fitscapades
I went from successful specialist doctor in rural Australia to a homeless addict selling my body for drugs and almost dead to living in full recovery in a three story house 30 meters from the beach with my amazing gorgeous partner, my son, his son, our cat and dog. I am an addict in recovery, my story is quite unique and I didn't live it all only to have it untold as the dusts pass over my grave at the eventual end of my life. I want to give hope to addicts in pain, to their families who worry that true recovery is possible even when you are as bad as I was. I want to try to shift perception in the community that addicts are not a waste of time we are capable of recovery and are not lost causes. I have learned so much and gained so much wisdom walking this pathway to recovery it seems a shame not share this. The lessons I have learned are useful to everyone not just those challenged by addiction.
fitscapades
Fat Kid to Physician: How Anorexia Nervosa and Disordered Eating Shaped My Life
"You're just sitting there obsessing over what's happening with your fat cells. It's fucking wild." These raw words capture the mental torment of anorexia nervosa—a reality I knew intimately as both patient and physician.
My relationship with food began as an obese child enduring bullying and humiliation. By fifteen, amid my parents' divorce, I found control through extreme calorie restriction. I dropped weight dramatically, earning praise until crossing that invisible line where congratulations turned to concern. At 45 kilos, I was a shell—perpetually cold, depressed, unable to enjoy my passion for drama. The black-and-white thinking of anorexia trapped me: I couldn't eat normally without fearing I'd become "a fat fuck again."
A child psychiatrist's blunt assessment—that I'd spend years in an eating disorder bed rather than attending university—finally flipped a switch. Medicine became my lifeline, my reason to recover. Yet recovery wasn't linear. Bulimia followed, with up to ten purging sessions daily through university. Later, stimulants became another way to suppress appetite, creating a dangerous addiction pathway.
Years later, as a renal physician, I helped build what became a model eating disorder unit in regional Australia. Drawing from personal experience, I transformed nursing culture from judgment to compassion. We'd tell nurses: imagine someone forcing you to eat something disgusting—that's how these patients feel about normal food. Through painstaking work, we created an environment where severely ill patients could heal.
Perhaps most transformative was my professional work with obese patients. Research revealed that much of what we believe about weight is wrong. Some bodies are genetically programmed to retain weight—traits once beneficial during famines. The blame and shame heaped upon larger people isn't just cruel but scientifically unfounded. Studies show people with BMIs around 31 actually live longer than those at the lower end of "normal."
Whether you've struggled with eating disorders, work in healthcare, or simply want to understand these complex conditions better, this episode offers insights from someone who's experienced the battle from both sides of the treatment room. If you take away one message, let it be this: compassion trumps judgment every time.
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Welcome back to Fitzgibades. My name is Michelle and I'm a recovered addict. But today, I don't know I plan to do a podcast on this, I guess in the future, but it's come up a little bit more sooner than what I had, I guess, planned to. I'm going to talk about my eating disorder background and the fact that I had anorexia nervosa as a young child and as an adolescent and I wanted to, yeah, just discuss that because how it relates to who I am now and and like, I guess, my my journey with throughout that. So, like anorexia nervosa, when you treat because I have also treated anorexia nervosa as part of a multidisciplinary team when I was a specialist in a hospital. So I've seen kind of both sides and I know quite a bit about the treatment of eating disorders. It's difficult but like treating an eating disorder, eating disorders in many ways are like addictions because, yeah, it's similar wiring in your brain and similar ways that you treat eating disorders is that you treat eating disorders, that you treat addictions as well in some ways. So you know this was sort of the precursor to my then developing, you know, addiction to substances and I think in certain patients it's quite common for that pathway to be followed from, you know, eating disorder to substances for many reasons, which I get into, you know. I guess, well, I could get into it. Now, really, I mean, it's sort of maybe you've got that sort of personality style where you get addicted and also you know, if stimulants suppress your appetite and they have the sort of ego-syntonic side effect of, you know, losing weight, which if you're that way wide, you don't mind. Being a bit thinner, you have stimulants and it makes it easier to have to diet restrict. So there's that to it. But over time too, actually, the appetite suppressant effects of stimulants go away, so that that sort of wears off and you can actually be a fat meth addict, believe it or not, it's true, meth addict, believe it or not, it's true anyway. Um. So, yeah, I feel like I just digressed down the tangent there. I'll come back to what we were talking about. So, yeah, I wanted to discuss that today, um, and I thought the best way to tackle this beast because it's a huge topic, it really is, um, and I guess for me it's not in in it's. Have I conquered I've conquered it? Yeah, I believe that I've conquered anorexia. I'm still somewhat eating disordered. I don't eat normally, but I don't have. You know, I'm not anorexic anymore, if you will, and I'll go in to explain that as I go along. It's a complicated topic, all right. So just buckle yourselves in and, you know, be prepared for a meaty deep dive. So I buckle yourselves in and, you know, be prepared for a meaty deep dive. So I thought the best way to tackle this was to just go throughout my life and like where eating disorders have been you know just the history of it in me um, in a semi in-depth but not too in-depth discussion and then, um, yeah, progress like that.
Speaker 1:So I was a fat kid man. When I was like a kid at school, in primary school, I was fat and I was obese. You know what I mean. Like I was obese, like I was a fat kid, one of them, and I got bullied. I got bullied for it and I don't remember ever eating or overeating. I had a normal diet meat and free veg. At night time I didn't mind a bit of chocolate, but not more than the next kid. You know I wasn't particularly athletic at that age. That could have been an issue, but I was active always outside, you know. So it wasn't like I was a fat, you know, like a slug, you know I got around, but I was just fat, you know, and this was a big issue for me. Like I was, yeah, as I say, bullied, teased.
Speaker 1:I remember, like my parents taking me to this endocrinologist when I was about maybe 11 and it was like I still remember it was fucking horrendous. It was a dude, a fat dude, a fat middle-aged dude. I was about 11. He made me strip off to no clothes in front of him, without my parents there, and then he got these fat caliper things and just measured the fat all over my body. It was like completely and utterly the most, one of the most humiliating experiences of my childhood. Like it was horrendous, and I remember it being really cold in this room and just just it was horrible, you know, and throughout my childhood too, like so my mum and dad also know this was a big issue for them that I was fat big deal, and I used to remember thinking, if only, like I could just be thin, you know, and I would be happy. Like this is the root of all of my problems, you know, and like, yeah, as I say, I didn't.
Speaker 1:I liked food but I didn't overeat, you know, but it's just fucking fat, you know, and um, so then what happened was, yeah, so, so, as we got to sort of that, I also got to the age of 12, 13, it was, you know, it's like it was time to take action. And I was fed up with it too. I couldn't wear the clothes everyone else wore. It was just miserable.
Speaker 1:So over the summer, between year seven and year eight, I went on this massive diet. It was a stupid diet. It was like food combining you couldn't eat starches and protein together, and that was how you're supposed to lose weight. It just made no sense. And then I also did exercise. Well, I went to the gym like three times a week, um, and yeah, it was a big thing. I've lost quite a bit of weight. So I went from being, you know, really, really timed and morbidly overweight to, you know, just a bit chunky. And yeah, I stayed just a bit chunky, like you know, still quite chubby, throughout my like, from between like 13 to like 15, maybe 12 to 15.
Speaker 1:And then, like at the age of 15, my parents got divorced, right, and there's a whole heap of like traumatic shit going on at home, and I was like you know what I'm going to be perfect, and I know just how I'm going to you, you know, improve my life and take control over my life, because everything is just so out of control. I'm going to restrict my diet and so I did, and I was really good at it. You know I would hate I'd never come at calories, but what I did have was this book called Fats and Figures, and I used to look every food up in that before I ate it. And I must have restricted myself down to, I reckon, maybe 600 calories a day, and the weight it just fell off me and everyone was congratulating me saying, oh, you look really good, you know, and so that was all very validating, and so I just kept on restricting and restricting.
Speaker 1:So when you go that down, that little rabbit warren with anorexia, what happens is that suddenly you start to get like too thin and in your own mind it's like there's only one way I either eat or I don't eat. If I go back to the way I was, was eating, I'm going to be fat and I cannot be fat. You know like you're terrified of becoming fat, and so yeah, in anorexia nervosa, like you, it's very black and white thinking. You can't think in grays. So it's like there's no happy medium. It's like I cannot eat now. So I have to keep going on this diet, but I realize I'm getting too thin, but I can't possibly. I'm terrified to actually eat because I don't. I'm terrified of being fat. Um, yeah, it's pretty pretty miserable.
Speaker 1:Um, and so like, yeah, as you like you know, anorexia kind of bumbles along. You know, you sort of start off and everyone's like congratulating you, like yeah, you know you're looking great, you know you're not fat anymore and everything like that, and life's really good because suddenly you can wear all these clothes that you couldn't wear before. You're not fat. Boys are starting to look at you. You, you know, because you're of that age, or I was of that age at that time when I was like really worried, like I'm fat and I'm never going to have a boyfriend, you know, and yeah, so life's really good for like a slight bit of time. And then it's like there's this tipping point and all of a sudden, instead of instead of congratulating you, everyone's now really worried. You know you're looking too thin.
Speaker 1:What's going on, you know, and you're you're like in your own head, you're like you don't buy it because it's like eating disorder going. Well, you know, if you go and eat normally, you're just going to be a fat fuck again. And then and you're terrified of that right, like absolutely nothing could be more worse. Like when you have anorexia nervosa and you eat something, you just sit there and just obsess over what's happening with your fat cells. You know it's fucking wild. And then, of course, you've got the body dysmorphia too.
Speaker 1:So you're like, looking at yourself, you're not seeing anyone who's thin. You're seeing, well, actually I did see someone was thin, but it was quite pleasing, you know what I mean. Like, and I was really too thin, like I got down to 45 kilos, like I was like a skeleton, but that, yeah, like I never thought I was fat at that weight. I knew I was potentially too thin, but I was terrified to eat because I didn't want to go back to fat again. So it's, yeah, more that sort of dynamic. But some girls do get really skinny and they think they're still fat. You know it's wild, really skinny and they think they're still fat. You know it's wild anyway.
Speaker 1:Um, so, yeah, you get to this point and everyone's really worried about you and you're like, yeah, but I can't go back now because I'm in this new way of living and and this has brought me all of my dreams, you know. But you know, and, um, and but then what happens is that like you start to really get the physical symptoms of being starved and that, and and along with that comes worsening depression. So like when I was at my worst, my lightest way, I just remember being so fucking cold all the time you know what I mean and having no energy, just being drained. You know, and throughout my whole like high school sort of career, shall we say I loved drama, like I loved performing on the stage. I loved drama, like I loved performing on the stage and I loved doing comedy, like that was my thing and we were having like there was a big production of the Midsummer Night's Dream coming up for our year 11 class and like I was going to be like if you know, midsummer Night's Dream, I was going to be Nick Bottom, which is like the starring comedian of the play.
Speaker 1:You know that was going to be me and I was so sick, I couldn't do comedy, I couldn't act, you know, like it just robbed me of all of my animation and my personality and I just became really deeply, darkly depressed, and listened to Nirvana and shit like that. And you know it was really dark days, you know, really, and I just didn't know how to get out of there because, you know, the only way to get out of that hole was to eat. And then I didn't want to be fat and it was just fucked, you know. And my mum she would like be didn't know what to do. We'd have these screaming arguments where she'd like try and lock me in the room and get me to eat, and I just would not eat, I just couldn't do it, you know. And so this went on and so eventually I went to see like a child's psychiatrist, right, and um and like um.
Speaker 1:So at the time too, along with this I was, I was, I wanted to do medicine, right, and there was nothing else that I was at would consider. I was hell-bent, I want to be a doctor, I have to get into medicine at Adelaide Uni, right. So I, I went into then, full, obsessively, studying like just everything had, like just typical person with perfection, young girl with perfection, I needed to get 100% on all my tests and and shit like that. So my physicality was going downhill, like I remember going, I was going to a% on all my tests and shit like that. So my physicality was going downhill, like I remember going. I was going to a gym, right, and they were getting concerned and I'd go to the gym, work out and I'd almost pass out walking back home Like I was really fucking sick and so we went to see the psychiatrist and I'd already really worked out to do Wiley shit, like you know, because I was going to my GP and he was weighing me and so I put like weights in my pockets and that sort of thing.
Speaker 1:This is, you know, to try and like here you fox the weigh-ins, um, because I knew there was no way I wanted to end up in hospital, you know, with a nasogastric tube down my nose, um, but I, you know when you're that one, well, you know that that's the way it's going. You know, and like I'd be going to like parties and stuff like that. You know this is a 16, people starting to drink, and you know like have boyfriends and stuff, and I just remember like, yeah, I'm really skinny. You know, like the boys look at me a little bit, but you know, like I'm just so fucking cold I can't even enjoy my time at this party and I'm really terrified of drinking any alcohol because of the calories in it. This is literally the troubles that I had.
Speaker 1:And so we went to this child psychiatrist, sat down and she's like, yeah, what's up, michelle? I'm like, yeah, here I am. And she's like, what do you want to do? What do you want to do after school? And said, like, well, I want to get into medicine, you know. And she just looked at me and she went. You know what, michelle, like you're gonna spend the next year to five years in an eating disorder bed in hospital. Like you're not going to uni if you continue on with this, and like it was like when she said that a fucking switch was thrown in my head, man, I was like I have to eat because I want to do medicine, you know, I was like it's one of the I've spoken before about the I've got defined points where I do believe it was either divine intervention or like my higher self stepping in um from the spiritual world. You know, like, because I just started to do the exact opposite of what Michelle really would have done, because she's a stubborn bitch, you know, uh. And so, yeah, I went home and it's like a switch was thrown and I just started to eat, you know, and I did. I started to eat.
Speaker 1:I weight restored, you know. Um, it wasn't as like completely cut and dried as that, but it was a pretty. So what happens is when you weight restore from being so really starved in anorexia, you tend to put on a lot of fat around the middle, if you will, and then it redistributes. The weight will redistribute in a more or less chubby sort of manner, but that can be quite distressing. It was distressing for me, but around about the same time that I started a weight restore, like I also had my first boyfriend.
Speaker 1:So I went on the oral contraceptive pill as well. My mum's like if you don't fucking take that, I'm going to crush it and put it in your weenies. So anyway, I had to take that. So that was miserable for me, because when I take estrogen, my tits blow out like balloons and I put on weight. Estrogen for me is terrible. Like as soon as I get pregnant, right, I am like a fat marshmallow within six weeks. Like no joke. Like, yeah, tits like Dolly Parton. And like, yeah, it's unbelievable. Like, yeah, it's like Dolly Parton. And like, yeah, it's unbelievable, anyway.
Speaker 1:So I then had to tolerate not only the weight restoring, the anorexia, but also, like, the added estrogen component of just being really super chunky and plus two added to that. You know, in my eating disordered brain it was like the way I'd lost the weight was by looking at fats and restricting them, but really what it was was just severe caloric restriction, but for me that the evil of the day was fats, right. So I was eating like a fairly high carb diet. So you know, that's why I probably stacked on the weight like I did and like then. So then I had my boyfriend who we, we went out for about, I reckon, two years and we had this breakup in first year.
Speaker 1:And then I was fat and chunky and I, um, I started to like purge, I started to like, uh, realize that, yeah, like you know, it's a bit hard to be severely calorically restricted, like in anorexia nervosa. It's too hard to do, it's hard tasks to really restrict your calories down that much. I know what I'll do I'll just purge every meal. That's a better idea. So off I went and that had its own set of misery.
Speaker 1:So when you look at eating disorders, there's true bulimia where chicks will go and have that whole massive, massive binge, like a whole, like the way you would characterise a binge is that it's more food than what you would typically like. It might be one sitting or two sitting like massive amounts, like a whole pizza and a whole box of cakes or something. I did that once or twice, but that was not my typical sort of pattern type thing. I would just, I really was just trying to restrict by spewing and I would spew every meal and I would spew until I got everything out, like I thought. So I thought, and I was really fucking unwell with that, like because you know, you throw all your electrolytes out of balance, and that was in uni and that was around about time too. I started to really get into meth for my because I was, yeah, couldn't concentrate, probably because I was spewing all the time and I also had ADHD, um, and so, yeah, like I had a real unhealthy milieu of shit going down with my body, um, but yeah, so like I, yeah, as I said, I would spew probably about 10 times a day. You know, like I would shudder to think what my electrolyte profile was on some of those days and I did that. I'm just trying to think, yeah, through all of uni pretty much. And then, um, I'm trying to think when I actually stopped?
Speaker 1:The last time I purged was about 2012, I reckon, and then I never did it again. It just sort of had run its course, but at the time when it was heavy going, I would have been classed as being severe, severely at risk, and I just kept living my life like that. And you know, the thing about purging is it's a really ineffective method of weight loss, like that's well documented throughout eating disorder journals, and I certainly discovered that myself. And so, since it wasn't so effective and it was making me feel pretty ordinary, I stopped doing it on a daily basis after a few years. But I was feeling really stressed or upset about something and I'd eaten a meal and then I an eating disorder brain kicked in, said you're a fat fucker, I would still purge, and that was right up until 2012. And then I then I was like you know, I'm done with. This is gross, I'm not doing it again.
Speaker 1:Um, so, a fair few years of abusing my esophageal sphincter, which came back to burn me when I got pregnant, but anyway. So, yeah, so throughout those years, right, there were other sort of symptoms or problems I had. Like, for instance, I hated going out to dinner, to restaurants, right Like I hated it because I had no idea what was going in my food. I was terrified that I was going to have something unhealthy and fattening. And I, yeah, just going out to restaurants was a real big deal for me. I hated, I was very fearful right up until, yeah, as I say, probably 2012 in in those years when I was purging, though it was easy, you know, like I'd have a meal I thought, you know that I'd then sit there and be guilty about and I'd just go and purge it, you know so I'd make sure that there was heaps of water on the table.
Speaker 1:I just like, just flood my stomach with water and then, in I'd go to the toilet and just, yeah, spew everything up, which, of course, came with its own set of really negative social, you know, impacting factors, like you know, coming back from the toilet, and everyone's like, yeah, we can see, you know your eyes are so red and bloodshot you've been spewing. You know, coming back from the toilet and everyone's like, yeah, we can see, you know, your eyes are so red and bloodshot you've been spewing, you know. And then, or someone might hear you spewing in the cubicle because, like, what can be really distressing if you're trying to have a real good purge and you can't get everything up and you will just sit there with your fingers down your throat, going like, just until your throat is red, raw, like it's so gross and um, yeah, it's not good for your health, um. So, yeah, I did that right up until, as I said, the last time I purged was 2020, 2012, definitely because I was going through a really um, stressful time at work. I was working as a registrar in harvey bay and I was quite like emotionally, um, distraught, and there was a few times when I had lunch and I just you know, what would happen is you have lunch, even though you probably needed the calories, and that you would sit there at your desk and you go. I can feel the food in my stomach, I'm getting fat, you and that was my way of relieving that emotional distress and discomfort was to purge, you know. And then also along the way too sorry, I then started to exercise and exercise became a really important way of purging I want to put in quotation marks because it is purging behavior, you know, because you're trying to get rid of the calories. But it in fact turned out to be a healthy thing, a healthy part of my life in the end. Although its origins started out in eating disorder, at the end of the day it became a more positive thing in my life, you know.
Speaker 1:And so I think, like, like, then I had my son and when I was pregnant I like put on massive amounts of weight because of the estrogen and also because, like, I was so carb restricted because like, so sorry, just go back to a little bit before my son was born, you know, I was still like, eating in an eating disordered manner. So my idea of an okay diet or safe diet was no carbs, you know, no fats, and only protein, so severely, severely restricted. And so then, when I came into but no purging. And then when I came into getting pregnant, and that like and being so carb restricted, getting pregnant, and that like and being so carb restricted, like then that's what can set the ground for really bad like uh nausea in pregnancy and I, like I was still working as a doctor at the time, so I had to be really functional. So I got pregnant with milesy and like I was like so sick, like like so sick, so nauseated, that the only thing that would fix it would be eating carbs, right? So all of a sudden I was just flooding my body with like chips, anything, because I still had to go to work, right, like I couldn't have days off sick. I had to go to work as a doctor, so I had to do anything to remain like functional. So I was just like eating the carbs, trying to go to work and not spew everywhere. Like you know, I would literally do ward rounds spewing into a spew bag, and then I'd like be driving home and I'd spew into a bag in my car, like I just it was like fucking, like wild, the vomiting and yeah, like it was wild. And so then so yeah, I was like a little hippo and that was really hard for me too, because I'd always had this skinny figure and then I just ballooned out.
Speaker 1:And then, of course, when you're pregnant, people don't hold back on their comments. You know if you don't put on enough weight, you're unhealthy, and if you put on too much weight, everyone has a comment too, and they don't hold back because they're like they figure you're pregnant, so you're public property, like I had colleagues going your tits are so big, or are you sure you're not having twins? And for someone who's been eating disordered, who's quite, you know, conscious about their body image and things, that's fucking destroyed me, you know to go home, cry and cry. But but for me, despite all of that, I was like, no, you know what, fuck them. Like you know, I'm going to eat whatever my body tells me to eat, because this is my body, is my baby's body at the moment, it's not mine. You know what I mean. So fuck off eating disorder behavior. I'm not doing that, you know, because I've got to keep this baby healthy. So I'm like, you know.
Speaker 1:So I put on so much weight I was like a mini elephant and like 30 kilos I should. You know, I put on in pregnancy and and then so I had milesy and then but see, this is the thing right after I had him, I this was not distressing for me, the way what I did was I looked at it very and non-emotionally, like a project, you know. I mean like, like I didn't get upset about being fat, I was like every day, you just chip at it. And I didn't engage in eating disordered behavior. I didn't purge, I ate a normal diet, probably not as much calories as one other one, as what everyone else would have, but, no, it was pretty normal, nothing wildly, yeah, nothing wildly disordered. Like I exercised. He was like I worked out about three times a day.
Speaker 1:I ate normally, and looked at it as a project, not emotionally, didn't purge, and I did take, I like, as soon as I wasn't really breastfeeding. I did take meth again though, um, but you know I didn't. That was the only well, okay, the only abnormal thing. It was still pretty abnormal, but, um, in terms of eating disorder, I like, at that point I was like, okay, I'm, I'm pretty much over this now I can go out to dinner and have a dinner and not purge and not get anxious about it. I'm quite happy to do that and I'm eating normally, I'm not throwing up and, yeah, I exercise a bit, but I can live with that. You know, um, and that was that. You know I was pretty much over the worst of it. Then, right, like, so, you know, yeah, and so, yeah, when I didn't resort to anything wildly eating disordered, given, despite the stimulus of having, you know, like, like all of the negative comments and the excess weight, I figured that that was a pretty solid sign that I'd recovered from my eating disorder.
Speaker 1:I just want to also preface that there's something that I had forgotten to mention in terms of, like you know, when you talk about something like an eating disorder, there's all this set of symptoms that is what we call ego-dystonic, so in terms of things you don't enjoy about your illness, so there's stuff that's ego syntonic, stuff you do enjoy. So, unlike any other illness, with anorexia the thing you enjoy is the weight loss. Right, that's ego syntonic. But then there's all this stuff that goes against you, that you don't enjoy and I guess it's not really a symptom, but it's more, yeah, like, um, you know, at the point when, like everyone's going, yeah, well done, michelle, you're not a fatty anymore, you know you lose your weight, and then everything changed and everyone was concerned.
Speaker 1:Also, what came along with that is like stigma. You know, like at school, you know, like all the boys like, oh, yeah, you know that's that girl with anorexia, you, there's this big stigma about it which was uncomfortable, you know. I mean I also felt that later with my addiction too. But yeah, yeah, the stigma was wild and I look back on it now and I go fuck, michelle. You know, like you feel ashamed of a little bit of an eating disorder. Look what all the other things you did later on you know that were really. You know, know, like that's nothing compared to anything else that you were stigmatized for, but anyway, it's just a little little side note there anyway. So then this was after I had my son. I yeah, I felt like I was, I'd, I'd like it wasn't.
Speaker 1:That's why, talking about this now, it's not even relevant to a large extent in my life today. It's just not because I love going out to dinner, to restaurants, I love eating, I love food, but after recovering again, I guess in my adulthood, then posting sort of like my idea of what a diet, a diet that I would want to eat, was really deranged, right? So, like you know, it's like the ideal diet was still this no carbs, no fat and only protein, you know, which is unsustainable, right? You cannot live on that, and nor can you actually manage to eat that either, you know. So what happened is like I lied to myself and go okay, this is what I mean, this is the only thing I'm going to eat. And then, of course, there'd be these other foods that would be around the house, other people would have them and I just eat them and I didn't count that in what I was putting in my diet. You know what I mean. Like this sort of the, the unseen calories and, yeah, like.
Speaker 1:So my weight yo-yoed quite a bit. I'd go really skinny if I was training hard and then then I didn't work out for like three years because I was a junkie I hate that word, I hate that term actually an IV drug addict. And I remember the time, you know, because when I made that switch, you know, I was like, oh, this is a better way to control my weight. I could just bang drugs and, you know, be skinny. Of course it was a horrendous way to go about any type of health plan, you know. And in fact what happened? I was just starting to get fat again, you know, even though I wasn't eating. Well, who knows, I was so cooked that I could have been doing anything. But the point being is that, yeah, if you're that egocentronic symptom of weight control and appetite suppression, it goes away when you're well into addiction and then you just become this fat marshmallow. That's really unfit, you know. It's what I became and I was fat, like I was getting fat. You know, really fat, fat, like like pudgy wasn't working out soft.
Speaker 1:And I, when I recovered, in early recovery, I was like, yeah, like I'm never gonna get my fitness back. I actually mourned it. You know, like I like I couldn't do simple things like walk up sets of stairs and stuff. You know, like in my younger life, when I'd be fit and healthy not healthy because I saw meth, but fit, you know, I never, my physicality was never a challenge to me I could move whatever set of furniture up, whatever set of stairs. You know that I was pretty much invincible, or at least I felt that way. And then, um, and then, and then in recovery, I was like, oh man, I've really fucked it. You know, I fucked my body and I'm never, ever going to be that fit person that I was and I really mourned it, mourned it, mourned it. And then I, yeah, started to go back to the gym later on and I got my fitness back.
Speaker 1:But the point I've gone off on a tangent. The point I was getting at was that, after recovering from eating disorder, yeah, like, my idea was this unhealthy diet was unsustainable, it was completely deranged, and so at the bottom of ground zero at that point, as I was getting my fitness back and looking at my diet again, I just went to myself Michelle, all these beliefs you have about your diet are fucked Like. They're so wrong. And why don't we just erase everything, all all this fat bullshit and all this you know? And just why don't I sit down and calculate my macros, how much I should be eating if I want to shred? And so I did that and I was like whoa fuck, I can actually still eat like two. I need to eat 200 grams of carbs a day. That's massive. I would never even consider doing that from eating disorder brain. And I need 40 grams of fat per day. My God Father, that's an unfathomable amount of fat, you know. And so, like there I was doing my macros.
Speaker 1:Most people would find that a restrictive process and I was like this is wild. I can now eat all this fat. I actually did, switched off all eating disorder beliefs and I went and I got like this fatty, like um packet of lamb chops and I cooked them and like I've never had anything that tasted so good. Eh, like that something about fatty chops they're good. And all of a sudden again like my, yeah, like I, for all of my adult life. I'm like don't eat fat. I'm terrified to eat fat. If I eat fat I'm going to get fat and I just went no, michelle, that's bullshit. Eating fat doesn't make you fat. You need to eat fat. You get your fat-soluble diet. There are no vitamins there and you need to have fat to be healthy. And yeah, now I just eat fat.
Speaker 1:Like literally last night, my partner, I think he cooked a lamb chop and I go, I can't have the fat off that. You know like literally no discomfort with eating fat, which is wild, like you know, anyone that knew me for the last sort of 40 years of my life would go that's inconceivable. In fact, I'll tell you what my ex, the father of my son's, the father of my ex, the father of my son's, the father of my child, the father of my son's, the father of my child, jane yeah, he came around and he goes what you eat fatty lamb chops. I'm like, yeah, and he's like blown away going. That's why I say that I pretty much over eating disordered thinking. It's not an encumbrance to me, I'm not limited by it and I do, but I eat what I want to eat, um, without. I don't even get guilt if I have something really unhealthy. Now I have it and I just go, yeah, whatever, like you know. Uh, so then, but the next part that I wanted to discuss was, I guess, professionally Like so, how I became involved, or one of the, I guess would you say, I built an eating disorder unit with my psychiatrist colleague in one of the regional hospitals in New South Wales here, and we built up a stellar eating disorder service which was, yeah, second to none in Australia.
Speaker 1:So I wanted to next discuss that and like my experiences treating eating disorders as a doctor, and then, in terms of, I guess, yeah, how you go about treating it, how I could like empathise with the patients there, how they are such difficult patients to treat. And there was another point that's nagging at me. I've forgotten it now, all right, so I guess I'll go through it in a chronological manner rather than, yeah, trying to be more clever about breaking it down for you. So when did I like start to treat eating disorders as specialists in a hospital? Um, so, I was a renal physician, um, and renal physicians are a specific breed of doctor. Okay, we, I want to say we. I'm not a renal physician anymore, but I was. Yeah, and at my heart I guess I am.
Speaker 1:Renal physicians deal with really complex disease and so we are the sort of doctors that will take on the hardest problems, the most impossible problems to tackle. We will take them on. The most problematic patients with the most problematic psych issues. We will take them on the most problematic patients with the most problematic psych issues. We will take them on because renal patients, let me tell you, are fucking cray cray and so that's in our skill set. So, anyways, I got to I won't say where I was, but anyway I got to the hospital.
Speaker 1:There I was working as a renal physician and then I had a patient who was headed for peritoneal dialysis. She also had an eating disorder, really fucking skinny, like almost about to die, and I was like, well, I can't do nothing, like she's only in her 30s. I know it's impossible to treat it, but how can I look at the problem like that? You know she's a young patient, need to do something. So I remember I spoke to the eating disorder like specialist in the peds joint here and then she's going. Well, you have to, like you know, admit her and you have to, if you can, chain her to the bed and put a nasal gastric tube down and I said, well, what happens when she vomits? She said, well, if she vomits, you make her sit in it. I'm like whoa man, that's some intense shit, anyway.
Speaker 1:So I brought this lady in and attempted to refeed her and it was an absolute shit show, right. What you would think would be simple was just not. She would act out, pull tubes out, make it impossible to refeed, do everything to sabotage the treatment, and it ended up falling in heat and I had to just let her go because nurses were beside themselves, were like we're not doing this anymore. This is dreadful. She's causing mayhem on the wards. And I was like, whoa, this is impossible. How do you fucking treat an eating disorder? And I was like these patients are so sick and they're like really medically compromised and we can't, how do we get around this? Because we have to do something.
Speaker 1:And then a couple of years went by and I can't remember how it actually happened, but somehow there might have been some inpatient or something. Yeah, there was a really chronically like bad, bad, anorexic patient, like she was really sick. And then somehow I got brought in as one of the treating physicians, because and that's where it took off, you know. So then I met the psychiatrist there and I was like you know, I'm really worried. There's this whole cohort of girls that are just so sick. One of them's going to die. It's going to be bad, you know.
Speaker 1:And so we built this eating disorders unit. So the challenge with managing eating disorders in the patient is eating disorder patients are really difficult behaviorally to have in hospital. It's like treating an addiction, and by the time they get to adulthood they are even worse than the adolescents because they now know all the fucking tricks to get around refeeding. So it's like, you know, it's like addicts want to keep taking drugs, anorexics want to keep starving, and so, um, you know, and, and it's, it's, it's a behavioral thing, like it's, it's all. You know. The yeah, how do I break this down?
Speaker 1:We then managed to get a very successful unit up and running in a regional hospital and the amount of work, blood, sweat and tears that went into that was phenomenal, because we had to change the whole nursing culture around this. You know, we literally had to like because we'd have nurses and they go. Well, they're just fucking skinny, you know, bitches or whatever, divas, you know we're not putting up with their shit, because they see the thing with, if you're eating disorder, imagine the thing that you could tolerate the least. So with anorexic patients, the thing is getting fat. So they have to come in. We have to, like, literally physically restrain them to the bed, shove a feeding tube down them and deliver to them what is the worst thing in their possible nightmares that they could have done to them. That's what you're doing to them, and it's a really hard thing to tolerate. And so nurses would look at them and go, you're just a skinny, vain bitch, whatever you know, and they'd be extra cruel to them and it's like so we had to do this whole like re-educated go, look, you can't be cruel, you know you have to try and empathize with her, and there was this one exercise that I used to make the nurses do. So go, here's a chocolate, take it in your hand, right, and the nurse would pick it up. Okay, all right, now what I want you to do is like, hold it in your hand until it goes really soft, and then I want you to put it under your shoe, step on it right and then rub it into the ground and pick it up right, give it to the nurse next to you Now I want you to eat that, and she'd go. What? And I'd go, yeah, that's how an anorexic person feels when you want to get them to eat a meal. Yeah, and they're like, oh. So we had to do all this really, really powerful education and stuff to shift the whole culture from.
Speaker 1:They all hated these girls. You know, they really did. And look, with good reason too, because they are right cunts when they come into hospital. You know, listen, I wasn't doing my job proper if I wasn't called a fucking dumb cunt, like at least three days in a day that I had, you know, one of these girls on the ward. But I could empathise because I'd been where they were at and I knew what they were feeling and, underneath it all, I actually quite liked them. Even the girls were borderline. I really did. I liked my girls because they were me, you know. I mean, I had so many things in common with them, I guess, and I could see where they're at. And people didn't understand, because it's very hard to understand an eating disorder until you've had one or been around one. You know it's really hard a concept to wrap your head around, you know. But not only that right. So what?
Speaker 1:The other thing that I'd faced as being as a treating physician in a hospital was the all the politics of it, because you know these girls, when they get really unwell they cause havoc on the wards. You know, because the only way imagine you're trying to there's something that you cannot tolerate and we're now chaining you in the bed, making you have to tolerate that. There's some breaking point where you know you're just going to break and go absolutely ballistic or act out or whatever. And um, yeah, it happened regularly. You know there'd be girls and they'd be cutting and it was just fucking mayhem, it was wild.
Speaker 1:And you know it was always at the hospital when we had a sick girl in, because they would be either cutting or just doing some sort of sabotaging behaviour, trying to suicide or something. And of course, the thing about that is that hospital admin and nursing up, higher up the chain do not like it, and so their response is well, it's not our problem, you know they need to go to the psych ward and the psych ward is your problem because they're medically unwell. So we'd have all these fucking awful arguments with hospital admin and stuff. And you know that's when I learned you can't go in and be a bleeding heart. You know you've got to work the system. You know like there are some times when you have an outcome which is just unfair, like a really unwell medical patient with anorexia will just be bunted to the lock-up ward in mental health because that's just what the system will do. And and it was useless to go in and get angry and start yelling at hospital admin because you know you get more bees with honey and it's a systems issue. You know and like, yeah, I like really learned how to be super calm and not get impassioned and you know, really worked out how to like, yeah, just pull my head in and not get emotional for the better of the patients, even though you really really were very upset by some of the things that happened. You know, um, and so yeah, like at the end. So we worked in consultation with the rpa, which is the only eating disorder acute unit in in new south wales, and we worked really close with them. I used to go down to like lots and lots of like uh, seminar days and stuff and we worked and they and at the end they were like you guys have got the model unit for um new south wales, like the regional unit that can competently manage eating disorders that are really sick, you, you know, in an inpatient ward and that was a huge, huge achievement.
Speaker 1:We managed to recover a girl who had struggled with anorexia from the age of 12 and she got better and we just thought for some point that she would die, like we would never get her. Well, there was a girl that did die um one or two one, definitely. I will never forget her um and we thought she would die and she just got better. And the way we fucking got her better was just being parents. Like we would go you have to adhere to this rule, motherfucker, you have to eat this. And she would back up and go yo, cunts, I'm not doing that. And said, yeah, you have to, and it was just through me and the psychiatrist going in and going now there's the rules, that that's the rules you know, and just being unbreakable. That then she just got better. Like, hands down, it's really telling you know, and, uh, she taught me a lot about parenting as well. Doing that job, um, yeah, it was wild, hang on. Yeah, I've just remembered the point that I forgot before. It's a really important one, um, so, like then.
Speaker 1:So then, actually with with my work in working with eating disorders, I was actually exposed to the other end of the spectrum as well, like, so people who are like really morbidly obese and needing like gastric uh you know, bypass surgery and stuff to deal with their obesity, so really severely morbidly obese patients I also worked with and it shifted my perspective a lot doing all the reading about it, because in my earlier years being eating disorder, of course, the most grotesque thing that I could ever see was a fat person. It was just awful, I couldn't tolerate it. That I could ever see was a fat person Like I hate, like it was just awful, I couldn't tolerate it. I fat shamed, I was cruel, whatever you know, I just couldn't. Yeah, obesity, it was just disgusting to me. And then I remember, that's right, I was a doctor, young doctor, working on intensive care.
Speaker 1:There was a really morbidly obese lady and I watched the nurses fat shame her and I looked at and I and I had this sudden wave of really intense empathy and I was like that's fucked man. There's a, this woman who's really sick and almost dead and in the most vulnerable point of her life, and there you are all fat shaming her and it was awful, and like she's still a fucking human underneath all of that, you know, and I was like, wow, this is not right, you know, this is just not right. So I had that experience and then later on in my professional career, of course, being an eating disorder sort of person in the hospital, so I got both fat and really skinny patients sent to me. I had to look after a series of really obese patients and I'm like, okay, like man, I want to do the right thing, the best thing by these patients. So I did a really deep dive into the treatment and the science behind it and it was really perspective changing for me. And can I preface this discussion by saying I will never, ever fat shame someone ever again, ever.
Speaker 1:Okay, like seriously, and and I hope that my audience here also will be, uh, of the same thinking after you hear this so like I was like, okay, obesity and stuff like that. Because, like I remember when I was doing it as a medical student in obesity clinic and this woman comes in and she was really overweight and she goes, yeah, but I eat like a bird and the specialist goes more like a fucking pterodactyl. I'm like, oh, that's so hilarious but that's awful. No, but it's true. So, like, what I'm getting at is that there are this group of people out there, like you might be one of them, of people out there, like you might be one of them and, unfortunately, like you, have a set of genes which means that your body wants to be obese, right? So back in times of famine, when food was a scarcity, this set of genes was an actual like. It was a survival advantage. You know, like your body did better in starvation, a survival advantage. You know, like your body did better in starvation. And unfortunately, though, in today's society of setting of food avidity you know, we're definitely not in a famine here this set of genes is disadvantaged, disadvantageous. So this set of genes will give you diabetes, obesity, all of those metabolic diseases and, unfortunately, right, the health industry and society in general.
Speaker 1:Well, what the general rule is? Well, what the trend is, people want to blame fat people. You know what I mean. There's a hell of a lot of blame and stigma, and they're like, yeah, you're just fat and lazy. Like you're lazy and you eat too much, you've got no discipline, that's why you're fat. Right, that's a common perception out there in society and it's actually really fucking flawed. Because what you'll find like what you'll find is that these like overweight people, their body just wants to be that way. You know, in today's cult, like with the food that we've got around and that sort of thing, and they really fucking struggle to lose weight. You know, their body just wants to be fat because of these genes.
Speaker 1:The second thing is that then they go on to get diabetes and again the stupid health system and all the health professionals go on their blaming and judgmental way and the theme has been to blame the fat person for their diabetes. You're so fat you couldn't pull your diet in. You're fat now. Look at you now. Your fatness has led to diabetes, right, and and you know what? It's fucked. Because what the new way of thinking is is that actually diabetes was always going to be inevitable and it was just the obesity showed up first. It's not that the obesity caused diabetes, it was just like all part of the same syndrome. And they did studies actually looking to see if actual fat reduction like they did, liposuction and shit, if that actually changed the diabetic risk profile or whether he would get I can't remember it was either whether they would go on to develop diabetes or no. I think it was whether fat reduction would increase glycemic control in diabetes, and there was no fucking correlation between it. So there we have been all these years erroneously blaming people for their diabetes, when it's just been a genetic, you know, foregone conclusion that that was going to happen.
Speaker 1:Now the next thing is that if you so, if you look at any weight reduction sort of like you know, diet and exercise the amount of body weight that will be lost over a year is not much. So, like you know you, I can't remember the actual figures, but it was definitely less than 10%, right? So you get a really fat person on a diet, exercise. Firstly, if you wanted to get them into like a normal way where you wouldn't go down the street and go you're a fatty, you know right so right into the sort of normal BMR range, the amount of shit they would have to do to get to that point would be like unhealthily phenomenal. Like you know, like one has to wonder. You know the stuff that show you're the biggest loser and that the actual stress that you're putting on the body, like it's actually proven that it's actually unhealthy and can hasten one's death, you know, because what happens is that you've got a fat person, they've got this set of genes. Their genes want them to be a certain weight.
Speaker 1:There's a theory called set point theory, where your body will do everything it can to hold on to the same body mass that you know doesn't want to change. It's called homeostasis. And so to shift that amount of weight you have to do so much, like I'm like, it's so risky cardiovascular wise. Like you know, we're talking like training, you know um, you know to, you know um crossfit level, someone who's been a century on the couch for you know 10 years. Like you know, it's such a shift in in in, like homeostasis it's, it's not healthy, you know. That's the thing. And so what studies in weight loss will show? There's a large proportion will not lose anything more than 5% over the year.
Speaker 1:There'll be a few outliers who probably are wired much like an anorexic. They're like you know, I'm going to beat everything, I'm going to really give this a go and go to extremes with what they do physically and with their diet and they get their weight down much lower. But then what happens is, over time, their weight just comes back. It's inevitable up to where it was, or in what we would say the wrong direction. They find it really hard to maintain a low body weight and if you actually look at their mortality, like, yeah, that's a difficult one.
Speaker 1:I don't have the papers in front of me, but well, there was another interesting paper that looked at mortality across bmis actually, and, and actually people with a bmi of 31 live the longest. Like you actually live far shorter. If you've got a bmi around like low end 20s and that sort of thing and there's so much in terms of looking at that data too, the BMI is really flawed, but it's the best we have in terms of, you know, comparing apples with apples. But yeah, so the point that I'm getting to is that society is so obsessed with being skinny that fat is really unhealthy. We must all try and get our weight down. When you look at the raw data, someone who's fatter, like a little bit fat, like that's low obese ranges 31, lives longer than someone who's really skinny. Uh, and so that's just, it's very telling where we have it wrong in society, you know.
Speaker 1:So you know, people who are like have got larger bodies genetically probably are meant to if you want to make them lose weight to the point that they're actually acceptable to look at from your perspective, that's going to make them actually unhealthier and that's a real mind flip. And if they have got that set of genes, they're not lazy and they don't lack willpower. It's just that you're you're looking at them from the privilege of a smaller body. You know, I mean, you've got a different set of genes and it really is true that if they wanted to be in a, you know, lighter body shape or whatever, they would probably have to do really extreme things that would be really unhealthy to get their weight down that way. And so so that's when I went yeah, man, I'm never fat shaming anyone again, because that chick at the gym who's really a little bit bigger or whatever, like it's actually really hard, a lot harder for her to shed than it is for me, and I'm privileged to be. I mean, is it privileged? I don't know, I'll probably live less long, but in terms of acceptability in society, you know, yeah, my body frame is more palatable to people than someone who's fat, you know. And yeah, like they really literally cannot help it. So if you walk away from this with anything, you must stop fat shaming people. Yeah, like I'm quite passionate about that. Yeah, it's mad. So that's a lot of talking. It's almost an hour, I guess. Yeah, it's a topic I'm really passionate about and yeah, because I've seen all sides of the corner there.
Speaker 1:And yeah, it's such a difficult set of diseases to manage because of the cultural and lifestyle elements of them and a lot of fucking misconceptions out there in society and everyone wants to have their own opinion on this topic, you know. But it is similar to drug addiction in terms of how you treat it. You know you have to, um, yeah, for a while there. You know that that person is not, not able to make decisions for themselves. You have to be a bit more paternalistic. It's like with drug addiction. You have, anyone who's really unwell with drug addiction has to have their autonomy taken away from them, at least for a short period of time, until they come to their senses. Until, you know, we come to our senses and then make better choices. And that's hard too to take someone's freedoms and, you know, privileges away to restrict them. You know it feels cruel to do that, but you have to keep in mind that it's for their own greater good.
Speaker 1:Um, so, yeah, I feel I've actually got a lot of my chest there with that one. Um, like I hope that, uh, yeah, that there's been a bit of wisdom imparted there, and thanks for listening. You've got to this point. Well done. What a lot of information to digest. Hey, I'll talk out to you next time. Be kind to one another and remember, yeah, just put out good energy vibes and get good energy vibes back. Namaste.