On This Day Just One Year Ago I Lied

On this day, just a year ago, I was at Albright. It was move-in day. I had spent the morning helping returning students check into their dorm rooms. I had sat out in the sun, outside the residence halls. I had eaten lunch in the dining hall (I had a salad and steamed broccoli), and then had returned to continue my work with Residence Life. That afternoon my supervisor had called me back to my own residence hall because one of my residents, a freshman, was already thinking about transferring. In my room, she told me through tears that she had an eating disorder and was already feeling like a relapse was about to happen because she had not eaten since she had moved in three days prior.

I saw so much of myself in her, and handing her tissue after tissue I told her my own story and that she could do it. Already by coming to me she was showing that she was stronger than her disease. We would help her. I would help her. Food was her friend. College food could really be excellent. I loved our dining hall! It was possible to overcome an eating disorder in college. Look at me; I was thriving and happy.

I believed everything I said to her and she did too, but everything I said turned out to be a lie. That day I had thought that I had done it too. I had defeated anorexia in college. But, food was not my friend. I truly loved the dining hall, but most of my fandom stemmed on it providing me with a daily salad bar, steamed vegetables, zero-calorie sodas, fresh fruit, booths to eat out of site, and the ability to take tiny samples of “cheat foods” so as to feel like I was eating what everyone else was raving about. I loved that dining hall, clearly more than I loved myself. I was not thriving and happy.

Because in that very afternoon I could feel anxiety creeping its way up my body. I had had to help with Residential Life duties all day… and I had not gotten to the gym. Panic. When did the gym close that day? Early. 7 pm. Why would the gym close so early on move-in day – did they not realize the importance of exercise? When would I get there?

And, dinner. The dining hall serves a Welcome Back Picnic every year on move-in day. It is on the baseball field, which means it might get chilly in August at 5pm when you have no body fat. The menu is always the same: baked beans, hamburgers, hot dogs, barbequed chicken, rolls, green beans, chips and dips, and desserts. See the dilemma? And, my friends were all texting me about what time we would all go to said picnic. If I went to the picnic though, when would I get to the gym? If I did not go to the picnic I would need to buy my own food… which also seemed stupid.

At 6pm I was on the elliptical at the gym, marveling at the fact that I was the only one there, watching the remaining people at the picnic laugh and romp together. I had gone, yes. I had sat on the grass with my friends and was happy to see them. But, I had felt cold and anxious. The gym was calling to me, constantly reminding me of its closing time approach. The air was too crisp, and I had worn a sweatshirt amongst all others in tank tops. The green beans were good. I had eaten so many of them. The chips and dips were good. I had allowed myself a rare treat of three chips and a small dollop of spinach dip. And on that elliptical, all I thought about was burning off all those beans and those three chips.

And earlier that day I had told a recovering anorexic that I was thriving and happy.

Today though, a year later, I am living a life that I would say is happy. This morning I did go to the gym, but it did not feel like I was its slave. I returned, spoke to my dad and ate two cookies. Then I made myself eggs and ate some cereal. When my brother came home I made him a wrap, and I snacked carrots and peanut butter while he ate. I had a piece of chocolate (okay it was four pieces). My family and I watched a baseball game on TV, and I ate graham crackers through it. My mom made zucchini cake, and I had a slice (okay, two slices). I snacked on some peanuts then, and later ate pizza (PIZZA) with my parents. My cousin visited in the evening, and I helped my mom unload firewood.

That.

That is thriving and happy. I probably weigh 40 pounds more today than I did a year ago. I am not letting an eating disorder dictate my happiness. I am not letting a gym write my schedule. I am not letting myself be a liar.

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Always Looking for Affirmation – The MinnieMaud Treatment

***Disclaimer*** All quotes and information compliments of Gwyneth Olwyn, owner of Your Eatopia. She is a patient advocate and a member of the Alliance of Professional Health Advocates.

If someone had shown me the site “Your Eatopia” (CHECK IT OUT) during my initial attempt at recovery, I feel I would have felt a lot better. This site is a recount of blogs based on the successes of the MinnieMaud guidelines and treatment plan for recovery.

There are three stages of recovery:

  1. Weight restoration
  2. Repair of physical damage
  3. Developing new non-restrictive neural patterns in response to usual anxiety triggers. To restore one’s weight, one must engage in
  4. Unrestricted eating with minimum intakes that are set to reflect actual average consumption of non-restricting equivalents.
  5. No workouts or exercise.

No weighing or taking measurements of self.

MinnieMaud’s guide lists various ages and heights to be used to determine how many calories one should eat daily, at minimum, to begin weight restoration. What I am intrigued about here is that it is not a meal plan. Nowhere does it say that one should eat half a cup of cereal at 9am, two tablespoons of peanut butter at 8pm, or 4 servings of vegetables each day. This guide says to eat unrestrictedly. Doesn’t that make all the sense in the world? To overcome a restrictive eating disorder, one should stop restricting. Brilliance. More and more I feel that my being put on a meal plan, while serving the purpose to put meat back on my bones, only allowed me to continue on a regimented schedule, though I was eating more. I was able to eat safe foods every day in a predictable fashion. I was thus allowed to continue my restricted eating.

It goes on to mention the phases of weight restoration and the accompanying symptoms. If I had seen these, if I had been told to expect them and to welcome them and assured they would not persist, I too might have reached stability and happiness soon after my initial attempt.

The first phase is edema. During it, one effect with which I am too familiar is water retention. I was often bloated after eating seemingly little food, and this caused my anorexic mind to believe I had become obese in a matter of hours. MinnieMaud states: “Someone not prepared for this will panic and restrict before she gets too far along. The “weight” almost exclusively water retention (edema). The body needs the water for cellular repair and the normalization of both liver and kidney functions [WB Salt, 2004; GFM Russell, JT Bruce, 1990].” Was I prepared for that extra water weight and girth? No. Did I panic and try to restrict even more? Yes.

The second phase also rings true in my memory, past and recent: digestive distress. More often than not this summer I have felt some form of constipation. Several days were marked with bouts of diarrhea. For a while I knew eating any amount of refined sugar would result in a watery bowel movement the next morning. Further, the stomach apparently does not empty itself sufficiently when one is starving, and to correct this takes much time and much food:

…they also have to overcome gastroparesis. [RW McCallum et. al., 1990]. Gastroparesis is a survival mechanism whereby the stomach doubles its emptying time to the small intestine, meaning the food is churned in the stomach for longer to try to allow for the small intestine to maximize the too-little energy coming in to the body. Gastroparesis begins easing within a few days of doggedly staying at or above the minimum intake and it resolves quickly if you persist in eating the recovery guideline amounts, usually within a couple of weeks to a month. In fact the motility of the entire gut is slowed to try to extract as much energy as possible during starvation [M Hirakawa et. al., 1990] and this resolves during dedicated refeeding efforts.

THIS MAKES SO MUCH SENSE.

Linked to digestive distress is pain… and, again, I have been in pain. It is said to be mostly caused from the water retention, as the body is essentially swollen. It will hurt to be touched. It might hurt to move. And, this is normal.

Another effect is rest. Recovery and weight restoration will leave you feeling exhausted, and this will be most confusing due to the hyperactivity you probably felt while restricting. This is because the brain has been tricked for so long to function on so little, and it is now overwhelmed and confused itself. Oh yeah, I often go to bed by 9:30pm after a long day of doing nothing but eating….

MinnieMaud stresses no exercise during refeeding. While I know I too was told not to exercise during recovery, it was very challenging. I can see the point though: why expend calories that you need? For me too, the exercise was just as regimented as the eating. If I had been allowed to exercise, I probably would have fared even worse in recovery. I would have been able to keep a strict mindset of thinking I needed to do X, Y, and Z at the gym every day or the whole day would be a failure. While I will admit that I have been exercising during this final shot at reaching full recovery, I can completely see where it would be beneficial for me to stop. The fact that it is difficult for me to even admit that should be a strong indicator that this suggestion is worthy of consideration.

The next effect, The Honeymoon, is one I hold dear to my heart. When beginning to eat, the recovering anorexic will feel new freedom and relief in eating without restriction. He or she will be so excited to be seemingly free from the disorder thoughts. But, “the restrictive eating disorder will not allow that relief to stand for very long. Soon you will find yourself starting to feel edgy and anxious.” Oh speak to me, MinnieMaud. This is so true as well. I remember one early appointment with my nutritionist during which I asked her if I could possibly overeat. She said, “Absolutely not.” That was great. I remember feeling like I had suddenly been granted permission to eat! I went home that evening and ate ice cream (fat free) from the container in pure bliss. I felt so happy. I felt strong and independent, confident even. And then that night, I felt weak. I had let myself down. I had deviated from the plan. I had lost my resolve. The next day of eating was strictly following the meal plan and trying to take all the shortcuts within it that I could possibly devise. If only I would have been told MinnieMaud’s truths:

  1. Your body has an optimal weight set point that it can and will defend. [RE Keesey et al., 1997; RE Keesey, 1988] Your body can manage without your conscious interference. Your set point is managed and distributed throughout brain structures that are far more mature, evolutionarily speaking, than your late-to-the-party conscious thought. Think of this as your prime directive: do not interfere in a process that your body can manage.
  2. No one keeps gaining and gaining.
  3. Extreme hunger is a normal progression in recovery. It does not last. You do not ‘habituate’ to 6000-10,000 calories a day, but you need that energy during refeeding.

Phase Two is the insulation of vital organs. I could show you my belly right now. It looks a little pudgy. My waist is much wider, fuller, than it was before. My trunk is thick. This is my body’s decision. It is trying to protect my vital organs by enveloping them with a blanket of fatty protection. Finally, they are cushioned and corralled. And again, I think I was perhaps at this phase before, but I never allowed myself past this.

The key: “Again, someone in recovery who is not prepared for this will freak. You can feel huge (a combination of fat around the middle and the residual bloating and gas of a digestive system struggling to get up to speed again). Unfortunately, many relapse here. [LES Mayer et. al., 2009]” I know I did. Any time my belly became bigger than I thought it should be, which, granted, was not a large range of sizes, I relapsed. I cut calories. I worked out harder, longer, more frequently. I limited carbs. I avoided sugar. I threw myself into my school work. I isolated myself.

If I had only been told that “the redistribution of all that fat around the mid-section to the rest of the body only occurs if you persist right the final phase. [LES Mayer et. al., 2009]” If only I had known that when I pushed past this, this challenge like no other, I would get a body back that was my own to keep, a body that looked a lot like those around me, and a body that was healthy.

I think a large part of me felt that once I reached my lowest, minimal weight at which I was classified in the “healthy” BMI range, that it was time to cut back, time to restrict again. After all, disordered eaters fear becoming overweight, so to reach a weight beyond that that was set by a medical team seems to be failing additionally. No one told me that it was good and acceptable to overshoot my target weight. And, really, my target weight was likely too low for my own set point.

This is where I see a big flaw in most eating disorder treatments. That target weight may as well be an arbitrary number. It again serves as a way the disordered eater can focus and obsess over something. Perhaps it is a healthier number, but it is again a controlled number. Why not let the body tell you what the number should be? By setting a target, the brain is again in charge. When the brain is already sick, it will not heal when left in charge.

So, today I carry a new mantra: the “body may additionally need to temporarily overshoot its optimal weight set point in this process in order to return to a correct fat mass to fat-free mass ratio. [A Dulloo et. al., 1996, 1999]”

The third phase is the body’s restoration of muscles, and this is the phase that might be most rewarding. Though it may take seven years, osteopenia and osteoporosis will start to reverse. Weight redistribution will begin too, and that midsection weight will be pushed to other body parts. Your hair, nails, and skin will increase in suppleness. Even more importantly, I will feel more connected to myself. I will want more purpose to my life and will develop new goals. Emotions will be better regulated. The MinnieMaud Treatment suggests these changes happen around the six-month mark, which means I have a ways to go. And, of course, everyone is different. But I so look forward to this change.

The final phase is that of remission or of relapse. I think I have experienced both at this point. This time around, I want remission. I want this to be the last time I try to recover. I want this to be the last time I have to write about recovering and wanting to recover. I was to be in remission. MinnieMaud believes that the body will determine its own set point. Once it is reached. Your metabolism will revamp itself to allow you to continue eating nearly what you were eating in recovery without gaining too much more weight. During recovery your metabolism is suppressed, as all your energy is going into weight gain and repairing the body. Once weight has been restored, the metabolism will again send energy to systems that were previously on hold. This is when the body will be able to better send its own hunger cues and when the brain will be better equipped to interpret them and to act upon them.

Here though is where relapse just may happen again. Many professionals will encourage a patient to “restrict under the auspices of maintenance of … weight and health. Restriction of food intake will always precipitate relapse.” Again MinnieMaud is referring to society’s skewed view of what health looks like and how BMI numbers can be deathly inaccurate measures of one’s health range.

When I had reached my lowest target weight, I was released, seemingly cured. All I had to do now was maintain. But, that of course would mean eating less. And I began that, and I began restricting, and I definitely experienced what MinnieMaud calls the Reverse Honeymoon: “an initial phase of comfort and ease as your restrictive eating disorder begins to take hold.” All too often I can remember feeling this way even just after a weekend spent at my parents’ house. I would be driving back to school, feeling the seatbelt on my abdomen, swearing to myself that it was pinching me because I had added flesh to my stomach. How could I have been so loose with my diet? With every mile driven I was one vow closer to restricting again. A sense of peace would wash over me as I turned into my school’s campus. Finally, I could eat nothing again. All was well, or would be well. I knew the weight I had gained would be gone within the next 48 hours. I was back on track.

If only I had known about the way my hormones and body were affected by my restricted eating, and how they would respond during recovery. If I had known this:

“The restrictive eating disorder spectrum does not include binge eating disorder or night eating syndrome. Those sit on a completely different ED spectrum and have completely different genotypes involved.

On the restrictive eating disorder spectrum, your system responds to leptin in your body correctly and that system not broken.

Once your leptin levels get back to optimal levels (which will happen when you hit your natural weight set-point) then you will stop gaining weight. Leptin runs your appetite and metabolism—when it is optimal then everything is in balance. You maintain your weight naturally and eat when you are hungry when you get to that point.

So, every time the ED-skewed thoughts get you all panicked about gaining weight and not stopping, remind yourself that it is not biologically possible for that to happen to you.”

So much of my recovery would have been different. I might have recovered four years ago.

Fat and Fitting In

Recovering from an eating disorder brings about so many changes in the body, and the hardest for me to stomach is the additional flesh I find myself developing. My new fat is supple and soft. But it was the hardest part of me to love.

It sits on my hips, adheres itself to my tummy, cushions my butt, and wraps itself around my shoulders. When I touch various parts of myself, I am not longer meeting bone. There is meat there, and I can push on it and have it rebound back. No longer do I need to worry about slicing off a finger on my own hip bone… actually, where are my hip bones?

I hate this. This squish. This hideous cover. The webs of stretchmarks etched across what was once unblemished territory. The way my thighs stick together with sweat. The roll of fat over the waistband of my shorts… if I can even button them now.

But I also notice these findings in other women. I see other women with thighs that are touching, and they are doubled-over laughing over something in the Starbucks parking lot. I see other women with stretchmarks on their legs, and they are lifting more than I am at the gym. I see other women with extra cushion on their stomachs, and they are embracing a child’s head, resting it against those stomachs in a loving caress. I see other women with wide hips, and they are presenting their research to an audience who respects them. I a woman with arms that jiggle, and she is reassuring me that the medication she is prescribing me will cure my virus.

And I realize now that I am like these women. These women are helping others, helping themselves, making lives that they love to live. They are skinny and they are fat, and a lot are somewhere in between those two labels. But those labels are not what they laugh about, think about, or talk about. I can do that too.

There is something quite liberating about joining the ranks of women with flesh and, dare I say it, fat, on their bodies. Getting your period is one way to reach womanhood. But to be physically similar too, with breasts that demand support and thighs that touch, to women everywhere is a new feeling, I belong to new groups. I belong to new classes. I am one with others again.

Men can’t wear my stilettos or make decisions about my uterus

It was the week before midterms of my senior year of college. I was bloated and hungry, irritable, and snappy. Since I had been on an oral contraceptive for two years, this did not surprise me. These symptoms merely meant that in a week, I would begin menstruating, right on cue with my little pill pack: three rows of seven pills all labeled by week, counting down to that magical week when my body would shed itself of the uterine lining it had smartly prepared for the baby I did not want. Just in case though, the lining was there.

That week came, but my period did not. I had never missed a period since beginning the pill, and I was scared. I racked my brain for reasons: had my boyfriend and I had unprotected sex? No. Had one of our condoms broken? No. Had I missed a pill? No. Had I been raped without even knowing? No, of course not. My stress continued to build, and I told my boyfriend that my period was late. He was worried too, but, not being so connected to the situation, literally, he was able to keep his worry more at bay. He assured me he would be there along the way, whatever came about, and that he was sure it was just stress from school; I would surely get my period again next month.

You never know what a situation is like until you are in it. Suddenly all I saw were babies. Babies everywhere. Women walking with babies. Babies in church. Babies on TV. I was studying for midterms in “Human Development” and “The Family,” and I saw those discussions through new lenses. I began to think about my own family, which seemed to be looming right before me, growing within me as I tried to go about my school days normally. What would I do if I was pregnant? What were my options?

I knew about abortion and about adoption and about keeping a baby. What I did not know was how I would feel when I actually had to research those options. I had heard of Planned Parenthood and organizations like it; it was the first link I found in my Google search. At first, I was hopeful: there was a clinic right in Reading. So, if worst comes to worse, I would go there, I thought to myself. However, I then investigated further, and I found unsettling figures.

I could get an abortion, but only on Tuesdays and only after a consultation and only before 9 weeks and six days of pregnancy and only after a 24-hour wait period…. and this would cost me $450.00. Well, what if I did not meet those parameters? I deduced at that point that I could have been a month along already, and if I were to wait another month for my period to arrive, only find it still absent… I would be eight weeks along. What if I failed to make that 24-hour wait period before a Tuesday and had to wait another week? What if I ended up being 11 weeks into pregnancy?

I called my mother.

Why had I not taken a pregnancy test? she asked.  I was too embarrassed to buy one. My mom encouraged me to take one that week.

The next day I went to Wal-Mart… the farthest one from me; I was afraid of seeing someone I knew. Standing in that aisle was traumatizing. Firstly, there were too many options. Secondly, there were too many people milling about, surely all thinking of me and my unplanned pregnancy. I selected a test, hid it under my arm while still trying to look casual, and walked to the check-out area. Here was a new challenge: who best to see me buy this item? I went to the line of an older woman, “Brenda.” Everything was going smoothly until Brenda said: “Wasn’t there a coupon on this box?” She told me there should be a coupon on it to scan; she thought for sure it was $2.00 off. She held the box in the air, and with it my dignity.

I can still feel the eyes of the other shoppers whom I was imagining watching this scene and silently praying I would miscarry, saving their tax dollars from the welfare system I would be entering soon enough. But, I could not blame them because that was what I was praying for too.

Brenda could not find the coupon, but she entered the discount into the system and said “Every little bit helps, right?” I could not disagree, but as I bundled the test in the bag and nearly sprinted to my car, I could not help but fear she also was saving me money in hopes of saving her own.

A friend advised me to wait til morning, when urine is less dilute, to take the test, so that was my plan. Knowing that would happen in the morning made for a restless night, and I woke at 5am and could no longer wait. I took my cup and test, hid it under my arm, and went to the bathroom in my dorm building. Those three minutes were the longest of my life as I watched only one line speed across the little screen of the test. One line meant no baby.

I skipped back to my room after throwing the test away in the trash can without trying to hide it. Let the world see! No need to be ashamed now! I was not a young mother! I was not a failure.

Later, when the stress of the situation had subsided and I was able to breathe again and focus on life as I had before my pregnancy scare, I was able to reflect on the experience. I was shocked by how instantaneously I started to loathe myself. I had been angry at myself, thinking I was pregnant, even though I am quite careful with birth control and condoms. I felt like I had failed myself, my boyfriend, my family, and society as a whole, but someone bringing an unwanted life into the world. I felt that anyone who would have seen me buy that test would judge me, and harshly, shaming me for the obvious mistake I had made. I felt that anyone who saw me researching abortion would judge me. I felt that anyone who saw me pregnant would judge me, and that I would need to feel inferior. And I felt extremely limited in the options I had for terminating the pregnancy or forfeiting the baby after birth.

Why should others’ eyes though have such a power over me? Why should I be willing to allow someone to tell me how to govern my own body? If I want to be pregnant, I should be allowed. If I want to terminate a pregnancy for reasons of my own, I should be allowed. If I want to carry a baby to term but give him or her to a deserving couple, I should also be able to do so. Each of us was given a brain to make choices that are best  for us, and we should be allowed to utilize this power. However, power is the ability to do something, and it is not often in the hands of the ones who wish to do the deed. Until one is in a situation, there is a disconnect. I previously had no idea just how scary and intimidating it is to think you might be pregnant. I could sympathize, but it was not anything like the true feeling. Until you are in those shoes, walking that mile, you do not understand the labor of each breath to move you forward.

In this world, women are the group lacking power, and that limits their ability and personal agency. Rules and regulations regarding women, especially in terms of their health rights, are written and mandated by men. Men have never walked in a woman’s shoes; men do not wear stilettos.

The shame of having to buy a pregnancy test changed how I feel about women’s health rights. Not until I personally felt the eyes of others, whether they were doing so or not, did I realize how much stigma exists around such a natural process. Women’s pregnancies were once celebrated and wanted, and many still are. However, in this nation we are hesitant of allowing women to have children if we feel the woman cannot support the child. Often, the assessment of being able to support a child is based on whether or not the woman herself is supported by a man. Thus, essentially, I was ashamed of not having a man supporting me… I was ashamed of my independence and my ability to choose to have a baby. I was ashamed to be a woman.

And that is my Story of Self. Everyone has a story, and every story is different, but at some point there is a moment when one will realize that change is needed and possible. Planned Parenthood connects women because they create their services with women in mind and with their Stories of Self in mind as well. They are not merely acting for others but for themselves, and with this they are able to extend a helping hand to women in so many different and difficult paths of life.

Women must unite and must inspire other men and women to join them. This is no easy task, but it is not one that is impossible either. As an underrepresented subset of society, I, a woman, have experienced first-hand the oppression of leaders who do not know my Story of Self and who continue to make decisions that actually create my Story of Self. This is wrong. One cannot make the best decision for someone else without knowing the feelings of the other person. Legislators should not be able to make choices for my body when they themselves have never walked in my stilettos.