I’m extremely pleased to introduce a guest poster  this week: Margarita Tartakovsky, MS, a freelance writer who frequently contributes to the Web  site PsychCentral. The following article appeared originally on the PsychCentral web site and is reprinted here with their permission. Margarita  introduces us to the HAES model—Health at Every Size. HAES provides an especially useful alternative to dieting—not to lose weight, but to live and eat healthily. But I’ll let Margarita put it in her own words…

Health At Every Size, Exercise & Eating Disorder Recovery: Answering A Reader’s Question

Last week, a reader asked some important questions that I wanted to highlight today, switching gears a bit from our regular Monday posts on body image. In a post on Health At Every Size (HAES), where I interviewed professor and author Jon Robison, Ph.D, reader Erylin asked:

Any helpful advice for a recovering bulimic discovering HAES? Any tips for exercise without it turning into purging?

For insight, I turned to HAES experts. I think their answers are relevant for everyone, and provide an excellent way of looking at exercise, and health as a whole. Remember that HAES is a weight-neutral approach that focuses on developing healthy habits and self-acceptance, regardless of a person’s weight.

Thanks to shows like The Biggest Loser and various magazines regularly advocating rigorous, almost-daily exercise, it’s tough to know what’s healthy and what’s unhealthy exercise. There seems to be this great pressure to exercise all the time, which in my humble opinion can breed an all-or-nothing attitude toward physical activity and muddle up our motives (i.e. I’m exercising for weight loss, not health).

And, interestingly, as a society, we admire people who exercise all the time. How often have you heard someone talk about exercising five days a week, and felt an intense pang of envy? I know I have. Or heard someone say that they’re addicted to exercise, and wondered how great that would be for you? Maybe you’ve even said, “I wish I had that problem.”

Most of us think these thoughts, because exercise, like sticking to a restrictive diet, is praised and viewed as virtuous. I can imagine that for individuals trying to recover from an eating disorder, these views of exercise can make matters worse. And, like other purging behaviors, compulsive exercise has serious health consequences.

So I’m grateful to Erylin for bringing this up, and to the below individuals for generously contributing their insight.

According to psychologist and eating disorders specialist Deb Burgard, Ph.D:

It’s an important issue — in the context of an eating disorder, food and exercise get hijacked by the agenda to be a certain weight, and then the person’s experience of them is drenched in fear and guilt. In our book, Great Shape, (back in the day!) Pat Lyons and I talked about physical activity as a right, not an obligation. We included a guided relaxation to figure out the movement you might feel hungry for, exactly the same as you would do with intuitive eating (now on my website).

Basically, the antidote to the ED-driven exercise is playfulness — think recess, not boot camp. Movement motivated by curiosity, mastery, whimsy, fidgety-ness – the reasons kids move. No fear.

Eating disorder specialist Susan Schulherr, LCSW, wrote:

The idea that guides all my interventions with people with eating disorders is that the ED is an attempt to protect oneself from experiences that threaten emotional overwhelm. The person flips into ED behavior (including dieting) automatically to avoid the overwhelm. The opposite of automatic behavior is awareness. So change is a constant two-step process of bringing increased awareness to moments when the automatic behavior is getting triggered (e.g. Can she notice distinctions between how healthy exercise feels compared to “purging” exercise? Can she notice what’s going on when she flips from one to the other?) and developing more constructive options for dealing with the triggering experiences (e.g. self-soothing, problem-solving, reaching out for support, etc.).

People with bulimia tend to live with a lot of internal emotional chaos and shame and have tremendous fears of surrendering the dieting, bingeing and purging. It’s  really important to offer reassurance that moving toward healthy eating patterns will help their efforts to diminish the chaos and shame. Most people need (and deserve!) some kind of outside support and guidance to make these shifts.

Dee Miller, another HAES advocate, said:

This advice is just based on common sense and on being sensitive (in a negative way) to any type of exercise that feels weight loss focused. I’ve never had an eating disorder, nor am I a mental health professional.

I’d strongly advise her to stay away from exercise machines that track calories burned. It might also be best to avoid types of activity that lend themselves to quantitative measurement, like running or swimming laps. Things like team sports, dance, and hiking are harder to think of primarily as calorie burning mechanisms.

In addition, Nancy Hieber, R.D. and Michael E. Berrett, Ph.D, have written an article on “intuitive exercise“ here, which they say is crucial for anyone recovering from compulsive exercise, an eating disorder or other addictions. The authors caution against creating exercise-related rules for yourself. The below are guidelines for healthy exercise:

• Exercise because you want to – not because you feel that you have to.
• Do exercise activities that you enjoy – not exercises that you dislike.
• Include a variety of exercise activities – don’t get in the rut of doing only one or two things.
• Include leisure recreation activities such as bike riding or hiking in the canyon as part of your exercise.
• Stop if it hurts! Do not exercise when your body is in pain, or when fatigued.
• Never exercise with an injury.
• When your body is telling you something – listen!
• Get some physical activity every day, even if it is just walking around the block.
• Drink plenty of water during exercise and afterwards.
• Eat enough to properly fuel your body for the rigors of daily life and exercise.

Here’s where the intuitive part comes in, according to the authors:

• Spend some quiet and quality time listening to your mind, heart, and body.
• Respond to that self-understanding and approach exercise accordingly.
• Respect your inner needs and consequent internal messages.
• Respect and respond to your body, especially those messages of pain and fatigue.
• Examine your motives for exercise.
• Adjust your exercise as needed and develop the healthiest motives.
• Reserve and make sacred the time you need to take care of yourself.
• Find exercise and physical activities which are enjoyable.
• Remove concepts of fat, calories, and size from your exercise thoughts and language.
• Feed your body what it needs to assure nourishment and adequate fuel to burn.

In a future post, I plan on exploring healthy exercise in more detail.

Copyright (C) 2010 Psych Central. All rights reserved. Reprinted here with permission from http://blogs.psychcentral.com/weightless/2010/03/health-at-every-size-exercise-ed-recovery-answering-a-readers-question/

Let’s face it. Relapse episodes are the pits. They always feel seriously discouraging. It’s the same if you’re just starting your recovery, or if you’ve been thinking you’re out of the eating disorder woods. Everybody who’s ever tried to change anything in their lives can commiserate. Though we all sort of know better, we fall into believing that improvement is a straight–line process to our destination. Of course, this just isn’t reality.

My opinion is that if you’re going to have to deal with the misery of relapse, you deserve to come out of it with something to show for your trouble.  Unfortunately, the benefits you get from relapse don’t fall off trees or otherwise just come with the territory. You have to get in there and dig! But there are some guaranteed nuggets to be mined if you go looking for them. I’m going to discuss three relapse nuggets. Hopefully this will set you searching for your own.

Nugget 1: Learning from the relapse

If you’ve been working on recovery, I’m going to assume you’re already at least a little familiar with the necessary process of learning from your relapses. What led to the episode? How does this knowledge help you improve your recovery plan? What light does it shed on symptom triggers you may not have been aware of till now? Doing the post–relapse review is often one of the richest sources of information about your own personal eating disorder profile.

Nugget 2: Developing compassion for yourself

I’m an insight kind of therapist. By insight I mean gaining awareness about why we do the things we do. Not that I believe insight “cures,” but it’s awfully good for some things. One of the things insight seems good for is the way “getting it” about relapse episodes not only helps you plan better for recovery (see Nugget #1), it helps you forgive yourself.

Most of the time it seems to me my eating disorder clients start out with some pretty harsh explanations for their relapses and slips (for instance I’m stupid; I’m weak; I can’t succeed at anything.) Most of the time if they’re willing to dig for a deeper explanation, they discover the episodes actually happen for very human, very understandable reasons. More often than not, this involves seeing how their symptoms represent efforts to cope with overwhelming experiences. This awareness allows them to appreciate the positive intention of their symptoms while directing them to look for more constructive methods. Such a compassionate understanding can help neutralize the shame

Nugget 3: Building resilience

Think of all the unwanted personal experiences that confront you when you relapse: mistake–making, frustration, personal imperfection, disappointment and more.

All of these experiences are an inevitable part of recovery, just as they are a part of any change or self–improvement project, or, for that matter, of life itself.

So if we can’t avoid these experiences, what can we do? We can build our tolerance and flexibility in dealing with them when they occur. Tolerance means we come to know we can stand it even if we don’t like it. Flexibility means we can reset, learn from what happened, make appropriate adjustments, and move forward. When we work to increase our tolerance and flexibility in the face of recovery setbacks, we become more resilient, that is, we have more bounce–back. Bringing this increased resilience to life beyond an eating disorder is one of the great gifts of recovery.