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The One Rule of Eating Disorder Recovery I Don't Follow

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Finding healthcare professionals who understand your struggles and are willing to learn from your lived experiences can be life-changing. If a provider doesn’t serve you or triggers your self-destruction, you have every right to walk away.

Dear dietitian,

For about four years now, I’ve been in recovery from an eating disorder. I’ve been to two intensive treatment facilities, seen nine different therapists and have built meal plans more structured than the Egyptian pyramids. I’ve immersed my mind and soul in art therapy, psychotherapy, yoga, dialectical behavioral therapy, cognitive behavioral therapy, mindfulness courses, meditation…you name it, I’ve tried it. I’ve always followed the rules of recovery, laid out plainly for me by healthcare professionals in various stages of treatment. That is, I’ve followed all of the rules except one. Most people in eating disorder recovery will tell you: the recommended outpatient team consists of a therapist, psychiatrist and dietitian. For almost four years, I’ve flown under the radar. I see my therapist at least weekly – more when I’m having a rough time – and have done so since entering treatment in 2012. I visit my psychiatrist faithfully as we near the end of each page of the monthly calendar. But I avoid dietitians.

I can’t put my finger on exactly why seeing a dietitian feels like a chore worse than unloading the dishwasher for the millionth time. Maybe I don’t like giving up the control of my meals to a random individual. Or perhaps it’s a fear of having someone “normal” know the details and peculiarities of my eating habits. Even when I was forced to see nutritionists or dietitians in treatment centers, I struggled to open up to them. A constant worry of judgment. And a perpetual fear that their only mission was to make me fat. So maybe it’s a combination of these factors that makes me stray from dietitians more than any other healthcare professionals. Whatever the case, I decided to finally confront my fears after my recent relapse.

Last week, I clutched a hazelnut coffee tightly as I ran across streets in the center of town. I was running late — again — and had just clumsily tried to shove a few quarters into the nearest meter, while attempting to prevent the raindrops from diluting my coffee. My hands were shaking, no doubt, as I reached an unfamiliar building and frantically looked around for a staircase. Of course, it was nowhere to be found. I jammed my finger onto the grungy elevator button three times. Short of breath, I finally walked into the nutrition center. Greeted by the relaxing scent of a vanilla candle, dim lights and a smiling blonde, I let out a deep breath. Maybe this wouldn’t be so bad.

Dear dietitian,

That afternoon, I cried on my way home. Because all you wanted to talk about was the sugar content of fruit. Because you wrote out a meal plan with plain yogurt as a staple. Because you had not one, but two scales in the corner of your office.

“Experienced with eating disorders,” you told me. And as you explained ways I could limit carbs, I couldn’t help but wonder if your experience was from a personal standpoint rather than a professional one.

When you told me that vegetables are “freebies,” you placed an inherently negative quality on all other food groups. When you suggested I look for bread made from sprouted grains, I wanted to laugh at you. Because squishy white bread and an extra slice of cheese are OK, I’ve been told. When you put boundaries on my carbohydrate intake, you validate every irrational anorexic fear of pizza I’ve ever had. When you suggest that I choose only the low sugar granola bars, you’re slapping me across the face for listening to my body’s cravings and preferences.

Dear dietitian,

Trust me, I know what two tablespoons looks like. I’ve been unofficially trained in the art of dietary exchanges. But I’ve also become logically bound to the belief that there’s a place for intuitive eating. So when you tell me to only have a small snack, you’re tightening a knot in my mind that has taken years of treatment and hours of therapy to unwind. It’s sad because you don’t even realize that two years ago, I refused to certain fruits. It took me months to relearn my love of these fruits, and years to understand that there is no strength in deprivation.

Your proposed meal plan is a road map rooted in nightmares of years past. I remember one day in treatment, I was pulled out of group for an individual art therapy session. The therapist asked me to draw a road progressing from my eating disorder to recovery. “What would it look like?” she asked me. I still have that piece of artwork crumpled in the closet of my parents’ house. Your meal plan, though, belongs on the left-hand side of the page, where the bridges appeared rickety and jagged rocks threatened from below. Your voice sings in the corners of my mind, echoing thoughts of restriction and thinspiration. Light muffins, low calorie lunches, organic ketchup and empty stomachs are the foundation of your coveted nutritional advice.

But somewhere along the way, I learned that my mom’s homemade garlic-parmesan rolls leave me with more than oily residue between the ridges of my thumbprint. And Ben & Jerry’s might actually have more significance than the percent daily values written on the pint containers. Somehow, I’ve picked up on this notion that food is fuel, food is love, food is connection, food is OK.

Dear dietitian,

I think you scare me: not because I dislike you or suspect poor intentions, but because you are my eating disorder. Sitting across from you at a wooden table is like facing the other half of my disordered mind. For so long, I’ve been taught to scream, to yell, to disobey that voice telling me to stay away from buttery goodness. Now, during this hour, I’m face-to-face with my eating disorder personified as a sweet, young, vibrant nutritionist. Someone who promises she can help me. Someone who society might say “knows best.” I think you scare me because I want to like you. I want to listen to you. And it’s terrifying that after so many years, I’d even be tempted to return to a life of restriction and self-destruction.

I’m not claiming that your advice is inherently wrong. I’m simply saying that I’m… different. I’m not a patient struggling with weight loss before a wedding. I’m not the pregnant mother seeking nutritional benefit for her little one. In fact, I’m not even your by-the-books eating disorder patient. I’m not like the bulimic you helped three weeks ago. And the girl with binge-eating disorder (BED) you’ll help five years from today? Listen to her, listen to her needs.

But for now, just listen to me. When you ask if I’m concerned about weight gain and I nod vigorously, my reply isn’t a green light to outline a weight loss plan. In fact, that is not an option for me no matter how much I may seem excited for it. I am a human with a complex relationship to food. A disorder that waits in the wings for its re-entry: relapse. I have goals beyond my weight. I have a story that is all my own. Plain yogurt with a spice and sweetener might be perfect for your 1:30 client, but I am not a Scantron exam to be filled out with a No.2 pencil. There is not one right answer.

Dear dietitian,

Don’t mistake disordered eating habits for health. Don’t forget that my smile can be measured just as easily as my waist. Don’t let pop culture and the fad of gluten-free living skew your knowledge of foundational nutritional science. Don’t be upset if I mail this letter to you, and don’t be offended if I walk away from your practice. I’ve adopted a philosophy of honesty to others and advocacy for myself and others in recovery, which seems to be growing infinitely stronger than any invitation to return to my eating disorder.

Dear dietitian,

Thank you.


Photo by Sarah Pflug on Burst

Originally published: July 9, 2021
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