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.

Is Noom a Diet? An Inside Look into Noom

By now, you’ve probably seen an ad for Noom because they seem to be everywhere. They’re intriguing to many because they claim to be different than other weight-loss programs, largely in part due to having “psychology” element and also for not involving dieting. When I saw they were offering a free trial, I decided to sign up and check it out to see what it’s really all about. Now that I’ve had an inside look, I want pull back the curtain for you so you can see for yourself how accurate these claims are:

“Noom helps you build healthier habits to lose weight—no dieting needed!”
“Noom: Stop dieting. Get life-long results.”

Here we go 🙂

First, what IS a diet?

To be clear about what a diet actually is, here’s a definition from the Encyclopedia Britannica:

Dieting is regulating one’s food intake for the purpose of improving one’s physical condition, especially for the purpose of reducing obesity, or what is conceived to be excess body fat.

This “food regulation” can take on several forms, including reducing overall food consumed or cutting out specific foods.

So does Noom do those? Yes. And sorta yes.

Cutting Calories

The whole program is built on reducing calories. That’s really not so new, is it? That diet approach has been around for ages! How it works is you say what your goal weight is and if you want to go slow, medium or fast to get to that goal. Then they calculate how long it will take you to get there and give you a daily “calorie budget”. You don’t have to count the calories yourself, but you do have to log everything you eat and their program calculates it for you.

To be honest, my calorie budget was suitable for a toddler. Not a grown woman. Definitely not a woman who is nursing (which was never asked about in the assessment questions, by the way). I blew through my calorie budget by the afternoon. Of course, I wasn’t actually trying to stay within my allowance. To do so would mean eating less and/or choosing different foods (again, the very definition of a diet, amiright?)

Cutting Out Specific Foods

Now, they say that there are no “good” and “bad” foods and you can eat anything. Sounds great! Except that every food you log is coded in a color chart: green foods are thumbs up while yellow and red food should be “limited.” So, I guess technically there’s no cutting out certain foods. But color coding foods and saying some should be limited sure sounds like categorizing foods into good and bad categories. And it sure sounds like a way to make people feel bad about the foods in the red category.

“Get Life-long Results”

This is just a totally baseless claim to make. Their marketing claims that 77% of people lost weight and kept it off for nine months. First off, nine months is nothing in terms of a lifetime. Like every other diet, there is no evidence that it works long-term (meaning 5+ years). Weight loss research typically follows people one year or less, which isn’t a very long time considering most people aren’t interested in losing weight just to gain it back after 12-24 months. That kind of weight cycling is also incredibly bad for your health. (Check out this post to read about the negative health impact of yo-yo dieting.).

Additionally, that 77% success rate they tout is a bit misleading if you don’t know exactly what’s include… or in this case, left out. The study they used was by Chin et al (2016), which looked at data from about 36,000 people who used the app between October 2012 and April 2014. As clinical psychologist Alexis Conason Psy.D. explains:

At the time the study was written, the authors reported that over 10 million people had downloaded the app. However, the study only included people who used the app consistently for six months or more. In other words, the study only included the most successful users. Think about it: If you start a program, use it for a while, and it doesn’t work, what would you do? Would you continue paying each month for a service that isn’t delivering on its promises? No, if you are like most people, you would stop the program. And that is exactly what over 99% of Noom users did.

So, keeping in mind that this study is only looking at the 0.36% of Noom users (out of the 10 million people who downloaded the app) who stuck with the plan for six months of more, let’s see what they found. While actively using the app, over 30% of these users lost less than 5% of their weight. About 24% of users lost 10% of their weight and 22% lost more than 20%. That’s what happened in the short term, when participants were consistently engaging with the app.

At follow-up less than one year after starting the program, researchers had data on 15,376 of these participants (more than half of the sample was excluded due to missing data) and found that less than 10% of participants had lost and maintained 5-10% of their weight. Additionally 11% had already regained whatever weight they initially lost.

But because the millions of people who didn’t keep using the app weren’t even included in this particular study, the conclusion was that 77% lost weight while using the app—again, the stat Noom widely uses in their marketing. It’s actually pretty deceptive once you understand how that number was derived, isn’t it? As Conason puts it, “I guess it sounds better than 86% of users failed our program within a year. Or 99% of people couldn’t stick with our plan for six months.”

Other Concerns About Noom

Here are some other issues I have with Noom:

  • They don’t flag unhealthy goal weights. Of course, I think part of the problem with these programs and our weight-loss obsession in general is that a person’s healthy weight might be higher than what our culture considers a healthy weight. But that aside, I purposely set my goal weight to be low enough that it would be considered clinically underweight according to BMI. (Yes, I think BMI is horse manure but that’s a fun discussion for another time.) You should know that while the research on the dangers of being fat is questionable, the research about the dangers of being underweight is not. Being underweight is very dangerous medically. Setting an underweight goal should have been a big red flag for Noom. But the system didn’t flag anything and my “goal specialist” didn’t seem concerned. Yikes.
  • They expect daily weigh-ins. Now, I’m against weighing in general, but even if you do weigh, can we agree that doing so every day is excessive?
  • They encourage you to eat foods with more water in them so you get filled up on fewer calories. “Eat and drink more water” is a classic dieting and eating disorder tactic. Does it work in the short term? Sure, it can. Does it work in the long term? No, because no dieting hack does. I only did the app for one day, so there’s no telling what other dieting hacks they would have tried to push.
  • It doesn’t necessarily promote health like they claim. The kind of restriction they are promoting might be so extreme for some people, it would be incredibly not healthy physically, regardless of their current weight. Contrary to popular belief, people in larger bodies can be malnourished. And again, they didn’t care at all that my goal weight was clinically underweight.
  • They don’t screen for eating disorders. I have a huge problem with this, because they claim to be about health. Well, health includes mental health, people. Especially considering eating disorders have the highest mortality rate of all mental illnesses.

Final Thoughts…

Anytime someone is claiming to not be a diet, but wants you reduce calories or eliminate foods, see it for what it is: nothing more than a re-packaged diet. Companies and influencers know that dieting isn’t really en vogue anymore like it was in the 90’s, so now they try to pass diets off as “wellness” and “lifestyle changes” instead. We think we’ve shifted away from weight loss to being healthy… but we haven’t really.

If you’re stuck in chronic dieting or an eating disorder, I’d love to help! Please contact me or schedule an appointment online.

Much love,
Cherie signature

Sources
https://www.google.com/search?q=noom&oq=noom&aqs=chrome..69i57j69i60j69i61l3j69i60.2044j0j7&sourceid=chrome&ie=UTF-8
https://www.britannica.com/science/dieting
https://www.psychologytoday.com/us/blog/eating-mindfully/202005/is-noom-diet
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.

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#ScrewYourBeautyStandards

We are not born disliking our bodies. We are innocent in our self-acceptance until we learn there is a “right” way to look. After that, we evaluate ourselves against whatever ideal we are taught because it is our nature to compare. If we are fortunate, we will grow up in a family that values inner qualities over appearance. Sometimes that can protect us from internalizing the broader culture’s narrow beauty ideal. But it’s difficult to stay immune to all the messages from everywhere else… the teasing from kids at school… the magazine covers with Photoshopped images… the TV commercials pushing their weight-loss products…

And some are not fortunate enough to grow up in families where beauty is recognized in a diversity of shapes, sizes and colors. For too many, the pain starts at home and family opens the first wounds, which are only deepened by peers and the media.

Seemingly from all corners, the message is clear: We aren’t good enough. Not T-H-I-N enough.

Because thin = good and we so reason, therefore, fat must = bad, right? Some will even directly say that it is.

I used to buy into all of it, like so many do. I hated my body long before I developed an eating disorder, and it laid the foundation for me to go down that path. I was so desperate to lose weight, to be accepted, to feel okay for once. I was so mad at myself for not being thin like my friends and the pretty girls I saw in the media.

Thankfully, now I’m recovered—from both my eating disorder and my body hatred. But I’m still angry. I’m angry that we live in a culture that works so dang hard to make us feel bad about ourselves. You can’t go a day without seeing advertisements for products related to weight loss, makeup, hair dye, eye creams, tummy-control pants, and on and on and on. If you don’t feel pretty, thin, or young enough, then they promise to change that if you’re willing to spend enough time and money.

And I mean lots of money. Beauty is a $532 billion industry and is expected to just keep growing. The problem is that every commercial you see isn’t simply trying to sell you something; first, it tries to convince you that you need what they’re selling. It plays on, sometimes even creates, insecurities. The subtle goal is for you to feel bad about yourself so that you’ll then want to buy something that will (supposedly) make you feel more confident.

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While common sense likely tells us that we’re influenced by the media, it never hurts to have some research to back that up—which of course, it does. Indeed, research shows that media influence can lead children and adolescents to internalize ideals imposed by society, which also increases the probability that they will suffer from issues like body dysmorphia and eating disorders. Studies suggest this can start as young as six years old, if not even earlier. We’re talking Kindergarteners, maybe younger!

That makes me angry for every little girl that is harmed by these messages poured into her about her value and what she is supposed to be. I hope that like I have, you’ll learn to turn that anger and disgust that you direct at yourself for not being what you “should” be, and you’ll start getting angry at the diet and beauty cultures instead. Not because makeup is evil or dyeing your hair is inherently bad, but because being sold the idea that you can’t feel good about yourself without those things is wrong. Being told we have to be a certain BMI to be attractive and worthwhile is beyond shallow—it’s destructive and sick, and I will never stop fighting for a better world for my son and daughter.

If you’d like to talk about how to get break free from these destructive cultural messages and finally accept yourself as you are, please contact me about a teletherapy appointment or follow me on Instagram or Facebook.

Much love,
Cherie signature

Sources
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.572.7007&rep=rep1&type=pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540021/

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, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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A Potential Flaw in Positive Thinking Psychology

Dare 2 Hope_thoughts

Photo Credit: ileanaandrei.ro

There’s a lot of talk these days about positive thinking and how important it is to change your thinking to improve your health and happiness. And while I won’t argue that our mindset affects our feelings and behavior (because I believe it absolutely does), I am concerned that we can put too much emphasis on thinking. That’s a big statement for a Cognitive Behavioral Therapy (CBT) therapist to make! But here’s the balance that I would like to bring to the discussion: Though highly influential, thoughts are not an all-powerful force in our lives.

There are potential drawbacks to believing that everything we think affects our behavior. So even while we acknowledge the significance of our thoughts and strive to have healthier, more constructive thinking patterns, let’s also recognize some limitations of our thoughts. For example, thoughts…

  • do not always reflect what we really believe, feel or want.
  • do not always mean we will act on whatever that thought is.
  • do not always reflect reality.

Let’s take a closer look at why each of these points is relevant.

#1. Thoughts do not always reflect what we really believe, feel or want. We all have had bizarre, maybe even dark thoughts that pop into our heads at times—that is a normal part of being human. It does not mean you are “crazy” or a bad person. Some people struggle with these types of thoughts more than others, particularly people with issues like anxiety, obsessive-compulsive disorder, or postpartum depression. On the extreme end, I’ve had clients who had intrusive thoughts about things like stabbing their spouses or molesting their child (even though they had no reason or desire to do such things), and they worried it meant there was something evil inside of them. Being bothered by your thoughts is a sign that they don’t reflect your wants or values. In cases like these that go beyond the “normal” occasional bizarre thoughts we all have, there are often biological causes for these thoughts. There is sometimes trauma in that person’s past that can be influencing these thoughts.

#2. Thoughts do not always mean we will act on whatever that thought is. Thoughts do not automatically manifest into behavior. None of my clients who had bizarre, or even violent, intrusive thoughts ever acted on them because that is not who they were.

Now, sometimes our thoughts do line up with our feelings and that makes it more likely we will act on them, but it doesn’t mean we have to. This is key for my clients in eating disorder recovery, who might have obsessive thoughts about not eating or about thinking they are fat (and also feeling fat). Though it can be incredibly difficult, they can choose not to act on those thoughts. In her book, Life without Ed, Jenni Shaefer describes it as “disobeying” the eating disorder. We can have thoughts and feelings about harming ourselves and decide to call a friend instead. A tape can play in our head about how that big presentation at work will be a flop, but then it turns out we nail it.

#3. Thoughts do not always reflect reality. Thoughts, like feelings, are not facts. Research confirms that much of what we worry about doesn’t even happen.¹ And just because we think something doesn’t make it true. We can think we’re ugly and actually be attractive. We can think we’re an idiot and be very intelligent. We can think we are boring and socially awkward while in reality, people find us engaging and pleasant to be around. The stories we tell ourselves are just that: stories. And sometimes stories are only partially true or sometimes they are completely false.

It is really, really good news that while we work on changing detrimental thoughts, we are not completely at their mercy until they change or go away. We can still choose to ignore or to act opposite of our thoughts when they aren’t healthy. Remember friends, we are not just thoughts… we also have a will and a conscience and many other elements that make up who we are and drive what we do.

Much love,
Cherie Signature

¹References: “85 Percent of What We Worry About Never Happens” By Don Joseph Goewey (www.huffingtonpost.com/don-joseph-goewey-/85-of-what-we-worry-about_b_8028368.html)

About Cherie Miller @ Dare 2 Hope
Cherie Miller, MS, LPC opened Dare 2 Hope Counseling to help clients all over the country get free from their food, weight, and self-confidence struggles. Her specialty is eating disorders, including anorexia, bulimia, binge-eating, orthorexia and other unhealthy eating patterns. Contact her here.

When Recovery Is One More Way to Beat Yourself Up

Dare 2 Hope_discouraged

Most people with eating disorders struggle with perfectionism… and that certainly includes how they approach the recovery process. Is that you? Do you hold perfectionist standards for what recovery should look like and how long it should last? These standards are based less on the reality of recovery and more on the unhealthy expectations of yourself that contributed to the eating disorder in the first place. There is no room for error, little compassion for oneself, and the notion that recovery should be relatively quick once the decision is made to get better.

But dear one, that approach to recovery will leave you feeling like a failure because unrealistic expectations are always a set-up for failure. Recovery is worth it, yes, but no doubt about it, it is also messy and hard. And it always takes longer than we want it to. Going into the process accepting these things can help you avoid feeling discouraged or giving up entirely. So let’s create some new rules for recovery that are more compassionate, realistic, and ultimately, helpful. Here were my 5 rules for recovery when I was in it. I’ve seen clients come up with some amazing others. Make your own list and read them whenever you’re feeling frustrated with yourself about recovery.

My 5 Rules of Eating Disorder Recovery

1) I will not rush recovery. I will give myself whatever time I need to heal properly and wholly. And I will not be angry with myself for how long it takes.

2) I will not expect healing to be a straight path. There are going to be bad days and setbacks and temptations to give up. But I will keep going and will not let recovery be just one more area in my life where I demand perfection from myself.

3) I will not make excuses; I will take responsibility for my thoughts, feelings, and behaviors.

4) I will say my affirmations out loud every day, even if I don’t believe them. Even if it feels stupid or weird.

5) I will not listen to the inner terrorist, and I will challenge her lies with Truth.

I’d love to hear some of the ones you’d put on your list!

Much love,
Cherie Signature

About Cherie Miller @ Dare 2 Hope
Cherie Miller, MS, LPC opened Dare 2 Hope Counseling to help clients all over the country get free from their food, weight, and self-confidence struggles. Her specialty is eating disorders, including anorexia, bulimia, binge-eating, orthorexia and other unhealthy eating patterns. Contact her here.

How to Love a Porcupine

Dare2Hope_Hug a Porcupine

At an eating disorder support group I led recently, a mom said the one “gift” her daughter could give her was to try and recover from her anorexia. She was struggling with understanding how her daughter could see the damage her eating disorder was doing to their family and still refuse to even try recovery. Without saying these exact words, I believe her feelings were akin to, “If you loved me, you would stop.”

Anyone who has been in a relationship with someone with an eating disorder or substance addiction can probably relate to that. In your head, you might know it has nothing to do with you, but it feels like it does. And often, when you push people to get better before they are ready, they will act in pretty unloving ways to defend themselves. It can be be like trying to hug a porcupine…the more you try to help, the more you get hurt. This frustrating cycle usually leads to feelings of resentment and maybe even pretty strong anger—on both sides.  So how do you get out of the cycle without giving up on the other person? Here are some tips on how to love a porcupine (i.e. someone not ready to recover).

#1. Realize how difficult it is to even choose recovery, much less walk through it. Another girl in the group who has an eating disorder told that mom that her own mother had expressed similar things to her in the past before she started into recovery. “I love my mom so much. I felt like I would do anything for her… but she was literally asking me to do the one thing I couldn’t do at the time.” This brave young woman went on to explain that the fear was overwhelming, even to the point of overwhelming her love for others. “I was absolutely terrified at the thought of treatment and gaining weight.”

#2. Be a learner. Unless you have an eating disorder, you can never fully understand what it is like to have one, but you can educate yourself to become more sensitive and knowledgeable. There are a lot of books on the subject (see recommended reading at the end), online resources like NEDA and ANAD, and possibly some support groups local to you. If your loved one is willing to share about their experience, that is of course, an ideal place to learn. Eating disorders by nature tend to be surrounded by secrecy and shame, but there are things you can to make it more or less likely he or she will open up. Which leads to #3…

#3. Work on being a safe person. As you learn more about eating disorders, you’ll be more attune to things that could be detrimental for your loved one. Even with the best of intentions, people often say or suggest things that are triggering or insulting. Oversimplifying their struggles by telling them to just eat or to just stop throwing up, assuring them they look great, or suggesting diet plans are examples of common but counter-productive attempts to help.

In general, taking a non-judgmental approach that doesn’t shame, scold, or criticize the other person is more likely to foster open communication. Assure him or her that you want to understand better than you do now and that you’re ready to listen… and then really listen. At times, it will be appropriate to encourage them to get help, but if you jump to that too quickly, the other person is more often than not going to feel misunderstood. Check out this article from NEDA for more detailed tips on talking to a loved one about his or her eating disorder.

#4. Draw appropriate boundaries. This is a tricky one that could probably be its own blog post. Basically, you have to figure out where the line is between supporting someone and not trying to control them. Trying to control others doesn’t usually work and can even make them more resistant to change (thanks to that rebellious nature in all of us). For example, unless they’ve asked you to provide some accountability, comments about what they are or are not eating will likely backfire. Pushing someone to recover before they’re ready usually means recovery won’t be successful, even if they appear to be going through the motions. The person’s own motivation is key.

There are some exceptions to these principles. One is in cases where the eating disorder is so severe that medical care is necessary and then yes, intervention could mean life or death. If you’re not sure whether you’re in such a situation, talk to a medical doctor or therapist who is familiar with eating disorders.

The other exception is if you are the parent of a child or teenager. Naturally, your boundaries with that person are already different because they are under your care and you are responsible for their physical and emotional well-being. In that case, I believe forcing a child into treatment might make sense. But keep in mind the same caveat about personal motivation applies… recovery won’t happen until that person, regardless of age, decides for themselves to really try.

Following all these steps won’t guarantee you don’t get “poked” while trying to help. Believe it or not, people with eating disorders feel like they have a lot of reasons to stay sick and the thought of recovery can be, as that young woman said, absolutely terrifying. The fear and shame that accompany eating disorders make recovery hard to consider. Take care of yourself and resist the temptation to take on “fixing” them. Offer patience, support, and honesty, and by all means, seek out help and support for yourself! It’s not easy to love a porcupine.

Much love,
Cherie Signature

Recommended Reading:

Brave Girl Eating

Surviving an Eating Disorder: Strategies for Family and Friends

Life Without Ed

About Cherie Miller @ Dare 2 Hope
Cherie Miller, MS, LPC opened Dare 2 Hope Counseling to help clients all over the country get free from their food, weight, and self-confidence struggles. Her specialty is eating disorders, including anorexia, bulimia, binge-eating, orthorexia and other unhealthy eating patterns. Contact her here.

I Want to Be Happier… Now What?

Dare2Hope_Work of Art

Image credit: Daniel Posthuma on unsplash.com.

Last post, I talked about how becoming happier starts with a decision to choose happiness. Maybe it sounds lame and you’re thinking, who wouldn’t choose to be happy? But there are a lot of reasons we choose to be miserable instead… denying responsibility, side-stepping the discomfort of change, avoiding the anxiety of the unknown, being unwilling to make the sacrifices that might be required, etc. etc. etc.

Ok, but what if we do choose to be happy… what’s next?

Well, I wish I could give a formula, but it isn’t quite that simple. I know, I’d love a formula too! I like things very cut-and-dry. But living life isn’t like following a recipe. It’s more like creating a unique work of art, and that’s just what your life is: a work of art.

That being said, I do have some suggestions that might be helpful. Honestly, I could (and likely will at some point) do entire posts on each of these topics, but it would be overwhelming to try and cover it all here. So this 5-point list is a starting point and my best attempt at creating a “formula” for happiness.

#1. Practice Gratitude
It is easy to focus on the negative, on what is not going right and what we don’t have. It takes intentional effort to look for and focus on the positives. But doing so reminds us of all the good we take for granted and leads to more positive emotions. I agree with Melody Beattie: “Gratitude turns what we have into enough.”

#2. Create Soul Moments
Think about moments when you have felt peace or joy. Maybe it is being outside and soaking in nature, or reading a good book with a warm cup of coffee in hand. Perhaps it’s making connections with others through deep conversation, or cooking a delicious meal, or family game night and lots of laughter with your kids. Is it creating beauty through painting or planting beautiful flowers? Whether it’s playing tennis or playing Bunko (don’t worry, I won’t tell anyone), make a list of what makes you feel happy and do more of that.

#3. Release Expectations
Consider if your expectations of yourself, others, and perhaps even life, are realistic. Do you expect a toxic mother to treat you with respect and kindness? Do you expect your spouse to read your mind, or life to be fair, or you to be perfect all the time? Lowering your expectations is not always a bad thing. Sometimes it’s appropriate and incredibly freeing. Unrealistic expectations are a set-up for failure and hangover frustration, shame, or discontentment always follow.

#4. Live Your Values
What are your passions in life? For some, it’s family or friends. It might be spirituality. It could be humor, kindness, learning, service or wealth. Likely, you have a few top values and then secondary ones beneath those. But does your life reflect those values? If your highest value is family, but you’re working excessive hours, you’re not living within your values. Those long hours might be fine if your top value is wealth, but when our lives are incongruent with what is actually most important to us, we will usually feel frustrated and unhappy. Sometimes that’s unavoidable because there are bills to paid or other factors out of our control, but as much as you can take steps to bring your values and your life in parallel, the more fulfilled you will be.

#5. Take Care of Yourself
This is so common sense, but it’s completely not common. We are terrible at taking care of ourselves! Evaluate each of these areas in your own life and determine which ones need some improvement:

  • Are you getting enough rest and sleep? For most people that means at least 7-9 hours of sleep a night as well as time for relaxation.
  • Do you move your body? It doesn’t have to be 45 minutes at the gym; a 10-minute walk outside counts (and gives the extra benefit of a vitamin D boost from the sunshine!).
  • Are you eating a balanced diet and not over- or under-eating? It is impossible to feel good if we aren’t nourishing ourselves or if we are abusing our bodies with food.
  • Do you address any medical conditions with the proper care and medication? Do you even go to the doctor regularly to know if you have any medical conditions needing treatment? And yes, that includes treating mental health issues too!

Can you think of other ideas that cultivate happiness? Let me know what’s been helpful for you!

Much love,
Cherie Signature

About Cherie Miller @ Dare 2 Hope
Cherie Miller, MS, LPC opened Dare 2 Hope Counseling to help clients all over the country get free from their food, weight, and self-confidence struggles. Her specialty is eating disorders, including anorexia, bulimia, binge-eating, orthorexia and other unhealthy eating patterns. Contact her here.