5 Tips to Help You Develop Body Positivity

5 Tips to Help You Develop Body Positivity

Learning to view our bodies with any kind of positivity is a challenge in a culture that is obsessed with being young, thin, healthy, and beautiful. The only way most of us can call a truce with our bodies is through hard work unpacking body shame and its many layers (some of which might have nothing to do with our actual bodies, but that’s a different post…).

As a quick disclaimer, let me say that body positivity doesn’t necessarily mean loving your body. If you get there, great, I hope you do. But many people won’t, and that’s okay. Body positivity is rooted in a respect for your body, which not necessarily the same as loving or even liking it.

Now that we’ve gotten that out of the way, here are some tips to help you in your journey to learning body positivity.

1. Immerse yourself in body positivity. 

It is so, so hard to make changes all on our own. Especially when pretty much everything in our culture reinforces body shame. So seek out the work of body positive and fat acceptance influencers. Read books, listen to podcasts, subscribe to blogs. If you’re a Christian, read Scriptures in the Bible about the goodness of our bodies (hint: we are created in the image of God and our bodies are His temple).

By immersing yourself in all this, you’ll not only start counteracting all the weight-biased, diet culture messages we’re bombarded with, you will also start to see how totally possibly it is to make peace with your body. Which, I completely understand, might feel unattainable at this point.

Guess what? All of the influencers I’ve read and listened to felt the EXACT SAME WAY at some point. But with time and hard work, they were able to accept themselves. That’s the kind of inspiration we all need when it feels impossible.

2. Stop picking apart your body.

You probably have some nasty body-checking habits that you might or might not be aware of. Do you weigh? Pull or pinch at your fat? Spend forever checking every angle in the mirror when you get dressed? Whatever your habits are, you need to stop—pronto. Listen, I know it’s hard. When we feel anxious and insecure, those habits are supposed to help us feel better. But typically they don’t, and we end up feeling worse. And on the rare occasion we do feel better (like when you get on the scale and get a little boost from a lower number than yesterday), they absolutely feed body shame.

If you’re not convinced that it’s toxic, ask yourself if you would feel proud if a little girl watched you and emulated whatever your habit is. No? Then it’s not good for you either. Full stop.

3. Wear clothes that you like.

Clothes are made to fit our bodies—not the other way around. Physically, you can feel more comfortable by wearing sizes and styles that fit and better serve your body—which is what clothes are designed to do. They are supposed to keep you warm and protected and make you feel good. Any that don’t, aren’t serving you and need to go!

It might not be possible to overhaul your wardrobe all at once since that would be expensive, but even if it’s a piece here and there, start purchasing clothes that are fun instead of buying clothes that cover up your supposed flaws. And forget all the rules! Fat arms can wear sleeveless tops. Thighs with cellulite or calfs with spider veins can wear shorts. Mommy bellies can wear two-piece swimsuits.

And yes, as shocking as it is… you can even wear horizontal stripes if you want.

4. Diversify your social media.

Ok, this is similar to tip number one and is part of the immersion process, but this is important in a unique way. Our brains are trained by the images it sees over and over. And in the mainstream media, we see lots and lots of the thin ideal. Women in smaller bodies, filtered and posed just right, are the norm in media and so our brain interprets that as the norm in general.

It’s not. Not even close.

Does it surprise you to know that 67% of adult American women wear a size 14 or larger? You wouldn’t know it based on what we see and what sizes are offered in stores! So diversify your social media so you start seeing a wider variety of bodies. (Tip: If you sign up to receive my Food Freedom Therapy™ newsletter, you get immediate access to recommendations on anti-diet and body acceptance social media accounts to follow. There’s a signup form on this page.)

5. Join the movement

Body positivity is not just an individual endeavor aimed at “loving your body”. It’s a social justice movement that challenges the way current culture views and treats bodies, as well as elevate traditionally marginalized bodies. This includes larger bodies, and also bodies of color, differently-abled bodies, and many others.

Don’t get me wrong, that doesn’t mean you need to post pictures of yourself in a bikini on Instagram (although, if you want to, go for it!). It does mean that you need to see yourself as part of something bigger than yourself. This helps us as human beings feel connected to others on a similar mission and gives us a sense of purpose in the hard work we’re doing. Do you want a better world for other women? For your girlfriends, sister, daughter? Heck, even for the men you love because unfortunately, body shame is not just a female issue anymore. If so, then start thinking about how you can get involved. It can be as small and simple as leaving a supportive comment on someone else’s post or asking that coworker to stop making fat jokes.

Every movement starts with small changes that lead to big changes, and before you know it—we’re changing our world and THE world. You’re not alone and you can do this. XOXO

Much love,
Cherie Signature

About Cherie Miller @ Dare 2 HopeI’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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How to Do Intuitive Eating When You Don’t Feel Hunger

How to eat intuitively when you don't feel hunger

It’s very common for individuals who have an eating disorder, or even just disordered eating due to “normal” dieting, to say they don’t feel hungry. And so the question is, if you don’t have hunger, how can you eat intuitively? In this post, we’ll talk about what might be interfering with your hunger cues and what to do about it.

What are Hunger Cues?

First, it’s important to understand that when we typically talk about hunger, we’re referring to the grumbling or gnawing sensations in our stomachs. However, our bodies actually give us a range of other hunger cues that you might be missing, even if you’re not feeling anything in your tummy. Some other clues that you’re hungry and need to eat include:

  • Irritability
  • Low energy
  • Headache
  • Trouble concentrating
  • Lightheadedness
  • Shakiness
  • Nausea
  • Thinking about food

What Causes People to Stop Experiencing Hunger?

When we disrupt our bodies’ normal rhythms through restriction and/or chaotic eating patterns, our bodies adjust. If you’ve spent a lot of time ignoring your hunger, your body will sometimes stop sending you those sensations because it’s a waste of energy. It’s like a crying baby who crying eventually gives up when no one responds to them.

Another thing that could be happening is that your digestive system has slowed down. When this occurs, your stomach feels fuller sooner and longer because food empties from the stomach slower than it normally would. Called gastroparesis, this condition is common with restrictive eating disorders, and can include other symptoms such as heartburn, nausea, bloating, and vomiting. If you think you have gastroparesis, I highly suggest working with a gastroenterologist familiar with eating disorders.

Lastly, the other thing I often see with clients who don’t experience hunger is that they aren’t allowing themselves enough time between eating to feel hungry. If you eat more often than your body needs, you’re going to beat your hunger to the punch, so to speak.

How to Eat if You Don’t Feel Hunger

The first step is to put some structure in place in regards to your eating. Start by eating breakfast, even if it’s small, within an hour of waking up. (No, coffee is not breakfast!) Then eat every 3-4 hours, whether you are hungry or not. That likely would have you eating 3 meals a day, with 1-2 snacks. Do not eat before your snack or meal time. Don’t skip any, even if you binged.

I can imagine that you might be asking right now, “How is that intuitive eating?”

But I promise, it’s a necessary part of the healing process that makes intuitive eating possible. I heard Evelyn Tribole, co-author of Intuitive Eating, describe structured meals and snacks like putting a cast on a broken bone. The structure is necessary for healing, but it’s not meant to stay on forever. Once the bone (i.e. your relationship with food) is healed enough, you take the cast off.

Besides, contrary to the misconception that intuitive eating is simply about “eat when you’re hungry, stop when you’re full,” there’s more to it than that. Intuitive eating is not 100% instinct. It’s also based on logic, and when our hunger signals aren’t working properly, logic can ensure that our bodies still get what they need.

The goal is for regular eating of sufficient calories to restore normal digestive function and hopefully, normal hunger sensations. But until that happens, you can still practice attunement with your body by starting to notice other hunger cues that you’re likely missing if you’re focused solely on what’s going on in your stomach.

For more information about this topic, check out this Intuitive Bites podcast episode by Kirsten Ackerman, RD.

One More Thing…

Remember that intuitive eating involves ten principles. Only two of them are about hunger and fullness. Which means, even while you are working on restoring hunger, you can be practicing the other 8 principles related to rejecting diet mentality, making peace with food, respecting your body, and all the rest.


DISCLAIMER: These are general principles I hope you find helpful, but I highly encourage you to work with an eating disorder therapist or dietitian who can help you with this process! Recovery really is an individual thing and you need professionals who understand your unique physical and emotional needs to customize a suitable treatment plan for you. Don’t be afraid to reach out for help. XOXO

Much love,
Cherie Signature

About Cherie Miller @ Dare 2 HopeI’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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Exercise Series, Part 3: Developing a Healthy Relationship with Exercise

Now that we’ve talked about figuring out whether you relationship with exercise is toxic and about the role of exercise in eating disorder recovery, let’s take a look at how you can develop a healthy relationship with exercise.

If You Are in Active Eating Disorder Recovery

First and foremost, I need to state that if you are actively struggling with an eating disorder, especially if you are potentially under-nourishing your body, please do not undertake extra physical activity without the guidance of trusted professionals. As discussed on my previous post, exercising while malnourished can be very dangerous. Also, know that people of all sizes can be under-nourished so don’t assume that you are not even if you’re in a larger body!

If you’re not currently seeing a therapist or dietitian—or both—that is a good place to start. Just make sure they specialize in eating disorders because unfortunately, professionals who do not can unintentionally cause harm for eating disorder clients. (Please contact me if you need help finding an eating disorder therapist or dietitian.) Other members of your treatment team might include a medical doctor, a psychiatrist, and an occupational therapist. If you think you might need more treatment than outpatient can provide, check out this post about the levels of care available for eating disorder treatment.

Tips for Exercising In a Mentally and Physically Health Way

Even as you are renourishing (also called weight restoring), there could be a place for movement in your treatment. What your current relationship with exercise is like and your physical condition are critical considerations in developing a plan for exercise, which is why you should ultimately work with your treatment team on creating a plan since they know your specific challenges and needs.

Dr. Jennifer Gaudiani, author of Sick Enough: A Guide to the Medical Complications of Eating Disorders and Medical Director of the Gaudiani Clinic eating disorder treatment facility, recommends a slow increase in movement, making sure to have rest days in between. She also emphasizes the importance of adding more nutrition if needed. I want to mentioned that although exercise during this stage can result in some bone density loss in some patients, Dr. Gaudiani feels this is offset by the fact that a plan involving movement can lead to earlier eating disorder recovery, which can in turn have a better long-term effect on bone health.

What’s the Goal?

If I had to give a name to what a healthy relationship with exercise looks like, I would call it intuitive exercise (or intuitive movement if the word exercise has negative connotations for you). In the Intuitive Eating book, the authors call it joyful movement, so you can use that too if you like it better. 

I personally like having “intuitive” in there because I think that better personifies what it’s all about. Like intuitive eating, intuitive exercise involves tuning into the body and respecting the body’s cues, which means removing the obstacles to attunement—the disordered rules, beliefs, and thoughts that previously surrounded exercise. In other words, it is guided by internal cues rather than external ones. Again, like with intuitive eating, it can be quite a process getting there, but it’s so freeing once you do.

Tips for Learning Intuitive Exercise

In addition to taking a slow-increase approach recommended by Dr. Gaudiani and other experts, here are some other general principles to help you incorporate movement in a healthy way and to heal your relationship with exercise.

Tip #1 – Take a break

For many people who’ve had issues with exercise, taking a break from it can be a necessary step in healing. Yes, this can be very distressing, and that gives you an opportunity to deal with all the things that come up when you don’t exercise. It’s hard but important to learn other coping skills besides just exercise. Plus, taking a break gives you time to do a mental “reset” with the other tips here.

Tip #2 – Change your motivation for exercise

Just like the first step in developing a healthy relationship with food is challenging the diet mentality, it’s also an important starting point for changing your relationship with exercise. Sadly, in our current culture, movement is usually associated with trying to lose or maintain weight. Untangling exercise from those goals is difficult for most people, let alone people with an eating disorder. Yet there are so many benefits to our physical and mental health! Take some time to identify reasons to exercise that matter to you besides staying thin or losing weight. Here are a few that might be important to you:

  • Relieve stress
  • Improve learning and memory
  • Strengthen your heart
  • Build stronger muscles and bones
  • Promote better sleep
  • Improve mood
  • Decrease depression and anxiety
  • Improve digestion to help relieve constipation and help those with digestive disorders like inflammatory bowel disease and liver disease
  • Strengthen immune system
  • Reduces risk for disease like stroke, cardiovascular disease, and some forms of cancer
  • Improve sex life

Tip #3 – Rethink what defines “exercise”

Exercise does not have to be running X miles or doing X minutes on the elliptical. Resist the toxic thinking about exercise having to look a certain way. Often, we think it only “counts” if it’s a certain type, intensity, or amount of time. Not true! We can get a lot of benefits from a variety of movements, and they don’t have to be intense or high-impact. Dr. Jennifer Gaudiani recommends (and I agree) that it’s good to start by incorporating a variety of gentle activities such as yoga, walking, and free weights.

Over time, get creative and think about trying other types of movement like:

  • Walks with your pet or family
  • Hiking
  • Roller skating or ice skating
  • A dance party at home or try a dance class
  • Riding a bike
  • Martial arts
  • Wrestling or playing tag with your kids
  • Play a rec league sport
  • Play laser tag
  • Hula-hoop
  • Jump rope
  • Swimming or water aerobics
  • Think about what you enjoyed as a kid and do that!

In my eating disorder days, I was a compulsive runner. I gave that up when I went into recovery and years later, I’m still exploring what types of movement I enjoy. Watch the video at the end of this post to hear more about my recent journey with intuitive exercise!

Tip #4 – Listen to your body

Since the basis of intuitive exercise is tuning into your body, you need to work on practicing mindfulness, which you’re likely doing with intuitive eating already. Listening to your body means noticing when you feel the urge to move, and then honoring that by moving. It also means noticing when you’re feeling fatigued or sick and need to rest instead of exercising. 

As you’re exercising, respect your body’s cues. It’s okay for exercise to be a bit challenging and uncomfortable at times, but it should not be painful or miserable. The idea that we have to beat up our bodies for a workout to be beneficial is toxic fitness thinking and is just plain false.

A Warning About Starting to Exercise Again

As you get more stable physically and are consistently nourishing yourself, you can increase your intensity… but only if you want to—and want to for the right reasons. Emotions to watch out for are guilt, shame, stress or pressure. If it feels more like “I should” or “I need to” to increase workout intensity or times, that is a red flag that you’re slipping into compulsive exercise again.

Be aware of your thoughts too. If you start thinking about things like how many calories you burned, step back and challenge the diet mentality. Recognize those thoughts and feelings are a slippery slope back into disordered eating… and don’t give into them. With self-compassion, remind yourself of the healthy reasons you are exercising and that there are no rules for how it has to be. The point is for you to enjoy it both physically and mentally, and for it to add to the quality of your life. Scale back, try a different form of exercise, or take a break again if you need to. Like with food, healing our relationship with movement is not a linear process!

My Recent Journey with Intuitive Exercise

(If you missed the first two posts in this exercise series, check them out at Part 1: Is Your Relationship with Exercise Toxic? and Part 2: The Role of Exercise in Eating Disorder Recovery.)

Much love,
Cherie signature

Sources:
Cook, B., Wonderlich, S. A., Mitchell, J., Thompson, R., Sherman, R., & McCallum, K. (2016). Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines. Medicine and Science in Sports and Exercise48(7), 1408–1414. http://doi.org/10.1249/MSS.0000000000000912
https://www.intuitiveeating.org/definition-of-intuitive-eating/

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Exercise Series, Part 2: The Role of Exercise in Eating Disorder Recovery

The role of exercise in eating disorder treatment is complicated and a topic of some debate within the recovery field. Whereas I used to feel strongly that clients who were operating in a calorie deficit due to restriction should never be allowed extra movement or exercise, I’ve shifted my thinking a bit. Now I think it’s best to avoid approaching the topic with a one-size-fits-all approach, and recommendations should be based on each individual client, weighing the potential pros and cons of exercise during recovery.

What are the pros and cons of exercise during eating disorder recovery?

Potential Benefits

For the general population, exercise has many known health benefits, both mentally as well as physically, including:

  • Improving mood and ability to manage stress and emotions
  • Improving mobility and helping prevent injuries
  • Reducing risk for heart disease and reversing cardiac abnormalities
  • Reducing risk of some cancers
  • Strengthening muscles and increasing bone density
  • Helping manage blood sugar and insulin levels
  • Improving sleep

However, if an individual is not physically stable and properly nourished, exercise can actually worsen their physical condition. Which is a nice lead-in to the discussion about the drawbacks of exercise in recovery…

Potential Drawbacks

One of the most concerning issues for someone with an eating disorder exercising is that expending additional energy during a starvation state puts even more strain on an already stressed and weakened body. In other words, exercise exacerbates the physiological consequences of being malnourished. It can worsen hormonal dysfunctions, harm cardiovascular systems, and further decrease bone density. Injuries are more likely to happen (e.g. stress fractures are common).

I often hear clients say they are not working out to lose weight, and that it’s not wrapped up in their eating disorder. Common statements are “I want to exercise because….

I love it.”
It makes me feel good.”
It makes me feel strong and healthy.”

For now, let’s set aside the issue of whether these statements are actually true or whether the client is trying to maintain disordered behavior. That’s something to unpack with them a bit later. Initially, the foremost concern is that, as previously discussed, exercise can cause harm for those who are malnourished. So if a client talks about wanting to be healthy, then we have an opening with them to discuss how exercise at this point could be incredibly unhealthy for them. 

“Attempting to use the health argument to justify a behaviour that is contributing to energy deficit during starvation and thus helping perpetuate a life-threatening illness is classic eating-disorder logic.”
– Emily T. Troscianko, Ph.D.

So… to exercise or not to exercise?

In her book Sick Enough: A Guide to the Medical Complications of Eating Disorders, Dr. Jennifer Gaudiani makes a good argument that forbidding people in recovery from engaging in physical activity unintentionally reinforces the disordered idea that the main purpose of movement is to burn calories and prevent weight gain. She states that although “serious exercise is a privilege of full recovery… movement during weight restoration makes recovery sustainable.” Dr. Gaudiani supports physical movement as part of the recovery process for most patients. She has observed positive outcomes for patients who experience stronger, more independent bodies through a combination of rest, nutrition and expert physical and occupational therapy.

Once nutritional rehabilitation is achieved and caloric intake is sufficient, more serious exercise becomes safer. This means that good nutrition, weight restoration, and the return of normal hormonal and cardiac physiology are crucial to deciding when such exercise would be advisable.

However, we need to consider more than just the client’s physical condition. The mentality regarding exercise is equally important. Research has found that exercise is a predictor of relapse for approximately 30% of individuals after discharging from higher levels of treatment. Notably, the highest risk occurs between 4 and 17 months after discharge, but the risk of exercise contributing to relapse stays high for up to 2.5 years after treatment.

This is partially due to the fact that in our current culture, exercise is often tied to weight management. It can be tough for an average person to disconnect the two, so it’s understandable how difficult that is for a person recovering from an eating disorder. For many patients, exercise is interwoven into their disorder. The motivation for exercise can to serve many eating disorder functions for individuals, such as burning calories, attempting to control one’s body, managing anxiety about food, and even being a form of self-punishment.

The challenge, therefore, is developing a healthier relationship with exercise and reaping the benefits of it without triggering a relapse. I do think that Dr. Gaudiani’s approach can be helpful in repairing the disordered relationship with exercise, as well incorporating discussion of exercise into the therapy work.

Assessing your relationship with exercise

If you’re not sure whether a client’s (or your) relationship with exercise is healthy, check out my previous post, Is Your Relationship with Exercise Toxic?. Some of the red-flags to look for include:

  • Feeling guilty, anxious or ashamed when a workout is missed or isn’t as long or intense as the individual thinks it should be
  • Exercising even when they’re fatigued, injured, or ill
  • Exercise is focused on getting or staying in a certain type of body
  • “Earning” food through working out
  • Not really enjoying your workouts but feeling compelled to do them anyway
  • Working out causes stress instead of relieving it
  • Needing to exercise displaces other important things in the person’s life
  • Their identity/self-worth is wrapped up in working out

You can also check out these online assessments:

Stay tuned…
for my next post about HOW to incorporate healthy movement during—and after—eating disorder recovery!

Much love,
Cherie signature

Sources:
Bardone-Cone AM, Higgins MK, St George SM, et al. Behavioral and psychological aspects of exercise across stages of eating disorder recovery. Eat Disord. 2016;24(5):424-439. doi:10.1080/10640266.2016.1207452
Cook, B., Wonderlich, S. A., Mitchell, J., Thompson, R., Sherman, R., & McCallum, K. (2016). Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines. Medicine and Science in Sports and Exercise48(7), 1408–1414. http://doi.org/10.1249/MSS.0000000000000912
https://www.psychologytoday.com/us/blog/hunger-artist/201812/should-you-exercise-during-recovery-anorexia-part-1
https://edinstitute.org/paper/2013/2/26/exercise-ii-insidious-activity
https://www.allianceforeatingdisorders.com/exercise-during-recovery/

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Exercise Series, Part 1: Is Your Relationship with Exercise Toxic?

It’s generally accepted that exercise is healthy, but sometimes it isn’t. Sometimes, it can hurt our physical and emotional health. The line can be a bit blurry, so let’s talk a bit about when exercise stops being healthy and becomes harmful.

Signs of a Toxic Relationship with Exercise

Here are some signs to look for to help determine whether your relationship with exercise it healthy or toxic:

  • You feel guilty, anxious or ashamed when you don’t work out, or don’t work out as long or hard as you think you should
  • You exercise even when you’re fatigued, injured, or ill
  • If you couldn’t work out for a while, you’d freak out
  • Exercise is focused on getting or staying in a certain type of body
  • You “earn” food through working out
  • You don’t really enjoy your workouts anymore
  • Working out causes stress instead of relieving it
  • Needing to exercise displaces other important things in your life
  • Your identity/self-worth is wrapped up in your fitness and you’re not sure who you’d be without it—or you worry about losing the status of being the “fit” person everyone sees you as

If any of these describe you, then you probably need to re-evaluate your relationship with exercise. As Katherine Schreiber, the co-author of The Truth About Exercise Addiction: Understanding the Dark Side of Thinspiration said, “I think we can all agree that canceling plans with friends because you are a slave to the treadmill, running with an injured knee, or being terrified of taking a rest day, is not mentally healthy.”

Yet because working out is considered healthy in our society, we usually don’t question it… even when it becomes excessive, compulsive, or a source of distress. Too often, we’re not honest with ourselves about the ways it has become problematic. I think that can partly be attributed to a phenomena known as toxic fitness.

What is Toxic Fitness?

Toxic fitness happens when exercise and the pursuit of fitness is wrapped up in diet culture. So instead of being about health, it’s actually about weight loss, thinness and shaping our bodies—just like dieting and disordered eating, which, not surprisingly, often accompany toxic fitness.

“Toxic fitness culture has made working out into some kind of competition of who can look the slimmest or have the best body. It makes us feel like we have to push ourselves past our limits and prioritize fitness above everything else in our lives. It can have damaging effects on our body image and our fitness.” ~ Alice Kelly

Be discerning about the content and people you let influence your relationship with your body, exercise, and food. Here are some toxic fitness red flags:

  • Exercise for the primary purpose of losing or maintaining weight.
  • Promoting “fit” as a specific look (you know the one — the lean and toned ideal that’s plastered everywhere).
  • Motivating people with things like getting “bikini ready,” achieving a “new you,” looking good in a strapless wedding dress, or any other body-shaming tactic.
  • Promoting exercise as a “no pain, no gain” activity that only really counts if you beat your body up or it hurts.
  • Encouraging people to work out even when they are injured or should rest.
  • Associating exercise with food in a negative way (e.g. earning food through exercise or warning against negating a work out with what you eat).
  • Fitness gurus who don’t include body-diversity in their programs, which means featuring diverse people (sizes, color, etc.) as well as being able to offer exercises that accommodate people in larger or differently-abled bodies.
  • Emphasis on exercise and diet as the only ways to be healthy.
  • Shaming people—directly or indirectly—for not working out long enough or more often.
  • Tying one’s identity or self-worth to exercise or level of fitness.

No Pain, No Gain is Crap

Exercise shouldn’t be about punishing or even manipulating your body. It should be about taking care of it. It might be tough to develop a healthy relationship with exercise if it’s been toxic for you up until now, but you can change it—just like you can change your relationship with food. Stay tuned in the upcoming weeks for tips on how to do that!

Random side note, but …

Pleeeeease stop taking nutrition advice from personal trainers. One, that is outside their scope! My husband was a personal trainer for years and it drove him bonkers to hear other trainers coaching their clients on their diet. And two, he also believes that the majority (not all of course, but most) personal trainers have their own struggles with body image and food. There’s not a lot of research on the subject, but what is there supports his personal experience—there is a high rate of disordered eating amongst fitness professionals. That’s something to keep in mind when taking advice from them.

If you do need help with nutrition or your relationship with food, please talk to an anti-diet, Health at Every Size® therapist or dietitian. If you can’t find one in your area or don’t know where to start looking, reach out to me and I will do my best to help you find someone!

Much love,
Cherie signature

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

What is Binge Eating Disorder?

Below is the video transcript:

Today I want to talk a little bit about binge eating disorder. Maybe you have heard of it, maybe you haven’t, or maybe you have and you’ve wondered  if you have it. Hopefully today I will answer your question if that’s you. So real quick, this probably will surprise you, but binge eating disorder is actually the most common eating disorder. An estimated 2.8 million people in America have it and it’s actually three times more common than anorexia and bulimia combined.  So it’s actually a very common eating disorder and a lot of people don’t even meet full criteria but definitely have some symptoms of it.  

So what is it? Let’s talk about that. First, as the name implies, binge eating disorder involves  binge eating. Now, binge eating as more than just, “Oh, I overate–I had a little too much.” No, this is eating a very abnormal amount of food in a limited amount of time. So you’re going to be very uncomfortable–way past the point of fullness. Other symptoms of binge eating are bingeing in shame, excuse me, bingeing in secret, and then having intense feelings of shame as well as a feeling of being out of control. So not feeling like you can control the binges. 

So here’s the thing that might surprise you. The thing that mostly perpetuates binge eating is restricting and dieting. It makes sense why we would do that after we binge if we’re worried about gaining weight or how it’s going to affect our bodies. We feel guilty so we try to “make up” for it by not eating as much later that day or the next day. But the truth is that actually perpetuates the binge eating cycle. I know it’s not easy to think about giving up dieting and restricting when you’re so worried about weight, and that’s the topic for another video but if you  questions about binge eating binge eating disorder, please reach out to me and let me know–I’m happy to answer your questions. You can check out my website, there’s information on there plus a resource section for some books and podcasts.  You can also check out NEDA’s website, the National Eating Disorder Association, there’s good information on there. Food freedom awaits! I know it’s not easy to get there but it’s worth it, I promise. Take care and have a great day!

P.S. Check out this post for more info on the restriction-binge cycle.

Much love,
Cherie Signature

About Cherie Miller @ Dare 2 HopeI’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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Quasi-Recovery

Qausi-Eating Disorder Recovery Dandelion Pic

A previous post, Is Full Eating Disorder Recovery Possible?, brought up a lot of questions about a common challenge for people pursuing eating disorder recovery that I want to talk about today: partial recovery. I actually like the term qausi-recovery because the word “qausi” can mean both “almost but not fully” as well as “seemingly but not actually”. Though sometimes we are aware we are only partially recovered, other times, we think we are fully recovered when we’re not actually 100 percent there. My personal journey fell into the latter category. 

When I relapsed, I had been free of eating disorder behavior for 8 years and believed I was recovered. Slipping back into old behaviors took me by surprise because I didn’t think I was in danger of a relapse since I hadn’t really struggled with my eating disorder for so many years. I didn’t understand why it happened for a while, but eventually came to realize that all those years, I had really been in quasi-recovery.

Some might not agree, and that’s understandable. Part of the difficulty with this topic is that there is no one definition for recovery. Everyone defines it a bit differently, so for our discussion here, I wanted to clarify what I mean by recovery.

What is Full Eating Disorder Recovery?

From a clinical perspective, we would use the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to see if a person still meets any criteria for an eating disorder. The three most-known are anorexia nervosa, bulimia nervosa, and binge eating disorder. However, many people don’t meet all the criteria for these disorders, but could still be diagnosed with an eating disorder known as Other Specified Feeding and Eating Disorder (OSFED).

OSFED is diagnosed when a person has feeding or eating behaviors that cause clinically significant distress and impairment, but do not meet the full criteria for any of the other disorders. While some people start out with an OSFED diagnosis, some start with a different diagnosis and are later diagnosed with OSFED when they no longer meet criteria for anorexia, bulimia, and binge eating disorder. Some examples include:

  • Someone who has restored weight to a “normal” range but continues to significantly restrict
  • Someone who binges or binges/purges but not as frequently
  • Someone who doesn’t restrict caloric intake anymore, but has become overly conscientious about eating only “healthy” foods (now known as orthorexia

Anyone who still meets the diagnosis criteria for an eating disorder is still not recovered. I imagine most people would agree with that. But does not meeting criteria mean you’re recovered, as I was those 8 years? Perhaps from a clinical perspective, but I personally believe recovery goes beyond a clinical definition. For me, recovery from an eating disorder is more than just abstaining from eating disorder behaviors—it involves a real healing of the relationship with food and your body. 

What Quasi-Recovery Can Look Like

Some signs you might not be fully recovered from your eating disorder include (and during my qausi-recovery stage, I could check several of these boxes!):

  • Eating more than you did before but still not consistently honoring your hunger and/or eating an appropriate amount
  • Eating more foods than you did before but still labeling food as “good” and “bad” and avoiding “bad” foods much of the time
  • Having anxiety around food
  • Using exercise to “earn” or “make up” for what you eat
  • Having food rules about what, how much, or when you can eat
  • Continuing to hate your body and/or fear weight gain

How to Push Through Quasi-Recovery

Being honest with yourself about not having fully healed your relationship with food and your body is an important place to start, if you’re not there already. It’s equally important to believe that full recovery is possible. Don’t settle for believing that this is the best it can be for you, though I understand those feelings as well. I have vivid memories of saying through sobs that I would never be able to make peace with my body and therefore food, even though I wasn’t using explicit behaviors anymore. 

But recovery is about rooting out eating disorder thinking just as much as it is about quitting behaviors. So keep doing that internal work to challenge all the eating disorder/diet culture mentality that continues to drive food anxiety and fear of fatness. Here are some great books I recommend:

Read these and other anti-diet, fat-acceptance books and follow fat-positive, intuitive eating accounts on social media (sign up for my newsletter and I’ll send you a list of influencers!). Then unfollow, cancel, or otherwise disengage with people and content that continues to keep you in bondage to food issues. What we surround ourselves with influences us in a MAJOR way. Finding community with people who promote true body acceptance and food freedom is vital in changing your mindset. It made all the difference for me and I hear the same from so many others.

Final Thoughts

Based on my own experience and those of my clients, qausi-recovery is a common stage for many people with eating disorders. So if that’s where you find yourself, that’s totally okay. Please don’t feel like a failure or get discouraged. The journey to full eating disorder recovery is not a straight line, and it’s certainly not easy. Especially considering how disordered our culture’s relationship with food and bodies is! You CAN get there. It might be cliché, but it’s true:

Progress, not perfection, dear one.

Please reach out to me if there’s anything I can do to help you in your journey. If you’re ready to start therapy with me, you can schedule an appointment online.

Much love,
Cherie signature

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Is BMI Useful?

Because much of our health system revolves around BMI (body mass index), our BMI is supposedly a big deal. I get asked questions about what exactly is BMI, what does it really measure, and is it valid. Today I want to tackle those questions.

First, let’s start by defining BMI, which is a person’s weight divided by their height squared. According to the National Institute of Health (NIH), “BMI is a measure of body fat based on height and weight that applies to adult men and women.” Ok, so that’s questionable, but we’ll get into that later. I think a brief history lesson on the origins of BMI and the campaign against “obesity” is useful in helping understand BMI’s usefulness for us today.

How BMI Was Developed

BMI was introduced in the early 19th century by a Belgian mathematician (not a physician!) named Adolphe Quetelet to define the statistical norm of human beings, i.e., “the average man.” Quetelet himself said that his index should not be used as a measure of individual health.

Nevertheless, later in the 19th century, U.S. life insurance companies began using it to classify individuals as a way to determine what to charge prospective policyholders. These Metropolitan Life Insurance Company height-weight tables were used to define “ideal” weights for almost a century and helped popularize the idea that weight is a determinant of health.

In 1972, researcher Ancel Keys and colleagues tested several indices of body fat and compared those results to actual measurements of body fat taken from skin calipers and underwater weighing. They concluded that Quetelet’s index was superior to other indices of body fat, and proposed the formula be termed body mass index (BMI). Even then, Keys et al. admitted that BMI does not accurately represent a person’s body fat percentage. Yet another warning that people largely ignored.

Changes in the BMI Categories

In 1985, the National Institutes of Health (NIH) published a paper summarizing their Panel’s definition of “obesity” and its health implications. The NIH grouped “overweight” and “obese” together as a BMIs ≥ 27.8 for men and ≥ 27.3 for women.

Then in 1998, the NIH once again changed the definitions, not only differentiating between “overweight” and obese”, but also significantly lowering the cutoff to be medically considered fat. Now, for both men and women, a BMI greater than 25.0 is considered “overweight” and a BMI over 30.0 is “obese.” An estimated 29 million people went to sleep “normal” one day and woke up “overweight” the next day.

CNN summarized it well when they reported that “Millions of Americans became ‘fat’ [that] Wednesday — even if they didn’t gain a pound — as the federal government adopted a controversial method for determining who is considered overweight.”

Flaws with Using BMI

It Doesn’t Really Tell Us About Fatness

One of the most obvious flaws with the BMI is that, as Keys et al. admitted (even while supporting its use), BMI doesn’t actually measure body fat. This where the NIH definition I mentioned earlier isn’t quite accurate. The calculations make no allowance for muscle mass, bone density, and other factors that can highly influence a person’s weight.

For example, a person with higher muscle mass, such as an athlete, will have a higher weight even compared to someone with the same amount of body fat who has a lower muscle mass. Same for bone density. Also, even some who support the use of BMI are calling for the formula to be changed, criticizing the current formula for what they believe is a tendency to exaggerate thinness in short people and fatness in tall people.

It Doesn’t Really Tell Us About Health

First, let’s keep in mind that the data used to create the BMI scale were based primarily on Caucasian men. Why does that matter?

Well, because people of different sexes, ethnicities, ages, etc. are… well, different. It’s overly simplistic and rather ignorant to assume that a white man is the same as an Asian women. I would think the failings of a one-size-fits-all approach would be pretty obvious, especially given our current concern about diversity, but apparently not.

For example, on average, women have a higher percentage of body fat in relation to total weight than men do, but this does not necessarily mean more health risks. Studies published by the Endocrine Society indicate that because black people tend to have heavier bones and therefore weigh more than white people, the BMI overestimates fatness and health risks for black individuals. And on the other end of the spectrum, according to the WHO, the BMI underestimates health risks for Asian communities, which may contribute to underdiagnosis of certain conditions.

Is BMI Valid?

So Does Being at a Higher BMI Mean You’re Unhealthy or At-Risk for Diseases?

Not necessarily. First, let’s take a look at the supposedly-indisputable evidence that being at a higher BMI is bad for your health.

A Closer Look at the Research that Says Being “Overweight” is Bad

As I covered in a previous post, Can You Be Fat and Healthy?, while there is research that associates higher BMIs with certain health conditions, we don’t really know that higher weight causes those conditions. I’ll say it again and again: correlation does not equal causation.

Even the previously-mentioned NIH paper (1985) defining and vilifying “obesity” states that: “The distribution of fat deposits may be a better predictor of mortality than BMI.” And my personal favorite: “The mortality and morbidity related risks of obesity are influenced by concurrent risk factors such as smoking.”

Well yeah, of course it is. That sounds like a complete ‘duh’ statement, but I don’t think it is considering the disproportionate amount of attention that’s placed on weight. And smoking as a confounding factor is just the tip of the iceberg. There are a lot of factors that are considered determinants of health. Some of those factors include:

  • Genetics
  • Age
  • Sex
  • Ethnicity
  • Activity level
  • Stress levels
  • Mental health
  • Sleep quantity and quality
  • Personal behavior, such as sexual activity and even things like handwashing and oral hygiene
  • Amount of social support and social interactions
  • Socioeconomic conditions, such as poverty
  • Access to medical care
  • Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods
  • Alcohol, cigarette, and other drug use
  • Traumatic experiences
  • Social norms and attitudes, such as experiencing discrimination
  • Exposure to crime, violence, and social disorder
  • Environment, such as the presence of trash
  • Exposure to toxic substances and other physical hazards

This isn’t an exhaustive list, but hopefully you can see even considering just these factors, it’s incredibly difficult in research to account for all the possible variables. Much of the research about “obesity” doesn’t level the playing field by making sure all these things aren’t influencing the data negatively toward people with higher BMIs.

For example, a study found that people in the U.S. who live in the most poverty-dense counties are those most prone to being at an “obese” BMI—it showed “obesity” rates to be 145% greater than affluent counties. Now, we know that poverty reduces life expectancy and quality of life, and increases the risk for a number of health issues. Other studies have indicated that socioeconomic factors were found to be the most important predictors of death by all causes.

And yet, we’ve downplayed the poverty issue (along with all the other confounding factors) and have decided weight is the main issue when it comes to health. Based on the U.S. Census Bureau’s 2017 estimates, there are an estimated 39.7 million Americans living in poverty. If we truly care about health, perhaps our efforts would be much better spent on the “war on poverty” instead of “obesity.”

There is another issue with some of the studies that seemingly indicate being “obese” is bad for your health. Let’s consider what researchers often consider “healthy” from a metabolic standpoint (because there’s no standard definition, it can be a bit subjective). Typically, it would be individuals who exhibit good health markers such as appropriate levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol and blood pressure without the use of medications. So the question is… can thin people be “unhealthy” and fat people be “healthy” according to these types of metabolic markers?

Yes, absolutely.

But too often in studies that (supposedly) show “healthy obese” people are still at higher risk for disease and death, the “healthy obese” people are defined as individuals who have no more than 1 metabolic risk factor—hypertension (high blood pressure), for instance. That is problematic because hypertension alone increases the risk of death.

Do you see how misleading that is? The results seem compelling until you look closer and realize the “healthy obese” people weren’t actually healthy to begin with so their conclusion is inherently flawed.

A Look at the Research that Says Being “Overweight” Can be Okay, Sometimes Even Healthy

Contrary to popular belief, the studies associating higher BMIs with negative outcomes aren’t the only research on the topic. There are, in fact, a number of studies indicating being “overweight” is a protective factor for many health issues, meaning that for who people do get a certain condition, they are less likely to die from it if they are at a higher BMI. This phenomenon is referred to as “reverse epidemiology” or the “obesity paradox”.

For example, “obesity” has been associated with improved survival in patients with certain types of cancers as well as some chronic diseases, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), chronic kidney disease, and more.

A landmark study by Flegal et al. revealed that compared to being at a “normal” weight, “overweight” is associated with lower death rates by all causes. Unless you’re already into the Health At Every Size® (HAES) movement, you likely have never heard about that research. It doesn’t exactly fit into our normal fear-mongering paradigm about weight.

Though this study did account for some confounding variables such as smoking and pre-existing illness, this research has been criticized by some as not accounting for other variables. I think they did a pretty good job on that level, but again, we have to acknowledge how complex all the variables are when it comes to studies on health and the difficulty in isolating the one variable being studied. So perhaps there’s validity to that argument. But you have to admit the irony of such criticism. These critics are applying a standard of scientific rigor only to the research they want to discredit, while blatantly ignoring the same issues in the research supporting their preconceived ideas.

In 2018, researchers at York University’s Faculty of Health published a study comparing several groups, including individuals who were:

  • “obese” with no metabolic risk factors
  • “obese” with a metabolic risk factor
  • “normal” weight with no metabolic risk factors
  • “normal” weight with a metabolic risk factor

This is a more fair comparison than other research with “healthy obese” people who weren’t actually healthy. The conclusion of this study was that “obese” people with no metabolic risk factors do not have an increased rate of mortality over “normal” weight people without risk factors:

“We found that a person of normal weight with no other metabolic risk factors is just as likely to die as the person with obesity and no other risk factors…This means that hundreds of thousands of people in North America alone with metabolically healthy obesity will be told to lose weight when it’s questionable how much benefit they’ll actually receive.”

Final Thoughts…

Sadly, though our culture prides itself on being science-based, a whole segment of the research on weight and health is completely ignored while the other segment of the research is misinterpreted. Then those misinterpretations are treated as indisputable.

That’s how powerful and destructive fat bias is. It’s bad enough that we’ve marginalized fat people in the beauty industry, but now we also do it in the LAST places it should ever happen—in science and medicine.

This is not okay. Weight stigma is making people sick and even killing people through physical and mental illnesses. Taking the time to educate yourself about the Health at Every Size and body acceptance movements is a great place to start if you haven’t already.

Please reach out to me if there’s anything I can do to help you in your journey. May we all be better people tomorrow than we are today.

Much love,
Cherie signature

Sources
https://www.psychologytoday.com/us/blog/the-gravity-weight/201603/adolphe-quetelet-and-the-evolution-body-mass-index-bmi
https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb
https://frac.org/obesity-health
Semega, J; Fontenot, KR; Kollar, MA. Income and Poverty in the United States: 2017. Census Bureau, September 2018.
Levine J. A. (2011). Poverty and obesity in the U.S. Diabetes, 60(11), 2667–2668. https://doi.org/10.2337/db11-1118
Health Implications of Obesity. NIH Consens Statement Online 1985 Feb 11-13; 5(9):1-7.
Robert J Kuczmarski, Katherine M Flegal, Criteria for definition of overweight in transition: background and recommendations for the United States, The American Journal of Clinical Nutrition, Volume 72, Issue 5, November 2000, Pages 1074–1081, https://doi.org/10.1093/ajcn/72.5.1074
Wang Z, Liu M, Pan T, et al. . Lower mortality associated with overweight in the U.S. National health interview surveyMedicine 2016;95:e2424–e24. 10.1097/MD.0000000000002424
Melaku, Y. A., Gill, T. K., Appleton, S. L., Hill, C., Boyd, M. A., & Adams, R. J. (2019). Sociodemographic, lifestyle and metabolic predictors of all-cause mortality in a cohort of community-dwelling population: an 18-year follow-up of the North West Adelaide Health Study. BMJ open9(8), e030079. https://doi.org/10.1136/bmjopen-2019-030079
Hu FB. Obesity Epidemiology. Oxford University Press; New York: 2008.
York University. (2018, July 12). Obesity alone does not increase risk of death: New study could change the way we think about obesity and health. ScienceDaily. Retrieved June 18, 2020 from http://www.sciencedaily.com/releases/2018/07/180712114440.htm

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Is Full Eating Disorder Recovery Possible?

Is Eating Disoder Recovery Possible

Sometimes clients will ask me if I believe full eating disorder recovery is possible. This is such an understandable question given how difficult recovery is and, for some clients, how long they have been struggling. It’s not uncommon for eating disorder treatment to last years, and sometimes include repeated periods of being in a higher level of care.

Even with all those challenges, my answer to whether full eating disorder recovery is possible is YES.

I believe that because I’ve lived it myself and seen others recover too. And all of us questioned whether it was possible. It felt too hard at times. It was too messy, and we slipped up a lot. And it took much longer than we thought it should, much longer than we wanted it to.

Friend, I promise that is just the reality of eating disorder recovery and none of those things is evidence that you can’t do it.

What about “recovered” versus “recovering”?

There is some debate in the eating disorder community about whether people can be fully recovered without intentional maintenance or whether it is more like always being in recovery… that is, having to intentionally maintain being free of the eating disorder. Many alcoholics describe themselves as being in recovery, even years after they have stopped drinking. It implies a sense of fragility to recovery, as if losing that recovery is always a near possibility. I’ve found this thinking to be common in the 12-step communities.

I personally believe that full recovery without having to intentionally maintain it is possible. That is my experience and the experience of many others I’ve seen. However, I would never minimize the experiences of those who describe themselves in a state of recovery. I certainly have no right to tell them they are wrong. Yet I can’t help but wonder if those people just have settled for a state of qausi-recovery (a topic I’ll write about soon). It’s possible that they haven’t fully healed their relationship with food and their bodies, even though they are free of actual eating disorder behaviors. In the alcohol recovery world, that’s called being a dry drunk.

I have found qausi-recovery to be a very common experience for many people with eating disorders, so if that’s where you find yourself, you’re completely normal in that regard too. It doesn’t mean you’ve failed or can’t do it, it just means there are still some things to work on, things that still need healing. I was in qausi-recovery for 8 years so I know about that in-between place quite well. But against all odds, here I am, now completely recovered.

You can have full recovery too. Just don’t give up.

Please reach out to me if there’s anything I can do to help you in your journey. If you’re ready to start therapy with me, you can schedule an appointment online.

Much love,
Cherie signature

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Eating Disorder Treatment

Eating Disorder Treatment

Deciding what level of care you need or your loved one needs can be daunting. Today I will give an overview of the five levels of care that are available for eating disorder treatment and describe the type of person who would be a good fit for each level. If you’re still not sure which is right for you, please reach out to me so we can talk about it.

When deciding what level of care is needed, several factors should be considered. Historically, weight was the main determinant, but thankfully, we are slowly moving away from that approach. Now, most treatment providers and insurance companies take into account your overall physical condition, psychology, eating disorder behaviors, and other factors. The American Psychological Association (APA) provides suggested criteria for each level of eating disorder treatment. These criteria include:

  • Medical status
  • Suicidality
  • Weight (as a percentage of healthy body weight)
  • Motivation to recover, including cooperativeness, insight, and ability to control obsessive thoughts
  • Co-occurring disorders, including substance use, depression, and anxiety
  • Structure is needed for eating and gaining weight
  • Ability to control compulsive exercising

Let’s take a look a the levels of eating disorder treatment and how the APA’s guidelines apply to each of them.

Level One: Outpatient: Outpatient treatment includes individual sessions with a therapist and/or dietitian, typically once or twice a week. Outpatient treatment typically last for months to years, and can sometimes include periods of being in a higher level of care. Also, sometimes outpatient care can include group therapy. Outpatient eating disorder treatment is likely right for you if you:

  • are medically stable
  • have at least some motivation for recovery
  • can implement some structure on your own regarding meals
  • are able to at times limit your eating disorder behaviors, including compulsive exercise
  • are not suicidal with a plan or intent to harm yourself

Level Two: Intensive Outpatient Programs (IOP): IOPs usually include about three hours of programming for at least two to three days a week. At this level of care, you would live at home and could probably still work or go to school. Usually, one meal or snack takes place at the treatment center. IOP eating disorder treatment is likely right for you if you:

  • are medically stable
  • have at least some motivation for recovery
  • can implement some structure on your own regarding meals but need a bit of support/accountability
  • are able to at times limit your eating disorder behaviors, including compulsive exercise, but need a bit of support/accountability
  • are not suicidal with a plan or intent to harm yourself

Level Three: Partial Hospitalization (aka Day Programs): Partial hospitalization (PHP) is typically treatment during the day, while letting you still go home at night. PHP is usually 6 to 11 hours a day for at least five days a week, so the majority of meals are at the treatment center. PHP eating disorder treatment is likely right for you if you:

  • are medically stable
  • have some motivation for recovery but are struggling to feel motivated at times
  • need structure and support for most meals 
  • struggle to limit your eating disorder behaviors, including compulsive exercise and need quite a bit of support/accountability
  • are not suicidal with a plan or intent to harm yourself

Level Four: Residential Treatment: Residential treatment provides 24-hour care for those who are medically stable but still require round-the-clock supervision meals and behaviors. Residential treatment is typically 6 weeks or longer. This level of care is likely right for you if you are medically stable and have a/an:

  • need for supervision to eat 
  • need for supervision to not purge or use other behaviors
  • inability to stop exercising
  • lack of treatment options near home

Level Five: Inpatient Treatment: Inpatient treatment is 24-hour care in a medical hospital. This level is for individuals who are not medically stable and need round-the-clock medical assistance or monitoring (including intravenous fluids, tube feeds, and constant monitoring of vital signs). This is often a necessary level of care for individuals who do not cooperate with treatment protocols at lower levels of care. Inpatient stays can last days to weeks. This is likely the right level for you if you are not medically stable or if you have:

  • unstable heart rate or blood pressure
  • significant weight decline and/or food refusal
  • evidence of malnutrition
  • other psychiatric disorders that would require hospitalization
  • suicidal thoughts with intent to harm yourself

A quick note in case you’re asking yourself Am I Really Sick Enough for Treatment?

I hear this question all the time. Sweet friend, the answer is always “YES!”

Your eating disorder will try to convince you that you don’t need or don’t deserve help. It will whisper lies about things not being that bad, about you being able to handle it, about not looking like you even have an eating disorder…

Don’t listen to any of that or any other excuse your ED gives you. Eating disorders don’t have a “look” despite the stereotype, and people at all weighs can have an ED. And you don’t have to be at the point of needing hospitalization to be “sick enough”. Please, please don’t wait for that point to get help.

You could miss out on spending years of your life with joy and purpose instead of spending them still consumed with your ED. You could do irreparable damage to your body, or yes, even die.

Don’t believe your eating disorder. You are worthy of help and support. Today. Not sometime in the future when things get worse. TODAY.

xo.

Final Thoughts…

Again, I know it might feel overwhelming trying to figure out the right eating disorder treatment for you (or your loved one). If you’re still not sure which is right or if you need a referral to higher level of care, please reach out to me. If you’re ready to start outpatient therapy, it’s easy: schedule an appointment online.

Much love,
Cherie signature

Sources
https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients
About Cherie Miller @ Dare 2 Hope

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.