We call it the “anorexic wish:” the desire to recover from the cognitive symptoms of anorexia (like the obsessive thoughts about food and the body and weight preoccupation) without having to gain weight.

Anorexia is tricky to treat since so much about the condition can be reinforcing. Often both the dietary restriction and weight loss feel rewarding.  In the early stages of anorexia, when weight loss just begins, there may be compliments about how “good” you look or about how controlled or “healthy” your eating appears.  People may ask you for diet tips or feedback about how they can lose weight, too.  There’s often a budding identity formed around the diet and weight control efforts which provide a sense of control and mastery.  At least in the short term.  The anorexic behaviors are rarely sustainable and there’s usually a cost both in terms of a deterioration of health and with a mind that becomes totally overrun with thoughts about food and weight.

At Columbus Park eating disorder treatment center, we see many people come in exhausted by the constant chatter of the mind in relation to food and eating. While there can be mixed feelings about getting better, our patients engage in the treatment, understanding that as hard as it may be, eating is the necessary component for full recovery.  You just can’t get better from anorexia without eating and restoring lost weight.

Fearing fat is a hallmark of anorexia: fear of consuming fat and fear of getting fat.  As people with anorexia begin to recover by restoring weight sometimes – although not all the time – they will say that they “feel fat.”

Let’s talk about “feeling fat…”
Fat Distribution

First of all – and it may surprise you to hear me say this – there is some truth to your experience of feeling like your stomach is sticking out more… It’s important to understand that after being malnourished, fat cells will preferentially deposit at first around your mid-section. This is because the body knows first and foremost that your essential organs need to be protected/insulated.  So often early in recovery, people worry that the midsection is getting bigger. Rest assured, the fat accumulation redistributes over the course of a few months.  The body gets stronger under the influence of improved nutrition, so muscle development improves, and fat cells redistribute more evenly throughout the body.

Delayed Gastric Emptying

Compounding the “feeling fat” experience is a condition called delayed gastric emptying that is very common in anorexia. With prolonged food restriction (as in anorexia), there’s a decrease in function of the muscles that line the stomach, so food is pushed through the stomach to the small intestines at a slower pace.  The food just sits longer in the stomach which can lead to pain, nausea, bloating, gas and a premature feeling of fullness when eating.  So you’re actually not imagining it: your stomach IS distended since the food is sort of stuck in there churning. What’s essential to know is that this doesn’t go on indefinitely. Over several weeks the stomach adjusts and heals and begins to function more normally. Bloating, pain, nausea and gas subside.

So feeling fat in some way may be based on very real but unavoidable changes in your body as it returns to health. There is no way around it unfortunately.  The most important thing it so to continue to push through.

Distorted Body Image

Even though there are some very real factors that contribute to actually seeing your belly sticking out a bit during recovery… it’s worth noting that in general, people with anorexia are not great at accurately judging their own body weight and shape. The patients we see who focus most on their perceived “fatness” tend to be those in the earliest stages of recovery and still have skeletal frames; essentially, they look critically ill and there isn’t a planet where they would be viewed as fat. So it is a brain based, colossal distortion of reality that occurs when the body and brain are starved.  This distortion is actually caused by disruptions in the circuitry of the brain that may already exist before the onset of anorexia but that worsen under the influence of starvation.  Without pulling you too much into the weeds with the science of brain function, the bottom line is that in anorexia there is an inherent distortion in how one sees oneself and it’s highly likely that one will see themselves as “fat.”

As brain function is restored via nutrition, we know that perception begins to normalize. This shift happens slowly so “fat” feelings can endure for several months after weight restoration as the cognitive healing catches up with the physical healing.

So how can you continue to do what it takes to recover from anorexia even when you “feel fat.” A few tips:

 

You’ve heard this before: Fat is not a feeling.  You cannot “be” fat.  You can “have” fat.  So remember that you are a person and that the number of fat cells on your body cannot define you.

To some extent, we all check out our bodies but individuals who struggle with eating disorders tend to do so much more often.  The checking becoming a habitual pattern that fuels body dissatisfaction. When you check your body frequently, you tend to zero in on the parts of your body you view as flawed.  This kind of scrutiny intensifies dissatisfaction; it’s as if your placing your perceived flaws under a magnifying glass and in doing so, you’re completely disregarding other parts of yourself that you might see as attractive.

 

It’s important to recognize the triggers to feeling fat.  Some of the common ones to be aware of:
  • Body checking, again, is a common trigger to feelings of dissatisfaction.
  • After eating when the stomach may be distended and we feel full, it’s more likely to “feel fat.”  Try to keep in mind that your stomach is full and may be sticking out but this does not mean that you’ve gotten bigger overall. Getting “fatter” from one meal is simply impossible.
  • Emotional triggers: feeling lonely, sad, bored, unsettled, anxiety can prompt you to default to thinking about your body as the core issue. When under the influence of unpleasant feelings, it’s not uncommon to “distract” oneself with the very familiar “I’m fat” story and then proceed to problem solve how you’re going to make yourself “unfat” via recommitment to dieting, exercise etc.  This is such a common process: using food and weight as a means to avoid and/or resolve uncomfortable feelings.
  • Physically feeling full, bloated, hot, sweaty, or feeling the pressure of tight clothes can be triggers to feeling fat.  It’s important to check in with yourself to see if any of these factors may be influencing how you feel about or see yourself.
Body Image

Body image work is a central part of any treatment for anorexia but typically is reserved for later stages of the treatment process once weight is restored and the brain is fueled to function optimally (and therefore in a place to fully benefit from body image interventions).  In the meantime, the work during recovery is focused less on changing how you evaluate yourself but more on simply helping you cope with the feelings that come up around eating and restoring weight.  So there’s a lot of work on developing skills to tolerate, distract and stay forward moving even if you’re feeling scared… and/or “fat.”

If you’re struggling with negative body image or preoccupied with food and eating, it’s so important to get help. Call Columbus Park so we can guide you in the right direction for the support you deserve.