Day 4 in IOP

Got here early and seriously sometimes I feel I shouldn’t be here because I see everyone else and how they act and I am not like them. I know I shouldn’t compare myself to others in recovery but I can’t help it. I know everyone’s situation is different and people are here for different eating disorders but I guess I am still having a hard time admitting and dealing that I suffer from an eating disorder. Also today is the first Saturday that I am here. First thing we are doing is having lunch. When we have meals together I end up comparing plates. I look to see how little or how much everyone else eats.

During meal I actually ended up feeling really sick and nauseous. I felt that all the food that I was eating was getting stuck in my chest and that it was all going to come up. I even started to get red in the face and sweating. I did not think that my food was going to stay down. I went to the first therapy session which was about body image. I really felt this talk was going to make me vomit. But I managed to calm down and was able to talk about how I feel growing up in a Mexican family caused some of my emotional eating. They started calling me “Gordita” growing up as I started gaining weight. And I honestly don’t think that they were doing it to be mean. It was always felt that it was a term of endearment and they meant in a loving way. Now that I am an adult I feel that it caused some self confidence issues of some sort that I need to learn to work out.


Back in the saddle

Yesterday the fiancé and I went to get our bikes adjusted and cleaned because we decided we were going to try to get back into cycling. Nothing crazy, just getting back into it slowly and having fun. I started to feel anxious and started to think about bingeing. You see for me exercising was my purging. I would restrict my intake and would exercise 6 times a week and sometimes even twice a day. I would burn more calories than I consumed. I would sometimes binge on sweets and junk food. Then I would feel horrible and guilty go for a 10 mile run or spend hours at the gym. I would be at the gym or run until I was exhausted or felt like puking. So you can only imagine the thoughts that we running through my head. “How many miles should we do?” “I am going to look fat in my cycling kit”, ” I shouldn’t eat the rest of the day” “I hope I burn a lot of calories” these were all things that were running in my head over and over again. I tried to listen to some music to help calm my nerves. It didn’t work, I was feeling hopeless, but somehow was able to fall asleep.

I woke up super early and tried on all my kits and just kept looking at myself. Looking at all my imperfections. Looking at how tight they all fit now because I had gained some weight. I kept tugging and my cycling shirt trying to make it stretch so it wouldn’t be so tight. That of course didn’t work. I almost wanted to lie to my fiancé and say that I didn’t feel good and that he should just go without me. I wanted to stay home alone and just stuff my face with anything I would find in the kitchen. I heard my fiancé wake up and knew that I had to suck it up and just go and have fun. It was just a small ride, no big deal. Just a couple miles to feel free and relieve the stress. It’s how I wanted to feel about it. It’s how I wish I would feel like about all exercise activities and it’s a goal I have set for myself to just have fun when working out and not overdo it. And not feel self conscious about what I look like in my cycling gear. I know it’s going to take some time but I hope it will get better.


Day 3 and counting

I had woken up with a headache and was not in the mood to do anything. I didn’t wake to go to work. All I could think of was grabbing a bag of cookies, stay in my bed and Netflix! But I got up and showered, grabbed my lunch bag full of my meals and off I went to work. I had an appointment with my primary care physician to get medically cleared for therapy and get lab drawn. I want necessarily ready to repeat my story to another physician as to why I was going to get into treatment program. I wish I could go in there and just say here fill these out and I need these labs ordered. Okay bye! That wasn’t going to be the case, I had to get in that stupid scale. I had so much anxiety. Still it had to be done and now came explaining why I felt I needed help. Probably the hardest thing for me is admitting that I had an eating disorder to other people. I feel that they are judging me and that they look at me thinking that I’m fat and only skinny people have eating disorders. But of course that was just my imagination going wild and he was understanding and wished me the best and off I went to get my labs and then to work.

I arrived at therapy feeling tired and drained. My head was still hurting. I did not want to be there. I went to my first therapy session of the evening and I was zoned out. I didn’t pay attention. I was off in my own world looking out the window watching cars drive by. Then faintly I hear my name, it startled me. I was being asked to check in on how I was feeling. I said I’m tired and don’t want to be here and looked away. Mindful dinner came around and it’s time to prep my food. I was not hungry. I felt like restricting and felt nauseated as I prepared my food. Some how I pulled through it and sat down and waited for everyone before giving thanks. I picked at my food, moved it around for a little bit before taking a bit. Finally I gave in and ended up eating 85% of my food before I felt nauseous again. I threw the rest of my food away and went to process group. I knew this was going to be hard. I didn’t feel like sharing anything tonight my turn came around and before I got to saying how I was feeling body image wise I broke down and started crying. I couldn’t continue and they moved on to the next person. All in all it was just a bad day for me and all I can say is that I hope that things continue to get better.


Day 2 at IOP

Yesterday I went to my second day of IOP. It was eventful. They provided dinner for us and I was having anxiety about that. The not knowing what they will be giving us to eat was really messing me up. I was scared that I wasn’t going to like the food and that I was not going to be able to finish everything. They gave us spaghetti with a meatball, garlic bread and a salad that was my issue. The salad had garbanzo beans, olives and pepperoncini’s that I do not like. I played around with it and tried to eat as much as I could. I kept pushing the food I did not like around on the plate. It started to get to me and I started to feel nauseous. I also padded the grease off my garlic bread underneath the table to be able to eat it. I felt ashamed that I did that. But what can I do about it now. Today I have a huge headache. I don’t know the root of it. I think it’s because I haven’t had coffee. But then again I think it because this week has been overwhelming. The anxiety that I have had and the not being able to sleep has drained me. I sometimes don’t know if feeling this way and putting myself through bringing up all these old memories and emotions. I haven’t been following my meal plan 100% at all. Which makes me feel like a failure and because I feel like a failure and I want to go to the store and grab a bag of cookies and stuff my face! I know that is not the answer and I need to give this program a chance to work. I am just having one of those days today that I feel sad and feel like I am failing. I just have to be strong and realize that it has only been 2 days in the program. I just have to give it time and be resilient!

“Strength grows in the moments when you think you can’t go on but you keep going anyway.”

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What is Binge Eating Disorder? (B.E.D.) and What are the signs and symptoms?

I started this blog and realized that many of you may not know what Binge Eating Disorder is or what the signs and symptoms. Below is an article that is on the NEDA website. NEDA stands for the National Eating Disorder Association. They have many wonderful resources to help and for education. This website really helped me understand and gave me the courage to seek help.

Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. It is the most common eating disorder in the United States.Binge-Eating-Disorder.jpg

BED is one of the newest eating disorders formally recognized in the DSM-5. Before the most recent revision in 2013, BED was listed as a subtype of EDNOS (now referred to as OSFED). The change is important because some insurance companies will not cover eating disorder treatment without a DSM diagnosis. 

DIAGNOSTIC CRITERIA

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 
    • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
    • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
  • The binge eating episodes are associated with three (or more) of the following: 
    • Eating much more rapidly than normal.
    • Eating until feeling uncomfortably full.
    • Eating large amounts of food when not feeling physically hungry.
    • Eating alone because of feeling embarrassed by how much one is eating.
    • Feeling disgusted with oneself, depressed, or very guilty afterward.
  • Marked distress regarding binge eating is present.
  • The binge eating occurs, on average, at least once a week for 3 months.
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

WARNING SIGNS & SYMPTOMS OF BINGE EATING DISORDER

Emotional and behavioral 

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
  • Appears uncomfortable eating around others 
  • Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
  • Fear of eating in public or with others
  • Steals or hoards food in strange places  
  • Creates lifestyle schedules or rituals to make time for binge sessions  
  • Withdraws from usual friends and activities 
  • Frequently diets  
  • Shows extreme concern with body weight and shape  
  • Frequent checking in the mirror for perceived flaws in appearance
  • Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating  
  • Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting
  • Developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, and not allowing foods to touch).
  • Eating alone out of embarrassment at the quantity of food being eaten
  • Feelings of disgust, depression, or guilt after overeating
  • Fluctuations in weight
  • Feelings of low self-esteem

Physical 

  • Noticeable fluctuations in weight, both up and down 
  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.) 
  • Difficulties concentrating

HEALTH CONSEQUENCES OF BINGE EATING DISORDER

The health risks of BED are most commonly those associated with clinical obesity, weight stigma, and weight cycling (aka, yo-yo dieting). Most people who are labeled clinically obese do not have binge eating disorder. However, of individuals with BED, up to two-thirds are labelled clinically obese; people who struggle with binge eating disorder tend to be of normal or higher-than-average weight, though BED can be diagnosed at any weight.


My first day at Intensive Outpatient Program (IOP)

Overwhelming, confused, anxious, are just a few words to describe how I was feeling yesterday at my first day at IOP. Deciding to get treatment for my eating disorder was NOT easy. It meant I was admitting I had a problem and I needed help. Two things that was hard for me except. I cried and I was feeling drained the whole time I was there. To say that I didn’t learn a lot about myself the first day would be a lie. While talking to the therapist and the dietitian I learned that it was OK and normal to feel the way I do. They pointed out small things about my body language I did not know I did. I do what is called “body checking” I pull or fix the shirt or sweater that I am wearing so my lonja (spanish slang for the muffin top) doesn’t show. Which was shocking to me because I didn’t think I did that. It’s the being uncomfortable in my body and not liking the way I feel about myself. We also ate together and I learned a new term, exchange, which I was really confused about. What the heck is an exchange… are we changing or swapping foods out for something else? WTH is an exchange!? It wasn’t until the end of the session that I got the courage to ask what an exchange was. Exchange is a term they use instead of portion. So 1 exchange is basically 1 portion. I felt such a relief. It was causing me some anxiety! Ok back to eating with the group… to say it was different is an understatement. I put on my gloves and hair net and proceeded with to try to put together some sort of meal with what I had brought with me and what they had in their kitchen. I tried to be proactive and bring some sort of healthy meal with me. It kind of failed on me. I should have just waited for them to tell me my meal plan instead of guessing. I brought with me 1 cup spaghetti squash with some tomato sauce and 4 turkey meatballs. Usually this amount of food would make me full. So they told me I needed to add vegetables and another grain. So I added 1 cup of mixed greens and 1 cup for white rice. This was way too much food for me and I was overwhelmed. I sat at the table in the corner because I was not feeling like socializing. We say an affirmation and then we can eat. I was unable to finish my food and I felt like a failure and felt embarrassed. After everyone was done we are asked to grade our hunger and fullness from a scale of 1 to 10. With 10 being completely overly full and 1 being famished. I felt I was almost a 9 but changed to 7 because I felt full but I also got bored with what I was eating. I continued through my evening and went to a group therapy session that was going to be about family and anger. I was in there for about 15 minutes and thank goodness it was only for that amount of time! If I would have stayed in that session I know that it would have been a difficult situation that I was not going to be able to deal with on my first day. I was pulled to meet with my therapist one on one. We did a couple of assessments, there was crying and there was moments of “aha”! I thought my night was going to end there and I would be able to go home. Nope! It was time for group snack! What!? More food!? Yes… more food. I had to have 1 dairy and 1 grain. It was hard to stomach 6oz of milk and 6 animal crackers. I left with a full feeling and sort of feeling disgusted. I am still trying to keep a positive outlook. It was my first day and I hope it gets better.


How do I tell my family …

I thought that maybe admitting I had an eating disorder and deciding to get help and go into a program was hard. But what I am most afraid of is what my family if going to think or say. Mental health, depression and having an eating disorder is not something you talk about in my family. Although I do think that they will understand my depression, I think the 46b28277f2ae41d8636cfa2c80262b1deating disorder will be challenging. I feel that they will just say to stop eating. Like if it was that simple to do. I don’t think they understand that it has to do more than just food.  I know that my parents especially will just not understand. I don’t even know where to start to tell them. I would have to translate how I feel into spanish first. Then translate what an eating disorder is in spanish as well. I have no clue how to do that. I am hoping that maybe while going to therapy that I can become more comfortable with my ED and I can talk about it with out actually crying and having ugly cry face!!

 

So I realize that I have to do this for myself and try not to care what everyone else thinks! #edrecovery #eatingdisorderrecovery #selflove #sensitive

 

 


The Reality of Bariatric Surgery: A Life-Changing Procedure with Potential for Eating Problems

Here is a post that I thought was an interesting read. You can find the full post on Eating Disorder Therapy LA

Although I do believe that I had an eating disorder prior to having surgery I feel that the regain and being termed a “surgical failure” added to my disorder. I don’t feel that I was screened well prior to my first surgery in 2013 or my second in 2015. And I don’t feel I did not get adequate support post surgery. I was told to follow a strict diet and exercise. With most people with eating disorders its all or nothing. That is certainly true with me because I do go full fledged and all in when it comes to diet and exercise. I used to work out 5 to 6 times a week sometimes twice a day and only consuming about 800 to 1000 calories per day. I was so obsessed with being thin that I didn’t care how hard I trained or how little I ate. All that matter to me was the number on that scale. Unfortunately it came down to not being able to handle it all anymore and would burn out. I would fall into a slump and would start “grazing” and then it would turn into full blown binge on carbs and sweets. Afterwards I would fell horrible and would go to the gym or go for a run and try to sweat it out. I would workout until exhaustion. The vicious cycle of my disorder.


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Source: UConn Rudd Center for Food Policy & Obesity


 

By Dr. Elisha Carcieri, Ph.D., Psychologist at Eating Disorder Therapy LA

Approximately 200,000 people elect to undergo bariatric surgery each year. Many are encouraged by their doctors to undergo surgery with the hope of improving physical health outcomes like diabetes, and many are hoping that this will be the final answer to a lifetime struggle with their weight. This is a decision that should not be taken lightly, especially for those who have suffered from disordered eating patterns or a diagnosable eating disorder prior to surgery. While most people who undergo gastric bypass will lose weight and maintain this weight loss, bariatric surgery represents a unique challenge to those individuals with disordered eating patterns.

It is crucial to note here that not all people with obesity have an eating disorder, and that obesity is not an eating disorder. However, binge eating disorder (BED), which involves consuming large amounts of food in a discrete period of time with a sense of loss of control, is more prevalent among people who are obese than the general population. BED is especially common among people with obesity seeking weight loss surgery. Some prevalence estimates of BED among people seeking surgery range are as high as 50%. Night eating syndrome (NES) also appears to be common and other eating disorders including bulimia are observed among people who are obese.

There are various types of bariatric surgery, but all surgeries result in weight loss via restriction of gastric capacity resulting in eating less, or restriction combined with bypassing a portion of the intestine which results in malabsorbtion (interrupting the amount of calories that are absorbed). Most people have “successful” surgeries resulting in relatively rapid weight loss over the first 12-36 months followed by sustained and stabilized weight loss. Up to 20% will experience a “failed” surgery, meaning that their weight loss is considered inadequate (less than 50% of excess weight lost) or they gained a significant amount of weight back following initial weight loss. Being labeled as a “surgery failure” can be devastating, especially when surgery is often presented as a quick, easy, and final fix for obesity. It is unclear how many patients who fail to lose weight or regain weight do not present to their medical team for follow up due to shame or embarrassment.

In addition to the common risks associated with having a major surgery, bariatric surgery can result in certain food intolerances, such as red meat or white bread, and can result in vitamin deficiency (more common with surgeries involving malabsorbtion). Additional eating-related problems that do not necessarily constitute an eating disorder commonly develop related to surgery include:

  • Involuntary nausea and/or vomiting – usually from eating too quickly or consuming too much food too quickly; vomiting can also be voluntary to relieve discomfort.
  • “Plugging” – a sensation described as food being stuck in the upper digestive tract.
  • “Dumping syndrome” lightheadedness, sweating, palpitations, cramps, and diarrhea occurring in response to the consumption of too much sugary food, such as ice cream or cake, at one time.
  • “Chewing and spitting” – This pattern of eating may develop to avoid plugging.
  • “Grazing” – Frequent (often unplanned) snacking or nibbling, mindless eating

With regard to the development of eating disorders, it is rare that a full-blown classic eating disorder will develop post-surgery. A more common occurrence is the development of eating disorder symptoms that may not qualify as a diagnosable eating disorder but are distressing to the patient. These symptoms may begin as a common eating problem associated with surgery such as plugging or dumping. The continuation of BED or engaging in binge eating episodes is not uncommon following surgery, but may take a different form as it may be physically impossible for an individual to consume an objectively large amount of food post-surgery. Episodes of binge eating post-surgery may instead be described as subjectively large and may be characterized by a sense of loss of control eating. Also of note, it may be possible to binge on larger amounts of food further out from surgery as the capacity to consume more food in one sitting grows over time. This increased capacity may result in binge eating episodes involving objectively large amounts of food years after surgery.

Although reports of the development of bulimia following bariatric surgery are rare, for many patients, it may become unclear whether vomiting to relieve discomfort or “plugging” is simply an episodic habit associated with post-surgical life or an eating disorder behavior. In this case, it is important to consider the motivation behind vomiting: whether it is solely to relieve discomfort (likely an eating problem related to surgery) or to control weight and/or shape (better described as compensatory vomiting associated with eating disorders).

The diagnostic requirement that an individual maintain a below-normal weight to have anorexia nervosa (AN) means that most pre- or post-bariatric patients cannot be diagnosed with AN. However, the accelerated weight loss and dietary restriction that is characteristic of bariatric surgery, coupled with the common and somewhat expected preoccupation with food intake as a result of surgery may pose as risk factors for the development of a restrictive eating disorder like anorexia. Patients may maintain a weight that is still considered to be in the “normal range,” but is well below expected or recommended weight loss. An intense fear of gaining weight and disturbances in their self-perception of weight or body size or shape can also develop post-surgery which can be associated with a restrictive eating disorder. Additional distress related to body image may develop in response to the presence of loose skin following weight loss.

“Failure” to meet expected weight loss outcomes post surgery, significant weight regain, subjective binging or grazing, eating less than recommended amounts, and weight loss well beyond the recommendation of the medical team can be indicators of disordered eating post-surgery. Voluntary vomiting can also be an indicator, though this is difficult to determine given how common it is to vomit for relief and discomfort associated with “plugging.”

The development of surgery-related eating problems or disordered eating patterns following weight loss surgery can be extremely distressing. Patients who hoped that surgery would end a lifetime of dieting and obsession over food and eating may be surprised to find that they are thinking about it more than ever before. Those with history of an eating disorder may find that their doctor’s post-surgery dietary recommendations that encourage restriction and rule-based eating sound a lot like the voice of their eating disorder that has either been silenced in recovery or continues to lurk among every day thoughts.

Needless to say, all bariatric surgery candidates should be thoroughly screened and provided with support and resources prior to and following surgery. And while history of an eating disorder or a current eating disorder should not preclude an individual from surgery, these patients should be especially mindful of the potential for continuation of an eating disorder, or a relapse in response to surgery-related diet recommendations and eating-related problems.

See also Dr. Carcieri’s article on  Binge Eating Disorder

Our staff members have experience working with clients both pre- and post-bariatric surgery.

References

American Society for Metabolic and Bariatric Surgery. https://asmbs.org

Colles, S. L., Dixon, J. B., & O’brien, P. E. (2008). Grazing and loss of control related to eating: two high‐risk factors following bariatric surgery. Obesity16(3), 615-622.

Marino, J. M., Ertelt, T. W., Lancaster, K., Steffen, K., Peterson, L., de Zwaan, M., & Mitchell, J. E. (2012). The emergence of eating pathology after bariatric surgery: a rare outcome with important clinical implications. International Journal of Eating Disorders45(2), 179-184.

Sarwer, D. B., Wadden, T. A., & Fabricatore, A. N. (2005). Psychosocial and behavioral aspects of bariatric surgery. Obesity research13(4), 639-648


Monday Motivational Quotes

Quotes are something that usually help me in the early mornings. It gives me a chance to read63719471ae233a4812db016241cc3836 something positive or just an affirmation to have a great day or week! Sometimes we just need that little push to remind us that everything is going to be ok. Baby steps is going to help us get through the day!

#mondaymotivation #edrecovery


The Day before the big Day

Tomorrow I begin IOP. Can’t begin to tell you how anxious I was all weekend. I don’t think I even have to mention that I binged this weekend. I think I am still feeling the effects this morning because I have such a headache from probably my glucose being really high right now. I hope to grab a handle on this soon and that therapy will be the help that I need. I finished my About page with a little back story to who I am and how I got to where I am today.