food plan that I know is healthy for my body and spirit. I knew that what I was doing wasn’t working, so I had to put my faith in my treatment and just learn to trust. Although there is no moderation in sobriety, recovery from substance abuse was similar. I had to trust in something higher than myself in order to recover, and so it is with eating disorders. It’s harder having to constantly have to be exposed to my ‘drug of choice’ (that is, food), but I often think of it as my medicine. Without food, I wouldn’t be alive to help other addicts, to be a student, daughter, future aunt, or to even just be me.
I do have tough days where having to eat is harder than normal, but I am learning to cope. With moderation, I am learning to value myself in ways that don’t involve the scale or mirror. As Laurie Anderson put it, “I am beginning to measure myself in strength, not pounds. And sometimes in smiles.”
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