CW/TW - I talk about EDs and treatment for EDs in this post
Okay, a little bit about me first for some context. I’ve been overweight since puberty. In college, I learned about nutrition and calorie counting and tried multiple times to lose weight by tracking calories and exercising. I would lose weight, but then overeat, say “screw it” and go back to my old habits. I started dating my current partner, who is also overweight, and we both continued to gain weight together. Four years ago, I realized I might need some therapy to deal with my issues, and three years ago, I started seeing a therapist specifically for eating disorders.
The whole time, I’ve held two positions: 1) if you eat at a caloric deficit, you will lose weight, as has been shown time an time again through science and 2) my emotional and psychological issues were having me use food as a crutch, causing me to gain or maintain my higher weight.
I started working with her on my food issues. I developed mantras to use when I wanted to binge or compulsively eat. I started examining my body-image, self-worth, and social anxiety issues. In summer 2019, I started seeing a psychiatrist, as I didn’t feel like I was progressing fast enough and my depression was starting to creep back in. I was officially diagnosed with BED and I started the generic substitute for Vyvanse. This helped. I still had thoughts to binge and overeat, but the medication helped me say NO. I started practicing REAL intuitive eating. Full after half a bowl of oatmeal in the morning? Scrape it into the trash. Stomach growling at work in the afternoon? Have an apple and some nuts. Coworker having birthday cake, but you have a cookie at home you’d rather eat? Turn down the cake, eat the cookie later. I also started exercising in the morning and going to bed earlier at night. I started dropping about a pound a week for a total weight loss of about 30 pounds. I felt GREAT and was getting stronger. My therapist was pleased that I was able to feel more in control of my food choices and eat what I wanted. We were both excited I was trying new hobbies and developing new, sustainable routines.
Fast forward to the pandemic. I unexpectedly move far away. My therapist and I start meeting remotely. My work goes remote. No more morning gym. No more routine. I gained 40 pounds. I stopped seeing the psychiatrist I was seeing because of telehealth issues. Mental progress comes and goes during the pandemic. Suddenly, this spring, my therapist starts saying things that make me uncomfortable. About diets being shown to not work. Slightly deriding of intentional weight loss (she herself is a normal weight). She mentions how BMI isn’t an indicator of anyone’s actual health. I start getting uncomfortable. I want to love my body, but I want to love it so much that I treat it right. After experiencing severe abdominal pain, I get diagnosed with non-alcoholic fatty liver. I am scared. I want to practice intuitive eating like I did before when I was losing weight. I don’t want to just stuff my mouth without thinking about it. I try to intuitive eat for a few months, but I stay the same weight. I’m still scared. The only prescription for the fatty liver is weight loss. If I don’t take care of it I could develop cirrhosis, liver cancer, and/or need a transplant. I start counting calories again out of fear even though historically that has just led to binges.
I tell my therapist I’ve been counting calories for a week. She tells me I’ve been reporting a healthier relationship with food for the past two months, what happened? I tell her I am scared, I don’t want a liver transplant, I don’t want to be in pain. I tell her I’ve been putting off seeing the liver doctor because I don’t want to hear him say “lose weight”. I’m embarrassed that I haven’t lost any more weight despite health issues. She says it won’t help me to hear that right now and we agree I should just schedule an annual physical instead. But she seemed upset that I wanted to count calories again. Almost personally hurt. And I really adore this therapist, we’ve had a good working relationship, but HAES/FA stuff has slowly been slipping into her comments. I NEED to lose weight if I want to live. I want to develop a sustainable relationship with food, not a self-sabotaging cyclic one.
I just needed to vent. I don’t know what to do anymore. I have an appointment with the psychiatrist today, and I’m hoping he’ll prescribe me the other half of contrave, naltrexone (already on bupropion portion of it now.) I don't know how to approach my therapist. I need to talk to her, but I don't know what to say. If you have been in a similar situation, I'd love to hear about it.
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