Relapse prevention

The road to recovery is usually long and hard. No one travels it gracefully. There are many slips, trips, and lapses. Those who eventually do recover learn to pick themselves up when they fall, brush off the dust, and keep going. By doing so, they keep temporary lapses from turning into full-blown relapses.

Here are things to do when relapse threatens:

Relapse prevention: anorexia nervosa

It sounds simplistic, but it is true: if no one ever dieted there would be no anorexia nervosa. Instead of dieting, design a meal plan that gives your body all the nutrition it needs for normal growth and health. If you want to work towards a healthy weight, then limit (but don’t eliminate) your intake of fatty and sugary foods and refined carbohydrates. Eat lots of whole grains, fruits, vegetables, and enough dairy and protein foods to maintain strong bones and healthy muscles and organs. Also get 30 to 60 minutes of exercise or physical activity three to five days a week. Unless you are working under the supervision of a coach or trainer, anything more rigorous is excessive.

When you start to get overwhelmed by “feeling fat,” instead of dwelling on your appearance, ask yourself how your life would be better if you were thinner. What would you have then that you don’t have now? Friends? Self-confidence? Love? Control? The admiration of others? Their acceptance? Success and status?Then realize that being unhealthily thin will bring you none of these things, only a fragile illusion of success that has to be constantly reinforced with even more weight loss. All of the above items are legitimate goals of healthy people, but working to achieve them directly is much more effective than losing weight. If weight loss brought happiness, then starving Third World children would be ecstatic with joy. They are not. They are miserable and depressed, just like people who have anorexia nervosa.

Accept that your body shape is determined in part by genetics, and you may never have a totally flat stomach. Even if you are very thin, your internal organs will give a certain roundedness there, especially after you eat and if people in your family tend to store fat in the midsection.
If you feel yourself slipping back into unhealthy habits, call your therapist and schedule an appointment. Returning to counseling in no way means you have failed. It means only that it’s time to reevaluate and fine tune your recovery plan.

Relapse prevention: bulimia nervosa

Never ever let yourself get so hungry that the urge to binge is overwhelming. People who recover from bulimia say that they eat regularly. Because they are never ravenous, they have no physical reason to binge eat.Hunger is the most powerful binge trigger there is. It is a recognized fact that the longer one has dieted, and the more severely calories have been restricted, the higher the risk of binge eating.

Never ever deprive yourself of good-tasting food, even if it has more fat and calories than “safe” diet foods. If you refuse to eat appealing foods that you really want, you will feel deprived and crave them. Then you are vulnerable to bingeing.Remember Adam and Eve in the Garden of Eden? The one food they were not supposed to eat was the one they could not stay away from.

Don’t deprive yourself of other satisfying experiences either. If you make yourself feel needy, you will be tempted to look for comfort in the refrigerator. Make sure that every day you spend time with friends. In person is best, but phone calls and e-mail are better than nothing.

Also every day spend time doing things you are good at, things you can take pride in, things that demonstrate your competency and abilities. Allow yourself to enjoy your accomplishments and refuse to listen to the nagging inner voice that insists you could do better if only you tried harder.

Last, but by no means least, every day do something that’s fun and pleasurable. Watch comedy videos and laugh out loud at outrageous jokes. Play something — a board game, a computer game, tapes or CDs. Go outside and enjoy the birds, trees, flowers, and fresh air. If you live in the middle of a big city, go to a park. Figure out how to give yourself a fun break from the daily routine, and then do it.

Keep tabs on your feelings. Several times during the day, especially in the first stages of recovery, take time out and ask yourself how you feel. If you notice rising stress, anger, fear, sadness — and even strong joy — be alert to the possibility that you may try to dull these strong emotions by turning to food. Find a better way of dealing with your feelings such as talking them over with a trusted friend.The 12-step folks have a useful formula. When they feel on the verge of falling into old behaviors, they say HALT! Then they ask, “Am I too Hungry, too Angry, too Lonely, or too Tired?” All of those states are strong binge triggers. Additional triggers for people with eating disorders seem to be Boredom and Unstructured time. If you find yourself in any of these states, figure out a healthier and more effective way of dealing with the situation than binge eating.

Until you have achieved some balance and perspective, stay away from temptation. Don’t go to all-you-can-eat salad bars. If ice cream is a binge trigger, don’t keep it in your freezer.When you want potato salad, for example, or rocky road ice cream, go to a sit-down restaurant and order a single portion, ideally as part of a balanced meal. By doing so, you accomplish three things. You avoid depriving yourself. You avoid the urges to binge created by deprivation, and you also learn how to integrate normal food into a reasonable and healthy meal plan.

When you do feel powerful urges to binge, postpone the act for thirty minutes. Surely you can wait half an hour. During that time think about what is going on in your life. What stresses are you facing? What is missing right now from your life that you need in order to be happy and avoid the looming binge? Make a list of things you could you do instead of binge eating to deal with your situation. If you are truly committed to recovery, at least some of the time you will choose one of these healthier behaviors instead of binge food.

Take charge of your life. Stop using words like, “I wish,” “I want,” “I hope,” and “I can’t.” They are weak victim words. Say instead things like, “I choose,” even if you are choosing to binge. Say, “I will,” even if the thing you will do is vomit. These are words that express responsibility, power, and control. If you can choose to binge, then by implication at some future time you can choose NOT to binge. If you will vomit, then next week or next month or next year you can choose to say, “I WON’T vomit.”

If you feel yourself slipping back into unhealthy habits, call your therapist and schedule an appointment. Returning to counseling in no way means you have failed. It means only that it’s time to reevaluate and fine tune your recovery plan.

Relapse prevention: binge eating disorder

Same as for bulimia, above

Research on healthy weight management

Most diets that provide about 1500 calories per day will result in weight loss, but after about two months that loss slows, then plateaus, and then reverses. The person usually ends up weighing as much as, or even more, than before the diet.

Don’t diet. Ever. Diets don’t work. In fact, they work against you by making you hungry and leaving you feeling deprived. People who feel deprived, and who are hungry, are vulnerable to overeating — and overeating, of course, leads to weight gain.Research clearly shows that dieting in an attempt to control weight is associated with weight gain. It’s even worse. People who diet gain more weight than those who never restrict. Healthy weight management means following a healthy meal plan, not a restrictive one. (Pediatrics 2003. 112:900)

Programs such as the ones recommended by the American Heart Association and Weight Watchers have been shown to be more effective in maintaining weight loss than exotic, unorthodox approaches. (Journal of Obesity Research. March/April 2001) Effective plans recommend

No more than 30% of calories as fat

No more than 20% of calories as protein

Remaining calories to be complex carbohydrates: whole grains, fruits, vegetables

Limited amounts of salt, sugar, refined flour, processed foods, and fast foods

30 – 60 minutes of exercise or physical activity five to seven days a week

Social support: non-food fun times with friends and family. Also at least one close, mutually satisfying friendship or romantic relationship

Stress reduction