{"id":18904,"date":"2020-10-13T10:32:02","date_gmt":"2020-10-13T15:32:02","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=18904"},"modified":"2023-03-06T09:46:06","modified_gmt":"2023-03-06T14:46:06","slug":"navigating-virtual-eating-disorder-treatment","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/patient-stories\/navigating-virtual-eating-disorder-treatment\/","title":{"rendered":"Navigating Virtual Treatment for Eating Disorders"},"content":{"rendered":"

The seamstress gave the tag a quizzical look. \u201cYou’re a full size smaller,\u201d she told me.<\/span><\/p>\n

Some brides might be elated to learn they\u2019d lost weight in the months leading up to their wedding. But when I tried on my wedding dress for the first time, four months after I ordered it, I was devastated to feel the loose bodice around my waist.<\/span><\/p>\n

\u201cI’m going to gain weight. Can we not take the dress in yet?\u201d I asked the seamstress. To convince her that I\u2019d soon fill out my dress, I told her I was on a weight-gain plan, per my doctor\u2019s orders. But that was a lie. I wasn\u2019t currently seeing the physician who’d been monitoring my anorexia recovery for almost three years. Because of the pandemic, he\u2019d switched to telehealth for all routine care. <\/span>I only saw him for weigh-ins and vital-checks, which I considered in-person services, so paying out of pocket for video chats seemed pointless. <\/span>I relied on those appointments more than I realized, though, because without consistent monitoring by a doctor, I’d reverted to old habits.<\/span><\/p>\n

I knew I needed to get back on track before my slip-up became a full-on relapse.<\/span><\/p>\n

Triggers on top of triggers<\/h3>\n

The pandemic hasn\u2019t been easy on anyone. For those with eating disorders, several studies indicate an <\/span>increase in anxiety<\/span><\/a> and <\/span>symptoms<\/span><\/a> of their <\/span>conditions<\/span><\/a>, such as food <\/span>restriction, binge eating, purging and excessive exercising<\/span><\/a>. The specific triggers and responses tend to vary by the disorder.\u00a0\u00a0<\/span><\/p>\n

For many people in the US, the pandemic has reduced food options in some way over the past few months. For someone who has anorexia, it can be extremely distressing to lose access to foods that are \u201csafe\u201d and consistent with their meal plan. \u201cIf they were unable to physically go to a grocery store or if they could not navigate or afford an online delivery service, the default option is restriction,\u201d says Cynthia Bulik, founding director of the University of North Carolina Center of Excellence for Eating Disorders.<\/span><\/p>\n

Meanwhile, foot shortage concerns and subsequent stockpiling of energy-dense foods like pasta early on in the pandemic may have triggered people with bulimia and binge-eating disorders. \u201cThese are often the types of foods that people with binge-type eating disorders explicitly keep out of the house to remove the temptation to binge,\u201d Bulik explains.\u00a0<\/span><\/p>\n

There’s also the fact that people with eating disorders often cut themselves off from others. \u201cBy being forced to self-quarantine, there’s less availability for connection and support,\u201d which can lead to coping in less healthy ways, says Rebecca Berman, clinical training specialist at eating disorder treatment facility the Renfrew Center.<\/span><\/p>\n

Finally, conversations about quarantine weight gain only compounded the mental-health impact of gyms closing and workout routines being upended in other ways, Bulik notes. She co-authored an April-May survey of 1,000 people with self\u2010reported eating disorders. More than half of respondents reported frequently feeling <\/span>anxious about not being able to exercise<\/span><\/a>.\u00a0<\/span><\/p>\n

That was me. I believe that if not for the coronavirus, I would have kept up with my recovery, instead of restricting my caloric intake and going overboard with exercise. And without an upcoming wedding, I would have managed pandemic-related anxiety better. But the combined effects of both stressors got to me. Despite having ready access to treatment from a doctor and dietitian, I fell back into the familiar embrace of anorexia, comforted by the sense of control it gave me.\u00a0\u00a0<\/span><\/p>\n

Navigating a Different Kind of Care<\/h3>\n

A lot of healthcare, including talk therapy and many sick visits, can be done via telehealth. Virtual ED treatment is possible, but research suggests the abrupt shift to online care prompted by COVID has been a mixed experience for patients. In a <\/span>small study published online in the Journal of Eating Disorders<\/span><\/a>, some people with eating disorders who shifted to telehealth said the quality of care fell short compared to their pre-pandemic face-to-face visits.<\/span><\/p>\n

Successfully adapting in-person ED treatment to a virtual setting can require reimagining several different services. <\/span>Therapy<\/span><\/a>, a critical component of ED treatment, is fairly adaptable \u2014 but not without some thoughtful adjustments. \u201cTherapists cannot assume that virtual care is a perfect replacement for traditional psychotherapy, and work with their patients to optimize and personalize the digital treatment,\u201d Bulik says. This could include making sure patients and providers are in private spaces where neither can be overheard, and tweaking the setup if patients are preoccupied by, or otherwise uncomfortable with, seeing themselves on screen. For example, some patients angle their cameras to display only their heads; others change their settings so they can\u2019t see themselves at all.<\/span><\/p>\n

Therapists and dietitians also figured out how to provide meal support remotely:<\/span> A patient positions their camera so their food is in view of their provider for the entire meal. As they eat, \u201cwe talk about how they’re feeling and being in the moment, rather than distracting themselves,\u201d Berman explains. \u201cThe goal is to help them build emotional tolerance so they can do hard things and have real, sustainable change.\u201d\u00a0<\/span><\/p>\n

Weigh-ins, however, proved especially challenging.<\/span><\/p>\n

\u201cWeighing is absolutely the most difficult thing to adapt to virtual treatment,\u201d says Bullik.<\/span> \u201cIn<\/span> person, we can see if someone appears to be losing weight or looks unwell, but this basic visual contact is very distorted on a screen.\u201d\u00a0<\/span><\/p>\n

Typically ED patients are discouraged from keeping scales at home in order to prevent obsessive weight-checking. But when in-patient visits hit pause, some providers and treatment facilities like the Renfrew Center asked some nonresidential patients to buy scales and step on them in front of their webcams, so they could do weigh-ins during virtual visits. Then, just as they would have done pre-pandemic, providers discuss patients\u2019 feelings, sensations and thoughts in that moment.<\/span><\/p>\n

As with most healthcare during the pandemic, virtual ED treatment <\/span>remains a work in progress<\/span><\/a> for many providers. \u201cWe found ways to make it feel like [patients and providers] are in the same room, and we train staff to be animated and connect through the screen,\u201d Berman says. Both she and Bulik hope that telehealth continues to be an option. \u201cPeople can always come up with reasons not to come into treatment \u2014 they’re getting married, going to college, they just got a promotion,\u201d Berman says. \u201cThis helps us find ways to make treatment happen.\u201d\u00a0<\/span><\/p>\n

Of course, convenience is only a selling point for virtual care if you can access it. February and July, an estimated <\/span>12 million Americans lost their jobs and, as a result, insurance coverage<\/span><\/a>. \u201cIn our survey, 45 percent of individuals with active eating disorders were not receiving treatment \u2014 and that was in April,\u201d says Bulik. \u201cOur fear is that unemployment is going to keep rising, health insurance coverage will decrease in parallel and more people will be left without treatment teams. We could be facing a real converging disaster: mental health problems increasing, telehealth being cut off and loss of insurance.\u201d<\/span><\/p>\n

*<\/span><\/p>\n

My doctor didn\u2019t offer video weigh-ins. (Even if he had suggested the idea, I might have rejected it, knowing that owning a scale might lead to unhealthy behavior.)\u00a0I decided to stop seeing him until in-person care returned. I\u2019d be fine, I thought. I\u2019d resume our visits when life went back to normal. <\/span>\u00a0<\/b><\/p>\n

Then I tried on my beautiful wedding dress. The size I ordered should have been form-fitting, but it was baggy. I knew I couldn\u2019t wait for normal. I\u2019d worked too hard on my health to let a slip become something more permanent, and I was lucky enough to have the resources to get care during a pandemic. My doctor\u2019s office may have been closed, but telehealth was available. It was up to me to make it work.\u00a0<\/span><\/p>\n

I was already familiar with virtual care. In addition to seeing a doctor for quarterly weigh-ins, I\u2019d been doing monthly video visits with my dietitian for the better part of a year. During appointments, we discussed new goals, such as eating more diverse foods and not measuring portions, and also touched on the psychological challenges of confronting irrational thoughts. Our sessions were helpful \u2026 until COVID. As my anxiety surged, I began exercising more and eating less \u2014 and lying to my dietitian about it all.<\/span><\/p>\n

\u201cRecovery from eating disorders is often tenuous \u2014 it can go well when things in your life are going well, you don\u2019t have large stressors, and you are able to access resources and support,\u201d Bulik says. \u201cAccountability plays an important role. Clinicians have to work really hard to maintain the rapport virtually and work toward radical honesty.\u201d<\/span><\/p>\n

When we met the day after my dress fitting, I confessed to all the skimpy meal portions and extra workouts I\u2019d been hiding. I was ashamed that I needed concrete proof of weight loss to realize I\u2019d veered off course. To make me more accountable, we started meeting every other week (and I started telling the truth). And to make it harder to lie about what I\u2019m eating, she asked me to use a different app to log meals. Since that meeting, I\u2019ve been uploading photos of my meals instead of typing in what I ate.<\/span><\/p>\n

When I went in for a second dress fitting in August, my dress was still loose. So I let the seamstress take it in. Three weeks later, the waist felt tight. I reflected back on my sessions with my dietitian: <\/span>Focus on why I’m getting married. The dress has no bearing on my happiness. I can just get it taken out if I need to. <\/span><\/i>Plus, I saw my doctor when his office re-opened in late August. My weight was the same as when I’d last seen him in November. I was back on track.\u00a0<\/span><\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

After reverting to old, unhealthy habits during the pandemic, I learned how to get the most out of telehealth. <\/p>\n","protected":false},"author":40,"featured_media":18905,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[231],"tags":[158,41,150,154],"class_list":["post-18904","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-patient-stories","tag-eating-disorders","tag-mental-health","tag-videovisits","tag-video-visits","reviewer-dr-nassim-assefi"],"yoast_head":"\nNavigating Virtual Treatment for Eating Disorders - Patient Stories<\/title>\n<meta name=\"description\" content=\"After reverting to old, unhealthy habits during the pandemic, I learned how to get the most out of telehealth.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.zocdoc.com\/blog\/patient-stories\/navigating-virtual-eating-disorder-treatment\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Navigating Virtual Treatment for Eating Disorders - 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