Maggie’s 152 lb. Weight Loss—This Time, It’s Not Disordered

Eating Disorder Recovery is More than Achieving a Healthy Weight

At the MFA, Boston, MA

Just this Thursday yet another patient shared her beliefs, her fears about recovery. “If I’m at a normal weight then I won’t need to come in. And everyone will think I’m fine”, she stated. And that was one roadblock to her recovery. Wearing her eating disorder, just like, for a cutter, I suspect, wearing short sleeves, is a way of expressing that there’s a problem. It appears to be a way of passively asking for help, when words fall short. 

Some have been surprised when I described them as still having an eating disorder, complete with thoughts of restriction, denial of hunger, and food and weight preoccupation, in spite of having restored their weight.

A significant drop in weight could be a red flag for an eating disorder, or can be the result of healthy measures, in spite of an eating disorder history. And a normal weight can disguise the pain of your struggling with an eating disorder as well. All of the above apply to Maggie.

You’d think dropping 152 pounds would be a major accomplishment for someone close to 400 pounds. And it is, especially at the age of 67. But the more successful part of this story is the move away from reliance on eating disorder thoughts and behaviors, on both sides of the weight spectrum.

Also at the MFA, Boston

Maggie, at 130 pounds and 5’8” saw herself as a “big fat slob”. A low weight for her height by any medical standards, she was obese by her own. She reports never really feeling good about herself, and by her early 20’s had met criteria for anorexia, plummeting to 117 pounds with restrictive intake and bulimic exercise levels. By that I mean exercising excessively, typically to compensate for eating, in an obsessive way.

Like many I see, a motivation to conceive helped enable her to gain enough for normal menses to resume, and ultimately to carry and deliver a healthy daughter. She managed to maintain a healthy weight, although not a healthy relationship with food and her running shoes. And after some time, triggered by a traumatic event, Maggie’s eating disorder turned to binge eating, with a focus on night eating. (Let me assure you that with support from an eating disorder team, recovery from anorexia does not have to result in binge eating and subsequent obesity! But Maggie had not yet sought help.)

Fast forward to the summer of 2002, when at 388 lbs. Maggie presented to see me. Her goal? To lose weight and recover from her many years living with an unhealthy relationship with food. Basically, to learn how to eat and to listen to her body—something she had never really done.

Maggie still comes to see me, every 4-6 weeks. (She has also worked with a therapist, at my recommendation, but they have finished their work together.) Yes, it’s been a very long road, but her progress has been tremendous. It’s quite impressive that she is down 152 lbs. so far. But more impressive, is that it has been years since she has used behaviors to manage her eating and her weight. 

True, there have been slips where I have had to play the “tiger mom” role, insisting that she increase her food intake, when weight loss was getting a bit too rapid. But she heeded my firm warning, and stayed on course. 

And there were certainly frustrations, like when she went to see her primary care physician recently. In reviewing her history, the doctor asked what her weight had been before we began our work together. And when Maggie, somewhat shamefully, admitted it was 388 lbs., the doctor laughed and told her she had to be wrong, dismissing Maggie as exaggerating her weight loss. Could you imagine! This very same visit, the doctor denied her a referral for a therapeutic water program that I requested, to enable her to move more. Because after so many years, no matter how much weight she lost, her knees weren’t going to fix themselves and allow her to start walking. To her credit, the incredible anger and frustration she felt was verbalized, instead of buried with pastries.

Over these years of working together, Maggie has changed the rules. She allows herself to eat later at night—if she’s hungry, and she chooses foods she truly enjoys—but eats them mindfully. Sometimes I find her counting her carbs, but generally only when she’s concerned about her blood sugars, as she was diagnosed with Type 2 Diabetes several years ago.

Perhaps her next challenge will be learning to manage activity—after she has her knees replaced. And for the record, she also followed my most recent advice—she switched to a lovely new doctor, who gladly issued the prescription for the water exercise program!