Yet another diagnosis

[Night Elf]

At the latter part of last year, I finally went in to talk to someone about my disordered eating. I saw a counselor outside of Kaiser and a nutritionist within Kaiser. I emailed my Kaiser psychiatrist and described what was going on to ask her what I should do which is how I ended up with a counselor and nutritionist. My psych doc suggested I go to an eating disorder facility but I didn't think I needed that as I did not fit any specific eating disorder diagnosis. So at my appointment with my psych doc we talked about how things were going. I have not talked to her about it again either in person or through email. I got better and made better choices. Unfortunately I have found myself backsliding lately. But anyway, yesterday when I went in for my colonoscopy they had bulimia nervosa as an ongoing diagnosis in my medical record. When I got home, I looked up my medical record an sure enough, it's a real diagnosis assigned to my record. So I emailed my psych doc and told her I didn't have bulimia and wanted that taken off my records. She emailed me back and told me what her notes said that I said and she considers that bulimia. So now that's on my permanent record. 

I'm upset at the thought of it being there because it's describing something I feel is confusing and upsetting. I also don't like that I'm backsliding. I'm taking steps to get back to a better place but I no longer have my counselor and nutritionist. There is nothing they can say that would be different from what they said when I saw them before. I'm accumulating diagnoses and can't imagine how many things will be wrong with me in another decade. Good grief!!

[Annie G]

Gently....are you upset because you think it’s not an accurate diagnosis or upset because it’s scary to see it in black and white?  Your efforts to make better choices and being bothered by recent backsliding suggest that you want to get better, so perhaps the diagnosis isn’t a bad thing.  Maybe it’s that extra push you need to really conquer your disordered eating. We’re all rooting for you.   (Hugs)

[Night Elf]

2 minutes ago, Annie G said:

Gently....are you upset because you think it’s not an accurate diagnosis or upset because it’s scary to see it in black and white?  Your efforts to make better choices and being bothered by recent backsliding suggest that you want to get better, so perhaps the diagnosis isn’t a bad thing.  Maybe it’s that extra push you need to really conquer your disordered eating. We’re all rooting for you.   (Hugs)

Both. I do not purge and have never purged. I thought that was important to the diagnosis of bulimia. And of course I don't want to see it in black and white. Knowing it's on my permanent medical record bothers me since I have other mental behavioral diagnoses. It just makes me feel bad about myself.

[Annie G]

You don’t take laxatives, right? 

If it’s not accurate it should be removed, but probably replaced by an accurate diagnosis of what’s going on. 

I’m sorry it makes you feel bad about yourself. Mental illness is nothing to be ashamed of. It’s no different than cancer or any other illness, but of course the stigma lingers.  I hope you feel safe here, as we try to be  supportive about mental health issues. 

[Kim in Appalachia]

I'm sorry that you're struggling, but, and i'm saying this gently, you can't expect the doctor to change a diagnosis just because you called, that would be unethical. You need to be seen to update a medical note. 

Please don't let that weigh you down or stop you from feeling llike you can make progress. If you go to another doctor or are seen again an updated note can be done. You can also offer your own correction or opinion when encountering a new doctor.  

 

[Junie]

(((Nightelf)))

 

 

[Catwoman]

43 minutes ago, Night Elf said:

At the latter part of last year, I finally went in to talk to someone about my disordered eating. I saw a counselor outside of Kaiser and a nutritionist within Kaiser. I emailed my Kaiser psychiatrist and described what was going on to ask her what I should do which is how I ended up with a counselor and nutritionist. My psych doc suggested I go to an eating disorder facility but I didn't think I needed that as I did not fit any specific eating disorder diagnosis. So at my appointment with my psych doc we talked about how things were going. I have not talked to her about it again either in person or through email. I got better and made better choices. Unfortunately I have found myself backsliding lately. But anyway, yesterday when I went in for my colonoscopy they had bulimia nervosa as an ongoing diagnosis in my medical record. When I got home, I looked up my medical record an sure enough, it's a real diagnosis assigned to my record. So I emailed my psych doc and told her I didn't have bulimia and wanted that taken off my records. She emailed me back and told me what her notes said that I said and she considers that bulimia. So now that's on my permanent record. 

I'm upset at the thought of it being there because it's describing something I feel is confusing and upsetting. I also don't like that I'm backsliding. I'm taking steps to get back to a better place but I no longer have my counselor and nutritionist. There is nothing they can say that would be different from what they said when I saw them before. I'm accumulating diagnoses and can't imagine how many things will be wrong with me in another decade. Good grief!!

 

What did she tell you her notes said? 

Were her notes inaccurate about what you told her about your eating disorder?

Sorry to sound so clueless — I’m just trying to figure out what the doctor gave as her reasons for believing you have bulimia. 

[ktgrok]

30 minutes ago, Night Elf said:

Both. I do not purge and have never purged. I thought that was important to the diagnosis of bulimia. And of course I don't want to see it in black and white. Knowing it's on my permanent medical record bothers me since I have other mental behavioral diagnoses. It just makes me feel bad about myself.

It can be diagnosed without purging, if there is fasting instead. So periods of overeating followed by fasting would fit the criteria. 

Hugs. 

[Night Elf]

12 hours ago, Annie G said:

You don’t take laxatives, right? 

If it’s not accurate it should be removed, but probably replaced by an accurate diagnosis of what’s going on. 

I’m sorry it makes you feel bad about yourself. Mental illness is nothing to be ashamed of. It’s no different than cancer or any other illness, but of course the stigma lingers.  I hope you feel safe here, as we try to be  supportive about mental health issues. 

No, I don't take anything like that. The only thing I would do is binge and then restrict calories for the next couple of days to bring the weight back down. I don't even binge anymore. I haven't done that since last year. So really, bulimia doesn't seem to apply to me. I have an appointment with her in June. I'll talk to her about it then and see if she'd like to change the diagnosis.

[Night Elf]

12 hours ago, Catwoman said:

 

What did she tell you her notes said? 

Were her notes inaccurate about what you told her about your eating disorder?

Sorry to sound so clueless — I’m just trying to figure out what the doctor gave as her reasons for believing you have bulimia. 

They said I binge one day and restrict calories the next 2-3 days to get back down. Also my mood would be affected by the number on the scale. When I gained weight, I was depressed and when I lost it I was elated. I binged about once a week. I think she's stuck on the word 'binge'. Both my counselor and nutritionist say what I have is just called disordered eating. It's a diagnosis used when one doesn't fit properly into the description of an eating disorder. I'm not bulimic as the textbook definition goes. I'm not anorexic. I didn't exercise to burn calories. However, now I am exercising but it's cardio for my heart health, not weight loss.

I do think my diagnosis needs to change but I don't know what to change it to. Maybe she'll know. When I say I'm backsliding, I'm not binge eating anymore, I'm just restricting calories and I'm back to weighing myself every day. For months I was only weighing once a week and I was eating more calories but I gained more weight than I was happy with and fell back into watching calories.

[Pawz4me]

I could be wrong, but I think once something relatively important gets in your record it generally stays there. Because the record is really a history. If the criteria for bulimia includes overeating and then fasting to compensate, and you've done that and have (rightly) been diagnosed with it, then I doubt a doctor will be quick to remove it. It's an important part of your medical history. I have a couple of medical issues that aren't active (for lack of a better word) at the moment and haven't been in years, and yet they still show up on my list of diagnoses. And that's okay with me.

[Night Elf]

12 hours ago, Ktgrok said:

It can be diagnosed without purging, if there is fasting instead. So periods of overeating followed by fasting would fit the criteria. 

Hugs. 

But isn't fasting not eating? What I did was eat no more than 1200 calories for 2-3 days. That's a weight loss number.

[ktgrok]

15 minutes ago, Night Elf said:

But isn't fasting not eating? What I did was eat no more than 1200 calories for 2-3 days. That's a weight loss number.

How low did you go? Fasting could, in this situation, mean severely restricting. 

[Night Elf]

1 minute ago, Ktgrok said:

How low did you go? Fasting could, in this situation, mean severely restricting. 

I'd aim for 1200. It was usually in the upper 1100's, never below 1100, sometimes in the 1200's but never up to the 1300's. Then to maintain I'd eat in the upper 1200. In a thread here, I was told that was too low but it was maintaining my weight and I figured it was because I was sedentary. My weight on normal days never fluctuated more than half a pound up or down. And I maintained that for years, ever since I lost weight in 2012. 

[ktgrok]

Just now, Night Elf said:

I'd aim for 1200. It was usually in the upper 1100's, never below 1100, sometimes in the 1200's but never up to the 1300's. Then to maintain I'd eat in the upper 1200. In a thread here, I was told that was too low but it was maintaining my weight and I figured it was because I was sedentary. My weight on normal days never fluctuated more than half a pound up or down. And I maintained that for years, ever since I lost weight in 2012. 

I think that sounds like dieting, not bulimia. I do think the problem is you used the words binge. Sounds more like a cheat meal and dieting. However, the term binge eating disorder also might fit. Not bulimia. 

[Bluegoat]

28 minutes ago, Night Elf said:

But isn't fasting not eating? What I did was eat no more than 1200 calories for 2-3 days. That's a weight loss number.

 

Fasting doesn't necessarily mean not eating, it also means restricting in some way.

I'd say in this case the reason it's used is not so much the amount of calories, but the behaviour itself - it's the binging-fasting pattern that is the issue.  It doesn't really matter about the numbers.  

[Night Elf]

5 minutes ago, Ktgrok said:

I think that sounds like dieting, not bulimia. I do think the problem is you used the words binge. Sounds more like a cheat meal and dieting. However, the term binge eating disorder also might fit. Not bulimia. 

Yes, she fixated on my binge days. On those I just ate what I wanted and as much as I wanted. I didn't track calories so I have no idea how much I was really eating. I'd do things like eat a donut and chocolate milk for breakfast in addition to my regular breakfast, McDonald's for lunch, a big dinner which would usually make me feel ill, and lots of little snacks in between like candy bars and a few single bags of chips. I'd gain 2-3 lbs. of weight which I figured was some water weight. I'd aim for 1200 calories the next couple of days and lose that 2-3 lbs. again. It worked for me, but my husband didn't like it and neither did my psychiatrist.

[Night Elf]

10 minutes ago, Bluegoat said:

 

Fasting doesn't necessarily mean not eating, it also means restricting in some way.

I'd say in this case the reason it's used is not so much the amount of calories, but the behaviour itself - it's the binging-fasting pattern that is the issue.  It doesn't really matter about the numbers.  

Ah, that makes sense. It's hard to wrap my brain around when all I've ever known about eating disorders was the basics of the textbook definitions. In my researching of it, there are some other diagnoses as well but I still don't seem to have as many of the symptoms they describe. Basically my problem is I just like losing weight. It started in 2011 when I joined Weight Watchers and lost 45 lbs. then my doctor put me on a diabetic diet watching my carbs and I lost another 10 lbs in 2012. It just felt good to see that weight coming off so easily that I continue eating the way I had been. I never went below what the healthy weight range guidelines said though. I just got near the bottom. I didn't have any inclination to lose beyond that. I wasn't looking to become unhealthy. 

[Annie G]

It sounds like you’re really bothered by the binge part of the diagnosis, as if you’re ashamed of that part much more than the restriction of food the following few days of the binge. Perhaps your disordered eating has changed and you’re no longer binging, but the disordered eating is still there. The diagnosis is there to help you, not hurt you.  It’s there to alert other medical professionals. If you gain a few pounds during menopause and go to a gyno and are distraught about it, seeing the disordered eating diagnosis in your history might help the doc understand why you are so upset. Likewise, if you exhibit more anxiety or depression it can alert your docs to explore if your weight is the cause.  

A while ago when your treadmill was broken and you were waiting for the replacement, you were super anxious about it because you hadn’t been able to exercise for several days. That is a little bit  of an overreaction for a person who is walking for heart health.  

Perhaps the doc will modify/add ‘disordered eating/not other specified’  to your history since that seems to include the whole spectrum of what you deal with.

When our dd was struggling with disordered eating she wasn’t honest with how many calories she was consuming (or how much she exercised, how many laxatives she took, etc). She would carefully track calories and show us the charts. But when I delved deeper, I saw that she was inflating the calorie counts in order to reach her goal (which really wasn’t her goal, it was the number she knew would keep us and the doc happy).  That diagnosis really helped us get her the help she needed. Without it I would have looked like a controlling, obsesssed with perfection mother. It’s still in her medical history today, and it’s ok. She has conquered her eating disorder but now with young girls of her own, she has to make sure she doesn’t pass on her issues to her girls. One is rail thin, one is chubby, and dd has to work hard to not be overly worried about the slightly overweight one.  I tell you all this because it impacts so many relationships and I want to encourage you to be ok with having an official diagnosis. 

[AmandaVT]

1 hour ago, Night Elf said:

They said I binge one day and restrict calories the next 2-3 days to get back down. Also my mood would be affected by the number on the scale. When I gained weight, I was depressed and when I lost it I was elated. I binged about once a week. I think she's stuck on the word 'binge'. Both my counselor and nutritionist say what I have is just called disordered eating. It's a diagnosis used when one doesn't fit properly into the description of an eating disorder. I'm not bulimic as the textbook definition goes. I'm not anorexic. I didn't exercise to burn calories. However, now I am exercising but it's cardio for my heart health, not weight loss.

I do think my diagnosis needs to change but I don't know what to change it to. Maybe she'll know. When I say I'm backsliding, I'm not binge eating anymore, I'm just restricting calories and I'm back to weighing myself every day. For months I was only weighing once a week and I was eating more calories but I gained more weight than I was happy with and fell back into watching calories.

 

Disordered eating isn't a code a Dr. could use in a chart. There's nothing in the codebook for that (I just looked it up). Your Dr. would have to best fit your symptoms into a billable code in your chart. I just looked up the eating disorder codes and they could have used "eating disorder, unspecified" but many insurances are cracking down on unspecified diagnoses and do not allow them. The only other options I see, are variations on anorexia and bulimia. We're running into this in the mental health field  - we just got a notice that unspecified diagnoses will be cut back in July.

[Night Elf]

1 hour ago, Annie G said:

 

A while ago when your treadmill was broken and you were waiting for the replacement, you were super anxious about it because you hadn’t been able to exercise for several days. That is a little bit  of an overreaction for a person who is walking for heart health.

That's because this is the longest I've ever exercised and if I go a few days without walking, I lose my motivation to get back on. My normal pattern is to walk about 2-3 weeks then peter out over the next 2 weeks until I'm bored with it and don't want to do it again and months will go by before I decide to get back on. This time around, I started walking in February and this is May and I'm still going. I've gotten over the hump and actually enjoy walking now. I don't walk fast. I get my heart rate up for heart health but I could truly do so much more but I don't want to exert myself more than I do. I don't like hard exercise. My dd and her boyfriend have repeatedly asked me to join their gym and they'd work out with me but gosh, that's so much work! I don't want to do that much. And I choose the treadmill because I can watch my favorite British comedies while walking. I don't like walking outside where it's so boring and seems to last much longer than when I'm on my treadmill.

[Night Elf]

20 minutes ago, Amanda Pugliese said:

 

Disordered eating isn't a code a Dr. could use in a chart. There's nothing in the codebook for that (I just looked it up). Your Dr. would have to best fit your symptoms into a billable code in your chart. I just looked up the eating disorder codes and they could have used "eating disorder, unspecified" but many insurances are cracking down on unspecified diagnoses and do not allow them. The only other options I see, are variations on anorexia and bulimia. We're running into this in the mental health field  - we just got a notice that unspecified diagnoses will be cut back in July.

Yeah. I'm not going to worry about it. I'm not seeking services for it but if I ever need to do so I guess the diagnosis will be helpful then. I just don't think I'll get to that point.

[learning123]

You have so much self awareness about what you need!  : )  But throw the scale away! It sounds like it's a trigger for a fail/reward system with food-- You're rewarding yourself when you see the number on the scale fall after an overeating session.  That scale is like a big pat on the back for the overeating/restricting pattern because you've discovered how successful you are at controlling your weight, and not (or only partly) your eating patterns. Trust yourself to be fine without the scale AND the disordered eating!?

[katilac]

3 hours ago, Night Elf said:

They said I binge one day and restrict calories the next 2-3 days to get back down.  

 

 

Apparently half of the country is bulimic, then. 

[GinaPagnato]

40 minutes ago, katilac said:

 

Apparently half of the country is bulimic, then. 

Seriously! I suppose it depends on what "binge" means? If I eat out at a restaurant and actually *almost* finish my meal, I feel like I've binged, simply because I ate way past full and feel sick afterwards. But my BFF was bulimic for 15 years, and she would eat cartons of ice cream, sleeves of oreos, bags of doritos, then throw up. So I've always considered the binging part of bulimia to mean that kind of eating, not the kind in my personal experience.

[katilac]

1 hour ago, GinaPagnato said:

Seriously! I suppose it depends on what "binge" means? If I eat out at a restaurant and actually *almost* finish my meal, I feel like I've binged, simply because I ate way past full and feel sick afterwards. But my BFF was bulimic for 15 years, and she would eat cartons of ice cream, sleeves of oreos, bags of doritos, then throw up. So I've always considered the binging part of bulimia to mean that kind of eating, not the kind in my personal experience.

 

Me, too. I'm going to be very careful about what words I use at the doctor! 

[scholastica]

33 minutes ago, katilac said:

 

Me, too. I'm going to be very careful about what words I use at the doctor! 

It’s really the pattern they’re looking for. If you tell the doctor that occasionally you eat too much at an event and then watch it for a few days after that’s entirely different from I ate a large quantity of junk foods that I don’t normally eat , was not able to stop and then severely restricted calories for several days laden with guilt and shame. If the latter happens repeatedly within a set period of time, that’s a sign of a disorder. Eating too much at an event and then watching it for a few days a few times a year is a totally different thing. Doctors can tell the difference.

[Night Elf]

7 minutes ago, scholastica said:

It’s really the pattern they’re looking for. If you tell the doctor that occasionally you eat too much at an event and then watch it for a few days after that’s entirely different from I ate a large quantity of junk foods that I don’t normally eat , was not able to stop and then severely restricted calories for several days laden with guilt and shame. If the latter happens repeatedly within a set period of time, that’s a sign of a disorder. Eating too much at an event and then watching it for a few days a few times a year is a totally different thing. Doctors can tell the difference.

This. I'd overeat once a week and restrict 2-3 days afterwards then just eat what was normal for me until the next day I decided to overeat. I used the word binge because I considered I ate too much but when I see what bulimics eat when they binge, I'm no where near that much food. But it was definitely a pattern for me and I did have mood swings because of it. So yes, I know I have a disorder of some kind. 

[marbel]

13 minutes ago, scholastica said:

It’s really the pattern they’re looking for. If you tell the doctor that occasionally you eat too much at an event and then watch it for a few days after that’s entirely different from I ate a large quantity of junk foods that I don’t normally eat , was not able to stop and then severely restricted calories for several days laden with guilt and shame. If the latter happens repeatedly within a set period of time, that’s a sign of a disorder. Eating too much at an event and then watching it for a few days a few times a year is a totally different thing. Doctors can tell the difference.

 

And that's consistent with the way doctors have been telling me to eat for the past 20 years.  90%  of the time, follow whatever guidelines are appropriate (whole foods, low carb, whatever) and 10% of the time, allow for treats, feasting, etc. 

[scholastica]

17 minutes ago, Night Elf said:

This. I'd overeat once a week and restrict 2-3 days afterwards then just eat what was normal for me until the next day I decided to overeat. I used the word binge because I considered I ate too much but when I see what bulimics eat when they binge, I'm no where near that much food. But it was definitely a pattern for me and I did have mood swings because of it. So yes, I know I have a disorder of some kind. 

I think you’re smart to question the exact diagnosis and see if it can be changed to something less specific.

[Guest]

Honestly, threads like this one make me determined to say as little as possible to my doctors about my eating and exercising preferences. 

I think weighing oneself daily is wise because then you don’t have ten pounds “sneak” up on you. It is also one of the consistent behaviors noted in people who lost a large amount of weight and did not gain it back. 

[ktgrok]

31 minutes ago, Quill said:

Honestly, threads like this one make me determined to say as little as possible to my doctors about my eating and exercising preferences. 

I think weighing oneself daily is wise because then you don’t have ten pounds “sneak” up on you. It is also one of the consistent behaviors noted in people who lost a large amount of weight and did not gain it back. 

Agreed. Really, unless she is truly binging, not just eating a bit more like standard american fare, on those days she eats more, I would consider it pretty normal EXCEPT for the mood issues.if she's obsessing about it that puts it into more of a disorder vs healthy habit. 

[scholastica]

33 minutes ago, Quill said:

Honestly, threads like this one make me determined to say as little as possible to my doctors about my eating and exercising preferences. 

I think weighing oneself daily is wise because then you don’t have ten pounds “sneak” up on you. It is also one of the consistent behaviors noted in people who lost a large amount of weight and did not gain it back. 

Since weight can fluctuate even day to day, someone invented a scale that tells you your average weight over the previous 10 days. Then you can really see a pattern before they sneak up on you.

[Guest]

1 hour ago, scholastica said:

Since weight can fluctuate even day to day, someone invented a scale that tells you your average weight over the previous 10 days. Then you can really see a pattern before they sneak up on you.

Yeah, that would be fine. I just think daily weighing is not the worst idea, at least, of itself. I don’t freak out if I gained two pounds, but it also helps me regulate my behavior better. If I gained two pounds recently, I might turn down that second glass of wine tonight, KWIM? 

[scholastica]

I’m right there with you. The scale is an objective observer who helps hold me accountable. 

[Pawz4me]

An app like Happy Scale helps level out the ups and downs and give you a better view of the overall trend. I have a history of an eating disorder and there's no way I could have safely gotten to the point of weighing myself daily w/o that app.

[Catwoman]

6 hours ago, Night Elf said:

This. I'd overeat once a week and restrict 2-3 days afterwards then just eat what was normal for me until the next day I decided to overeat. I used the word binge because I considered I ate too much but when I see what bulimics eat when they binge, I'm no where near that much food. But it was definitely a pattern for me and I did have mood swings because of it. So yes, I know I have a disorder of some kind. 

 

Could the doctor think it’s less about how much you actually ate and more about your attitude toward eating in general? Even if you didn’t eat that much, maybe the doctor felt you were obsessing too much about it and that you were too worried about how many calories you ate to compensate for the day you overate? Or perhaps the doctor heard what you ate and disagreed that you had overeaten at all, so he felt your thought patterns indicated a propensity toward bulimia? 

I’m just guessing here, because I’m trying to figure out why the doctor chose that particular diagnosis.

[Night Elf]

1 hour ago, Catwoman said:

 

Could the doctor think it’s less about how much you actually ate and more about your attitude toward eating in general? Even if you didn’t eat that much, maybe the doctor felt you were obsessing too much about it and that’s you were too worried about how many calories you ate to compensate for the day you overate? Or perhaps the doctor heard what you ate and disagreed that you had overeaten at all, so he felt your thought patterns indicated a propensity toward bulimia? 

I’m just guessing here, because I’m trying to figure out why the doctor chose that particular diagnosis.

I can only guess. I think she's thinking of the overeating as binging because I'm sure I used that word because that is what I felt like I was doing and that I was doing it every week. I had a predictable pattern. I honestly was moody with the results of my weighing myself. If I had lost, even if it was just .2 of a lb., I was excited and started my day off feeling good about myself. I'd eat normal without feeling guilty. But if I gained, even if .2 of a lb., I'd feel horrible and guilty that I must have had just that one bite too much the previous day. That started my day off on a bad note and I felt guilty with everything I ate during that day. Honestly, as soon as my eyes opened in the morning, my very first thought every morning was about getting on the scale. Yes, I was hyper focused on food and how it affected my body. I was also super focused on the number on the scale. It was an obsession. I see her next month. I'm going to talk to her about why she chose that diagnosis. 

[Catwoman]

6 minutes ago, Night Elf said:

I can only guess. I think she's thinking of the overeating as binging because I'm sure I used that word because that is what I felt like I was doing and that I was doing it every week. I had a predictable pattern. I honestly was moody with the results of my weighing myself. If I had lost, even if it was just .2 of a lb., I was excited and started my day off feeling good about myself. I'd eat normal without feeling guilty. But if I gained, even if .2 of a lb., I'd feel horrible and guilty that I must have had just that one bite too much the previous day. That started my day off on a bad note and I felt guilty with everything I ate during that day. Honestly, as soon as my eyes opened in the morning, my very first thought every morning was about getting on the scale. Yes, I was hyper focused on food and how it affected my body. I was also super focused on the number on the scale. It was an obsession. I see her next month. I'm going to talk to her about why she chose that diagnosis. 

 

Well, if your doctor knew that you were obsessed to the point where gaining two tenths of a pound would make you feel horrible and guilty and would basically ruin your day, and it would also make you feel guilty about everything you ate all day, I’m starting to understand the diagnosis a bit better.  I suspect the doctor is focusing more on your obsessive feelings and not on how much you actually ate.