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On Being a Fat Person With Anorexia

“It doesn’t matter how you do it, just lose the weight”

Photo: Arno Images/Getty Images

Note: This essay contains mentions of eating disorder behaviors, self-harm, fatphobia, and weight loss surgery. Although I tried to be as vague as I could around specific behaviors, there are parts of this that may be difficult to read if you are actively struggling with an eating disorder. Help and support are available. Please reach out to the National Eating Disorders Association. Recovery is possible.

TThe first time my doctor mentioned my weight, I was about 11 years old. I was a chunky kid, like I’d always been. When I came up to the plate during kickball, the other kids shouted “easy out!” I was often teased about my body. But back to the doctor: As I sat there listening, she told my mom that my weight was fine as long as I only got taller during puberty and not heavier.

You can guess how that went. I gained weight. And that wasn’t wrong. In fact, it was completely normal. Research shows that 50 percent of your adult body weight is gained during adolescence. But I only knew what my doctor and the kids at school said about me.

As a kid and teen, I tried to eat “healthy.” I now know that what I was doing was restrictive, not healthy. I would avoid eating certain foods because, in my mind, these were bad foods. If I ate them, I would be as bad as the food itself. But then, when I did eat, I felt out of control and I couldn’t stop. I just had to eat more.

I was in Girl Scouts as a kid, so we often had supplies for s’mores around the house. Sometimes I’d grab a Hershey’s chocolate bar and hide it under my plate while I ate my lunch. I’d take bites when my parents were out of the room and then hide the chocolate again when they came back. I remember going into the kitchen late at night and eating a plain pre-made graham cracker crust. I ate part of the crust and put it back on the shelf. Somehow I thought this trick might make the crust look like it was defective and then my mom wouldn’t notice. Over the next few days, I finished the crust and hid the container in the trash.

Our society doesn’t talk about how fat people can have eating disorders, especially restrictive ones.

I now know this is fairly normal behavior for someone with a restrictive eating disorder. It’s a phenomenon that’s often referred to as the scarcity mindset: When our bodies don’t know when we’ll be allowed that food again, they fixate on it. Then, when we have access to that food, we eat as much as we can. Your body says: “We have to save up! When will it be back? I need it now!”

The problem is that when you’re fat, nobody sees the restrictive part of this equation. Instead, all they see is a fat girl who binges on sweets. They don’t see the part where you try to avoid those sweets all day, or all week. They don’t see the secret purging. They don’t see those behaviors for what they are: an eating disorder. All they see is a fat girl, doing the “right” thing by restricting her calories and “dieting.”

It doesn’t matter how you do it, just lose the weight.

II joined Weight Watchers for the first time in middle school. It was just the beginning: I would start and stop Weight Watchers for the next eight years of my life. And when I wasn’t using Weight Watchers, I relied on all sorts of diets. A diet app was my favorite way to obsessively count calories because it suggested calorie limits for weight loss, but I could customize those limits and make them lower. During high school, I searched “calories per day for anorexia” on Google and made that number my daily calorie goal. If I went over it by even 10 calories, I’d run on the treadmill in the garage until the treadmill said I’d burned the calories off. Sometimes I’d pass out after or during my workouts. No one knew. I didn’t tell my parents until this year.

Around the same time, I joined a weight loss application study I heard about on NPR. I weighed myself daily on a smart scale that reported my weight to the study team. (This is super unhealthy. If you feel like you need to weigh yourself in this way, please reach out for support.)

If I was feeling hungry between meals or like I wanted to eat more, I was told I should look at the research app, which contained gross pictures intended to make me feel less hungry. I won’t go into vivid detail here, but I will say that some of the photos were of fat people. These photos were used without permission, and they were supposed to shame fat teens like me into losing weight. I was being shamed into ignoring my body’s natural hunger cues.

I was one of the oldest teens in the study, and I actually stood up to the researchers. I quit the study altogether and told them their application was encouraging disordered eating behaviors. They were, of course, shocked by my response because no one cares how you make fat people feel. They just care that you lose the weight, whatever it takes.

I experimented with purging during high school too. I was graduating a year early, so I was in two different English and social studies classes. In my senior English class, my teacher focused on the students struggling to graduate, not the kids like me. No one noticed when I left class and then came back, red-faced and ashamed, 20 minutes later.

It doesn’t matter how you do it, just lose the weight.

MyMy therapist in high school pointed out that I seemed to have some “disordered eating behaviors,” but this was only mentioned in passing. We never really talked much about it. My therapist, my doctors, and my parents were all a lot more worried about my self-harm and suicidal ideation, so my disordered eating slipped through the cracks. But they were related: The first time I self-harmed, my goal was to work up to eventually removing fat from my body.

I don’t blame any of these people for missing the signs. I wasn’t ready to talk about it then, and they weren’t trained to see it. Our society doesn’t talk about how fat people can have eating disorders, especially restrictive ones. For fat folks, a restrictive eating disorder isn’t often seen as an eating disorder. Instead, it’s just seen as a diet.

Some things got better during high school. I became intensely involved with the body positivity community on Tumblr. I made some internet friends who talked to me about the science behind dieting and weight loss, and the harm those things can cause. I learned and tried to practice a Health At Every Size (HAES) approach. I had some good times. I had a few good years of college too. But an eating disorder doesn’t just go away without professional help. Mine came back with a vengeance.

Maybe it was my abusive relationship. Maybe it was the fact that school was hard for me in a way it hadn’t been before. Maybe I needed to feel like I was in control as I approached graduation and had to figure out my life. Maybe I couldn’t keep fighting everyone and everything that was telling me to lose weight. That refrain popped up, time and time again: It doesn’t matter how you do it, just lose the weight.

OnOn the advice of my doctors, after years of having everything blamed on my weight and my body, I finally gave in. I decided I was ready to have weight loss surgery. I’ve since learned that my insurance has one of the better psychiatric screening processes for weight loss surgery. But even then, they didn’t catch that I had a restrictive eating disorder. All the psychiatrists cared about was that I sometimes did what I self-described as “bingeing.” You can’t binge if you’re going to have your stomach cut in half and sewn shut during weight loss surgery. It will explode and you can die.

And so I was referred to an eating disorder treatment center for evaluation before I could be further considered for the surgery. I had to go back to D.C. for my senior year of college, so I found a therapist there who specialized in eating disorders. I figured I could knock this out over the course of the year. Then I’d have the surgery the summer after I graduated. That was… not what happened.

My therapist referred me to a nutritionist when she realized how bad my restriction had become. I was barely eating all day and then I would try to catch up by “bingeing” at night. I was light-headed all the time. I missed classes sometimes because I was so dizzy I couldn’t walk the block-and-a-half from my job to class. I was running on fumes.

I’d been dieting and trying to lose weight for so long that what I considered a binge meal was, in fact, a pretty standard meal.

I often laughed my behaviors off. I was just so busy, I said. I was helping run a nonprofit! I was applying to law school! I was finishing my major and my minor! I was deeply involved with my photography classes and business! So what if sometimes I didn’t have a chance to grab a meal before 8 p.m.? (This is where I say again that if my behavior reminds you of yourself, that’s not normal. NEDA has so many resources and a helpline.)

I saw a nutritionist who subscribed to the same HAES philosophy I’d followed during parts of high school. Unlike the psychiatrist I’d seen during the screening for weight loss surgery, this nutritionist asked what I meant by bingeing. I explained: I’d have a burger, fries, and cheesecake from the Cheesecake Factory. Sometimes I’d order chicken Alfredo with tiramisu. (I’m lactose intolerant and knew it would make me sick.)

She looked at me with her mouth open. “Zoey, that’s not bingeing. That’s maybe a big meal. Plenty of people go out to dinner and eat that. How is that overeating? Especially when you haven’t eaten all day. And it makes you sick.” I was pretty shocked. I’d been dieting and trying to lose weight for so long that what I considered a binge meal was, in fact, a pretty standard meal. And I hadn’t even considered that I was using my lactose intolerance as a way to purge my one meal a day.

I was spiraling. I was out of control and I don’t know how I graduated college. There are parts of my senior year I barely remember because I was so hazy. I tried hard to recover, but seeing a nutritionist and therapist once a week wasn’t enough. My friends, my parents, and my team are the only reason I made it across that stage. I couldn’t have done it without them. But I still had a long way to go.

MyMy nutritionist said I needed a higher level of care. She wanted me to start intensive outpatient (IOP) therapy when I moved back to Seattle for law school. IOP involves 10 to 15 hours of treatment each week. That felt doable. She recommended Opal: Food + Body Wisdom, an eating disorder treatment center that also uses a HAES and intuitive eating approach to recovery. It was the best thing that ever happened to me.

As soon as I called Opal to set up my intake, they told me over the phone that I would likely need to do a partial hospitalization program (PHP) to start. PHP is 50-hour-per-week treatment setup. You’re in treatment from 8 a.m. to 6 p.m., every day. You eat all your meals and snacks there.

I thought that recommendation was ridiculous. There was no way I was that sick. I agreed I’d try PHP for a few days, and then I figured I’d likely step down to IOP. Spoiler alert: I did not step down after a few days. I spent most of that summer, from June to August, in 50 hours per week of treatment. Only then could I step down to IOP for a bit. After that summer, I started law school and continued 17 hours a week of treatment, in addition to working.

Luckily, my insurance (Regence) covered my time at Opal. But if I hadn’t exhibited a history of purging behaviors during high school, my health insurance would not have covered my treatment. Regence doesn’t cover anorexia treatment unless someone is underweight. In other words, despite the fact that current anorexia diagnostic standards do not include a weight requirement, my insurance does. This further perpetuates the harmful stereotype that only underweight people have restrictive eating disorders. This is the kind of stereotype that kept my therapists from discovering and treating my eating disorder for many years.

GGoing to treatment was one of the hardest things I have ever done. I bared my soul to so many therapists and nutritionists. I told my life story (literally, there is a group called Life Story) to a bunch of other strangers who also had eating disorders.

I ate Oreos as a snack for a week and a half and then suddenly realized that they didn’t hold any power over me when I wasn’t restricting my access to them. Honestly, I was sick of the damn things.

Treatment was one of the hardest things I’ve ever done, and it was one of the best.

I changed my relationship with exercise. I learned to use exercise not as compensation for food, and I also learned not to avoid exercise altogether because I was afraid of misusing it. I learned that I’m actually pretty good at softball, which was shocking. I wasn’t an “easy out” anymore. I went to family therapy, established boundaries about some things and broke down others.

Treatment was one of the hardest things I’ve ever done, and it was also one of the best. My eating disorder still isn’t gone. It’s still a challenge. But I have the tools now. I have an amazing medical team behind me. The strangers I told my life story to are now some of my closest friends. I’m not afraid of food as much as I used to be. I bought a crop top the other day that says “Damn Fine Belly Line,” and I am going to wear it in public this spring. My co-workers know about my eating disorder. They ordered me lemonade for the office fridge because I don’t drink diet soda (it’s a recovery thing). I have so much space in my brain now for stuff other than obsessing over food, like obsessing over politics instead. I get to enjoy food. I loved to cook when I was little and I get to do that again. I am very into my Instant Pot now. Mushroom risotto is my favorite recipe.

RRecovery is hard. Recovery is a process. Recovery is ongoing. Recovery is beautiful. I’m fat and I’m anorexic. I deserve care as much as anyone with an eating disorder does.

Photos: John Sage/FinchHaven, and Tiffany Perkins/Mini Mama Photography

In both of these photos, I have an eating disorder. In recovery, I look like the girl on the right. And I smile and laugh like that more often. I love the body on the right a lot more these days. It blessed me with recovery. Some people are always going to hate it. Some days I still will too. But I’m done trying to change it.

You deserve to be nourished and to live a full and happy life. You can be busy and successful and still eat food. I owe a lot to my classmate who called me out and said, “No one is that busy.” If you’re waiting for someone to call you out like that, consider this your moment. Please, seek help. The NEDA has so many resources and they also offer a helpline. If you live in Seattle, reach out to Opal. Help is a phone call away. You deserve it.

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