Wednesday, November 18, 2009

The Efficacy of Weight Loss Blogging

I got my weight-loss shit together when I lost a good friend almost two years ago. She was a hardcore bulimic: she would typically spend an hour in my bathroom, several times a day, flushing the toilet over and over again. One time, she flooded the bathroom. Even as the toilet water, toilet paper and undigested food swirled around her feet on the bathroom floor, she thought her disorder was a secret to us. The other signs were there, too. The flushed, chipmunk face from swollen salivary glands. The bloating. The abnormal hair loss. The teeth. I played along with the denial game with her, that game of "let's pretend I'm not going to purge this sandwich." Her fixation on food was profound. It was the subject of most of our conversations. We would go out to eat or order pizza and relish the pleasure it gave us. We were binge-buddies. And Bob and I would silently stare at each other when she left the table immediately after eating to go to the bathroom. Again.

I didn't have the courage to confront her with it. I was scared to. Scared that she would fly off the handle. Again. That she would disappear and not speak to me. Or threaten suicide. Again. See, it wasn't just the bulimia. Indeed, that was a just a symptom of something much deeper and darker. For instance:

1. She regularly engaged in "splitting." In other words, she held extreme black and white views of events, trivial matters, herself and her relationship with others. Most of it negative. She demanded nothing less than unconditional acceptance. The slightest (and unintended criticism) was met with harsh rebuke or great hurt and offense. She would obsess over perceived criticisms of her.

2. Manipulated by this splitting behavior, I learned to say and do the right things to her. Unconditional, noncritical words and compassion were like currency. The more I pleased her, the better she felt about herself and the more she rewarded me with kindness and acceptance. Later, my therapist (I'll get to that in a moment) would describe this type of conditioning as akin to a mother bird feeding a hungry hatchling. It was a neverending process of feeding her unstable ego.

3. At the high point in our relationship, I was her best and only friend, someone who didn't abandon her. At the time, I didn't notice her long history of broken relationships with her family, friends and boyfriends. I also didn't pay mind to the other current friends who were disappearing. It was them, not her. They were assholes, like she said.

4. Her low self-esteem was bottomless. Certainly, she had days where she felt positive and empowered. On her dark days (there were many), she was a loser. She was fat (she wasn't). Nobody liked her.

She became so embedded in our lives that it was not unlike having a third spouse. Or child. She demanded more attention. She was going to spend holidays with us and our family--without being invited. When I sheepishly tried to quell her plan, she became depressed and withdrawn until I promised her an alternate visit.

And we wanted to help solve her problems for her. I didn't want to hurt her because I thought we could position ourselves to help with her bulimia and dark moods. More importantly, I thought that if I broke off our relationship she would severely hurt or kill herself because, at that point, she had no one else and was in a dark place. She was in pain, harboring negative self-views that increasingly worsened. My responses, no matter how well-intentioned or loving, were not helping her. In fact, it was exacerbating her condition. She did not need my compassion...she needed professional help. I certainly was unqualified to do it.

In the end, the friendship became so destructive and turbulent that I went into therapy. I thought it was me, that there was something wrong with me because I couldn't fix this relationship.

It was during that therapy that the psychologist explained that my friend was displaying symptoms of borderline personality disorder. Imagine that...my therapist counseling me on the problems of someone else. It was during this therapy that the doctor explained my friend's eating disorder and how it was just one symptom of a much larger issue that would take years of intensive professional treatment to resolve or at least minimize. Until that happened, I needed to walk away.

She advised me to break off my relationship with her immediately and cleanly. No follow up phone call. No letter of explanation. No email. I did it. It hurt bad, the resulting guilt and sudden separation and loss. It was like she died. I lost a best friend just like that.

To get over that grief, I worked on myself. I re-evaluated this fixation on food, alcohol (she was also a heavy drinker) and self-image that was destroying my friend and bringing me down with her. With that, I was able to overhaul my own physical and mental roadmap and, well, that was that.

I didn't read other weight loss blogs and start this blog until a year after I rebooted my weight loss program and already lost about 70-75 pounds of my starting weight. And I'm glad I didn't.

Most obese people do not have eating disorders ("ED"). Statistics to that effect are readily available for your Google research pleasure. From my own unscientific observations over the past year, most weight loss bloggers do not identify ED as an underlying cause of their issues.

There are, however, bloggers who claim to have an ED. Usually self-diagnosed. Usually untreated. There are actually PRO-ED blogs and message boards out there. Lots of them. The proana (anorexia) and promia (bulimia) sites are disturbing, for sure. But some are much more subtle in reinforcing ED, perhaps unintentionally so.

As is human nature, we tend to seek out others who are like-minded, or at least seem to share whatever our own issues might be. What I've found in this little corner of the blogging universe is a surprising lack of meaningful exchange of information and opinions. Sure, there are informative and provocative blogs. But communication in a blogging context is typically unidirectional, like an arrow shooting into the great expanse that is the internet. Feedback is limited to friendly words of support and encouragement, humor and/or light commentary. Perhaps some differing viewpoints, but those are rare as they tend to be perceived as hostile or confrontational. Us floggers like harmony and would like to buy the world a Diet Coke. That is the nature of blogs in general, I suppose. By saying this, I'm not suggesting that blogs must be so interactive, or even so important. They don't, and they can't usually. This is not a message board or chatroom, after all.

But in the case of some ED blogs, it is particularly worrisome. I'm not talking about those who have sought and obtained professional treatment and are in recovery. There are plenty of those, and they are quite insightful, helpful and inspiring. Instead, I am referring to those blogs where the person has identified himself or herself as having an ED, but who has consciously chosen to forgo treatment.

First, I wonder how this person came to diagnose himself or herself as having an ED. Does she even have binge eating disorder or is it a matter of simply overeating and failure to regularly exercise? There is a significant difference between binging and overeating. I have even used the word binge casually myself. But does it rise to the level of a medical condition? Or is identifying oneself as a "binger" one way to medicalize or justify a weight problem, like a cloak or a shield?

Binge Eating Disorder--which research has suggested is more prevalent than even anorexia and bulimia--is a big deal. It effects not only the victim/patient, but also that person's family and friends. Though not yet formally recognized on the DSM-V until at least 2012, it is a serious disorder that requires serious treatment. If a person does truly have BED, but refuses treatment and instead resorts to blogging, it is potentially dangerous not only to herself, but to other readers who may also have (or think they have) an ED and have identified with him or her for that reason.

For those who don't get professional treatment and instead engage in virtual self-help via blogging, they risk dealing with the ED in isolation of the other problems intertwined with the disorder. While they publicly journalize their attempts to fix themselves, they deny, minimize, omit or distort the extent of their underlying emotional and psychological issues, deliberately or unintentionally. There is a fixation on the food (healthy or unhealthy), scale numbers and measurements, and attempts to limit calorie intake. Well-intentioned words of encouragement and support (which is about all most readers can offer) can reinforce that blogger's conviction that he or she can continue to do this on their own. More troubling, it sends a message to other readers with ED that they, too, can beat this without getting help.

However, according to many ED specialists, this self-help approach can be dangerous, as it may ultimately undermine that person's ability to successfully recover from the ED. Sure, there is a dispute among some professionals as to what to treat first: the weight or the disordered eating? But obesity treatments in and of themselves tend to be ineffective in the long run. And there is little disagreement that the psychological aspects must still be addressed to facilitate recovery. Changing eating habits, for instance, is not enough and may even make the problem worse. "Strict or unsupervised dieting" or calorie restriction can even trigger binge eating or other ED complications.

ED is a tough disorder to treat. As it is, therapy--under the guidance and supervision of a professional qualified to deal with ED and related issues--isn't always successful, though still effective and certainly better than going at it alone. For example, therapist-led group therapy for binge eating disorder, which is a common cognitive-behavioral treatment approach, has a success rate of approximately 51%. Only half. Of course, individualized treatment may be more effective, and necessary, depending on that person's circumstances.

More to the point, for patients engaging in self-help, the numbers drop dramatically. Even in self-help group therapy, less than 18% of members abstained from disordered eating. And that's in a structured group setting.

Imagine, then, the recovery prognosis for those who attempt to treat the ED on their own, without any therapy.

That is not to say there are no proper forums for dealing with an ED on the internet. For instance, there is a compelling ED website called Something Fishy, which provides abundant resources for ED treatment and recovery, including an impressive national referral system. Interestingly, its moderated message board is very trigger-conscious. Its policy specifically prohibits the disclosure of weight, weight goals, size, measurements, before/after pictures of participants, etc. There is no bragging about ED behaviors (what you binged on, when you last purged, etc.) or links to a participant's personal journal, website or blog. There is no discussion about calorie intake. Wow. This policy really drives home the depth and seriousness of ED. The factoids we take for granted and are helpful to us are poison to someone with an ED. For that person, those elements need to be stripped away in order to effectively deal with the illness. It seems so counter-intuitive at first, but ultimately makes sense.

At this point in this long post, as I wind things up, I could wax poetic about the epidemic of obesity and how we should talk about our WL goals/obstacles/successes if it helps us and support each other and all of that. That would be stating the obvious.

The harder, the more difficult thing is realizing that there are some very sick people here. You or I may even be sick ourselves but haven't brought ourselves to confront that fact. It is important to be careful of identifying yourself with or as someone with an ED (as I have in the past and might have again) unless, well, you have things sorted out upstairs and, where necessary, obtained the help of a therapist, nutritionist and other professionals. And to understand that ED is a sickness that requires help that blogging may not provide for someone with an untreated ED. Or worse.


9 comments:

  1. Very informative post, I had never looked at blogs and ED in that light. I don't have an eating disorder, I just eat more than I burn off so I have never been able to relate to those who do-- though I have read their posts with sympathy and concern.

    Just a note, I found the choice of background and colours very difficult to read, but my eyes aren't as young as they once were.

    Barb

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  2. Very informative and insightful post--thank you! I honestly don't know much about eating disorders and had never recognized the 'competition' aspect of binge reports. It makes a few blogs I've come across make a lot more sense.

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  3. Hi, I'm visiting for the first time today. I'm new to fitness blogging, but this is one of the best, most informative posts I've read. Clearly a lot of thought went into the writing. I appreciate your thoughts on the subject of eating disorders.

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  4. What a compelling post. And I'm sorry about your friend...sound like she was a total mindf*ck and it's good you got out when you did.

    As for reading about other blogger's binges, I find that I usually skip over the details - and yes, I do think that some take a lot of pleasure in describing all that they ate. I'm talking about people who binge over and over, not ones who happen to have a crazy food day.

    Thanks for bringing this out in the open.

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  5. I'm sorry you lost a friend, but I'm happy you found yourself.

    Strong stuff. Very well done.

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  7. I haven't had much exposure to the ED blogs, but it sounds like some of them take a very warped perspective that is not going to help much with recovery.

    And yeah, dealing with borderlines is definitely a no-win; even many therapists will often refer them elsewhere because they are so high-maintenance and difficult to treat. But they can be very compelling because they are often very skilled at emotional manipulation. Compassion is order, because their lives generally suck, but friendship is nearly impossible unless they get treatment.

    Good for you for moving on and taking good care of yourself!

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  8. Have you read Stephanie Klein's book MOOSE: A memoir of Fat Camp?

    There is a section about eating disorders.

    I am so sorry that you had to have that kind of sadness in your life. You seem to have the emotional intelligence to understand that it was a disease.

    Thanks for sharing this story in such a candid manner. I think it is very helpful for people to hear your perspective.

    Denise Burks
    www.successfulweightlossinthesuburbs.blogspot.com

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