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My 70-ish sister was sold this bill of goods by her PCP, who ostensibly wanted to “get her off the diabetes drugs.” My sister did the liquid diet and weigh-ins for maybe a year, and she lost weight…only to regain when she stopped. I didn’t see that coming, did you? <s> She’d gone through the same experience many years earlier, in her 40s. I did not want to make her feel bad by criticizing her choices…she’s my big sister, and I think she feels shame about her weight, even though she, my younger sister, and I are all fat, carrying on the tradition of our mother and grandmothers. These docs should face ethics investigations, but far more egregious violations slide by every day, so not much hope of that.

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And I'm sure when this snakeoil didn't succeed long-term, the doctor blamed your sister's insufficient will power.

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I'm thinking our PCPs think we are a special kind of stupid. Do orthopedists hawk their bone-straightening gizmos on the side? Do our gynecologists try to sell us their personal brand of suppositories to prevent cancer? Do our therapists encourage us to buy their self-eponymic elixirs to cure us of adhd? That jump-start-weight-loss "doctor" should be reported to the AMA and whatever Boards he claims. Unconscionable.

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Yes, I think they think all us fats are stupid.

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Ah, but are angry and intelligent. They should tread more carefully.

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I think I want them to fear us.

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My current primary is a nurse practitioner who came recommended by a speech pathologist I was seeing when I had severe laryngitis post-covid. SP was a great guy and we touched on medical fatphobia. He taught me more about GERD (because it can cause or worsen laryngitis) than ALL of my previous doctors combined. Even though I started reflux meds at age 18 (then went to as-needed because treating my undiagnosed celiac disease means gerd only flares up when I get contaminated now) all treatments centered around weight loss to cure GERD.

Anyway, so the SP says 4 of his patients see this NP and love her. But her office is full of quackery… she sells vitamin injections and IVs for everything from stress to fatigue to weight loss. It was such a red flag I almost left, but I REALLY need a primary.

Luckily, she hasn’t tried to upsell me. I don’t know why. I’ve always refused to be weighed and at my first visit I brought a sheet listing meds, allergies, and chronic conditions, with a note at the top that said I practice HAES and will refuse weigh-ins and all discussions of intentional weight loss. Thing is, she never acknowledged it and idek if she read it— it was her assistant who entered everything into my chart. So I don’t know if that’s why, or if she just thinks all the advertising in the office is adequate. Still it’s so shady because I thought vitamin injections and IVs weren’t actually FDA approved for anything except deficiencies. (And even then, I think uses are limited?)

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Ugh, yet another Noctor.

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It's not your responsibility to do so, but if you're up to it, I wonder if this might be worth discussing with the doctor who recommended her?

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Nah… my speech pathologist wasn’t specifically recommending her to me, he just said he had patients who saw her and liked her. Since he knew I was desperate for a primary, he suggested checking her out with the caveat that he didn’t know her personally.

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Hello Ragen,

Thank you for this, and for your supportive articles on a regular, frequent basis. They bring--or yank--me back to reality from diet culture and my endless yearning for weight loss, despite my many years of HAES reading, ED recovery work, and efforts to accept my size.

I have a really entrenched restrict-binge pattern: daytime restriction and nighttime eating I'm trying to recover from. That pattern started when a doctor put me on a diet at age 14. That diet led to decades of a daily restrict-binge cycle, which then turned into massive weight gain after trying the so-called "intuitive eating" approach. (That's a whole separate topic for another time.)

Over the past 10 years, I've found that as I've gradually, occasionally increased my eating of daytime meals and snacks, my nighttime eating has decreased, and I eat more nutritious food at night: dinner, instead of an endless feast of baking chocolate chip cookies and inhaling them, and eating cup after cup of chocolate ice cream with chocolate sauce.

Over the past 10 years of working to eat more of my meals and snacks during daytime, my weight has gradually and sporadically decreased, but I am still very high weight.

In recent weeks, I lost a modest amount of weight from being restricted while in a hospital, and then afterward, from eating more during the daytime.

But weight loss always messes with my head, and the obsessive, weight-loss focused ED thoughts kick in.

My ED is like a hamster in my head that hops on its wheel and starts running, running, running, with thoughts of, "I lost a pound! A pound! A pound! A pound!" "Lose more! Lose more! Lose more!"

And then I restrict more.

And you know how that goes.

Binge-city.

Then weight goes up.

Then disappointment, self-recrimination, and thoughts of, "What can I do better to lose weight and reach those little weight benchmarks?"

Then I see your posts, and I'm (painfully) reminded to return to trying to accept my weight and size as they are, and to just focus on taking good care of myself.

I'm in that spot now, from just having read your last two posts.

It's not easy to return to size acceptance thoughts, but I know they're healthier, and I'm healthier for them.

So my point here is: thank you. You have no idea how much you help me return to reality, sanity, self-acceptance, and self-care.

I can describe HAES and ED recovery teachings to everyone in the hospital, such as the mechanical eating approach that also grounds me, and helps bring me back to reality, in the small amounts I can eat meals or a snack "on time" per my mechanical eating schedule. And follow the generous (unlimited food) recovery exchange plan that I love and also grounds me. But putting all of that into practice is still really, really hard. Of the 3 meals and 3 snacks I want to eat on the beautiful, grounding schedule i have written down and aspire to practice, I still rarely eat all of them. And not on the schedule, by a long shot. For example, today's been rough day, and I'm eating breakfast right now, at 4 pm. But I'm working toward being on that schedule more often, and that number of meals and snacks, and it really, really helps me. (I detest so-called "intuitive eating": my worst nightmare, and totally it's inappropriate for where I am in still-early recovery, anyway.)

Anyway, my point here is: thank you for bringing me back to reality, and in a supportive, kind, informative, and logical way with your research and frequent posts.

And thanks for reading all of this. If you don't feel it's appropriate for your readers, please feel free to leave it out of the comments section.

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I wanted to say that from an outsider’s perspective, your body is doing an amazing job of making sure you get enough to eat, even though you wish it was more on the schedule you’re aiming to practice ❤️ You are not failing at taking good care of yourself! Your body is getting the nutrients it needs!

I hope it’s okay for me to say this. It sounds like you’re working really hard with a complicated relationship with your hunger/fullness and I don’t want to minimize that at all with overly positive platitudes. I am just always in love with how bodies work so hard for us to get enough energy to survive, even though that can feel so messy and uncomfortable in practice (ie via bingeing).

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Thank you, Laura. What a great comment. I agree with you: our bodies are amazing in ensuring they get enough to eat. And thank you for acknowledging that I've been working really hard with my complicated relationship with eating. It is really, really hard, and so exhausting, all day every day. Aiming to eat 6 times a day, every 3 hours, is a full time job for me. Especially given I'm still up most of the night, either because I'm hungry and eating, or hungry and procrastinating on eating without even realizing it, and doing what I can to distract myself from eating, and from the emotional pain caused by years of harm caused by "intuitive eating" and their recommendation to eat according to hunger/satiety: something so painful, I don't want to discuss here. (I hope everyone here will respect that and not being it up any further. Part of what I hate--truly hate--about IE is that the authors falsely promote it is the solution and goal for everyone, and that, like AA, if that doesn't help someone, it must because they aren't trying hard enough, which is abusive and traumatizing. And it encourages people to proselytize it, especially if anyone says IE didn't work for them and harm them. IE has generated a whole cottage industry of therapists amd lay people wanting to "teach" the religion of IE and how to get in touch with hunger and satiety and eat that way. And I want to talk about what I'm doing and not discuss IE and hunger and satiety. (You didn't have a way of knowing this, Laura, amd are very sensitive and compassionate and respectful. I just bring this up so that other commenters i plead will not mention IE or hunger and satiety.

For those who haven't heard of mechanical eating, an approach that is practiced in ED treatment facilities, and unfortunately has largely been drowned out by the spread of the religion of IE in outpatient settings, especially for plus-sized people or people with a BED diagnosis, who are assumed to not have difficulty eating when hungry, the purpose of mechanical eating is to provide nutrition on a consistent, sufficiently frequent schedule, who aren't doing that for themselves because hunger and satiety signals are absent. Mechanical eating is called "eating by the clock", according to the meal schedule set by the dietitian, typically every 3 hours. My ideal schedule is 6 am, 9 am, noon, 3 pm, 6 pm, and 9 pm. I love that schedule, and don't want to change it. So please, to those reading this besides Laura, don't suggest I change that. I need support in achieving it. It brings me immeasurable support, relief,, and comfort when I can eat a meal or snack on any part of that schedule. It's also really scary to do. Restrict-binge is sometimes referred to as "daytime anorexia, nighttime binging," which is exactly what I experience, thanks to dieting and IE.

Mechanical eating supposedly helps people become more aware of those hunger and satiety signals, which I've found to be true, but without the pain and trauma that comes for me with IE (trying to be aware of and eating by those signals. Instead, mechanical eating allows me to just eat by the clock, and eat a menu according to my meal plan. Which is an immense relief. I can't even express how much I love this, and how healing it is.) I used to attend an annual ED conference for ED professionals, but as a client, in a city close by. IE was endlessly promoted there. But one year, the most brilliant speaker at those conferences, a pediatrician who only worked with ED patients, who was clearly a recovering anorexic herself, who always made a point to seek me out, talk to, and support me, told me one year, "There are people for whom IE, and eating according to hunger and satiety will never be right. People for whom mechanical eating works for them. So they practice mechanical eating for the rest of their lives. That's perfectly fine. If that works for you better, do it." I love her for that, and am eternally grateful for it.

Sorry for going on and on here, but the whole hunger satiety topic is triggering for me, and again, Laura, you would have no way of knowing that. You are very kind and respectful. I'm writing this for all who might read it and be tempted to reply and comment on or be tempted to ask about or try to "problem-solve" IE for me, which i don't need or want.

One more note on mechanical eating, or eating bybthe clock, which is what most people in American society, at least, do, or used to do: eat breakfast early morning before work or school, lunch at noom, and dinner around 6 pm, with snacks as needed in between. Child feeding expert Ellyn Satter recommends eating on a set schedule such as this for everyone. It takes the guesswork out of when to eat, it creates a rhythm to the day for the individual or a whole family, it helps ensure family meal times to socialize and catch up with each other, and create family bonds, and ensures everyone getting in needed nutrition on a steady basis all day. I think it makes way more sense than each individual waiting for hunger cues to eat at that moment. If someone is hungry before the next meal, they can have a snack or appetizer. I realized from mechanical eating, that's what appetizers are for! Q nosh while the meal is being prepared. The one thing I don't agree with about this schedule is that roughly 6 hours between meals is too long for most people. Thats where having a planned, scheduled snack 3 hours after a meal makes sense to me, so as to not get overly hungry.

Thank you again, Laura, for your kind, thoughtful reply.

It's 6:08, and I'm now motivated to gp eat breakfast. Writing all this

out is helpful. I apologize for my rant here. Hunger/satiety is a touchy subject for me, which no one would know, but you were

very kind in your reply.

I'm curious if there is anyone else on here who has done mechanical eating.

Thanks for reading all this.

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I just want to add, for anyone for whom IE, or awareness of hunger and satiety cues is helpful and provides comfort, healing, and peace, I'm glad. Hallelujah! I don't want to mess with anyone's success. I just am super sensitive from the IE, HAES, and ED recovery communities promoting IE as the best, one true way to eat; and that if anyone doesn't eat that way, or has been harmed by it, that that person "isn't doing it right" and needs help to do so. (And again,, none of which Laura implied.) I'm just super sensitized and on guard about that possibly being brought up by anyone else, because of my past experiences of this happening so many times. I apologize for my super sensitivity on this.

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I absolutely despise the "you must not be doing it right" crap. Its a sign one is in a cult imo, when the practice can never fail but can only be failed. I've lost/regained a bunch of weight four times, and have been told by a number of people (when they finally are convinced I'm not just lying about what I was eating) that I just didn't do it right, I lost too fast, I lost too slow, I restricted too much, I didn't restrict enough, if only I could have done it correctly I would have seen how effective it is, if I could just keep trying until I find that one narrow margin in which weight loss works....

At this point, its hard for me not to get punchy when someone says "you just didn't do it right".

And that's speaking as someone who did get something out of IE! (Not weight loss related, of course) There is so much variety in individual physiology and psychology and personal history esp regarding the issue of weight and food, there is no way a single approach could possibly work for everyone. I think people get invested in mindsets etc and when their thing fails to work for someone else, they feel like their identity is being attacked or they are being invalidated when in reality it just means this person has different circumstances that make them work better using a different method and that in no way invalidates other possibilities for other people. Might as well get cheesed off because that other person uses their left hand to sign their name instead of the right hand like you do- or vice versa.

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Great comment, Demonhype. Thank you. I agree with all you wrote about "you're just not doing it right." It does strike me, as well, as a protective/defensive response and feeling threatened by their thing not working for for someone else. And as you wrote, no one thing works for or helps everyone. Thanks for your great analysis. It is a toxic, hurtful message. It ends up, in effect, invalidating the experience of the person for whom that "thing" didn't work. And ouch that people have used that against you regarding without loss. I'm sorry to hear. How insulting to be told you "just weren't doing it right." Especially with all that's known about the low success rate and our biological resistance to intentional weight loss, making long-term weight loss "success stories" the outliers, not the norm at all. "You just didn't do it rightist hurtful and gaslighting. It also can compel someone to keep pursuing weight loss or anything else to the point of really harming oneself and creating an eating disorder.

Thank you for your great insights.

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And yes, "You just didn't try hard enough is a red flag of a cult, and create a cult by wounding or bullying someone into staying in a group that is harming oneself, and that creates insiders and outsiders, and obsessively loyal devotees.

If anyone Google's "intuitive eating" + "critics" they will likely find an article a few years back, I think in the New York Times, with interviews of people who've been harmed by IE, and the topic of the cult-like nature of it is brought up, which i was glad to see.

I'm very concerned that at the intersections of the size acceptance and eating disorder fields, and HAES, there is an especially fanatical and exclusive pushing of IE as the One True Way to eat and recover from an ED or from diet culture, and to be a fat activist.

I think there's an assumption in the ED treatment field that fat people have no difficulty eating, and that if someone has BED or is plus-sized, it must only be because they are an "emotional overeater," (and not an undereater/restricted who is on a restrict/binge cycle) for which IE will tame their "overeating."

And that, therefore, fat people with a restrict/binge ED will not receive any other form of treatment, or treatment recommendation, than IE.

When in fact, for most underweight or expected-weight people in in-patient ED treatment (typically, anorexics and bulimics) receive mechanical eating advice and treatment.

I had never even heard of mechanical eating in size acceptance or anti-diet spaces, until I went to that first conference i attended for ED professionals, which also allowed a small number of ED clients such as myself.

I wonder how many plus-size people interested in the anti-diet and size acceptance movements would really appreciate receiving mechanical eating advice, instead of only being told about IE as the One True Way to eat and recover from diet culture.

For anyone who is interested or curious about mechanical eating, two great resources are a website by dietitian Shena Jaramilo called Peace and Nutrition, and another, which also has a YouTube channel, called Change Creates Change.

If anyone Google's Peace and Nutrition + mechanical eating, there is tons of great information about mechanical eating there: the most thorough I've found so far. I like her whole site.

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Good for you! It is so insidious this diet culture brain washing. I too stopped eating a particular food that I enjoy because the Ed said “ I am eating too much” . I also started skipping my online Ed support with excuses like “ they are all so much younger and blah, blah, blah”

Guess what? I started binging again. My therapist asked me what was I doing before that worked. Immediately I came up with those two reasons: No support and restriction. It never works to do that. Otherwise, I am being supported by the culture to restrict and think like them. I now know I need ED support and satisfying and plentiful food. It feels like a radical and selfish act, well the Ed says so. But in this world of no pain, no gain ( or loss as it maybe) it is rebellious in a very healthy and good way.✊🏾🦸‍♀️

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Hi Paula, Yes, yes, and yes! I'm glad you discovered what was unhelpful despite diet culture giving such a different message that's hard to recognize or overcome because we're surrounded by it. And I'm so glad you have the support of an ED group that is helpful. I no longer have one and wish I did.

Do you read Christy Harrison's blog as well, which has restriction as its central theme?

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Thanks! I go to two free online support groups. mailto:info@eatingdisorderfoundation.org

That is one of them. The other janice@edrcsv.org

You can email for info.

Yes! I love Christy Harrison RD. Been listening to her for years. Read her new book- The Wellness trap too. Good stuff for a saner mind!

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Thank you for the information!

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You’re welcome!

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IWL fails no matter what it’s called. That’s the bottom line, though I keep seeing ads claiming to achieve permanent WL. Somehow I’m guessing it’s all smoke and mirrors.

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This doctor is so ill informed it makes my head spin. Most doctors at least prescribe well balanced meal plans that are “easily sustained”. We know of course even that backfires.

Any prescription of a diet for weight loss is a scam as far as I know. Thanks to Ragan and Lindo Bacon, I know better. My eating disorder wants so badly to go on these diets but I am thankfully armed with the truth. Ok time now to get my head from spinning 😵‍💫

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Ragen, I think a paragraph might be missing, as you didn’t mention a workshop, but then had a paragraph about payment options??

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author

Fixed it, thank you!

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Yeah well I would like to kick start these guys in the _ss!!😡

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