An App for Recovery from Anorexia
Baby steps towards a new way of helping full recovery happen.
Posted Jun 27, 2017
Maybe LA has been getting to me: this spring, I realised I want to create an app. I see it guiding the user along the entire arc of recovery from anorexia: from making the initial decision to act (by eating more), to resisting the urge to stop weight restoration at a predetermined BMI, to learning to leave the app’s support behind. It will involve no total calorie calculations and no bodyweight targets. Instead, it will encourage the user to follow the standard cognitive-behavioural model of incorporating 500kcal extra into their usual daily intake (on top of what maintains a stable pre-recovery weight), and adjust upwards later as needed. And it will help the user learn to appreciate the importance of accepting two facts:
1) that one cannot know exactly where weight restoration will end,
and 2) that a temporary overshoot beyond one’s ultimately stable bodyweight may very well need to happen.
Uncertainty and gaining more than minimal amounts of weight are what anorexia hates above all other things, but (or therefore) getting better requires both.
One of the most sobering things I’ve learned from the thousands of comments and questions that you, my readers, have shared over the past eight years is that a surefire way to stay ill, or semi-ill, forever is to decide on a final ‘acceptable’ bodyweight, eat enough to get there, and then reduce one’s intake again to make sure one goes no further. Coming to realise just how often this happens has helped me understand in a new light my own late-teenage relapse, and more broadly the problematic principles underlying much clinical treatment of anorexia. It should be obvious that dieting cannot be part of recovery from anorexia, but deliberate calorie restriction is tacitly advocated, accepted as a necessary evil, or, at best, factored in as a likely occupational hazard, whenever a final bodyweight target is set.
For someone with anorexia, treating a bodyweight target as a minimum rather than a maximum is supremely difficult, and it’s my impression that encouragement to do so is rarely very vehement. And even if it is, the target is often set on the basis of generic BMI ranges that mean little at an individual level, and/or is set right at the very bottom end of those ranges, on the flawed assumption that it’s better to ask someone to aim low than high. Many of us are given a conservative weight target in the very early months of illness, and many people start dieting when they reach it, and then spend years wondering why nothing ever seems to really truly improve. It’s terribly easy to remain haunted by that number and by what it costs to stay there, as well as by fear of what it would seem to cost to go beyond it. It may be surreally difficult to conceive of recovery without a weight target, but accepting a degree of numerical unknowability is essential to letting life back in.
The app I envisage will help the whole process feel less dauntingly vague. It will offer light-touch tracking not just of eating and exercise according to your own detailed recovery plan, but of other things that will change as your mind and body start to heal, like energy levels or mood. And it will learn from your habits and your successes and failures to provide reminders and encouragement when they’re most needed. Alongside this support, there will also be more self-contained sections for tackling specific challenges. Above all, there are the two major sticking points: how to translate insight into action, i.e. decide to get better, and how to keep going beyond whatever bodyweight threshold you may long have had in mind, if that is what your body needs. But there will be other challenges too, along the way, like making your eating more varied or more sociable. And there’ll be weekly planning and reflection sessions, too, to make sure you feel invested, seriously, individually, in what is changing and why.
The support system I have in mind will put food at the centre of recovery, without making it all there is. It will make recovery a personal thing (inspired by my own and others’ experiences of illness and recovery, and honouring the user’s own experience), while accepting that generalisations can be made and that robust new habits need establishing pragmatically, even ruthlessly at times. It will refuse the anorexic instinct to set an endpoint to recovery before it even begins. And it will respect the natural arc that recovery takes, insisting that recovery can and should be not just frightening and sometimes painful, but also exhilarating, personal, momentous, systematic, and – above all – finite.
The support will be specific to anorexia because a starting point of underweight shapes the recovery process in important ways. But it will be for you whether you were diagnosed with anorexia last week and don’t yet believe there’s anything really wrong, or you’ve been feeling for months that you must be about to hit rock bottom but never quite seem to be sure that you have, or you’re looking back on a distant stalled recovery with a life so bound up with not-quite anorexia that you can barely imagine living any other way. I hope the app will complement the book I’m writing (I’m aware I first mentioned the book ages ago, but I am making progress, and I’ve just happily emerged from the exhausted depths of another big project, so have more time for it again). How exactly it will interact with the user’s other sources of therapeutic support is something that still needs working out, and this will be tricky, because on the one hand it is by no means envisaged as substituting for professional support (where that exists), but on the other hand, significant conflicts may well arise when it comes to things like target weights. I know I’ll have to tread carefully here.
I have precisely zero of the technical skills needed to make this become a reality, but I hope to find people to work with who do. The idea was recently awarded second place in a Humanities Innovation competition at the University of Oxford, and now I’m keen to try to make something happen. Writing this post feels like another little step towards that, and if you have any questions or criticisms or suggestions, I’d love to hear from you.