How to safely manage weight in bulimia recovery

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When in bulimia recovery, or after recovering from another eating disorder, someone may still be struggling to manage their body weight. Where is the line between disordered weight-focused behavior and stable weight maintenance? Practicing intuitive eating and paying attention to how your body feels when engaging in movement can help.

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In this article

What is disordered eating?

Eating is disordered when it interferes with daily functioning, causes psychological distress, and results in fluctuating weight, such as what is experienced in people with bulimia nervosa (BN). 

Signs of disordered eating may include:

  1. Frequent dieting, starving, binge eating, purging, or using laxatives or diuretics to lose weight. Engaging in these behaviors long-term damages the body and results in emotional distress. (1) 
  2. Social isolation, anxiety, and depression. As disordered eating behaviors increase, individuals tend to isolate themselves from friends and family, avoiding social activities and even work or school obligations. This, in turn, can lead to increased anxiety and depression.
  3. Weight fluctuation. In one longitudinal study, those who used unhealthy weight-control methods were three times more likely to have higher body weights after five years, six times more likely to develop binge eating disorder, and five times more likely to become addicted to diet pills, laxatives, or diuretics. (2) 

Motivations behind disordered eating

The biggest motivating factors driving disordered eating include: (3)

  • Media use
  • Rebound from failed dieting attempt
  • Body dissatisfaction
  • Weight-related teasing or shaming

If someone feels compelled to lose weight due to these factors, which is very common in our society, discussing them in counseling, learning about how diet culture influences our views of food, eating, and exercise, acknowledging distressing feelings, and practicing mindfulness and intuitive eating can help prevent falling into disordered eating.

A truly healthy approach to body weight entails unlearning our society’s harmful messaging that fat is bad, weight is an indicator of health and is to blame for many health problems, and losing weight will solve those problems. This approach entails learning about all the factors that can actually lead to weight gain and how weight is not a viable indicator of health. Educating yourself about concepts that include Health at Every Size® (HAES®), weight stigma, fatphobia, body positivity, and weight neutrality will help you understand how skewed our perception of health is and how biased we are against fat. 

Body acceptance comes from a place of self-love, respect, and compassion. That’s hard to achieve in a culture that idealizes certain body types over others, teaches us to hate our bodies, and tells us we need to change our bodies to fit in–which leads to eating disorders. But there are things you can do to redirect your efforts to pay attention to what your body needs to function effectively and for you to feel good about yourself. 

How do I eat mindfully in bulimia recovery?

While disordered eating stems from negative emotions and feeling badly about yourself and your body, maintaining weight mindfully is a positive paradigm and honors the body’s innate cues for hunger, satiety–or feeling satisfied, and fullness. (4) Applying the principles of mindful eating can help you improve your relationship with food, eating, and your body and give your body what it needs to function properly. They include: (5)

  1. Awareness of physical sensations. Notice how it feels to be hungry, satiated, full, and uncomfortably full. If nausea arises before, during, or after eating, pause and reflect on the psychological drive behind the nausea. The body needs food to survive, so nausea (rejecting the food), stems from viewing food as negative, the enemy, or the cause of unpleasant feelings. 
  2. Awareness of thoughts and feelings related to eating. If anxiety or uncomfortable feelings arise, note where they sit in the body. For some, it may start in the chest, or reside in the belly. Some describe it as pressure or burning. Simply note what arises.
  3. Acceptance and non-judgement of sensations, thoughts, feelings, and the body. Allow the feelings of nausea, anxiety, etc., to be present in the body and mind. Thank the body and mind for trying to protect itself.
  4. Awareness and step-by-step change of daily patterns and eating habits. Explore other ways of self-soothing. This process takes time and is best done with a trained therapist or physician. Relapse is entirely normal and to be expected. If this happens, avoid self-deprecating thoughts or behaviors, and continue to repeat steps 1-4.

Studies also show that group therapy, body scan-guided imagery, journaling, and art therapy can be highly beneficial and supportive to walking through the steps outlined above. (5)

What is considered unhealthy exercise?

People who have bulimia and other eating disorders often exercise excessively to compensate for food eaten. Exercise is considered extreme if you: (6)

  • Feel preoccupied with exercise (think about it when not exercising)
  • Feel a need to exercise in increasing amounts of time in order to achieve satisfaction
  • Have an inability to control exercise
  • Feel restless or irritable when attempting to cut down or stop exercising 
  • Use exercise as a way of escaping from problems or of relieving a poor mood (feelings of helplessness, guilt, anxiety, or depression)
  • Lie to family members or friends to conceal the extent of involvement with exercise
  • Jeopardize or risk the loss of a significant relationship, job, educational, or career opportunity because of exercise
  • Keep returning to exercise after spending an excessive amount of money on exercise related expenses
  • Go through withdrawal when not exercising (increased depression, anxiety)
  • Exercise longer than originally intended

How do I exercise mindfully?

When an unhealthy relationship with exercise develops, someone will feel emotionally distraught and guilty when they do not exercise. They may restrict eating to only on days when they can exercise or purge when they miss a workout. Injuries often occur due to nutritional deficiencies or over exertion. At the end of working out, instead of feeling accomplished, someone will feel relieved, or that they have permission to eat. They may compulsively track caloric intake and compare this with how many calories they’ve burned while exercising. (6) 

Mindful exercise in bulimia recovery integrates mind and body and includes profound inward mental focus. Examples include yoga or tai chi, which focuses on non-judgemental inward focus, instead of compulsively targeting heart rate. Mind-body exercise incorporates these criteria: (6)

  1. Meditative/contemplative in nature. This means performing exercise in a non-competitive way. Focus on being present instead of goal oriented.
  2. Proprioceptive and kinesthetic body awareness. This means honing mental focus with muscular movement.
  3. Breathwork. Focusing on the breath and controlling how you breath regulates your nervous system and alleviates distress.
  4. Anatomic alignment or proper choreographic form. Focusing on this will prevent overuse injuries, sprains, and strains. If pain develops while exercising, instead of pushing through it, mindfully acknowledge the pain and tailor back.
  5. Energy centric. This means noticing the flow of the body’s intrinsic energy. If someone is feeling sluggish, weak, or tired while exercising, then positively, compassionately note this and respect how the body is feeling.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. UpToDate. (n.d.). Retrieved October 27, 2022, from https://www.uptodate.com/contents/eating-disorders-overview-of-epidemiology-clinical-features-and-diagnosis 
  2. Neumark-Sztainer, D., Wall, M., Guo, J., Story, M., Haines, J., & Eisenberg, M. (2006). Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later?. Journal of the American Dietetic Association, 106(4), 559–568. https://doi.org/10.1016/j.jada.2006.01.003 
  3. Haines, J., & Neumark-Sztainer, D. (2006). Prevention of obesity and eating disorders: a consideration of shared risk factors. Health Education Research, 21(6), 770–782. https://doi.org/10.1093/her/cyl094 
  4. Warren, J., Smith, N., & Ashwell, M. (2017). A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviors: Effectiveness and associated potential mechanisms. Nutrition Research Reviews, 30(2), 272-283. doi:10.1017/S0954422417000154 
  5. Alberts, H.J., Thewissen, R. & Raes, L. (2012). Dealing with problematic eating behavior. The effects of a mindfulness-based intervention on eating behavior, food cravings, dichotomous thinking and body image concern. Appetite, 58, 847–851. https://doi.org/10.1016/j.appet.2012.01.009 
  6. Calogero, R., Pedrotty, K. (2007). Daily Practices for Mindful Exercise. In: L’Abate, L. (eds) Low-Cost Approaches to Promote Physical and Mental Health. Springer, New York, NY. https://doi.org/10.1007/0-387-36899-X_7
  7. La Forge, Ralph. (2016). Mind-Body (Mindful) Exercise in Practice. Health & Fitness Journal, 20(4), 6-8. doi: 10.1249/FIT.0000000000000212

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