Making Enemies 101: Tips From the Blogosphere

Anger. All I could feel was their anger. Their perhaps valuable messages got muffled, but I was left with my tail between my legs. That was my experience of reading a couple of blogs I respect and frequent often, one with a focus on eating disorder recovery, one on size acceptance of the obese. No doubt this post of mine may provoke more anger—that is not my intent. And while these two topics may seem vastly different, I hope to show that they have many commonalities.

Laura's Soap Box

I have learned a lot from Laura’s Soap Box: http://www.laurassoapbox.net

It has, more than anything, strengthened my stance that we have no time to waste, when it comes to recovery; that the ever-hopeful practitioners that patiently wait while engaging in therapy often do so for way too long. And especially for the young anorexics and those new to their eating disorder behaviors and thoughts, those with a narrow window of time for weight restoration for growth and development, for preventing hard-wiring of their approach to eating. The parenting style, more loving tiger mom than most of us like to approach, has its merits. Yes, for survival and health, it takes a tough parental stand.

Yet when I read the post http://www.laurassoapbox.net/2011/10/why-words-matter-and-whose-job-it-is-to.html I was struck not by this very appropriate message, but by the anger and frustration at parents and practitioners who haven’t mastered the art of (eek) Maudsley? Family-Based Therapy? Modified? I’ll refer to it as Maudsley-style from this point forward, so as not to incite more anger.

I’m guilty. 

It's a long way to travel to get to where we need to be.

I admit it. In my 25 years practicing as a dietitian, I have never formally been taught this approach. (Nor, for that matter, was I formally trained in an academic setting on eating disorders; they were only minimally covered in my graduate studies). I have learned what I know by educating myself through eating disorder conferences, literature, as well as more recently through blogs like hers. And, through seeing vast numbers of eating disordered individuals over my career. From my understanding, in this approach, nutritionists/RD have no place. But that’s another story. In my version, RDs play a very valuable role.

Anorexia recovery is not one-size-fits all.     


Many families I see are not candidates for this approach. Some are quite dysfunctional, frequently making supervision at mealtimes disastrous; it would take years to educate them about their inappropriate messages, to correct their nutrition misinformation—I could go on. And we just don’t have that kind of time. Caution: I am in no way suggesting that these dysfunctional families caused their child’s eating disorder, merely that they are in no position to take charge of the recovery.


Some families aren’t candidates, as I see it, as they have too many other demands, such as caring for another family member—a parent, a child with special needs, a newborn, working multiple jobs, etc.

Some families certainly could learn to use a Maudsley-style approach—if they were prepared to take the time. Yet I find many parents want their kids fixed—they bring them for care with an unrealistic perspective on what recovery entails, how it is measured and how long it might take. And most importantly, they have no idea how important a role they play as parents, Maudsley-style or non-Maudsley-style.

I say some intentionally. Many parents couldn’t be further from this description. They are present, physically, and emotionally for their kids; they are anxious to know just what they could do to help their child, and how best to do it, and they adjust their schedules to make treatment appointments a priority. They are scared, but they work on accepting that treatment is a process and takes time. 


In such families, some of the kids with anorexia may be supported by their parents, without the parents having the level of supervision and involvement I understand a Maudsley-type approach to have. They set appropriate safety limits, from a health standpoint (ie—they respect and enforce the outpatient team’s recommendation that there is to be no physical activity, for now). But their children are able to make progress, measurable progress with weight restoration and vital sign changes, that enable them to continue in this setting, without their parents taking charge of their food plating or supervising their snacks. And they are able to engage in therapy, both mental health counseling as well as nutritional counseling in the process.

But then there are those for whom the Maudsley-style approach is perfect. A willing family, with the time it takes to be an active player, to be intimately involved in refeeding. Parents willing to shift the relationship to that of supportive team members, fighting the anorexia along side their child, taking charge the way their unhealthy child can’t, at this time. And I have seen recovery with both these approaches.

Treatment for eating disorders needs to be as varied as the individuals with the eating disorders. As health care providers, we too are not a homogeneous group, not by specialty, not by style and approach. We also get frustrated and angry, when we encounter patients and families, as well as other medical providers who fail to support our stand, to set appropriate limits to ensure recovery. We too recognize that it takes a nourished mind to engage in the process of recovery and decision-making, a role many starving anorexics simply cannot do.

I believe we all share the very same goal—to foster recovery and normalize life for the individual as well as the family dealing with anorexia. And we need to stand united in this goal. There is no single best treatment for all individuals. But educating with a consistent message about the seriousness of eating disorders of all types and the need for treatment and support is essential.

We put our heart and soul into doing the work we do.  But few will respond well when faced with angry rants—by me, by parents, or by Maudsely-style bloggers. We, too, are works in progress.  

And yes, I will soon address the other angry blog in an upcoming post.