Authors: Kathryn Hansen
PART III:
Therapy Concepts Reexamined
31
: Normal Eating
T
he tricky thing about bulimia was, I could stop binge eating, but I couldn't stop eating. It wasn't like breaking the habit of drug or alcohol addiction, where one can just avoid a substance completely. I needed to eat to live, but I needed to learn to eat "normally." And, unfortunately, there is no easy answer to the question of how to eat normally. Everyone has different needs, different tastes, different likes and dislikes, different metabolisms, different activity levels, and different needs to lose or gain weight. Furthermore, the question of how to eat normally is not specific to those with a history of eating disorders. Everyone faces the challenges of making food choices, listening to the needs of the body, and trying to eat optimally based on their goals.
When I first quit binge eating, I defined "normal eating" in general terms:
normal eating meant I did not binge, and I did not diet restrictively.
I knew my eating habits should ideally meet all of my nutritional needs, make me feel healthy, allow me to maintain a healthy weight, yet be pleasurable and allow for some indulgences. My only real goal at that point, however, was to stop binge eating, not to have a perfect diet. I told myself that once I got over my habit, I would work on perfecting my diet; but to this day, I still don't have what I would consider a perfect diet.
I eat when I'm hungry and stop when I'm full, although not 100 percent of the time. I eat a little too much at meals occasionally, and sometimes I don't eat enough because I'm too busy to sit down for a meal. I like desserts, and I probably eat a little too much sugar and processed foods. However, my imperfect diet is not a signal that my eating disorder is not over. I've learned over the years that no one eats perfectly. All that matters is that I am generally satisfied with my eating habits because I now have the freedom to eat what I want, when I want, and yet I never take it to the extreme, meaning I never binge or diet. I enjoy eating healthy food and exercising, and I strive to maintain good nutritional habits.
I AM NOT THAT DIFFERENT
My recovery did not involve establishing a healthy eating plan and sticking to it, attaining and maintaining my ideal weight, being able to eat any type of food without worrying about weight gain, or even avoiding all overeating, because those things are not specific to bulimia. Recovery taught me a simple fact when it came to my diet (and many other topics I often talked about in therapy): I am not that different. It was a misfortune that I learned in therapy to set myself apart from the rest of the population. I got the message that I couldn't just eat like everyone else.
Those who recover with traditional therapy often follow meal plans indefinitely, thinking that those plans will somehow keep the bulimia from coming back. However, after I recovered, I realized I could simply resume eating like other people. This doesn't mean I haven't had food challenges since recovery, it only means that the challenges I've faced are similar to those that everyone else faces every day. Everyone—not just those with eating disorders—has to decide what to eat for meals and snacks, assess their body's hunger and fullness signals, and decide whether or not to overindulge in favorite foods. Many people worry that certain foods will make them gain weight. In fact, it seems as though most of the U.S. population has some sort of food issue. I am not saying the prevalence of hang-ups about eating should be an acceptable thing in our culture; however, less-than-healthy eating habits and attitudes do not define an eating disorder.
When I was in therapy, I often looked at some of my friends, coworkers, and family members with curiosity, wondering how it was that they didn't have eating disorders when it seemed obvious to me that they had many food issues. A couple of my co-workers talked endlessly about their diets—what they'd had for lunch, how many calories they'd burned during their last workout, how much weight they'd gained or lost. Some of my friends frequently turned down desserts, fast food, and foods high in carbohydrates because they were trying to lose weight. Others lamented about eating too much at a meal or special occasion. Some of my family members were much more fervent about running than I ever was during my days of anorexia.
It often made me angry that other people could have what I thought were "eating disorder symptoms," yet still be considered normal. Why was I singled out as the one with the eating disorder when everywhere I looked, other people had all kinds of food issues? After I recovered and returned to the world of normal eaters, I realized that the spectrum of "normal" is so wide that it was foolish of me to think that many of those I knew had eating disorders. They might have had some food hang-ups, but they were normal nonetheless. Some people simply choose to place a high emphasis on appearance and spend a lot of time trying to get or maintain an ideal body, without it being a problem for them. This is not a lifestyle choice I personally agree with, but I'm not going to condemn others for it or call them "eating disordered."
Therapy gave too much significance to what, when, and how I ate and the feelings surrounding eating. In therapy, it was as if I wrapped up every food issue I had in a box and stamped it
BULIMIA,
when in fact binge eating and purging were the only food issues that should have been in that box. The advice I gave to myself after I stopped binge eating is the same advice I would give to anyone with any type of food issue: if the food issues I have don't affect my life negatively, I don't need to address them; but if my food hang-ups do affect my life negatively, I should change them.
Indeed, I have changed some of my eating habits for the better. Without binge eating getting in the way, I am now able to see the amazing health benefits food can have. For instance, I rid my diet of an overabundance of artificially sweetened "low-calorie" foods. For years during my eating disorder, I thought low-calorie soda, cookies, yogurt, and candy were good for me just because they were "diet" food. I often chose those options over things I considered "too fattening," like avocados and nuts, which are in fact extremely healthy, even if high in calories. Today, I would much rather munch down a large serving of almonds for a snack than eat a few artificially sweetened cookies. I'm not saying I'd always refuse a "diet" snack; but if I do choose to eat one on a rare occasion, I'm no longer deceived into thinking it's always healthy.
Another food issue I changed was my tendency to always accept dessert when it was offered to me, even if I truly didn't want it. Now, if I have no desire for a dessert, I simply say no. I've also stopped comparing what I eat to what others eat, especially other women. I have a high metabolism, so I can eat—and need to eat—more food than the average woman. I've also become very decisive about what I'm going to eat. I used to deliberate for a long time when looking at menus or deciding what to fix myself for meals. Now I just choose something quickly—remembering that it's just one meal and it doesn't have to be perfect—and then get on with the business of living. These simple improvements just increased my quality of life; they were not a part of recovery or relapse prevention.
I hope to make even more improvements to my eating habits in the future. I have a vision of myself eating primarily whole, organic foods; enjoying cooking; and eating to fully and completely nourish every cell in my body and ward off disease, because food is truly an amazing thing when considering all of the health benefits of eating optimally. Right now, due to time and financial constraints, not to mention lack of cooking skills, I don't come close to that ideal. But I'm doing my best until circumstances will allow me to do better. Until then, I take some supplements to try to reap the benefits that may be lacking from my regular diet.
SURPRISE: I DIDN'T LOSE TOUCH WITH MY APPETITE
While I was caught up in binge eating and purging, it was hard to fathom simply eating normally. I felt I'd lost touch with my fullness and hunger signals, because I'd plowed through the fullness signals so many times while bingeing and ignored the hunger signals so many times while purging. I felt I'd never be able to control myself around food. I thought I would never be able to just eat and not worry much about it. But after I stopped binge eating, I realized that I hadn't lost touch after all.
I already knew how to eat normally, even though I hadn't done it in a long time. I also knew what normal eating looked like because I'd spent years watching other people eat, often critiquing their eating habits. Furthermore, I was highly educated about healthy diets, and I had followed plenty of nutritionist-approved meal plans over the years. My bulimia most likely did alter my hunger and satiety mechanisms to some extent, but it didn't take long for those signals to re-regulate themselves. In the weeks and months after I quit binge eating, I just ate normally day after day, based on my understanding of normal eating, and my body and brain adjusted quickly. Soon, eating normally based on my levels of hunger and fullness became effortless.
BRAIN POWER
I found that it was not useful to worry much about my diet in the weeks and months after my recovery. I ate what worked for me, and I ate what I liked; I just didn't listen to my lower brain when it urged me to binge. I believe that my lack of focus on my diet during that period was tremendously helpful, in that it turned my attention away from food. I was devoting less brain power to food and eating; and not obsessing about it showed my lower brain that food and eating didn't need to be assigned so much significance. As explained in Chapter 25, this lack of attention allowed my brain to weaken the neural connections that kept me focused on food.
Even though I tried not to worry so much about food after I quit binge eating, what and how much I ate sometimes caused my brain to react automatically. My lower brain sometimes acted up when I ate too much, too little, or when I ate certain types of foods. I found that there were three main eating situations that caused these reactions:
1. Urges to Binge Arose When I Overate
When I first stopped binge eating, my lower brain definitely acted up when I overate. This only made sense. Overeating had led me to binge in the past, so my lower brain had learned an association or pattern. Since that was what was currently programmed in my brain, that's what I had to live with until it learned otherwise. For example, if I ate a little too much at a restaurant, I sometimes experienced a conditioned response. Automatic thoughts arose such as,
You overdid it. This is proof that you can't control yourself around food; you might as well binge now and start over tomorrow,
and I sometimes began to feel a craving to binge.
I tried not to let this catch me off guard. I learned to expect my lower brain to act up when I ate a bit too much, and I always reminded myself that overeating was not the problem—it was never the cause of my binge eating. Besides, it wasn't realistic to think that I'd go through life never indulging a little too much in pleasurable foods; everyone overeats from time to time. It didn't take long for my lower brain to stop producing urges when I was full. Then I was able to eat an extra piece of cake or another helping of a delicious dinner with confidence that it wouldn't get out of hand.
Obviously, I'm not saying that overeating is actually a goal of mine; but although I aim to eat healthy portions as often as possible, I do enjoy having the freedom to indulge every now and then. I like being able to eat a big holiday meal without worrying that I'll polish off the leftovers after the guests go home. It's actually nice to feel a little too full once in a while.
2. Urges to Binge Arose When I Underate
I also found that my lower brain generated urges to binge when I ate too little or when I chose low-calorie foods. Again, this was my brain's automatic, conditioned response. By dieting, I'd made my lower brain hypersensitive to food shortages, so that it became particularly resistant to any form of dieting. Even though I had not dieted in a long time, my survival instincts were still on heightened alert; and furthermore, since I often binged soon after undereating, my lower brain had learned that undereating leads to binge eating. So it automatically produced urges to binge whenever there was any hint of food restriction.
I was well aware that food restriction caused this brain reaction. Until some time went by and my lower brain learned that there was no longer a threat of starvation and that I no longer binged after undereating, I had to deal with this. This is not to say I allowed myself to eat anything and everything in order to prevent my body from feeling deprived. That would not have been healthy, and it also would not have been dealing with the real problem—the urges to binge.
For example, let's say I went to dinner at a restaurant and really wanted a hamburger, but instead ordered a salad because I had eaten a lot for lunch. As I ate the salad, I began having an urge to binge, and my lower brain generated thoughts of all the food I could eat when I got home. I felt automatic feelings of resentment for the salad, longing for more fattening foods. It wasn't the salad's fault that I had the urge to binge, and it wasn't my fault for ordering the salad, because I really thought it was the best choice. But my decision to have salad didn't mean I was then destined to binge, because what I did or did not eat was never the cause of binge eating.
In the weeks and months after I stopped binge eating, what I did or didn't eat could certainly trigger urges to binge. During my years of therapy, I was in for a real mess every time I tried to sit down for a meal. Because therapy had taught me that what I ate or didn't eat was the problem, I had to constantly ask myself,
What food is least likely to cause binge eating?
I had to try to pick meals that weren't too excessive, weren't too restrictive, didn't contain any binge foods, and didn't contain much sugar; even so, there were no guarantees against binge eating.