Why Am I Not Dead Yet

As previously suggested, the ED Support Forum and other websites of its kind might constitute either a blessing or a curse. We reviewed a few of the various suggestions offered to eating disorder sufferers involved with refeeding, and worse yet, with refeeding syndrome. That condition may lead to consequences as severe as seizures.

One young woman reported in a post that she had suffered three of them, but told no one “because then they would find out about my ED, lol.” Laugh out loud, indeed. A paranoid mind might suspect that the forum exists, literally, to support eating disorders themselves, rather than the overcoming of them.

The contradictions and restrictions involved in maintaining binge eating disorder are exhausting. Keeping up with all the rules is like a full-time job, and the prospect of suffering the equally self-imposed penalties is dreaded.

A phrase seems to turn up frequently in the forum questions and answers about the hellscape known as disordered eating: “Why am I not dead yet” — without a question mark, which seems to remove it from the realm of the ordinary interrogatory. Put that way, the tone is not questioning, but resigned. Seemingly, the only thing a victim hates more than the eating disorder is the prospect of release from it.

That lying mirror

A peculiarity of pathologically emaciated individuals is the inability to actually see themselves in mirrors, photos, or the flesh. To themselves, they look repulsively fat, always. A forum participant known as Hiraeth_, a bulimia patient who accumulated more than 5,000 posts on the site, reminisced about the time when she had made herself so ill the question was legitimate — “Why am I not dead yet?” In one post, she named her ultimate goal as “being so […] thin that even I can see it.”

To maintain her “ideal” weight of 50 kilograms (110 pounds) she binged and purged almost every day, and took laxatives multiple times per day. A court ordered her into a hospital, where despite observation and strict rules, she still managed somehow to almost kill herself. That episode was followed by a year of being “in and out of hospital so many times I lost count, literally.” She writes,

After that horrible year, it surprisingly went better. I didn’t get hospitalized for 14 months. Until last week, lol. I hope this rollercoaster won’t start over again. Because this time, I bet I can’t be saved.

The gender factor

For whatever reasons, few eating disorder studies include males, but, surprise!

Despite the stereotype that eating disorders only occur in women, about one in three people struggling with an eating disorder is male, and subclinical disordered eating behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among men as they are among women.

One might think that this refers to gay men, but one would be mistaken. Despite the shortage of reliable and wide-ranging statistics, it is suspected that males binge almost as often as females, although females are more likely to purge. Furthermore, it appears that women are more likely to purge in reaction to “normal” consumption patterns, and in the absence of binge eating.

Back to the ED Support Forum, one individual reported that she or he had been binging and purging for nearly five years, yet their blood work remained “completely normal,” which is “a bummer” because “I’m kinda hoping this kills me but it might take longer than I intended.”

The whole mess raises philosophical questions that can probably not be answered, such as: What does this have to do with the worldwide epidemic of childhood obesity? In a sense, it is almost as if the BP (binge and purge) people are some strange order of penitents doomed to suffer their ailment to compensate for all the planet-smothering obesity.

Like religious zealots who parade through the streets flogging themselves with whips, it is their destiny to take upon themselves the world’s sins of overindulgence, and somehow restore balance to the cosmic order. The one thing they cannot abide is the sin of obesity.

Your responses and feedback are welcome!

Source: “Search results for query: refeeding,” EDSupportForum.com, 2023
Source: “Bulimia Discussions,” EDSupportForum.com, June 2016
Source: “Eating Disorders in Men and Boys,” NationalEatingDisorders.org, undated
Source: “Bulimia Discussions,” EDSupportForum.com, 2016
Image by Gareth Williams/Attribution 2.0 Generic

Mutual Aid for Eating Disorders

One dangerous aspect of the World Wide Web is that young people can go there to be coached on exactly how to slim down in hazardous ways, by experts, i.e. other kids — or worse yet, adults — who are only too happy to indoctrinate them. The uninhibited spread of dangerous knowledge has been an ongoing problem ever since online forums were invented.

The one consulted here is ED Support Forum, a useful font of information on these topics, for better or worse. It apparently intends to help people escape from problem conditions, but in the course of helping, of course, readers will unavoidably find out a lot about how to acquire and maintain dangerous conditions.

The site is a huge resource, sorted into categories, where even those with unusual and arcane issues can find kindred souls. For instance, they ask each other about refeeding syndrome — a frequent consequence of malnutrition, whatever the cause, and not a challenge for amateurs to be handling on their own. Refeeding is the process of reconditioning the patient’s body to accept food without going all haywire from electrolyte imbalance and other complications. Refeeding syndrome is when it goes all haywire anyway.

The looming hazard posed by refeeding syndrome is a major reason for wanting to make sure that misguided young people do not become involved with any of the pathological and often grotesque efforts to lose weight in unsafe ways. Asking advice from people in the same boat is not a great choice but it’s as far as many people will go. They’re giving each other advice about how to manage refeeding syndrome at home, on their own. One poster asks,

Has anyone ever been thru refeeding at home? Went 8 days fasting with very little liquid. Then tried consuming the last 3 days. Every time I try, I break out in sweats head to toe. Then nausea. My lower legs and feet and ankles are swollen and even after hours of elevation don’t go down much. I have passed out a few times. My blood pressure is low. Last check was 86/58.

This person goes on to say that they have social anxiety, and rarely leave home, so of course going to a hospital “isn’t an option.” So they request not to be offered any advice like calling 911 or visiting a doctor or the emergency room. But then their next post says they “did end up at ER sunday.” The poster wrote:

Because of malnutrition/starvation/dehydration my body is trying to hold on to fluid nutrients or whatever it can. Fluid in chest/abdominal wall is what is causing the pain… I’m weaker now than I was Sunday. Still swollen. Wt up 8 lbs from swelling. My stomach has been removed and I’ve had 3 bowel resections.

This really sounds like hell on earth, and another member of the forum confirms that “refeed edema is super painful… Stick to whole foods, avoid processed since processed has high levels of sodium,” and goes on to give other advice gleaned from research papers. Another amateur counselor notes that the mental health toll an eating disorder imposes can be devastating. Implementing “damage control” is exhaustingly time-consuming, and the whole process is something “you can really beat yourself up over.” They write,

You will have to challenge your perfectionism which the ED is tightly bound around, so that’ll freak it out. Unfortunately, challenging perfectionism a little might be what keeps you mentally and physically safer during your ED.

Another person, and just for ease of communication we’re going to assume this is a female, confides that her “ED brain” looks in the mirror and sees a big, fat blob that absolutely needs to continue losing weight. Even if her calorie count is tiny, the ED brain gets angry. When the number on the scale goes up by even one pound, the ED brain tells her she is a failure, and is only happy when the number decreases. The person writes:

Then my little bit of sanity I have left sees the real me in the mirror and thinks I look disgusting… That this is the one body I’ll ever get and I’m ruining it… Also stop losing before I get put in forced recovery.

“Dark Seas” contributes information about how prickly and defensive her ED brain is, because when someone advises her not to vomit, or offers some other helpful advice, the ED brain hisses, “Of course they’d say that, because they don’t want me to be skinny.” So even a helpfully-intended intervention is received as an insult and a challenge.

Your responses and feedback are welcome!

Source: “Refeeding at Home,” EdSupportForum.com, 05/22/24
Source: “How to avoid/lessen binging,” EdSupportForum.com, 01/25/24
Source: “ed brain vs rational mind,” EdSupportForum.com, 06/11/22
Source: “ED Brain,” EdSupportForum.com, 03/08/22
Image by Edvard Munch/CC BY 4.0 rawpixel.com

Oprah Through the Years, Part 21

Courtesy of the Oprah Winfrey Network, March of 2011 brought the TV audience a new reality show, “Addicted to Food.” It was recorded on location at the Shades of Hope Treatment Center, a facility specializing in eating disorders and addiction. Shades of Hope founder and CEO Tennie McCarty has found that addicts come from homes affected by dysfunction, abuse, addiction, or some combination of all three. The work that must be done is “to delve deep within and confront not only the outward behaviors of addiction, but also the secrets, pain, self-loathing, and blame that lie beneath.”

How long does that take? At minimum, 42 days, which is the length of the Intensive Residential Program. This has been shown to be enough time to dig into the psychological issues, learn the tools of recovery, and achieve a solid state of abstinence. The process is not easy, and the rules are strict, for good reason. No alcohol, no smoking, no other types of addictive substances are allowed, because to run a program meant to end one sort of addiction while allowing other addictive substance to be used is just plain silly.

While a client’s weight may be tracked, it is not revealed. The point is to get away from the idea that “it is always about the numbers and the connection of worth/control/success to the number on the scale.”

And that’s not all…

Oh — and no TV, or books or magazines are allowed either, because people need to be thinking about their own issues, not about the larger world or some imaginary characters. McCarty explains that the goal is to allow all the negative feelings to emerge and “slap the client in the face.” Hopefully, that blow will metaphorically knock the mask right off, exposing the anger and all the other stuff. When this happens, the client is said to be “showing up.”

The Intensive period includes Family Week, and then another week in which to process whatever transpired during that time, and to figure out what’s next — which might be a transitional period, either still at the Shades of Hope, or at another facility. Or perhaps it is time to return home, and get back to school, work, or whatever.

But… and this is a big but…

None of these stages can be regarded as an end point, because this is not a race where a person breaks through a ribbon at the end of the course. Nope, says McCarty. It’s all about a lifelong commitment, during which the individual must be constantly on guard because that inner void still cries out to be filled, and “switching” addictions is definitely a real possibility, to be avoided at all costs. Day by day and minute by minute, the commitment — to use new attitudes and new tools to change old patterns — must be scrupulously kept.

McCarty offers five helpful “tips” for recovery, more thoroughly described on her page, and worth looking into:

1. Be conscious of what you eat.
2. Eat with intention.
3. Maintain a healthy meal plan.
4. Eat by the clock.
5. Recovery is not a diet, but a way of life.

The show made at this “extremely difficult rehab center” involved eight clients, and it must have been edifying for Oprah to recognize which one (or ones) she most closely identified with. Seven years later, InTouchWeekly.com made an attempt to follow up on the participants, which proved to be rather half-hearted and largely unsuccessful. But their website also contains the trailer for the original show, which is pretty interesting. SocialWorkersSpeak.org also took note of the series and made some comments.

In the next chapter of Oprah Winfrey’s life of up-and-down weight shifts, we will see things take off in a whole different direction.

Your responses and feedback are welcome!

Source: “Addicted to Food Q&A: Tennie McCarty and Tough Love,” Oprah.com Source: “Remember Oprah’s Reality Show ‘Addicted to Food’? Here’s What the Cast Is up to in 2018,” InTouchWeekly.com, 03/01/18
Source: “Oprah Winfrey Network’s ‘Addicted to Food’ Tackles Emotions Behind Eating Disorders,” SocialWorkersSpeak.org, 05/12/11
Image by Pat Hartman

Oprah Through the Years, Part 20

We left off last time by mentioning how the rules change. This is one of life’s little jokes. As soon as you get used to one condition or set of circumstances, it will probably be necessary, before too long, to readjust to something else. For humans, the primary survival trait is adaptability, and the young are better at it. This is one reason why, when correctly applied, being like a little child is a very desirable state.

Youth is when many people are easily able to swallow and assimilate anything without suffering a physical penalty. As the body ages, it becomes less tolerant and… the rules change. When something else is going on at the same time, this fact might be easy to ignore. In the case of Oprah Winfrey, trainer and friend Bob Greene pointed out that her thyroid issue was an easy excuse to fall back on, and that she had “absolutely” done so on more than one occasion.

People are usually pretty good at generating excuses for not achieving their dreams. Just like a regular human, the global influencer and star had a particular and individual issue to deal with. In her case, it was a medical condition that required expert management, as well as patient compliance.

At the same time, like billions of regular people, Oprah was getting older every minute. As time goes on, and even with dedicated effort, it becomes more and more difficult to stave off weight gain.

In human history, this has rarely been the case. For obesity to become a significant problem, a society has to reach the stage of having food surplus to its needs. The civilization advances to where it can afford to have some members unable to defend themselves, and dependent on others for their continued well-being. When the society has abundant food, and physical fitness is not a priority requirement, people can become obese.

The Bob Greene worldview

Greene theorized that no one, be they an anonymous teenager or a world-famous star, would ever be able to completely overcome food addiction; that the problem would never completely disappear, and would always need conscious and diligent management. He also suggested that no one could properly start the recovery journey without squarely facing five crucial questions:

What are you hungry for?
Why are you overweight?
Why have you been unable to maintain weight loss in the past?
What in your life is not working?
Why do you want to lose weight?

The last query is a particular challenge, because the seeker is quite likely to come up with the wrong answer. “Then I’ll be happy” is not the right one, because it encompasses only two possible outcomes, neither of which can satisfy, as Greene explains:

You never reach that size or weight and you’re never happy. And even worse, you reach that size and weight and realize it has nothing to do with your happiness.

The following year, 2010, was when Oprah famously stated for publication that she was not fond of the term “food addict,” but…

I realize that I really have been one. And believe me, I — like so many of you — have punished myself for that. But I know that I’m not alone, and I know that the battle hasn’t ended.

This admission seems to cover two bases: First, it pleads guilty to the same fat-hate that dwells in the heart of even the most compassionate person. Also, it appears to confirm that the last person anyone is ever able to forgive is their own self.

Your responses and feedback are welcome!

Source: “Oprah’s Weight Loss Confession,” Oprah.com, undated
Image by Oprah.com/Fair Use

Oprah Through the Years, Part 19

As we learned, during a decade or so of time the weight issue was not a major problem for Oprah. She had found a large amount of inner peace in not hating any part of herself, not even the pockets of cellulite. But old mental habits die hard, and there are contradictions involved in embracing the self, no matter how calorically challenged, while also carrying out public activities (on national television, for instance) that might be regarded by the cynically minded as the very embodiment of fat-hate.

Imagine this scenario: The problem you overcame, and so triumphantly buried with a great deal of ceremony (and publicity), has clawed its way out of the grave, hitched a ride on a garbage truck, and is now demolishing your front door. What could be more disheartening? Oprah Winfrey, after a lot of emotional ups and downs, had reached a pretty good emotional equilibrium and, if there was any justice, ought to have been able to coast.

Instead, after being advised to “learn to embrace hunger,” she gradually gained back 40 pounds. Some of the difficulty was simply due to nature taking its course. As a human body ages, multiple processes are responsible for making it less resilient. It does not mend itself like it used to, and pain occurs in parts you never even knew you had. The entire organism might suddenly begin to demonstrate an uncanny propensity to grow.

O, the publication

At the beginning of 2009, the cover of Oprah’s very own slick magazine showed her current self next to an earlier, much slimmer version, and the words “How did I let this happen again?”… all of which looked like a pretty clear case of fat-hate. The inside pages held her musings on that subject, including a strong suspicion that the ultimate cause was a life out of balance, “with too much work and not enough play, not enough time to calm down… I let the well run dry.”

The conclusion seemed to point in a productive direction:

I don’t have a weight problem — I have a self-care problem that manifests through weight.

In that same year, a segment of the immensely popular “The Oprah Winfrey Show” featured 16 teens participating in “a grueling eight-hour intervention where they confront the reasons why they’re overweight.” Author Natalie Flynn described it as “humanizing” and as a way for booth the participants and the audience to grasp “what living with obesity truly entails.”

A recent Salon.com article looked back over that time with a congratulatory pronouncement:

[W]hat Winfrey has largely consistently managed to get right is her approach to childhood obesity. In her recent special and in old episodes […] Winfrey allows children to speak candidly about their weight, often showing in raw detail how obesity takes a toll on them mentally, socially and physically.

Cynics might have identified it as just another, though perhaps superficially compassionate, demonstration of how obsessed society is with maintaining a standard of fat-hate, while at the same time blaming the victims for “abusing food.” That in itself is a tricky phrase, which could logically encompass chaining up food in a basement and striking it with a belt.

Meanwhile, Bob Greene was also in the public eye, providing for the official website “Oprah’s Weight Loss Confession.” Some of the problems in the media star’s case, not relevant to most teenagers, were the concurrent challenges presented by worldwide success. Oprah had met and overcome so many obstacles, he theorized, that it was difficult for her to grasp the inevitable challenge of aging, which means “the rules change.”

Your responses and feedback are welcome!

Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” EOnline.com, 03/24/24
Source: “On abandoning ‘fattertainment’: Why the way we talk about childhood obesity matters,” Salon.com, 03/22/24
Source: “Oprah’s Weight Loss Confession,” Oprah.com, 01/05/09
Image by aphrodite-in-nyc/Attribution 2.0 Generic

Oprah Through the Years, Part 18

We have discussed the concept of displacement and its various manifestations. In the most primitive sense, displacement is an escape valve for the mental energy generated by a threatening situation. In the most elemental case, the choices might be limited to “fight” or “flight.”

In the simplest terms, someone with a threatening food addiction might opt to fight, by getting into a program of some kind; or to flee by ignoring the threat and by putting all that mental energy into (for instance) online gaming, a very sedentary occupation that offers a lot of opportunity for snacking.

But we humans are more complicated than that, and sometimes our wires get crossed. A previous post offered the example of the so-called “fitness freak,” who trades in their doughnut habit for an obsession with working out, losing fat, and gaining muscle — to a degree that bystanders might call obsessive. But as long as a displacement activity keeps the person away from their drug of choice, while at the same time doing no harm, and while actually achieving good results, why not just accept it and move on?

The fly in the ointment

For Oprah Winfrey, however, no amount of activity could displace her craving for bread and potatoes and a whole lot of other edibles. For decades, she was a whirlwind of energy, constantly involved with professional obligations and thoroughly invested in charitable efforts.

Going back to the most elementary definition of displacement behavior, she focused on helping people flee or fight; to escape or defeat obesity. One of her 1995 TV episodes on “fattertainment” was optimistically described like this: “By providing solutions, rather than showcasing problems, the show hopes to use the power of broadcasting in a positive manner.”

Three young girls had written to the host about their uncomfortable feelings and experiences around excess weight. Oprah’s crews filmed their families and the girls and their mothers appeared on the show to talk about the “emotional roadblocks” that contribute to obesity among the young.

On the personal level

In 1995, at age 47, Oprah started to work with trainer Bob Greene, because like any sane person, she realized that having an intellectual realization is not the same thing as living the newly revealed truth. Still, it took a few more years and some unnerving heart palpitations to really jolt her into high gear. Eventually, it occurred her that “taking care of my heart, the life force of my body, had never been my priority” — and then proceeded to organize life differently with an eye toward shrinking the influence of the three ominous O’s — “Overeating. Overstressing. Overdoing.”

Furthermore — and this appears to be a vital element of the whole equation — to quote Oprah, “I no longer hated any part of myself, including the cellulite.” Ten years later, the cover of O magazine feature a toned 160-pound Oprah. By this time, she thought the actual battle with excess weight had been won. Looking back later, she said,

I’d conquered it. I was so sure, I was even cocky. I had the nerve to say to friends who were struggling, ‘All you have to do is work out harder and eat less! Get your 10,000 steps in! None of that starchy stuff!’

Not long afterwards, puzzled medical professionals diagnosed her first with hyperthyroidism, then with hypothyroidism, and what with one thing and another, exercise began to seem less of a priority, and she was warned by a doctor that it would be necessary to “learn to embrace hunger,” which she was in no way prepared to do.

Your responses and feedback are welcome!

Source: “On abandoning ‘fattertainment’: Why the way we talk about childhood obesity matters,” Salon.com, 03/22/24
Source: “Making Peace With My Body,” Oprah.com, 08/01/02
Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” MSN.com, 03/24/24
Image by aphrodite-in-nyc/Attribution 2.0 Generic