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The confronting truth about caring for people with eating disorders.

Mamamia logo Mamamia 15/04/2016 Clare Stephens

What is it really like to work with someone who has an eating disorder? © Sipa Press/Rex Shutterstock What is it really like to work with someone who has an eating disorder? In 2014 I worked as a mental health worker with girls suffering from eating disorders.

I was living in Boston, where they provide the option of residential treatment for eating disorders, something they are just starting to introduce in Australia.

To an outsider, the centre looked like your typical suburban Boston home. It had a few bedrooms, with two or three beds each, a dining room, a kitchen, a living room, a few smaller rooms for individual counselling sessions, and a few bigger ones for group therapy.

The fact that this house was being used to treat one of the most deadly psychiatric conditions was only discernable when you looked closely at the details.

The locks on the bathroom doors and the pantry. The small nurses station set up near the living room, for taking blood tests and administering medication. The affirmations that sat colourfully at the dining table. The 24/7 supervision, and the strict, individualised dietary plans displayed in the kitchen.

These girls were very sick, and I thought my education in psychology meant I understood what they were experiencing. (As a side note, males develop eating disorders too. But the higher incidence among females means that many treatment programs are targeted specifically at girls and women).

When I started as a mental health worker, I had a broad knowledge of the different types of eating disorders and their symptoms. I was even prepared for the less well-known realities that come with re-feeding after having an eating disorder – the particularly unglamorous ones.

The abnormal bowel movements. The frequency of self-harm. The dishonesty.

But nothing prepares you for the devastating, scary and inexpressibly sad impact that eating problems have on peoples lives.

One woman, despite looking like an adolescent, was 27 years old. She had been in and out of treatment for anorexia for 13 years – almost half her life.

Another had been in serious trouble with the law for theft, because her compulsion to binge and purge was so severe that even when she couldn’t afford it, she continued to do it.

Another very young girl changed her clothes several times a day. No matter what she wore, or how much time she invested in her appearance, she felt fundamentally unattractive.

These beliefs and behaviours are far from trivial. All eating disorders come with medical complications, increased mortality rates, and a long road to recovery.

And when I worked with girls with eating disorders, I observed for the first time what I believe to be a key part of the problem. That there is a blatant disconnect between what we tell girls when we’re treating them for an eating disorder, and what society tells them once they leave.

Within our centre, we delivered carefully considered messages to the girls.

We marked out the calorie information on all food packaging, to encourage the girls to think less about what food meant for their weight, and more about what food meant for their mood and energy levels.

We had group therapy sessions focused on affirmations that deliberately had nothing to do with appearance, weight or shape.

We listened while one girl yelled through tears that she “just felt so fat” and “hated being in her body right now”. We told her that would change, and that she could develop a relationship with her body that wasn’t only about how her body looked, but how it felt.

We banned the word ‘fat’ altogether – among the clients and the staff.

But at the end of the day, I left the centre. And entered a different world.

A world where everywhere I looked, I was being warned about weight. A world that functioned in direct opposition to what we were trying to teach our patients.

We’re surrounded by public health messages and media scare tactics to prevent obesity. Calorie labels are displayed at restaurants and fast-food outlets. Magazines and websites (although, proudly, not this one) are dedicated to informing us of which celebrity has put on weight and why. We have television shows based solely on the pursuit of weight loss. Social media accounts excitedly document weight loss and body transformations.

We wrongly equate any type of fat with laziness, incompetence and greed. And this type of message isn’t helpful for anyone. Not those in larger bodies, who are made to feel worthless, and not those in smaller bodies, who start to fear gaining weight.

The message is loud and clear, and it’s aimed at everyone:

You need to lose weight.

But we rarely qualify this message with warnings that might be relevant to ones circumstances, or consider that the resulting stigma around fat is seriously harmful.

What I learnt from working in a treatment centre for eating disorders was that in order to truly recover, these patients must go home to their day-to-day lives. But the world they return to often supports and fosters their eating disorder.

We need to start delivering messages about obesity that don’t encourage eating disorders. After all, the ultimate goal for tackling obesity and eating disorders is the same: We want people to eat healthy, balanced diets and engage in regular (but not extreme) exercise.

The next step is to start noticing when our messages are problematic, and start challenging them. Because I want to live in a world that makes it easy, and not difficult, to recover from an eating disorder.

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