From the Treatment Room: Common Questions We Hear From Anorexia Clients
Although every client is different, here are five anorexia questions we often hear from clients at Columbus Park and short responses for each one.
1. “Why can’t I stop thinking about food?”
That’s what happens when your body is starving.
Chronic food deprivation and loss of body weight results in heightened interest in food. When your body weight drops below a comfortable set point range, the brain switches into starvation mode—metabolism slows and hunger signals pick up. This focus of the starved mind on food may lead to increased interest in food preparation (often for others, not oneself), obsessive planning of meals, extending eating experiences for long periods, reading about recipes, and/or looking at photos of food. Many describe this fixation on food as persistent and profoundly distressing. Weight restoration helps reverse these effects.
2. “My weight isn’t low enough; how can I be starving?”
Your body feels starved long before you look emaciated.
The popular image of anorexia and under-eating is that of someone emaciated. While some people do get to this point, most enter starvation mode at higher weights. Each of our bodies has a set point range (usually about a 5-7 pound range) it works to maintain. Set points vary by individual—based on genetics, lifestyle, height and weight as a child, and where the body was prior to the start of the eating disorder. Once weight falls below your set point, your body enters starvation mode.
3. “Why can’t I keep exercising a lot? It makes me feel calmer.”
Yes, exercise can be relaxing, but too much can impede your recovery.
Mammals who are in areas of famine show remarkable strength and single-minded focus to migrate to areas where food is more plentiful. There is some evidence to suggest a similar effect in those with anorexia; a kind of hyper energy even in the absence of adequate food. Exercise also stimulates the production of neurochemicals which serve as natural soothers.
4. “Why can’t I limit my diet to just healthy, clean foods?”
Is it really about health?
I’m all for healthy eating – but “healthy and clean” eating often gets taken to unhealthy extremes. When clients with anorexia frame healthy, clean eating as in the service of health, I remind them that this extreme restriction and rigidity has actually had the opposite impact; it has taken them to a dangerously unhealthy place (hair loss, poor circulation in extremities, slowed heart rate, loss of periods in women, and more). These clients typically require intensive medical oversight due to their compromised health – hardly a “healthy” place. It’s not really about a pursuit of health; it’s about taking eating habits that might be considered ideal or even virtuous to an extreme.
5. “Why can’t I get better without gaining weight?”
It’s not possible. Your body and mind simply cannot recover if you remain underweight and malnourished.
The consequences of maintaining a low weight include constant thoughts about food, low energy, avoidance of social situations, isolation, poor sleep, inability to focus, and obsessing about the number on the scale. Clients sometimes want to shed those unpleasantries without actually gaining weight. It can’t be done; they are inseparable. Achieving a full and balanced life means restoring health and balance to your body. Most of our clients with anorexia notice that as they restore weight they feel better, not worse. Depression and anxiety symptoms remit along with obsessive food and body thoughts. They develop the kind of flexibility required to re-engage socially. Physically, they feel stronger, more energetic, and better able to concentrate.