In the last post, I covered what an 'abstinence' approach to overcoming a restrictive eating disorder and addiction to energy deficit might involve and why it can be an effective method to overcome an eating disorder. This post looks at the alternative to going for abstinence and what can be considered a 'moderation' approach to overcome a restrictive eating disorder and addiction to energy deficit.
It can be easy to think that a gradual reduction in engaging in your pursuit of energy deficit and in 'giving up' the eating disorder would be an easier method but the moderation approach can actually be harder.
When you continue to use the eating disordered behaviours, even if in a reduced capacity, it’s effectively the same as still taking your drug and getting a fix. Once your brain has sampled another taste of your drug of energy deficit, the brain circuits pursuing the addictive behaviours will spark into life, and your brain will automatically try to pursue it further. The resulting dopamine response is also going to create powerful cravings for even more. This all makes it much harder to engage in the behaviours in a reduced way when compared to aiming to just stop them.
Attempting moderation also comes with a greater risk that your brain will find other ways to still get its fix in ways that look like reduced engagement in the eating disorder behaviours but which really aren't. Examples of this can be that you have decided to eat more but as you are using a moderation approach rather than give up all restriction, you find that you are eating more frequently but when you take a step back and look at what you are eating over the day, it's actually of no or very little difference to how much your intake was before.
I do get it though that for some, giving everything up in one go is not something you are ready to do. Perhaps it feels too big a leap, too difficult emotionally, or you are still contemplating how willing you are to make changes. Therefore, there will be those of you for whom smaller changes, which could be considered a moderation approach rather than full abstinence, is the preferred option, at least to start with.
What then can a moderation approach look like practically and what are the risks to be aware of when you do use these methods?
Examples of Moderation to Overcome a Restrictive Eating Disorder & Addiction to Energy Deficit
Perhaps the most common tool used in eating disorder treatment that prescribes moderation rather than abstinence from restrictive eating is a meal plan.
Meal plans are essentially a prescription for food of what to eat, when and how much. In some cases, people given meal plans are told not to eat above the plan (which takes away any ability to eat without restriction). Others are told that the plan is the minimum they need to eat, but the amounts the plan provides are very restrictive when compared to the person’s hunger and this exacerbates thoughts that their high appetite is wrong and should be suppressed. This has the effect of maintaining brain circuits that pursue restrictive eating.
Overcoming an eating disorder takes self-empowerment and self-direction, albeit with support and reassurance. Meal plans can prevent a person developing their own sense of empowerment to overcome the eating disorder. Meal plans are often compared to riding a bike with stabilisers (or training wheels). To me, they are more comparable to being the backseat passenger on a bike while someone else is riding it. It does very little to teach you how to ride the bike yourself.
But having said that, meals plans can have their place.
At first, you might feel that you need more structured guidance to increase your eating in a more prescribed way. This can also be of value if you are at risk of refeeding syndrome in the short term. Meal plans can also serve as a means of damage limitation if you are not ready to make more changes but need to maintain physical stability.
Meal plans should be used with caution and in the short term, if at all, for those committed to overcome the eating disorder. Meal plans prescribe moderation, and while rules and limits remain in place with your food intake, they will prevent you from ever developing the necessary skills to understand your body signals and trust your hunger.
Exercise Reduction or Switching
When it comes to exercise and movement, you might decide that you won't abstain but will work on reducing it or switching from one type of exercise to another.
You might work with a professional on an exercise reduction program which might be to reduce the amount of time you spend exercising each day or week, reducing the intensity or perhaps switching something like swimming for yoga.
It's very likely that professionals who advocate this approach are unaware of just how highly addictive the exercise is. A lot of professionals who don’t fully understand eating disorders might consider the only problem with a person exercising when they are attempting to overcome one is that it hinders their weight gain. Of course, continuing to exercise, even in 'moderated amounts' doesn't help with brain reprogramming in the most effective ways and as with meal plans, this approach is not one I would ever recommend for anything other than the very short term, if at all, or as a means of damage limitation.
At the end of the day, abstinence is always going to be the method with the lowest risk of failure but you might decide that this approach will be a stepping stone of your process to overcome the eating disorder.
Moderating Other Behaviours
When it comes to other behaviours, you might also choose to apply a moderation approach rather than full abstinence, or even be advised by professionals to cut back, rather than stop. Please though, don't believe anyone, no matter how qualified they seem, who tells you that 'you won't cope' with stopping behaviours or giving up the eating disorder. You will cope with more than you know.
Purging through vomiting - Applying a moderation approach to purging will involve creating very strict boundaries for yourself in terms of how often you will allow yourself to purge, hopefully with a significant reduction to now. You will then need to find barriers that will help prevent you from engaging in purging behaviours outside of these times to ensure that the behaviours do reduce and don't re-escalate, aiming to stop it entirely in as short a time period as you can.
Use of laxatives or diet pills - Stopping substances like these suddenly might be medically unadvisable. Therefore, if you have a dependence on laxatives or other substances, seek medical support and advice reducing and stopping them.
Weighing yourself - This is a topic for a future post in itself. Consider the benefits or potential harm weighing yourself or being weighed and knowing your weight will have in this process. If you decide you would like to continue to weigh yourself, then, as with other behaviours, set boundaries and find ways to keep to them.
Calorie Counting - Abstaining from any numbers is recommended as you give up restriction. However, if stopping suddenly seems too big a leap, moderation might look like setting boundaries, such as only allowing yourself to count once a day or, if you usually write the numbers down, stopping this.
Behaviours stemming from food obsession - Food obsession is in part a natural response of your brain to being in a malnourished state. However, the more you engaged in these behaviours and the more reward your brain deemed from them, the more habitual they became. To an extent, these behaviours will reduce naturally as you eat more and become energy-balanced, but there will also be unwiring and rewiring work to do. Therefore, if you look at recipes frequently, follow food porn accounts on social media, or spend more time than an average person in the supermarkets, and you want to apply a moderation rather than abstinence approach, set boundaries. Decide to only look up recipes when you absolutely need to and no more than once a week. Reduce the number of food porn accounts you follow and only scroll through social media for a certain amount of time a day and visit the supermarket just once or twice a week and buy large amounts at once.
Overall, applying a moderation approach to the process of reprogramming your brain from an eating disorder will only take you so far. With a moderation approach there is a real risk of getting trapped in a life of moderation, still having to work hard to control your behaviours each day, which ultimately maintains a negative impact on your life. This is what can happen when people hit a state of what is commonly thought of as quasi recovery and that is another topic for a future post (or it's in the book if you want to know more now!).
Honestly though, this is your recovery journey and you take ownership of it. It might be you decide to toe dip into the process initially. You may need to reassure yourself that changes are possible before you take that larger leap of faith. Perhaps there are medical issues that apply, and you need to apply moderation in the first couple of weeks.
A period of full abstinence is always going to be preferable because it gives your brain the best chance to fully reprogram and a lower risk of lapses. Once in the abstinence process, most people find that it’s easier than attempting to navigate the more confusing waters of behaviour reduction and moderation. Conversely to what you might think, in 99 percent of cases, abstinence really is less distressing than moderation…. (yes that is an official statistic I might or might not have just made up!).
**The information here is taken from my newly available book, 'Addicted to Energy Deficit - A Neuroscience Based Guide to Restrictive Eating Disorders' which you can buy now!**
If you like to listen, as well as (or instead of read!) then this blog post is the transcript of a podcast episode which you will find on my podcast series,
available on this website, all mainstream podcast platforms and on YouTube.