Tag Archives: weight loss

Overweight and in Recovery from an Eating Disorder

Photo from a client in recovery
Photo from a client in recovery

Last week following a presentation about eating disorders to a group of mental health professionals a participant stood up and shared that a relative of hers had just returned from eating disorder treatment and was overweight. What should she (the relative in recovery) do?

Each time I hear this question my heart sinks. We live in a culture where the primary metric for health is weight. If someone does not meet clinical criteria for a “healthy” weight range she is encouraged by everyone around her, often including her health providers, to “diet.” It astounds me that even when a person has struggled with a full-blown eating disorder the focus remains on weight, and too often “dieting” is the recommendation. Keep in mind that a “diet” for someone with an eating disorder is like a drink for someone addicted to alcohol.

Responding to the question about what to do next is difficult for many reasons. First, I know nothing about this person’s eating disorder journey – how it began, the form it took, the treatment she received, current support, etc. What I do know is that no matter what her journey looks like, working with a combination of outpatient therapist and dietitian with training and experience in eating disorders is the ideal next step. I’d like to say this type of follow up care is essential based on the many stories I’ve heard from my eating disorder clients about working with professionals not experienced with eating disorders. Unfortunately the reality of living in areas where specialized services are not available makes this an ideal scenario rather than an essential one.

The long term nutrition goal is to create a positive relationship with food (body and emotions too but these are more in the psychotherapy realm). Here are my top 3 next steps for nutrition in eating disorder recovery after some type of residential or inpatient treatment:

  • Seek support related to a more intuitive and mindful approach to eating. There are several books and websites on these topics. For Intuitive Eating resources Evelyn Tribole’s website is great http://www.evelyntribole.com/resources/intuitive-eating-articles-studies-support-groups/10-principles-of-intuitive-eating and for Mindful Eating guidance Michelle May, MD has some really good resources http://amihungry.com/resources/about-the-mindful-eating-cycle/
  • Be aware of any type of food restriction – especially if your eating disorder includes binge eating. This is one of the most counter-intuitive aspects of eating disorder recovery for those who struggle with binge eating. This is also commonly ignored among dietitians and other health professionals not experienced in eating disorder treatment. The focus is too often on the binge rather than the food restriction that can begin a cycle of disordered eating. Skipping meals and snacks, avoiding certain foods or food groups, only allowing yourself to eat at certain times, or arbitrarily determining portions sizes rather than relying on your body to tell you what and how much you need, are all forms of food restriction that can be harmful in eating disorder recovery.
  • Watch for “always” and “never” thoughts and statements. These words are red flags for “black-and-white” “all-or-nothing” types of thinking that support disordered eating behaviors of all kinds. These words are rarely true when it comes to food and can help you identify struggles that lurk beneath the surface during your recovery journey.

There are many more issues to address in support of long-term, sustainable eating disorder recovery and a positive relationship with food. If you are overweight as you face the next stage of your recovery these steps can help you stay focused on health and well-being while you support your body’s return to a healthy weight range tailored to your individual needs.

Should You Really Skip Breakfast Before a Workout?

Nutrition headlines are notoriously misleading, spinning the latest research to make it seem sexy, new, controversial, or otherwise exciting. One such headline struck me this week “Skip Breakfast Before Exercise to Burn More Fat.” Despite the fact that this report emerged from a recently published study this concept is far from new. This appears to be yet another take on the fat burning myth that has been popular among some personal trainers for over a decade.

The implication of this headline, and the persistent fat-burning myth, is that you can skip breakfast, do your usual workout (meaning you’ll burn the same number of calories) and more of what you burn will be fat.  The reality is that without proper fueling you will not go as intensely (translate: as hard or as fast) therefore you will not burn the same amount of calories. So, more of the calories you burn may be fat calories but in the grand scheme of things if you want to lose weight you want to burn more calories (preferably without sacrificing muscle). For sports performance you probably want to go faster, harder or longer and to build (or at least maintain) muscle mass. Skipping breakfast prior to your usual workout is not likely to help you achieve any of these goals.

Now if you prefer slower exercise that happens to be more in the “fat burning zone” that’s great. Making exercise enjoyable is important for both short term weight loss and long term maintenance of good health. But you will need to exercise longer or more often (translate: longer duration overall) than you will with higher intensity exercise to lose weight or to gain other improvements related to sports performance. Again, not a problem but skipping breakfast is a bad idea if you want to increase the amount of time you exercise, even at a lower intensity. For one thing you’ll get hungry and what’s fun about exercising slowly with lots of time to think about how hungry you are?!

One caveat in the whole fast vs. fed before exercise is that you may not need a big breakfast – or a breakfast at all to sustain a decent workout. A small snack may be plenty, especially if you exercise for an hour or less.  If your exercise of choice includes sprinting or doing laps on hills you may not be able to digest anything solid so some kind of beverage may be all you can tolerate before exercise. There is a lot of individual variation among athletes with respect to optimal fueling. The quality of your workout, as well as how you feel before, during and after your workout, will help you find the best fueling strategy.

If you are a casual exerciser just trying to drop a few pounds I recommend doing whatever makes you feel the best and keeps you motivated for your exercise routine. If you currently don’t eat before you hit the gym and you feel great, have plenty of energy and are meeting your weight loss goals, fine. If not eating makes you think about food the whole time, work out less intensely, for less time or less often you may want to add a snack or small breakfast to fuel your workout.