not your average nutritionist blog

By: Lauren MacLeod
Lauren is finishing up her dietetic internship at Cal Poly San Luis Obispo to become a registered dietitian. She hopes to work in outpatient counseling and has enjoyed working with the eating disorder population. ​

Body Positivity/Body Acceptance - Comes from The Body Positive, which was founded in 1996 as an alternative treatment for anorexia nervosa; it shifts focus away from changing body weight. The core competency of body positive movement is:
“uncover the messages that have influenced your relationships with your body, food, and exercise and develop a weight-neutral, health-centered approach to self-care to become the authority of your own body by sorting out facts from distorted societal myths about health, weight, and identity.”
In summary, body positivity is about accepting your body as it is and encouraging lifestyle choices that focus on health, not weight.

Fat Acceptance - A political movement focusing on equal rights and medical treatment of fat* people. The National Association to Advance Fat Acceptance (NAAFA) was established in 1969, when fat people realized they were being discriminated against in the workplace and medical settings based on body size. NAAFA gives them access to education and support for self-empowerment.
*“Fat” is a word that is being reclaimed, as “queer” has been reclaimed by the LGBTQ+ movement. It is meant to be empowering, not demoralizing.

Health at Every Size - Health is not determined by weight, but rather by healthy lifestyle changes: eating all foods in balance (intuitive eating), and mindful and enjoyable movement. It focuses on taking care of your body at whatever size it is, and looking for actual markers of health, such as blood pressure, rather than a number on the scale. It was established by Linda Bacon, PhD in her book Health at Every Size: The Surprising Truth About Your Weight. She has since written another book to combat the modern fight against diet culture: Body Respect.

Intuitive Eating: A term championed by Evelyn Tribole and Elyse Resch (CEDRDs) in 1995 through their book Intuitive Eating. It is composed of 10 principles that focus on rejecting diet culture, listening to what our bodies truly want and need, and repairing our broken relationships with food. It is not a diet, but rather the way humans naturally eat when listening to their body.

Diet Culture: I think the Eating Disorder Registered Dietitians and Professionals really hit the nail on the head with their definition: “...a belief system that focuses on and values weight, shape, and size over well-being. Variations of diet culture also include rigid eating patterns that on the surface are in the name of health, but in reality are about weight shape or size.”

Eating Disorder vs Disordered Eating: An eating disorder fits the diagnostic criteria as defined by DSM (Diagnostic and Statistical Manual of Mental Disorders). Disordered eating classifies irregular eating behaviors that do not neatly fit in to an existing diagnosis, but may still pose health risks, physical and/or psychological.

No matter which definitions you identify with, I hope to help you find a way to love yourself. Even if you cannot accept the body you’re in now, can you appreciate all the work that it does for you? Maybe you can even work towards loving it tomorrow.

Kayla Douthitt is an intuitive eating health coach, and owner of Wisdom ‘N Wellness. Her goal is to inspire and empower others by looking inward to heal negative body image, self-esteem issues, eating disorders, and honoring their body fully. She’s on a mission to help end crazy dieting, stop negative spectators who damage body image, and believes strongly in healing from the inside out. Kayla overcame a 10-year battle with anorexia and binge eating that she hid from the world for so long, and now she truly wants to give back to bring awareness to the community and fight for those suffering low confidence and eating issues. Her positive attitude is infectious, she loves all things chocolate, and finally isn’t afraid to talk about the “F” word…Food, that is. Kayla recently started managing Project Heal, (the Largest US non-profit organization providing funds & recovery support for people suffering from eating disorders) Facebook page and is actively seeking more opportunities to end body shaming and food blaming. Learn more at www.facebook.com/WisdomNWellness
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Do you find yourself stuck? Stuck staring in the mirror wondering why you think your butt looks big? Or why you think you arms need to be toned in that shirt? Heck, maybe you often wonder why you can’t look like THAT girl. You know the one that seems to have her “stuff” together. How the heck does she have 4 kids and still able to wear a bikini? How is it that those skinny jeans make her look…well…skinny?

Then you get mad. You get angry at yourself. You compare and perhaps even cry. I’ve been there. It’s human nature to want to look good. I would be doing you disservice if I didn’t say that everyone wants to look good, even if they don’t admit it. Looking good is not the problem. The problem is how you treat your body and what you say TO your body.

I say that to say this - Why are you body hating? You aren’t doing yourself any favors by pin-pointing every little area that you think is wrong. Because I can promise you, it’s society that is wrong! It’s the tabloids, the media, the articles, etc. They have us thinking salad is better than cake and celery juice is the next BIG thing.

Folks, I spent years of my own life wishing I should have, could have, would have, looked perfect. I searched for flawless clothes, the just perfect food choices, the ideal hair, etc. If it was the latest and greatest in terms of lookin’ good, you can bet I probably tried it or attempted to try.
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By Miranda Daschian
Daschian is a student-athlete at Cal Poly - SLO majoring in Psychology with a minor in Ethnic Studies. She aspires to work with athletes struggling with eating disorders and promote body positivity to those competing in adolescence and beyond. 

Imagine a young student who has recently begun high school. Freshman year, full of
opportunity...and a vast amount of awkwardness and hormones. This student, now
surrounded by peers years older and influences from the world of adulthood, begins to
feel pressure. This pressure is on the appearance of their body. They begin checking
mirrors more often, analyzing their face for any ominous pimples, poking and prodding
at their stomach and arms. Mom and Dad notice their once carefree child is now highly
selective at meals and has been frequently skipping homework and assignments to go on
runs or to the neighborhood gym. Weeks pass, and yet these behaviors only increase.
The student’s body is now changing noticeably, and yet they still don’t feel good enough.
Based on this, what gender do you believe the student is?

If you said girl, you may be one of many who thinks of eating disorders as a cis-gender
female-specific issue. While the problem may effect more females than males to this
day, the rates of disordered eating traits and diagnoses in males is on the rise...and at
alarming rates. According to NEDA (National Eating Disorders Association) around 10
million males in the United States alone will experience disordered eating symptoms,
and rates of sub-clinical eating disorder behaviors are almost as common in males as
females. These rates may even be higher when stigmatization of males with these issues
is taken into account, causing many to suffer in silence. 

So if all genders are susceptible, why do we so rarely hear about one of the populations
at risk? Many aspects of masculinity in our culture involve reluctance to be open or
acknowledge illness or weakness. “Just tough it out”, “don’t be a sissy”...all push males
to put their heads down and ignore things that may be going wrong in their lives. This
masculine stereotype not only tells someone how to process their emotions but also goes
as far as to push them into certain physical portrayals of how a “real man” should look.
If you need examples of this, google “dorito body” or “superhero body” and you will see
an endless array of muscular males (in various degree of dress) who we all know don’t
just naturally look that way. Photoshopped and posed images rule the internet and are

presumed to be the ideal, circulated broadly across social media and the internet. We
have assumed a type of sexualized and polished beauty to be superb, yet the influence of
this type of imagery is toxic and can be seen in rates of disordered eating increasing
among the spectrum of gender.

The biggest impact on eating disorders across the board can be made by changing
aspects of our culture. Sound easy? Not likely, but steps are being made slowly. Breaking
down gender roles and body image stereotypes will allow more individuals to develop a
sense of self separate from how they or others view their body. Individuals who identify
as male that deviate from a traditional “built” frame or masculine features won’t feel
devalued or shamed, and students like the hypothetical one I mentioned earlier will base
their self-worth on aspects other than their bodies. Self-love or body positivity
campaigns in groups as young as elementary school can promote the ideal that one
should love their body for what it is and the purpose it serves. Families can take new
approaches to how meals are introduced in the household, emphasizing less on any
critiquing and more on the energy and sustenance gained from these meals. And more
than anything, future generations should be taught that every body is different, but
every body holds worth.

Picture this: you’re a NCAA Division I student-athlete who spends over 25 hours a week at practice… and you’re struggling with an eating disorder (ED). You have practice every morning at 7am, and you run anywhere from 4-14 miles… you eat as little as possible afterward. You go to class and then back to your second practice of the day and run some more… and you think about what food will be most beneficial to eat so that your legs don’t get too shaky during weight room. Then you finally go to dinner at the dining hall… and you spend all your time online looking up the nutrition information for every item at the buffet. You repeat that day for weeks or even months, and ask yourself why you never have time for other things and why you’re so tired and unhappy.

That was my life in college. A horrible cycle of falling in and out of that pattern for years. I spent a long, long time being torn in half by my sport and my eating disorder.

At the time, the cycle felt impossible to break.

Gradually, I  learned how to be happy again. Once I started seeing a psychologist, I was able to get help and express the pain I’d been feeling. Slowly but surely, I saw the return of the “old” me. It didn’t happen overnight, in a week, or even a month. It’s still ongoing, but I began noticing the smallest things as victories. My college coach used to preach, “it’s the little things that make big things happen.”

So I got tools from a psychologist and my support from friends and family, and I started to mend everything on the inside—piece by piece—that had felt broken for so long. At first, a victory was something as minimal as “I ate a full breakfast with my team after practice,” or “my hands didn’t shake at all during weight room today.” But they build on each other. Small accomplishments like that transition into “I didn’t look at a single nutrition facts label all week,” to “I don’t know how much I weigh because I stopped using my scale.” It was all about knowing that there was a win in each of these steps. The greatest feeling in recovery came when I finally reached all these steps and I was no longer just checking things off a list that the dietitian gave me, but I was actually OKAY with taking these steps—both on an emotional and mental level.

Then came one of the most momentous steps in my own personal recovery. I was able to go for a run and not think about the calories I was burning according to pace and mileage. I wasn’t basing my run on which foods I had eaten that day, the calories would be “canceling out.” I was just running—for fun, for me. With lots of time spent working on my recovery process, and myself, I was able to mend the horribly fractured chain that linked me to my ED on one side and my sport on the other.

Since that day and the moment I realized what an accomplishment that run was, things haven’t always been perfect or smooth. Anyone who has been through a similar relationship with food knows that recovery is a messy, ongoing battle. Some days or weeks I’m lured back into calorie counting and I think a little too often about food and its ingredients/labels. Other weeks I’m pulled in the opposite direction by running and I waste energy trying to make the perfect workout schedule and do everything according to pace. BUT, I know exactly what to do or who to reach out to when either of these things happen, and I find ways to re-center myself. It doesn’t have to be one or the other, and I don’t have to be stuck in the middle of two equally difficult problems. Both my sport and my ED will always be a central part of making me into the person I am today, but I am no longer being torn apart by either. I’m in control of how I spend my time, what I think about, and what deserves my attention—on any given day.

And, wow, regaining control over my life feels so damn good.

Author: Jessica Cushing-Murray is a graduate student at University of Hawaii Manoa pursuing a Master's degree in Nutrition. She was a member of the UCLA Cross Country and Track teams during her undergraduate career and is using her last season of eligibility as a grad student now on Oahu. As a competitive long distance runner, Jessica understands the difficulties of trying to balance proper nutrition with college athletics, and hopes that she can make a career out of educating and counseling student-athletes as her future career.
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In this beautiful letter to herself a woman, whom I had the privilege to work with, wrote her personal reasons for wanting to recover. I was so moved by this statement of self love and respect I asked if she would please share in hopes that it would inspire others.

You don’t have to have this eloquent of a “why” statement, but I do encourage you to write out why YOU want to recover. What will you be able to do that you can’t while staying in your disorder? Read it every day. If you feel bold, please share in the comments, perhaps it will inspire someone else.

“People say motivation doesn’t last. Well, neither does bathing, which is why we recommend it daily.” -Zig Ziglar

“My Why”

I want my desires back. I want my sense of belonging back, my right to belong. I want my voice back -- my own voice that listens to my desires from a place of giving my body freedom to just be, to just be comforted, to just be heard, to come out of my own shadows, to regain self-trust and self-approval, to recognize that while my body may expand or contract, it is an injustice when I fall short of being a safe confidante to my body.

It is similar to living a lie, to gaslighting my body into believing that it is wholly wrong.

Overriding my body, judging my body, slandering my body, muting those voices within my body is almost akin to perpetrating a crime against all of me. In some ways, it also adds up to me becoming my own judge and jury and, so-to-speak, to being my own executioner.

That all shapes up to me becoming a threat to my own being, a threat to my own survival. It poses a form of self-harm. Self-harm be gone.

I want to be in conversation with my body -- to mind my body by mining for the gold within its contours, between the layers of my skin, in my jiggly, squishy or soft rolls.

Otherwise, I am and may forever be constrained by cultural chatter that breeds fear of food and fear of self.

Otherwise, I am confused by mixed signals, and I easily misunderstand my own self, my own wisdom, my own nature.

Otherwise, eating enters a state of chaos and confusion.

Otherwise, I live by dictates of “should I?” or “should I not?”

Otherwise, I omit all questions about my desires and about my deeply personal choices for food and in life.

I want the memories I have of meals to be soothing memories, and I want to be able to connect food and meals to comforting thoughts -- not to feelings of restraint or to lost opportunities for self-connection. I don’t want to be my own troll, posting critical messages in my mind concerning food.

In the end, I want to rethink my life, rethink the words I speak to myself, rethink the actions I take around current meals and meals that I am planning. I want to arrive at my table open and curious.

I want to readily pull up a seat at the table and honestly be all I am. All I am, meaning welcoming my whole self -- knowing my vulnerabilities, subtleties, and nuances and sitting with and helping myself to meet my truest desires. All I am, meaning that I fill my plate in tandem with becoming a more fulfilled self.

In the end, I no longer want to forsake myself. I want to feel that I deserve a place setting and a place at my own table -- and in the communal table of the larger world.   
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By Alyssa Los
Alyssa is in the process of becoming a Registered Dietitian through the California Polytechnic State University of San Luis Obispo. Alyssa has worked with the fabulous Not Your Average Nutritionist for two weeks learning about how to implement motivational interviewing and sensitivity when discussing body image into her future practice. In her free time, Alyssa enjoys yoga, hiking the beautiful Central Coast mountains and trying out unique, new foods. 

Recovery from eating disorders is a process.
When one restores their weight a state known as hypermetabolism is likely to occur. So what does this complex word mean? To break it down, hypermetabolism is the increased rate of how the body processes food into energy. When our bodies are put into a starvation state such as Anorexia Nervosa, it is common that our metabolic rate or the speed of which we process energy is slowed down. Therefore, when food is reintroduced at a higher rate our bodies have to learn how to process food as well as it needs even more calories to replenish our body’s hair, nails, bones and other essential cells our amazing bodies form!

Due to hypermetabolism, increased energy needs are required to meet our body’s demands. If you are in the process of recovering, a trusted health care professional will guide you to restoring you back to your individualized body weight. For those in recovery, approximately 50-60 kcals/kg of body weight is needed, but a Registered Dietitian is still essential at this stage as ranges can differ (1).

If you are in the process of weight restoration you may have experienced waking up at night soaked in sweat. Night sweats are a common occurrence caused by hypermetabolism seen in recovering anorexic clients. The reasoning behind this incidence is due to human bodies relearning how to utilize their new energy intake. Often our bodies end up turning the energy we are feeding ourselves into heat in the process. A study by Marzola and colleagues shows that anorexic patients had approximately a 15% higher energy expenditure with elevated body temperatures at night time compared to non-anorexic counterparts (1). Other common symptoms of hypermetabolism include gastrointestinal problems, headaches, low blood sugar and anxiety (2). Please see a professional for help as introducing foods should occur at a low pace to prevent refeeding syndrome, a disorder characterized by low Phosphorus, Potassium and Magnesium levels leading to heart irregularities, respiratory failure and seizures (3).​
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Remember, food is the reason we are alive. Without it our hair falls out, our nails don’t grow, our bones become brittle and many other negative consequences can occur. Reduction of fat stores in the body also results in a common condition in anorexic patients called amenorrhea, loss of your menstrual period for over 3 months (4). Therefore, when our bodies are restricted from food intake our internal biological system only focuses on the most essential parts of keeping us alive.

 The metabolism is a complex and astonishing part of our bodies. It makes up every cell and practically has a mind of its own adjusting to fluctuations in intake. So the next time you wake up sweating know your body is working hard to get back on track and replenish itself back to its regular state! 

Sources:
1.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3829207/
2.   https://www.mirror-mirror.org/weight-gain-anorexia-nervosa.htm
3.   http://eatingdisorders.ucsd.edu/research/pub/pdf/2015/Marzola_%20AnorexiaNervosa.pdf
4.   https://www.aafp.org/afp/2001/0801/p445.html

By Marissa Pendlebury
​Marissa is a "compassioneer" helping others recover from eating disorders like she did. Her passion for helping others break away from their eating disorder led her to develop "Nourishing Routes" a platform for empowering others who suffer from EDs.  She is also author of Nourishing Routes - Love Food, Adore Your Body, Become Yourself. More about Marissa, here: www.nourishingroutes.com 
(Not Your Average Nutritionist is not an affiliate. The ideas/opinions in this post are not necessarily the ideas/opinions of Not Your Average Nutritionist  staff.)

Recovery from an eating disorder is quite a contested area.
For one, not everyone believes that full recovery is possible - particularly among the medical community, who might suggest that there will always be some element of control around food in a person’s life. However, there are many testaments out there, my own included, that recovery actually IS possible. So why is there a bit of a divide between the view of recovery of medical professionals and those in recovery? 
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In short, full recovery for me and many others, has its roots in the meaning that recovery holds for each individual - based on unmeasurable personal experiences and not a text book full of calculations and people’s opinions. Full recovery is a unique concept for every person who has encountered an eating disorder first hand, and is not for any medical professional - notably those who have never had a true insight into the eating disorder mindset - what recovery truly is or means. Still, look into any research journal and article related to eating disorders, and the word recovery and categorising recovered and non-recovered individuals is batted about more times than a hyperactive tennis ball. 

For me, recovery is about regaining life, freedom and love of oneself. It is not just based on gaining a certain amount of weight, or getting within a Body Mass Index range that is deemed ‘healthy’ by medical standards (which tend to be flawed anyway). Equally, just because someone does get to a ‘healthy’ weight, which is the bench marker most research findings on eating disorders tend to use to assess recovery, doesn’t necessarily mean that individuals are free from restriction and control. For example, when a person does gain weight to a point that seems ‘healthy’, they may still be engaging in behaviours that provide them a feeling of safety, such as limiting the consumption of certain food groups and/or ensuring that they follow a particular diet (e.g. clean eating or plant-based food only). They may still, after eating over a certain quantity of food or Calories, feel an uncomfortable pang of guilt or an urge to compensate what they have eaten by using exercise or restricting food at the next meal or day. 

Some individuals suggest that ‘normal eating’ should be the goal of recovery. However, there are many negative behaviours and feelings are encountered by the majority of the population in terms of the way they eat and see food. In particular, over recent years, we have created a diet-obsessed culture where fixations around healthy eating, alongside developing unhealthy relationships with food and body, is the norm for the many rather than the few. 

With the above issues in mind, making ‘normal’ eating or getting to a ‘healthy’ weight the aim of recovery seems to be a substandard goal in reclaiming back life following an eating disorder. Moreover, what might seem a healthy weight to a medical professional, is not the true healthy weight for the person in recovery, since their body might naturally function more optimally at a higher weight - even above the optimal weight medically set out for their height. What we have to understand here is that, despite living in a world with an advanced medical system and forms of monitoring wellbeing, that medical standards of recovery are still flawed and not applicable to every individuals’ unique recovery journey. 

So what does this mean for your own recovery and where do you set your own bar and goals? 

In a nutshell, your recovery goals need to, ideally, be focussed around attaining a lifestyle that will allow you to feel free, able to socialise, revolve your activities around life rather than food, and be able to eat whatever foods you like without feelings of guilt or an urge to compensate. This lifestyle might look completely different to someone else’s in recovery, but it is important that your journey is founded upon your own values and what is ‘healthy’ to you. This might exclude the need to regularly consume nutritionally dense, low sugar plant based foods for the rest of your life (as might be advised for the majority of the non-eating disorder population). Alternatively, your values  might involve being able to relive positive food memories and socialise with friends while eating pizza or your favourite fast food to your heart’s content - rather than a Calorie Quota or diet regime.

To help you gauge what recovery means for you, I’m going to share some of the key things that allowed me to understand what real recovery would look like in the context of my own life. These are listed below:  
-Being able to go to sleep and wake up without wondering what I'm going to be eating in the morning.

-Scheduling my day around life, rather than around what I will and won’t be eating.

-Not spending hours planning meals for the next day or obsessively calculating Calories.

-Going to a restaurant spontaneously, rather than planning in advance and scrolling through menus online to pick a "healthy" or low-Calorie option.

-Ordering a meal to come as it is stated on a menu rather than making a billion adjustments so that it feels safer, ‘healthier’ and guilt-consuming to eat.

-Enjoying the prospect of eating with others rather than creating very safe and lonely spaces to eat in (with rigid controls and the need for everything to be perfect).

-Planning a day with social activities in mind first, and then food, without worrying about where and when we will be eating .

-Going into the supermarket and choosing foods that I genuinely enjoy, including my favourite chocolate bars, rather than healthy cereal bars that are lower in Calories but taste dreadful.

-Choosing snacks based on how appetising they look rather than looking at Calorie labels or how much fat and/or sugar that they contain. 

-Looking forward to planning time out with friends without worrying about food or wearing a fake smile and personality. 

-Feeling part of the real world and able to be fully myself while stepping outside the small bubble that used to keep me feeling safe but also restricted and lonely. 

-Laughing whole-heartedly and finding joy and fun in everyday life. 

-Not worrying about eating meals at certain time periods, and being able to eat spontaneously at any time of day.

-Baking cakes and tray bakes, licking the mixture out of the bowl before it goes in the oven, and actually eating the results myself.

-When going out to a cafe, ordering coffee and tea with ‘normal’ or full-fat milk without asking for skimmed or ‘skinny’ alternatives. 

-Being able to eat a main course AS WELL AS a starter and/or dessert without guilt - and continuing to still eat throughout the day or evening if I feel peckish. 

-Honouring feelings of hunger, even if I might feel like I have probably eaten my energy requirements for that day already. 

-Hearing about a new diet or wellness regime on social media and not being tempted to follow it; knowing that it is just a lure away from what is going to help you find life rather than more restriction and rules.

-Being able to have a full day of relaxation and spending large amounts of time sedentary without worrying about how much exercise or physical activity I "should" be doing.

-Walking around the block for enjoyment rather than trying to walk a certain number of steps and obsessively trying to walk further in order to burn off more energy. 

-Being able to move my body for pure fun and enjoyment rather than because it makes me feel like I can deserve food, or compensate for what I have recently eaten.

-Looking in the mirror and feeling appreciative of my body rather than focussing on the parts that don’t appear perfect or like someone else’s body I admire.

-Being able to listen to other people talk about dieting, losing weight, or their body shape without feeling the urge to restrict food.

-Not feeling guilty for eating more than other people I am eating with.

-Not feeling triggered or having the urge to restrict food when encountering someone who is slimmer than me, or has an eating disorder.

-Carving out time for self-care everyday without needing to "earn" permission to take care of myself and enjoy things.

-Allowing myself to buy nice things that I like or enjoy without feeling that I don’t deserve them or have to earn them in some way (other than actually earning money). 

-Sometimes eating more than my body needs or what i’m hungry for, just because I can and am enjoying eating, without directing negative thoughts and feelings towards myself afterwards, or trying to compensate later.

-Knowing that my identity and purpose of existence on this planet is not to worry about the quality of food I eat, what I weigh, or the thickness of my thighs.

-Being able to love who I am right now, unconditionally, while being able to think about life goals that don’t involve or revolve around food, exercise or trying to control weight.

​With these different aspects and dimensions of recovery in mind, you might be able to see how ‘real’ recovery is not just solely based on a physical marker of health. Recovery is just as much about emotional and social functioning in the real world, alongside an identity that is separate from a being who revolves their world around food, weight and/or exercise. Real recovery, for me, requires us to not only to gain weight, but also the courage to step out a transparent bubble that has held us feeling both safe and a captive prisoner. We may have been able to see the real world, and even believe that we were a part of it, but this bubble has been an unbreakable barrier between the life we currently live and the one we deserve and were born to thrive in. 

When we can step outside of this bubble, or even burst it all together, of course the world is going to feel overwhelming, scary and even foreign in terms of your ability to navigate every day social and emotional situations. However, the more your identity and self-worth grows beyond the limitations of a specific weight or the amount and types of food you eat, the chains of restriction become looser and looser every single day. Real recovery isn’t about waking up one day and having your eating disorder cast aside by a magical spell that bursts the bubble. Real recovery is the journey itself - each day making a choice to choose life and your long term happiness rather than pleasing the anxiety relief of succumbing to the controlling voice of an eating disorder.

Maybe real recovery for you still involves hearing a foreign voice every now and then, tempting you back into the false sense of security an eating disorder one offered, but then having the strength to say no and walk away. For example, despite feeling unworthy of food or needing to earn it through exercise or hard work, you choose to eat that biscuit with your tea anyway and order whatever the hell you like off a menu without succumbing to immense guilt. 

Recovering from any type of trauma follows a similar path - recovery from trauma isn’t about never experiencing trauma again, but it is about having the strength to conquer anxiety, tackle fears and navigate your own life again. In a similar way, real recovery is the non-relinquishing strength and determination to reclaim back our lives. If we can think of it like this, then there really is no black and whites of recovery, no specific weights and nothing we can set in stone on a medical chart or research article. The realm of real recovery is within the depths of your own mind and personal functioning. No one on this earth can determine or understand your real recovery other than you, but this is part of the beauty that makes the journey towards recovery such a wonderful one. Not only does it make us stronger, but it allows us to ask ourselves questions about our true values, beliefs and purpose. In this way, even though eating disorders can be soul destroying, and recovery seems like a constant uphill battle, it prepares us for an inner journey. This is a journey to really know, in our hearts, who we are, how we are connected with the world,  and the enormity of what we are capable of. 

On a final note, I would just like to say, your eating disorder and mission for recovery so far, no matter where you are at, is not wasted time. Every day you have battled on, even when you have felt you couldn’t fight any longer, have all played a role in making you YOU. Your real recovery is all about you - finding the courage to look inside the darkness, but also the immense beauty, intelligence and wisdom that you were born with. Never lose hope, because real recovery is always just a heartbeat away. When you choose the life your heart beats to no one other than you can say that real recovery isn’t possible.
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-Marissa Pendlebury

By: Lauren Goette
Lauren Goette received her B.S. in Psychology from Cal Poly, San Luis Obispo June 2017, and plans to become a licensed professional counselor in the future. Having personally struggled with anorexia, Lauren has become an advocate for mental health, working as a Peer Health Educator at Cal Poly and speaking out against the stigma surrounding mental illness. This was a paper she wrote her senior year (published with permission). ​

    The deadliest mental disorder in existence, Anorexia Nervosa (AN) threatens the lives of millions of US citizens each year. According to Arcelus, Mitchell, Wales, and Nielsen (2011), anorexia has the highest mortality rate of any mental disorder. In fact, it has been estimated that anywhere from five to twenty percent of individuals with AN will die from the disorder (“Anorexia Nervosa,” n.d.). This exceptionally high mortality rate is largely the result of anorexics’ self-induced starvation, which can be achieved through methods such as calorie restriction and excessive exercise (“Feeding and Eating Disorders,” 2013). As a result of these behaviors, anorexia can lead to serious physical problems, such as slow heart rate, low blood pressure, reduced bone density, severe dehydration, fatigue, hair loss, and a plethora of other physiological issues (“Health Consequences of Eating Disorders,” n.d.). And while there are numerous physical complications that result from this disorder, a significant amount of damage is also inflicted on the cognitive level. A variety of studies conducted in the past two decades have shed light on the devastating cognitive impacts of anorexia, as well as the promising positive effects of refeeding. Current evidence shows, as a result of semi starvation, individuals struggling with anorexia can experience drastic structural brain changes, inhibited cognitive abilities, and memory impairments, which may be improved with weight restoration.
Structural Brain Changes
    One of the most severe physical and psychological costs of anorexia is structural brain changes, which can cause significant harm to the cognitive functioning and overall mental health of anorexia sufferers. In the short term, a diet deficient in calories and nutrients, often coupled with excessive exercising, can lead to loss of both white and gray matter (Sidiropoulos, 2007). Prolonged caloric restriction promotes “abnormal reward responses to food and a deviation from a healthy feeling/perception of the body when eating.” These structural changes may, in part, explain why anorexics continually avoid food consumption, as the act itself appears to elicit a negative perception and/or sensation of the body. Additionally, this reduction of gray matter in may also contribute to the disturbance of the brain’s typical reward responses which encourage food consumption.
Cognitive Impairments
    Often the direct result of structural brain changes, AN sufferers can experience a wide range of cognitive difficulties. Higgs (2009) explored the impact of interference from diet-related thoughts on anorexics’ cognitive abilities. On a cognitive task, restrained eaters’ reaction times when imagining eating cake were significantly slower compared to when they imagined drinking water. On the other hand, unrestrained eaters' reaction times did not significantly differ between the cake or the water conditions. Higgs maintained that the cognitive impairments displayed by restrained eaters were the direct result of a “reduction in processing capacity due to interference from diet-related thoughts.” With this reduction in processing capacity, dieters’ ability to perform basic cognitive tasks was drastically diminished, highlighting how impactful caloric restriction can be on AN individual's thoughts and on their execution of simple cognitive tasks.
    In addition to these milder cognitive issues, AN sufferers can also develop chronic cognitive deficits. Specifically, Gillberg et al. (2010) found, eighteen years after AN onset, anorexics had more attention, executive function, and mentalizing problems. Anorexia was found to be associated with “a range of neuropsychological problems that are present long after the eating disorder… is no longer an important feature.” Even after starvation has ceased, weight-restored anorexia survivors can experience lingering cognitive issues. Gillberg et al. suggested that this is the result of severe structural damage which can leave important cognitive facilities critically damaged. Moreover, Fowler et al. (2006) found that even “relatively severe” neurocognitive impairments have the potential to adversely affect AN sufferers’ daily social and occupational functioning in the long term. These impairments can have a substantially negative effect on recovered individuals’ quality of life, making typically simple cognitive tasks exceptionally difficult to accomplish.
Memory Impairments
    Along with cognitive difficulties, AN can also cause notable memory impairment. Kemps, Tiggeman, Wade, Ben-Tovim, and Breyer (2006) found that anorexic individuals’ frequent obsessive eating-disordered thoughts actively prevent their working memory from operating effectively, which can lead to various issues with basic memory functions such as recall. Chan et al. (2013) also found anorexic’s impairment in memory functions to be positively correlated with BMI. In other words, the lower an AN sufferer’s BMI, the worse their memory functions were, and vice versa. Kingston, Szmukler, Andrewes, Tress, and Desmond (1996) also discovered an association between anorexics’ lower weight and poorer performance on memory tasks. Kingston et al. maintained that this poor performance was directly related to anorexics’ degree of weight loss, concluding that anorexics’ memory performance declines with their decrease in weight. Chan et al. proposed that this correlation between BMI and memory impairment indicates that anorexics’ memory deficits may, in part, be associated with malnutrition, however current research remains inconclusive.
Weight Restoration
    Having focused largely on the starvation-induced structural, cognitive, and memory impairments of AN, it is also imperative to recognize the simplest yet most effective treatment for such damage: weight restoration. Though not a “cure-all,” weight restoration, accomplished through the refeeding of the anorexic patient, has the potential to reverse much of the structural and cognitive damage caused by the disorder. In terms of brain matter recovery, Sidiropoulos (2007) demonstrated how weight restoration resulted in the return of white matter to premorbid levels. Simply by increasing caloric intake, anorexic patients were able to recover all of the white matter they had lost throughout the course of their disorder. Similarly, Wagner et al. (2006) found that weight restoration in long-term recovered anorexic individuals resulted in the reversal of structural brain abnormalities. These results imply that weight restoration has the power to reverse structural brain damage, and restore any and all white matter lost to anorexia.
    Focusing on the psychological implications of structural brain recovery, Bernardoni et al. (2016) found a strong association between partial weight restoration and improvements in affect and eating disorder symptoms. With even minor increases in weight, recovering anorexics experienced significant improvements to their psychological wellbeing. On the cognitive side, Hatch et al. (2009) discovered that weight-restored individuals were notably faster on cognitive tasks, and exhibited superior verbal fluency and working memory. Hatch et al. concluded that, with refeeding and weight gain, cognitive impairments in weight-restored AN sufferers appeared to normalize.
    Despite the existing support for weight restoration, it has noteworthy limitations. First and foremost, complete structural brain repair is not entirely possible through weight restoration While Sidiropoulos (2007) did find significant improvements in the quantity of white matter recovered in weight-restored individuals, in truth, some gray matter loss persisted. In spite of the recovery of white matter to premorbid levels, previously anorexic individuals sustained irreversible gray matter loss, which remained unaffected by their increased weight. Secondly, weight restoration fails to improve distorted cognitions about body image. Even after weight restoration, Bernardoni et al. (2016) revealed that patients remained dissatisfied with their bodies. Lastly, weight restoration fails to recover weight-restored individuals’ memory abilities. Nikendei et al. (2010), discovered that deficits in immediate and delayed story recall in currently ill AN patients persisted even after these patients were weight-restored. Nikendei et al. suggested that this was the result of a so-called “scar effect” on the brain caused by chronic starvation. They maintained that this scar effect may play an important role in the etiology and/or persistence of AN, and might also explain why memory impairments sustained during AN are seemingly irreparable.
Conclusion
    The vast body of anorexia research available today highlights both the extensive damage AN can cause to anorexics’ brain structure, cognitive abilities, and memory, in addition to the reparative power of weight restoration. Tragically, for individuals struggling with AN, the damage sustained throughout the course of the disorder can inhibit their brains’ basic cognitive functions. The structural brain changes caused by AN can lead to an irreversible loss of brain matter, as well as serious complications with cognitive and memory functioning. Anorexia nervosa can make simple cognitive and memory tasks, such as attention and recall, exceedingly difficult to accomplish. These cognitive and memory impairments, which can be caused by both structural brain damage and cognitive interference, can make everyday functioning a challenge. Not to mention, the irreversible nature of some of this damage can cause long-term impairment, even in weight-restored individuals. Despite the seemingly endless list of structural, cognitive, and memory complications caused by AN, weight restoration may hold the key to the recovery of both brain matter and cognitive abilities. In spite of its shortcomings, weight restoration has the ability to effectively repair the structural brain damage and cognitive impairment caused by anorexia nervosa.

References

• Anorexia Nervosa. Retrieved December 03, 2016, from https://www.nationaleatingdisorders.org/anorexia-nervosa
• Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011, July). Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders. JAMA Psychiatry, 68(7), 724-731. doi:10.1001/archgenpsychiatry.2011.74.
• Bernardoni, F., King, J. A., Geisler, D., Stein, E., Jaite, C., Natsch, D., . . . Ehrlich, S. (2016, April 15). Weight restoration therapy rapidly reverses cortical thinning in anorexia nervosa: A longitudinal study. NeuroImage, 130, 214-222. Web. November 26, 2016.
• Chan, T. W., Ahn, W., Bates, J. E., Busemeyer, J. R., Guillaume, S., Redgrave, G. W., . . . Courtet, P. (2013). Differential impairments underlying decision making in anorexia nervosa and bulimia nervosa: A cognitive modeling analysis. International Journal of Eating Disorders, 47(2), 157-167. doi:10.1002/eat.22223
• Chui, H. T., Christensen, B. K., Zipursky, R. B., Richards, B. A., Hanratty, M. K., Kabani, N. J., . . . Katzman, D. K. (2008). Cognitive Function and Brain Structure in Females With a History of Adolescent-Onset Anorexia Nervosa. Pediatrics, 122(2). doi:10.1542/peds.2008-0170
• Feeding and Eating Disorders - DSM-5. (2013). Retrieved November 12, 2016, from http://www.dsm5.org/Documents/Eating Disorders Fact Sheet.pdf
• Fowler, L., Blackwell, A., Jaffa, A., Palmer, R., Robbins, T. W., Sahakian, B. J., & Dowson, J. H. (2005). Profile of neurocognitive impairments associated with female in-patients with anorexia nervosa. Psychological Medicine, 36(04), 517. doi:10.1017/s0033291705006379
• Gillberg, I. C., Billstedt, E., Wentz, E., Anckarsäter, H., Råstam, M., & Gillberg, C. (2010). Attention, executive functions, and mentalizing in anorexia nervosa eighteen years after onset of eating disorder. Journal of Clinical and Experimental Neuropsychology, 32(4), 358-365. doi:10.1080/13803390903066857
• Hatch, A., Madden, S., Kohn, M. R., Clarke, S., Touyz, S., Gordon, E., & Williams, L. M. (2009). In first presentation adolescent anorexia nervosa, do cognitive markers of underweight status change with weight gain following a refeeding intervention? International Journal of Eating Disorders, 295-306. doi:10.1002/eat.20695
• Health Consequences of Eating Disorders. (n.d.). Retrieved December 04, 2016, from https://www.nationaleatingdisorders.org/health-consequences-eating-disorders
• Higgs, Suzanne. "Impairment of cognitive performance in dietary restrained women when imagining eating is not affected by anticipated consumption." Eating Behaviors 8 (2006): 157-61. Web. 25 Nov. 2016.
• Kemps, E., Tiggeman, M., Wade, T., Ben-Tovim, D., & Breyer, R. (2006). Selective working memory deficits in anorexia nervosa. European Eating Disorders Review, 14, 97-103. doi:10.1002/erv.685
• Kingston, K., Szmukler, G., Andrewes, D., Tress, B., & Desmond, P. (1996). Neuropsychological and structural brain changes in anorexia nervosa before and after refeeding. Psychological Medicine, 26(01), 15. doi:10.1017/s0033291700033687
• Nikendei, C., Funiok, C., Pfüller, U., Zastrow, A., Aschenbrenner, S., Weisbrod, M., . . . Friederich, H. (2010). Memory performance in acute and weight-restored anorexia nervosa patients. Psychological Medicine, 41(04), 829-838. doi:10.1017/s0033291710001121
• Sidiropoulos, M. (2007, January). Anorexia nervosa: The physiological consequences of starvation and the need for primary prevention efforts. McGill Journal of Medicine, 10(1), 20-25. Web. 25 Nov. 2016.
• Wagner, A., Greer, P., Bailer, U. F., Frank, G. K., Henry, S. E., Putnam, K., . . . Kaye, W. H. (2006). Normal Brain Tissue Volumes after Long-Term Recovery in Anorexia and Bulimia Nervosa. Biological Psychiatry, 59(3), 291-293. doi:10.1016/j.biopsych.2005.06.014