So many of you shared your own horror stories. The scope of this is hard to capture in words.
Putting it bluntly: Eating disorder recovery centers are failing their patients in larger bodies. And their inability to treat patients of size has done immense harm on a scale that just can’t be understated.
Many of you asked, “What can we do? I backed the GoFundMe, but how do we fix this for everyone else?” I asked myself the same thing.
The long game, obviously, is dismantling fatphobia wherever it exists. But there are people in treatment right now who need support. So, with the input of Shira and some fabulous babes in recovery, I created this printable letter that patients of size can give to their providers.
Explaining what shouldn’t have to be explained is painful. It’s traumatic to have to outline the most basic information just to secure dignity in treatment.
If having this letter handy eases that burden, and educates providers along the way, I’m hoping it’s a step in the right direction.
While this doesn’t dismantle systemic fatphobia, it does offer an advocacy tool for this immediate moment. The most important thing was just getting this resource out into the world for anyone who needs it — which unfortunately was far, far too many of you.
I hope that this can help ease the unfair burden that folks are facing in treatment. You deserve the very best in recovery.
Please know that I won’t stop fighting for that until it’s a guarantee.
Allies and especially providers: If you appreciate the resource and have the ability to do so, please donate to Shira’s GoFundMe for treatment, and share among your networks.
When Shira and I first connected, I had a feeling in my gut that we were meant to cross paths.
She had read my article on how I used body positivity to avoid confronting my years-long battle with anorexia nervosa, and we clicked immediately.
As a fellow blogger and advocate, no one could come closer to understanding how I felt than Shira did. (Not to mention, her winning combination of New York attitude and snark, and love of all things sparkly, captured my heart immediately.)
While her organs were literally shutting down, and a terrifying fall left her badly concussed and her nose broken, she existed in a private hell that few knew about. The outside world only knew Shira as the same beam of sunshine and powerful advocate for body liberation she’d always been. But in private, Shira was dying.
In those earlier days of my recovery, Shira was a lifeline to me. To be honest, she still is.
Because even in the depths of anguish, Shira has the biggest heart of anyone I know. No matter how far down she’s fallen, she is a relentless cheerleader for those that she cares about, and the thousands of followers who have been inspired by her journey.
That’s because as a therapist, as a blogger, and as a friend, her sincere belief is that no one — not one single person — gets left behind.
Shira fought tooth and nail for four months in residential treatment, making enormous strides.
And while she was there, in a moment of extraordinary courage, Shira revealed to the world her 20-year-long battle with an eating disorder — putting her reputation as a therapist and advocate on the line to tell an undeniably powerful truth about the reality of eating disorders.
She wanted to affirm that, yes, eating disorders are a mental illness that doesn’t discriminate, even among healing professionals.
And even those who know everything there is to know about an eating disorder, about body positivity, about health at every size? Can still suffer from these relentless illnesses.
Her bravery in that moment has stuck with me every day in my recovery since then.
Throughout this past year, over texts and calls and audio messages on the train, we took on our eating disorders together. I watched Shira fight her way from the brink of death in a residential facility for four months, in awe of the grit and determination she showed up with day after day.
On the days when I didn’t want to keep going, she’d somehow telepathically sense it, I swear, because it would be less than five minutes later that I’d get a text asking, “What’s for lunch?”
After she was medically stable and eating consistently, it was time to transition to a partial hospitalization program back home, which would help ease her back into her daily life. We were both hopeful that she was well on her way to the recovery she so deserved.
Miraculously, she was able to secure a full scholarship for PHP, as insurance providers seldom cover eating disorder treatment. We were elated and hopeful.
I want to be able to tell you that, once in program, the momentum continued. But this is not that story. That program nearly destroyed her.
I don’t say that as an exaggeration. I say that as someone who listened helplessly on the other end of the phone, filled with rage, shock, and horror at everything my friend had to endure.
As an advocate, I’m not unfamiliar with the mental health care system and its horrors. As a survivor, I have stories of my own. But despite that knowledge and experience, what happened to Shira shook me to my core.
From day one, the first text I got from Shira about her new treatment team told me everything I need to know about the place: “They mocked Health at Every Size and the fact that I’m a therapist.”
My blood went cold. “Wait, what?” I typed back.
“Yeah,” she replied. “My case manager said, ‘Health at Every Size therapist? How does THAT work?’ And then when I tried to explain, she said, ‘Well, you seem to have ALL the answers.’”
But a snide comment from a case manager was just the tip of the iceberg. Things were about to get much, much worse.
The day program Shira was a part of had a “three strike” rule as part of a contract they require patients to sign.
In her gut, Shira knew that a strike system would bring out perfectionistic tendencies (a fear of failure is super common in folks with eating disorders). She voiced that, in the past, this sense of shame had sabotaged her recovery efforts.
Her concerns were brushed aside. They insisted that their “three strike” rule helps them determine if someone needs a higher level of care, and that these “boundaries” were an important part of the care they provided.
This became a pattern, though: Whenever Shira tried to voice that something wasn’t working, she was told that her “malnourishment” and her eating disorder’s “tendency to manipulate” made her an unreliable advocate for herself.
This part, of course, comes as no surprise to me. Clinicians often treat people with mental illnesses as if they aren’t competent enough to vocalize their needs and expectations.
But the strike rule would become a sticking point, because within one month, Shira — despite all of her success in her four months of residential care — would accrue all three of her allotted strikes.
The first strike happened when she refused to eat ice cream. She did so not because she was unwilling to eat it, but because of the instructions her dietician gave her cohort.
“The dietician said, ‘You three get two scoops of ice cream.’ She then looked at me and said, ‘You’ll get a kiddie scoop.’”
Some of you won’t understand the gravity of that comment. To be clear, a dietician told a patient with anorexia nervosa to eat less food than her peers, because she is a patient in a larger body.
The message here being, of course, that Shira needed to eat a child-sized portion of ice cream, because she wasn’t thin enough to “safely” consume more than that.
This plays directly into the eating disorder’s conviction that she needed to tightly control her food intake and her body. Her peers could eat a “normal” amount of ice cream. But she couldn’t and was singled out, because something was “wrong” with her body.
“This was the message I received my entire damn life,” Shira told me. “That I couldn’t eat like everyone else.”
This dietician perpetuated a fear of food and implicitly encouraged restriction, all of which are absolutely inappropriate to suggest to someone with anorexia nervosa, regardless of size.
Restriction is never an appropriate recommendation for someone with an eating disorder.
And yet that’s what she was told… in a prestigious treatment center.
Shira refused to eat the ice cream, grappling with an immense amount of shame, self-loathing, and fear. And by refusing to eat the ice cream, Shira earned her first strike.
This became an ongoing problem in treatment, in which she was told, for example, to eat 70% of her sandwich (yes, seriously). It left her feeling guilty about eating, and when she was still hungry afterward, she wondered if something was wrong with her.
Even after the center agreed to stop controlling her food intake with numbers, the damage had already been done — she knew she only “needed” to eat a percentage of what she was given, both from what she was told and what she overheard when other patients were given their food.
She began to backslide in her recovery.
Prescribing restriction for larger patients, though, wasn’t the worst part. It was the silencing of Shira’s voice, particularly around size inclusion.
Whenever Shira tried to address the complexities of recovering in a larger body, she was shut down by clinicians and peers alike.
She was discouraged from discussing her fears around returning to a bigger body, as someone who had lived in one most of her life, and understood that her recovered body would likely be a fat one.
“I needed them to acknowledge, just ACKNOWLEDGE, that recovering in a fat body is terrifying in a world that hates fat people,” she texted me once.
Instead, she said, they remarked that she needed to “take her therapist hat off” and suggested that she was being difficult, and lacked commitment to her own recovery.
Being surrounded by a treatment team that couldn’t validate her fears, suggested that she restrict her intake, and questioned her investment in recovery, began to erode her sense of faith that she was supported.
Shira accumulated two more strikes as she continued to struggle. And rather than ask how they could better show up for her, they called her in for a meeting, and immediately blamed her for not progressing quickly enough.
That’s when they told Shira she needed to start calling residential centers, and ‘prove’ that she wanted to recover.
I remember how she described the heartbreak, realizing that her treatment team didn’t at all honor how hard she had been working, nor did they hear her when she explained how she needed the space to talk about recovery in a larger body.
She felt defeated, wondering if she had failed. Calling her outside providers, the feedback from her external therapist and dietician was unanimous: Shira didn’t need to go back to residential. She needed trauma-informed, size-conscious care at the outpatient level.
Having accrued three strikes, though, the contract dictated that Shira couldn’t continue in their program.
Shira didn’t want to give up. After meeting with her therapist, she sent a powerful email to her treatment team at the center, explaining that she would like to come back.
She reiterated her commitment to her own recovery, expressing that she simply wanted a care team that could affirm her experiences of fatphobia in the outside world, and one that could create an environment that had more consciousness around what might trigger someone in a larger, recovering body.
After sending that email, she heard nothing for two days. Wracked with guilt and self-blame, she relapsed — hard.
How could she not? In their last meeting, she was blamed for being unable to “comply” with treatment, and was told over and over again that her “manipulative” eating disorder was making it difficult — if not impossible — to help her.
When she finally heard back, she was invited to meet with her treatment team again… one week from then. Mind you, Shira’s outside providers have been contacting the center, warning them of the relapse and acute state that Shira is in.
This is the same center that told her that she needed to come to their center within an hour of her plane landing, for fear of being left with any lapse in care. Now, they’ve told her to wait an additional week to “discuss” the future of her care.
When Shira asked what she should do to keep herself safe in the meantime, the answer was short. “You left,” they told her, not acknowledging that the contract they had her sign meant she was being kicked out.
She was told to rely on her outside providers, suggesting that maybe they could’ve come up with an alternative if she hadn’t left.
Once again, the buck was passed.
Shira spent that entire week unable to afford much care from outside providers and, in an acute relapse, she unraveled quickly.
She and I held out hope, though. After all, why have a meeting at all if not to discuss how they could help her? I had read the email Shira sent, and it was gracious and encouraging, emphasizing that she was hopeful that they could find a path forward.
Clearly they were going to regroup and find a way to support her, I thought. Her email was so reasonable, and it was a powerful moment of self-advocacy for someone who struggled to find her voice.
But I thought wrong. After a week-and-a-half without care, now navigating a dangerous relapse brought on by her traumatic treatment experience, Shira attended a “meeting” with the center.
I put “meeting” in quotation marks, because it wasn’t a meeting at all. They, instead, took it as an opportunity to reiterate her failures under their care.
They told her that they would be discharging her and revoking her scholarship. Their rationale? She was ‘non-compliant.’
They went on to tell her that it was a “slap in the face” that, after being given a scholarship, she wasn’t trying harder. Shira listened, heartbroken and in shock, as she was told that she was to blame for her treatment being unsuccessful.
They would not be helping her secure care elsewhere. They called her into a meeting to simply tell her she had failed.
They knowingly allowed Shira to relapse for a week-and-a-half with a deadly mental illness, and kept her in limbo with no intention of helping her, for what reason, exactly?
They could’ve told her from the beginning that she needed to arrange for some other form of care. They could’ve offered some kind of contingency support to transition out of their care. They, at the very least, could’ve called her on the phone earlier rather than have her wait.
“She’s in a bad way,” one of her outside providers warned them that week, impressing upon them the dire stakes. During that week, Shira was fainting, and again at risk for serious esophageal injuries due to her purging behavior, which had reemerged fiercely during the relapse as she struggled to cope.
No one can know for certain why a clinical team would deliberately string someone along in an acute crisis in that way.
Only they can answer to that.
That’s where we find ourselves now: Shira was abandoned by her day treatment team, and she cannot afford another program.
Furious doesn’t even begin to describe how I feel, watching this all unfold from a distance.
Shira is dying — there’s no other way to describe what happens to our bodies in these states of ED relapse. And the hope she once carried for a life on the other side of this was pummeled by clinicians she had trusted to support her.
But somehow, she still wants recovery. After everything that’s happened, she still wants to fight. Not that I’m surprised, because Shira already sacrificed so much to get to where she is.
But after everything she’s endured, both at that center and others, I wouldn’t have blamed her at all if she’d given up.
And this is the part where I get extremely, uncomfortably honest with you all: I don’t want to lose Shira. I can’t lose Shira.
This is the first fundraiser like this that I’ve ever been a part of, and believe me, I wouldn’t be asking if this weren’t important to me.
I believe that the advocacy and clinical work that Shira does is invaluable, and it’s work I want to continue doing alongside her. I want to believe that those of us with mental illnesses can recover, and go on to help others — as healers, as writers, and YES, as therapists.
I want Shira to continue to be a shining example of what happens when those of us who are wounded go on to become healers.
But Shira needs help — desperately. And somewhat selfishly, I don’t want to do this whole recovery thing without her.
I want us both to get better. I want us to start our own treatment center one day (I’ll admit, Shira is making me seriously consider becoming a therapist myself), to fight for policies that protect people like us, and hold accountable any and all clinicians who do harm to their patients.
I know you probably see hundreds of GoFundMes every week, floating across your screen. And I won’t try to convince you they aren’t all worthy of your support.
But this one, for me, is personal. Because of everything Shira represents, but more than that, because of everything she’s done to pull me out from the depths of my anorexia, even as she struggled with her own.
When I recently wrote a Twitter thread about my people-pleasing tendencies, I didn’t at all expect for it to go viral. Yet that’s exactly what happened.
As I shared my experiences with trauma and people-pleasing, I was hit with an avalanche of emotion. So many of you could relate to this phenomenon known as “fawning,” and it became immediately clear that we needed this resource to exist outside of Twitter.
So let’s keep the conversation going. I’m going to share both the original thread, as well as building on it. Let’s talk about the link between people-pleasers and emotional abuse.
Confession: I am a people-pleaser.
It took me a long time to realize this, though. Because I’m opinionated! And I speak my mind! I’m an “open book” about a lot of what I’ve been through. Clearly I don’t care what people think… right?
But in the last year, I’ve come to understand that people-pleasing is a lot more complex than that. We all curate our lives to some extent. And for people-pleasers, the ways in which we do that “curating” piece often stems from a place of fear.
To avoid conflict, negative emotions, and re-traumatization, people who “fawn” when triggered will go out of their way to mirror someone’s opinions and appease them in order to deescalate situations or potential issues.
For me, this meant that the more invested I was in an emotional connection, the less likely I was to criticize that person, vocalize when my boundaries were crossed, express unhappiness with their behavior, or share anything that I felt might damage that relationship.
This could come across as being excessively nice and complimentary, overly-concerned with another person’s happiness, and waiting for cues in conversation to determine if something was “safe” to share or disclose.
You could say that people-pleasers are sort of ’emotional chameleons,’ trying to blend in in order to feel safe.
We try to embody whatever articulation of ourselves feels the least threatening to the person that we’re trying to be close to.
This can show up in a number of ways. People-pleasers are often really warm, encouraging, and generous people. They tend to overextend themselves and say “yes” to everything and everyone, eager to make those they care about happy and comfortable.
This tendency usually stems from childhood. They often grow up in very controlling and chaotic environments, and internalized the idea that if they were perfectly good or well-behaved, they could minimize conflict and secure love and attachment.
When you have this tendency to defer, make yourself subordinate, try to become smaller, ignore your boundaries and intuition, and minimize your own needs… you are profoundly vulnerable to emotional abuse.
This vulnerability to abuse is often a continuation of the familiar, chaotic dynamic from earlier in life.
When you are excessively concerned with pleasing others, you learn that in order to be effective at this, you have to shut down your gut instincts, your values, your emotions — because being an individual, rather than a mirror, doesn’t serve you in securing the love that you want.
That’s why people-pleasers can become drawn to abusive relationships, and repelled from relationships that are abundantly loving. We’ve internalized the idea that love has to feel “earned” in order to feel secure.
In other words? If love is given too freely or easily, it doesn’t feel safe.
This means people-pleasers can be drawn to relationships that are controlling (they feel safest when they defer to others), emotionally-withholding (they are driven by the need to “secure” affection, and feel elated when they do), and even abusive (their lack of boundaries is exploited).
Another part of being vulnerable to abuse is that people-pleasers are so easily gaslit, because when they are inclined to suppress their own instincts, values, and beliefs, they’re infinitely more likely to defer to an abuser’s version of events or narrative.
This also means that “fawn” types often go through cycles of restricting emotionally (I can’t be “too much” for others) and then purging emotionally (“unloading” onto a trusted person) because the expectation to be perfect and to repress gets to be too much.
I think this is why so many of us have eating disorders, too. The ways in which we restrict and purge emotionally can be reflected in the relationships we have to food. It’s driven by this internal battle of being “too much” and “not enough.” It’s fundamentally the same fear of simply being.
It’s important to understand that fawning isn’t intended to manipulate others.
It’s not exactly dishonest, either. Every single person presents a version of themselves to others. This merely describes how trauma informs that presentation on an often unconscious level.
The “fawn” response is driven by fear, not a hidden agenda. The “fawn” type is less about manipulation, because it’s not being used to overpower someone. Instead, it’s an excessive relinquishing of personal power, driven by fear and a desire for validation.
For example, someone who runs personal errands for their boss — despite it not being part of their job description — is not manipulating their boss into liking them. (It won’t work anyway.) Their boss, testing those thin boundaries, is exploiting their need for approval.
In more intimate relationships, this can show up as “fawn” types gravitating towards hot/cold dynamics, where affection and love are offered unpredictably.
You have someone who is controlling, who feels safest in relationships where they call the shots, and feels loved when someone is actively seeking out their approval.
Enter: The “fawn” type.
An abuser will offer validation and love to keep the fawn type tethered. They’re usually the sort of person that feels distant, so the affection they offer to the fawn type comes across as special or unique.
But they’ll withdraw that affection before things feel stable, to ensure that the pleaser will continue going out of their way to “fawn” and secure that affection again. An abuser in this scenario feels safest when someone is actively pursuing them, so they get to replicate this sense of control and security over and over again… each time they withdraw their affection.
In the process, the fawn type is repeatedly giving over their power and autonomy so the abuse can continue. All the controller needs to do is rotate between withdrawing affection and, at the right moment, offer it abundantly.
I know this dynamic better than anyone, really, because it’s come up in my life repeatedly.
I’m sharing this because, holy shit, my friends, the number of traumatic relationships I’ve thrown myself into — professionally, personally, romantically — to get stuck in this cycle, with my self-esteem pulverized, has made my heart so heavy.
It took stepping away from a friendship that had so thoroughly gaslit and demolished me — while plummeting into the deep depths of anorexia — before I realized that chasing controlling, emotionally unavailable, even abusive people was crushing my spirit.
I sought out the most emotionally inaccessible people, and I threw myself into the pursuit, somehow believing that if I could secure the love and affection of the most unattainable person, it would indisputably prove my worthiness.
It’s a painful cycle. But for me, simply being aware of it was the first step towards healing.
If you’re reading this and saying, “Holy shit… it me. Oh god. What do I do?” Don’t panic. I’ve got you.
For starters, I’m going to ask you something: Which of your friends do you cancel on?
Personal experience: I had this tendency to bail on friends, partners, acquaintances, whoever, that were the most generous, warm, and emotionally-available.
I avoided those relationships where love was free and easy. Because it didn’t feel “earned,” so I didn’t feel “worthy.”
Which isn’t to say that everyone with this trauma response does this, but humans often seek out the familiar. Which means many of us tend to avoid what feels unsafe. For people-pleasers, we’re so used to working endlessly hard in relationships — it’s disorienting when we aren’t asked to.
I made a google doc (no, I seriously did) where I listed out people who were “way too nice to me.” And then I asked myself, do I like this person? Do I enjoy their company? If I did, I sent them a text message and told them I wanted to commit to spending more time with them.
I was completely honest about my process with those folks, too. I said, “Listen, I get really scared when people are nice to me. You’ve always been SO nice to me, and I get afraid of disappointing you. But I want to change that, because I just enjoy your company so very much.”
In my phone contacts, I put emojis by their names. I put strawberries next to people who were super loving. I put seedling emojis by folks who taught me things that made me think/grow. So when I saw a text from them, it reminded me that I should prioritize that message. 🌱🍓
My life completely changed… in every imaginable way.
My ‘strawberry people’ went from being sort of friendly to becoming chosen family that I can’t imagine my life without.
With the help of some amazing therapy (trauma-informed therapy, if you can access it, is a game-changer), I grew to love myself so much — because that love was being modeled for me in a healthy way.
I’ve struggled with addiction and eating disorders, because I’ve taken this out on my body as much as I have my mind. When you have an overwhelming sense of being “too much” and “not enough” all at once, it’s not surprising when you try to numb every emotion and shrink yourself down.
And my strawberry people (who are now all in a group text together!) have been there every step of my recovery. I reached a year in my sobriety this last month. And I’m finally medically stable after being severely malnourished from anorexia nervosa.
Choosing love — unconditional love of self, and being loved unconditionally by others — literally saved my life.
It all began just by affirming, “I am enough, here and now, and I deserve love that doesn’t hurt.”
It’s not an easy process by any means, but I can’t begin to tell you how much happier I am as a result.
If this all sounds familiar, I do have some recommendations on next steps — because this blog post is really just the tip of the iceberg.
So much of what I know about complex trauma and fawning is from the groundwork that Pete laid out in that book. I have a few of his other books as well, and he’s uniquely positioned as both a trauma-informed clinician and as a survivor of complex trauma.
I also have a few blog posts around complex trauma that I think are really useful in this conversation…
I also do a bit of blogging about recovery, especially as it relates to disordered eating, over on Instagram and Twitter.
Most of all though, I just want to validate the hell out of you.
I understand the very difficult cycle that we find ourselves in when we’re consumed by this idea that we need to be “exactly enough,” and that, if we measure it out correctly, we’ll never hurt or be hurt again.
But relationships involve putting ourselves in harm’s way sometimes. What they shouldn’t involve, though, is self-harm — and ultimately, that’s what “fawning” does. We’re harming ourselves. We’re making ourselves smaller, we’re self-silencing, and we’re punishing ourselves.
You are allowed to have all the feelings. You are allowed to take up all the space. You’re allowed to be everything that you are and then some.
The right people — your people — will love you even more when they see how expansive your life becomes when you give yourself that space.
It doesn’t happen overnight. It’s a process! But I want you to know that it’s a process you can begin at any time.
It’s never too late to give yourself permission to be, to show up more authentically, and to find those who will celebrate you for it. I promise you that. 🍓
When we entered into this world, I can’t imagine that we feared becoming more. Back then, the moon was full and the world was fuller; the majesty of being small was only in relation to everything that was still unknown.
We had not yet been told to fear hunger. We knew hunger in the way we know our names — you always answer to it.
Body, this is my olive branch to you.
I was 27 years old when “anorexia nervosa” appeared on my medical chart. In a quiet moment, staring at a flickering screen, I listened to my breath empty out of my body, a mix of relief and petrification.
Someone named what I could not: I was hungry.
The kind of hunger that moves in like an eclipse, enveloping your whole world in empty shadows. The kind of hunger you invite because staying small, in a cocoon or a corset of your own painful design, feels safer than stepping into the fullness of your life.
Your stubbornness and mine, colliding day after day. I ask you to die; you demand to live. I ask you to diminish yourself; you hold the line. I ask you to hide; you remain tangible. I am angry at every headache, every dizzy spell, every time I nearly fell down on the train. I am angry that you keep me tethered here.
I mistook your refusal to allow me to starve as a weakness, but I’m breathless now, looking back at all the ways you would not back down from survival. All the times you revolted, sounding every alarm, as if by sheer force of will we might find the urge again to live.
Body, I am in awe of you.
You are daring and spectacular. You’ve shrieked in defiance of every label you couldn’t hold. You held the truth of “boy” before I could feel it for myself. You were uncompromising in the truth of what you carried, chest open on an operating table, with a river of bright red blood exposed by two perfect incisions.
The truth of the body, you whispered, runs deeper than the mind. When I woke up, shrouded in the fog of anesthesia, I felt us move closer — like two pieces of a puzzle, surrendering to each other — and I was not afraid. The shape was new and the picture was clearer.
The bottom of the glass, the bowl, the bottle was not enough to dissuade you from being. When I hid, you followed; when I silenced you, you boomed and bellowed like thunder. I am still here, you sighed. You would not disappear. You would not dim.
Body, you are a vision.
When I began to eat again, I could feel you coming back to life. The noise was ecstatic and overwhelming. Sometimes I raged with so much hunger, it scared me. It was the first time I knew myself as an animal first, above all else.
Somewhere along the way, I’d forgotten that you needed me, that I needed you, that we were bound to each other. You were so patient still. You promised me a home when I had nowhere else to go. You promised me a vessel for the adventure of a lifetime. You were the light that drew me back, like a moth continually pulled from the darkness again, and again, and again.
Sitting in the dark with me, you waited. A lighthouse on the cove, a flare popping open in the sky, a smoke signal spiraling — every pang of hunger, every shaky hand, every heart palpitation and terror a subtlety that said, “More than this, Sam, we need more.”
Body, your courage stuns me.
I realized I was truly starving when I couldn’t shake the tunnel vision. Had the walls around us been any smaller, it might have become a casket. Back then, the world was a single dimension, an endless stream of self-imposed calculations. They were abstractions I used to comfort myself, to convince myself that I’d done good.
I will be exactly enough, I told you.
For the boys who couldn’t love me, the parents who couldn’t understand me, the world that couldn’t see me. I will make myself so small and inconsequential, I’ll be as harmless as the fly that sits on the windowsill. I will be the closest thing I can to being nothing, because to be nothing means that I will never take up more space than I deserved, more love than I’d earned.
But you refused. You kept the lights on. I shattered every lantern; you reassembled the pieces.
And stubbornly, you survived, so that I might one day understand that worthiness is not awarded like a ribbon at the spelling bee.
There is space here. There is love here. And both are the gifts of being.
Body, teach me.
I am learning to love you back. I pause to feel the spaciousness between each breath.
“Marvel at this,” you remind me, eyes fixed on the horizon. “Let me show you.” One bite at a time, you restore me. The warmth returns to my belly. The sweetness to my laugh. The glow to my cheeks.
I will not pretend that I’m not afraid. There are days when I will be withholding. Being alive is a tremendous responsibility, and every so often, it scares the hell out of me.
To be a breathing, feeling, trembling animal is something none of us are prepared for. We enter this world screeching and gasping and blue, and spend a lifetime learning to breathe our way through it.
But I will not abandon you. I will come back, again and again, as many times as it takes to live.
That is what I can promise you.
I’ve teased apart the taste of honey when drinking my tea. I’ve let raspberries slowly dissolve on my tongue; I’ve savored every bite of a sponge cake flavored with cardamom and pistachio, so decadent you wouldn’t trade it for anything.
I’ve learned to cherish the warmth of someone’s chest against mine, the ephemeral magic of a song so loud it reverberates inside me, and the ripeness of a pea-pod from a stranger’s spring garden, sliced open between my teeth.
When you speak to me, the cadence has become familiar — I need, I want, I am, we are. Together, we move with clumsy but purposeful choreography.
And I know now to hold the gratitude for where you’ve carried me. I know that you are not an anchor, but rather, an altar. You house everything that is sacred in me.
Body, you are a blessing.
This blog post was sponsored by Eating Recovery Center in honor of this year’s Eating Recovery Day on May 7th! The theme, #MyRecoveryLetter, is an open invitation to reflect gratefully on what has helped us in recovery. I invite every one of you to share your own letters to whomever or whatever has helped you in your journey!
Struggling with food? Body stuff? Or just need someone to talk to? The National Eating Disorder Association (NEDA) is a wonderful place to start. They’ve been an incredible resource for me — and I hope they’ll be for you as well!
This blog is not sponsored by any fancy pants investors that are trying to sell you stuff.
Coming out of denial has been such a terrifying process. It’s like discovering that I’d fallen asleep at the wheel, and, eyes open now, I’m forced to assess the damage I can’t even remember causing.
One minute, I swear, I was on the road — the next, there are wires attached to my chest, and I’m getting an EKG and wondering how the hell I got there.
The shock comes in waves, and some triggers feel more sensitive than others. My stomach drops every time I hear my dietician say the word “refeeding.” I cringe when a doctor says “starvation.” They feel like heavy words, too grim, and the gravity hasn’t set in for me just yet.
I can’t decide what scares me more — the fact that I’m so malnourished that I have to reintroduce my body to food, as though we’re strangers to one another, or that my fear of food still, at times, outweighs my fear of destroying my own body.
How could I have fallen this far down the rabbit hole and not noticed?
I want to share what I’ve realized about my own denial, not just to get it off my chest, but because I think it speaks to the larger issue of how eating disorders are characterized.
Because as I began to unpack the reasons why I missed the signs, one thing became obvious: It’s not that I missed it.
It’s that our culture never gave me the tools to recognize an eating disorder in the first place.
1. My eating disorder wasn’t as ‘obvious’ as I thought it would be.
My eating disorder didn’t present in what I considered the “typical” way.
I wasn’t obsessively weighing myself, I wasn’t counting every calorie that I consumed, and I hated exercise. I didn’t cry if I ate a slice of pizza or have a deep-seated fear of butter. I didn’t fit the stereotype, which made the denial much easier to cling to.
Food caused me so much anxiety — the decisions involved, the binary of “good” and “bad” foods, having “too much” of something and “too little” of something else, and all the pressure of making the “right” choice.
Even with all of that anxiety, I pointed to the fact that I wasn’t trying to lose weight as “proof” I didn’t have an ED. I just wanted to stay exactly the same — which I insisted wasn’t about my body image or a fear of fat.
If I was always just a little hungry, I reasoned, I could prevent my body from ever changing. No one told me that an obsession with size, even if it’s not about getting smaller, is still an obsession rooted in a fear of fat.
Basic things like cooking or even looking in the pantry could send me spiraling. That anxiety led to cycles of restricting, in which I would eat very little, just to avoid the obsessive, overwhelming thoughts that emerged each and every time I had to make a decision around food.
It escalated, too, to the point of being unable to feed my own cats, for fear of making the “wrong choice” for them.
My partner is still solely responsible for determining what our cats eat and giving them food, because the panic I felt about their diets became too unmanageable for me.
My eating disorder also wasn’t as static as I expected. I had periods of time that I ate more, but as my life stressors increased, my restricting did, too. I thought eating disorders had to be constant and consistent, and mine wasn’t. I figured that let me off the hook, because it was “just stress.”
All of this is still dysfunctional, but in my mind, I could only picture the stereotypes that I had heard. I could eat pizza and ice cream! I could eat takeout! I wasn’t vomiting!
I was quick to point to the things that normalized my behavior, but eager to deny the things that were clearly disordered.
2. My body didn’t ‘look’ sick.
The one thing that still boggles my mind about eating disorders is that they truly have a mind of their own.
I knew, logically, that eating disorders can impact anyone of any body size. But I still denied having a problem, because the body that I saw in the mirror didn’t look emaciated.
Where was my terrifying “before” picture? And even if I tried to get help, who would believe me if I wasn’t “thin enough”?
But eating disorders don’t describe a type of body — they describe a specific relationship to food and to our bodies that causes psychological distress.
It took a long time before I was willing to accept that my body didn’t reflect whether or not I had an eating disorder; my state of mind did.
3. Everyone around me had disordered eating.
Disordered eating is everywhere. Skipping meals, weight loss resolutions, detoxes and fasts, even smoothies that replace meals are totally ubiquitous and, at times, inescapable.
When you’re immersed in diet culture, recognizing that you have an eating disorder can be impossible when everyone around you is validating your mentality, however unintentionally.
Being transgender especially, it’s normal for people to struggle with their bodies, and to push themselves to change as quickly as possible, no matter what it takes. And while gender dysphoria is a very serious struggle, I often used mine as an excuse to dig deeper into my eating disorder.
“It’s not an eating disorder,” I’d tell myself. “It’s just dysphoria.” But these aren’t mutually exclusive — in fact, this is why transgender people are at such an extraordinarily high risk for eating disorders.
How could I know that what was happening to me was dangerous if everywhere I looked, it was presented to me as normal and even desirable behavior?
4. My justifications for restricting seemed totally reasonable.
My eating disorder was really good at pointing fingers. For every disordered behavior or thought I had, I could always come up with a hundred excuses for why I engaged with food that way.
I went vegan for ethical reasons. I just hate cooking, okay? The kitchen is too messy. I’m saving money by skipping lunch. I don’t really have any food in the house. I’m a picky eater. I’m just lazy. I’m not good at meal planning. I’ve been so busy. I’m just saving room for dessert. I just prefer snacking throughout the day. I don’t need that. That doesn’t have vegetables. I’ll eat later.
I think a lot of people imagine that an eating disorder is a deliberate and conscious decision like a structured diet that spun out of control, but in reality, it’s a lot sneakier for many of us with EDs.
I didn’t wake up one morning and decide that I was going to stop eating. Rather, these little excuses that popped into my head enabled my restricting one meal at a time. And before I knew it? I had a much bigger problem.
My eating disorder wore down my defenses a little bit at a time — look how much creamer I put in my coffee! That’s practically breakfast! — which allowed it to escalate in an insidious, practically unrecognizable way.
It wasn’t until I was sitting in the doctor’s office, trying to explain what I was eating on a typical day (“Trail mix,” I explained, “and then I eat ice cream if I think I might faint”), that it finally hit me that I’d been duped.
5. It became my ‘new normal.’
Eating disorders are built on a house of lies, but if it’s the only house you’ve ever lived in, you just won’t see it that way.
One of the things that’s been most jarring about eating disorder recovery is realizing how skewed and even broken my barometer was around food.
I don’t remember what it’s like to feel “full” because I’ve spent so long being hungry. Things that I considered “a lot of food” turned out to be very little food to everyone else. I didn’t understand the difference between a meal and a snack.
I was convinced that hunger wasn’t a prompt that our bodies give us to eat, but rather, something that I had to fight to suppress by calculating the minimal amount of food I would need to manage. In other words, to me, hunger wasn’t natural — it was an ailment or a problem to “fix.”
When you have a relationship like this to food and to your body for a long time, it becomes the only reality that you know.
It’s like when my dietician asked me to have a nutritional shake and trail mix for breakfast, and I blurted out, “In the same sitting?” Hearing myself say that made me realize that, all along, I’d constructed rules that were strictly define by my fears, rather than the reality of what my body needed.
Recovery, for me, has been about completely dismantling that house of lies. It’s learning to be skeptical of everything you believed to be normal, and rather than allowing your eating disorder to dictate what “normal” is, it’s letting your body guide you to create an entirely new paradigm.
That paradigm is one that doesn’t react to hunger from a place of fear and trauma (fight or flight), but rather, from a place of body trust.
6. Having an eating disorder didn’t feel the way I thought it would.
I genuinely believed that if I had an eating disorder, I would have felt miserable all the time.
I was supposed to be angry, volatile, depressed! Instead, even in the midst of my disorder, I didn’t have the extreme despair that I assumed would accompany something as serious as an eating disorder.
But the reality is, eating disorders don’t always co-occur with a mood disorder. Mine didn’t — I have obsessive-compulsive disorder, not depression.
So if you’re expecting yourself to be constantly depressed? That may not be how EDs show up for you specifically.
You might actually feel “fine” — but it doesn’t mean that you are.
Mood swings can be part of it (and I certainly had my fair share), but some of us are more likely to experience emotional numbness, anxiety, irritability, restlessness, or even euphoria, rather than depression.
There is so much happening chemically in the midst of an eating disorder, it can be hard to predict how our emotions will respond, except to say that they can be super unpredictable.
Eating disorders are coping mechanisms, and as such, there really is no way you are “supposed” to feel in order for your eating disorder to be valid.
Truthfully, I felt the most depressed and despondent in recovery, when I first tried to start eating again. When I had to actually sit with my fear and discomfort instead of restricting, that’s when my mood absolutely crashed.
The misery that I felt when I started in recovery made it even harder to believe I had a problem, too. I kept thinking, “If this is treatment, shouldn’t it be making things better?”
But I promise you, that’s normal! Sometimes it does get worse before it gets better — and that’s just part of the process.
7. I thought I ‘knew better.’
I wrote about this in my last blog but it bears repeating: Anyone, even mental health advocates who write about this shit for a living, can have an eating disorder.
One of my gorgeous friends in recovery said to me recently, “Sam, you’re talking about eating disorders as though they aren’t mental illnesses.”
And that was the crux of the issue, really — I believed that if I had the right attitude, the right meal plan, or shared enough body positive Instagram posts, I could worm my way out of having an eating disorder.
But eating disorders are mental illnesses and they have to be treated as such. Reading a book or taking a selfie in a crop top can be empowering, and it can open the door to recovery, but eating disorders require more than positive thinking.
I needed help.
Eating disorders are so much bigger than an attitude adjustment. It’s asking you to create an entirely new relationship to your body, to your food, and to the world around you. That is a lifelong process — but a worthwhile one, too.
I’ve had an eating disorder most of my life, and yet it was unrecognizable to me.
And I can’t help but feel that, in a culture that was simply more informed about what eating disorders are and the diverse ways they show up, we’d all be much quicker to recognize them in ourselves and our loved ones.
That’s ultimately why I’m sharing my experiences so openly. I want each one of us to be able to embrace recovery, knowing that our struggles are valid regardless of how they compare to anyone else’s.
Please know: If you’re struggling with food for any reason — if it scares you, makes you angry, overwhelms you, whatever it is — there’s no harm in reaching out and talking to someone.
You deserve whatever support and affirmation you need to have a safe relationship with your body and with food.
And I hope that someday, we’ll live in a world where those relationships are modeled for us, so that we never have to question what that looks like.
Want more real talk about recovery?
The conversation continues over on Patreon, where I film weekly videos talking about mental health, recovery, self-care, and more. This week’s video dives deeper into how social media can perpetuate denial in recovery — go check it out!
Arbour’s video “Dear Fat People” is symptomatic of a fatphobic culture.
When I watched Nicole Arbour’s video to fat people, I couldn’t help but be struck by her complete conviction that shaming fat folks would motivate them to be healthy.
The research does not back this claim – in fact, it consistently refutes it – and fat folks have asserted time and time again that shaming them does real psychological harm.
So I’m confused on how making people feel like shit is supposed to be encouraging, but okay.
Throughout the video, Arbour takes jabs at the body positivity movement, stating, like many trolls have before, that it promotes unhealthiness (while her very original insults and hatred of fat folks, comments that they certainly haven’t heard before, will definitely promote health).
Yes, against my better judgment, I watched the video. And Nicole Arbour’s fat-shaming did nothing to motivate me as a person who is “overweight.” Body positivity, on the other hand, has motivated me – it has made me a healthier, happier, and stronger person.
I spent most of my life as a very thin person. But secretly, I was also terrified of being fat. Most of my family was, which made me feel like I was constantly trying to outrun my so-called genetic fate, and being constantly praised for being thin made me feel like I had to work hard to maintain it, to make sure I didn’t lose it.
So when I was a teenager, I started skipping meals. And worse, I felt accomplished when I did. I felt like I did something good, something I should be proud of. In fact, if Nicole Arbour had seen me a few years ago – underweight and depressed – she would have assumed I was healthy and applauded me for my efforts.
No one ever told me to diet, but I started restricting my intake anyway. At one point, I wasn’t eating much more than an apple at lunch time and a protein bar at dinner. Because we live in a society that teaches us that there’s nothing worse than being fat. Controlling my food intake gave me a certain kind of pride, a sense of moral superiority to my fat relatives who just needed to “get their act together.”
You see, I wasn’t much different from Nicole Arbour when I was thin. I was an asshole that had a lot of problematic ideas about fat people. And I think that’s why I take it so personally – because it hits close to home, because I know deep down that the problem isn’t with Arbour so much as it is the society that teaches us to fear fatness, to shame fat people, and to reject them as fully-formed human beings.
When we place this morality around fat bodies and food, we create a very toxic culture that lends itself so easily to eating disorders, depression, anxiety, and yes, discrimination against and hatred towards fat bodies.
My disordered eating was rooted directly in the ideas perpetuated by Nicole Arbour’s video – a panic and a fear around fatness, a call for self-control even if it means self-harm, and a disgust with fat people – and those same ideas were what led to me being underweight, unhappy, and destructive.
I finally felt a sense of peace and stability that I needed to get my life back.
But the universe, in some kind of act of karmic retribution, gave me weight gain as a side effect of that medication. I went from being thin to gaining sixty pounds, and hearing a doctor tell me I was “overweight” for the first time.
And despite being in the healthiest place I had ever been – finally mentally sound and capable – people who had never been concerned about my health before suddenly started asking if I was okay, if I wanted dieting tips, and encouraging me to “take control.”
Ah, yes, taking control. You mean when I was restricting, underweight, and depressed as hell.
Internalizing all of that negativity around my weight gain, I started to feel self-loathing and I couldn’t even look at myself in the mirror. I debated going off of the medication that had saved my life – because to me, it was better to have unmanaged bipolar disorder with all of its dangerous lows than to be fat.
I think the real sickness in our society is that someone who finally achieved mental health would risk everything just to be thin.
And to the rest of the world that saw my round belly and my big thighs, they, too, would rather me be back in that dark place and be thin than be mentally healthy, happy, and “overweight.”
Attitudes like those present in Nicole Arbour’s video are the same attitudes that I started wrestling with when I looked in the mirror and no longer saw someone who was lovable, desirable, and worthy. Somehow having fat on my body made me “less than,” and made other people treat me as such.
When I finally lost the privilege of being thin, I had to come face-to-face with the fatphobia that I had clung to for my entire life – and I had to acknowledge that I had been perpetuating really awful ideas about fat and fat people, and doing harm to the people in my life that I claimed to love.
I can understand why Nicole Arbour would resist that kind of criticism from viewers, because she, too, would have to acknowledge that she is actively doing harm. It’s not fun to admit that you’re hurting people, that these beliefs that you’ve bought into are actually causing real suffering to people of all sizes.
I, at first, felt helpless when I realized how fatphobic I really was. I didn’t know how to unpack those ideas, and I didn’t know if I could ever feel okay about myself and be “overweight.”
The hashtags that Nicole Arbour mocked in her video are the hashtags that ultimately turned my life around. I discovered the body positivity movement through social media, and realized that my self-worth did not need to rely on an impossible ideal that most of us will never attain.
I realized that being thin is not a requirement for being happy or healthy or fulfilled, and when we break away from diet culture and fatphobia, it can be transformative in the best way.
When I gained weight, I was convinced that it was the end of my self-esteem – I had no idea that it was actually the beginning of an unconditional love for myself.
It’s a kind of love that we all deserve to have, a self-love that is not a privilege reserved for a select few that fit into our norms, but rather, a relationship that we are all entitled to by virtue of our humanity. Outsiders do not get to dictate the kind of relationship I have to my body and myself.
Body positivity taught me that health cannot be measured by a number on the scale, cannot be observed by a stranger, and is something that we, ourselves, get to navigate and define on our own terms. I learned that we all get to exist in our bodies, whatever they may be, and that we set the rules.
Body positivity taught me that love, and confidence, and happiness are possible and do not need to be determined by our size.
Body positivity taught me that I do not need to resort to restricting and starving just to be worthy, and that the real problem was never my weight, but rather, the poisonous conflation of thinness and happiness that I was convinced held the secrets to self-esteem.
Body positivity taught me that hatred disguising itself as “health advice” is still hatred.
Here’s the thing: What people like Arbour don’t seem to understand is that loving myself was the healthiest decision I’ve ever made. Living without shame enabled me to make good choices for myself, because no choice that is rooted in self-hatred is ever sustainable and no choice rooted in self-hatred can ever be healthy.
Being thin never made me feel confident. Being thin never made me a better person. Being thin never made me healthy. But now, with a body that most would consider undesirable, I finally feel happy and I live a meaningful life, one in which I contribute positively to the world, one in which I do everything I can to reduce harm towards myself and others.
And for naysayers who insist that I’m unhealthy because of my size, I can only laugh. Because if it weren’t for the medication that caused this weight gain in the first place, my bipolar disorder would have ravaged what remained of my life until I could no longer bear to live it.
But when you look at me, you can’t see that. Because health is not a size.
If that’s the kind of world you want to live in, you need to own the fact that you are making it that way. You need to understand that these attitudes about fat people are actually harmful and discriminatory – stop hiding behind this so-called “health” crusade – because you aren’t motivating, you aren’t helpful, and you aren’t saying anything novel or new that the diet industry isn’t already profiting off of.
You do harm. And if you can live with that, so be it. But realize that you aren’t helping fat people – you’re hurting them, along with anyone who has ever struggled with their body, because at the root of that struggle is a fear of fat.
Honestly, sure, if I had watched this video when I was younger, I definitely would have felt motivated. Motivated to keep skipping meals. Motivated to celebrate my disordered eating. Motivated to scrape my dinner into the trash again. Motivated to starve myself into oblivion. Motivated to keep being cruel to fat people and making assumptions about strangers.
And if I hadn’t found body positivity, I would have been motivated to reject the medication that ultimately saved my life, because I thought it was better to be thin than to be sane.
And if that’s what health looks like to you… then I don’t want to be fucking healthy.
Editor’s Note: We use the word “overweight” in quotations because it is, indeed, a problematic term that suggests a normative weight. However, it is used for clarity and to make a distinction here because while Sam is not perceived as fat, he is also not perceived as thin, necessitating a term that acknowledges this “in-between” kind of space.