Thursday, April 11, 2013

Nutritionist(s)

My nutritionist is a lovely Australian with a pixie cut, a teeny dog that curls up at my feet while we have our session, an impressive shoe wardrobe, and an easy smile.  She is also currently with child, and having the kind of pregnancy in which sometimes her OB-GYN sends her home for bed rest on very little notice.  This means a lot of rescheduling lately.

But I saw her yesterday.  We are starting to formulate a plan for her summer maternity leave—she offered to help manage a temporary transition to another member of her practice, and I was able to say quite clearly that I didn't want to do that.  Which is true, I don't.  Her practice is primarily eating disorders, but I have had enough nasty experiences with folks who bill themselves this way that that doesn't go a whole long way in easing my fears.

When I was trying to find a post-treatment nutritionist in the city in which I went to college, I had to do a bunch of irritating first appointments before I found the right lady.  The first person I talked to, despite the fact that I'd said "eating disorder" and "just out of treatment" a bunch of times both on the phone making the appointment and in the opening moments of the actual appointment just then, commended me on the "better" choice of goat cheese for the sandwich I'd eaten for lunch.  "It's lower in calories than other cheeses."

Bitch, please.

No eating disorder nutritionist worth her salt would ever tell a patient that her choices are "good" or "bad" on the basis of calories.  I couldn't tell if this woman just wasn't worth her salt, or if she wouldn't say that to an under- to normal-weight patient but it was okay to say it to me because, fat.

My prescribing psychologist in inpatient once suggested that I try Weight Watchers after discharge.  In fairness, he was not part of the nutrition/behavioral team, but still.  I can't remember what I said.  (I wish I'd thrown a fit.  I wish I'd told someone.)  What's funny about that interaction was that that guy really liked me—I could tell that he thought I was smart and interesting.  I'm almost tempted to say that because of that, he was treating me in that moment too much like a normal person, and not enough like an eating-disordered person, and that was why he could recommend a diet program to a fat person, just like you would in regular life, because, duh.

I try to understand that these connections are difficult ones in human brains.  Fat people should always be on diets.  Fat people should always be choosing the lower-calorie cheese.  We know these things like we know any consensus opinion: the Yankees will always be contenders, the bus is slower than the subway, being fat is in and of itself unhealthy, Meryl Streep is a better actor than Sarah Michelle Gellar.  I try not to blame individual humans for reflecting back to me the ideological architecture of the world.  That effort is somewhat draining.

Anyway, for reasons that are, I think, reasonable and clear, I tend to presume until proven otherwise that people are going to come out with something like that when given a chance.  Nutritionist or not, ED professional or not, it seems to me likely that they are probably thinking that I should and could lose weight and it is part of their job to make that happen.

My own nutritionist has been my nutritionist for about five or six years now.  She has seen me through about one and a half weight cycles.  She is not pushy, which sometimes means I feel vaguely like we could have prevented something we have not prevented (see: weight cycle), but also means that she is never foisting some plan or program on me, she never has objectives beyond the short-term behavioral ones that we set at the end of sessions (eat earlier in the day, eat something I'm afraid of, no coffee after three PM, etc.) and the very long-term underlying one (normalize my relationship with food).  She does have opinions about the way that very long-term goal is best accomplished, and when she expresses them, she does so neutrally and informatively.  She's a great listener.  I keep a food log for her, where I note what I eat, when I eat it, how hungry I am when I start eating it, and how full I am when I finish eating it.  That's it.  In these settings I generally have anxiety responses going at a low rate in a constant undertone, and with her, after years, those responses have relaxed a fair bit.  I trust her.  She is not trying to herd me into weight loss, she does not think weight loss is an acceptable goal for me, or a panacea.  Recently, after the scheduling weirdness gave us a big gap between sessions, she saw a sizable drop on the scale and looked at me skeptically: "Do you feel like you're restricting?"  I just about cried from gratitude for that response, and how it wasn't, "Well, it's moving in the right direction" or "Congratulations!" or any of the other things medical professionals apprised of the situation have said to me.  The point is that she is not replaceable.  Not even by someone she hired.  I ain't got that kind of faith.  I would rather not see someone for the summer.  I'd rather go it alone than with someone who stresses me out.

She says she is sorry for the timing, that she knows I'm at a vulnerable spot.  She's right about that; I am.  But I've got fat stuff out in the open in therapy, and I'm pleased to have been able to express my actual feelings about seeing someone else in the interim.  And I feel good about our ability to make a plan as we approach her departure for the break.  Things that need dealing with: will I actually go over food logs with anybody?  Will I ever weigh myself?  The reason our sessions are so valuable to me is that they're the place I have contact with my actual behavior, with the patterns I'm working with and on, and also with the number that represents my weight.  In her office, we survey the scene, we assess and evaluate, we make the narrative and create the plan.  I'm going to have to figure out some other way of doing those things this summer, or of making their absence productive. 

3 comments:

F.F.A. said...

I dealt with the same thing when Marisa went on maternity leave. I have to say I was hugely and pleasantly surprised by how much I have liked working with someone else. It's made me see things differently and in some respects given me a clean slate. I can't make her understand the years of work with Marisa and I don't have to. I can start with what concerns me right now. The people who work like this are lifelines and so crucial to staying checked in, mentally well and making positive decisions for yourself. I was scared and like nuh uh not doing it, but really glad I took a chance. Worse comes to worse you don't see anyone and go back to the maternity leave plan.

Em said...

Yeah, I definitely see the positives about working with someone else in the interim. I'm just so phenomenally prickly about this stuff, though, that it seems like the entire time might be spent on working out a foundation from which to work, and that doesn't feel entirely productive to me. Your "I can start with what concerns me right now" is true, though—though I can also see the other stuff nagging at me in a distracting, continuous way. Thanks for the food for thought, either way. I might end up shooting you an email to ask some questions about Stephanie, if that would be okay.

F.F.A. said...

Email away! I am happy to answer any questions you have. diaryofaformerfoodaddict@gmail.com