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my mom is a dietitian. she's the reason i avoided diet culture, while my health classes basically promoted eating disorders. here's some important things i learned from her. TW: discussion of diets, food, and eating disorders.

you probably don't need to keep a scale in your house. unless you have health problems that require you to monitor your weight and it is recommended by your doctor, most people don't need to know what their weight is constantly. easy access to a scale promotes anxiety about your weight. i only get weighed at visits to the doctor, so i know my weight bracket. you don't need to know every tiny fluctuation. this is especially important for kids. growing up, i had no idea of how much weight i was gaining, so i was never able to associate my weight on the scale to my value. kids can't understand weight, and since they're growing they have to grapple with the societal notion that weight gain is bad alongside gaining weight because of their growth.

eating unhealthy food is better than not eating. i have arfid and a lot of my safe foods are unhealthy, but my mom keeps them stocked in the house while also offering to buy more healthy food to try. you need calories to live, and if the only way you'll get them is from "junk food" then eat the junk food. it's easier to add in healthy foods as opposed to forcing yourself not to eat anything outside of that.

sugar is not the devil that it's been made out to be. things like fruit contain sugar, but that does not make them bad. there is a difference between processed sugar found in candy and sugar found in fruits and veggies. you don't need to cut out sugar to be healthy.

fat is also not evil. things like avocados are considered "good fats". you need fat to live. it gives you energy and energy stores. also, being fat is not inherently unhealthy in the same way that being skinny is not inherently healthy.

carbs are good. complex carbs, like bread, give you energy for longer periods of time. by energy, i don't just mean physical energy. i mean the energy that keeps your bodily functions going.

calorie counting isn't helpful. unless you have health issues that require you to keep track of calories as advised by a doctor, you should not count your calories. calories are too simple to account for a good diet, and calorie counting often leads to disordered eating. you should focus on getting enough nutrients, and fuelling your body.

listen to your body. eat when you're hungry, whether that means meals or snacks. some people have issues with hunger cues, and if you have trouble listening to your body when it comes to diet i recommend seeing a dietitian. your diet is personal. some people need to eat more due to genetics, health issues, lifestyle, etc. you can't follow diets you see online and expect to see the same results as the person promoting them.

most fad diets do more harm than good. cutting out necessary nutrients messes up bodily functions, and most are done without medical supervision. they all claim similar things, but no diet will do the same for everyone. things like fasting often increase weight gain after a short period of weight loss. they also promote orthorexia.

nutritionists are not the same as dietitians. they don't require the same certification, they don't require the same education, and nutritionists aren't as regulated. dietitians are healthcare professionals, meaning they have to go through schooling and training and exams. people can't just call themselves dietitians. the same cannot be said for nutritionists. it's different depending on location, but most places don't require people to go through much regulation to call themselves nutritionists. they also don't face the same consequences. nutritionists can peddle fad diets and make outrageous claims without issue, but dietitians often work in hospitals and must follow the rules. dietitians also don't tend to run their own businesses like some nutritionists, which is an issue because it means nutritionists may have a financial incentive to support incorrect information. basically, if you need diet advice, go to a dietitian. nutritionist is a title that does not actually mean someone knows what they're talking about.

[never-not-ever]

First Week Outpatient

August 1st-7th

So I discharged around 1pm on that Thursday. For weeks prior I had been taking useless junk home so that on my day of discharge I wouldn’t be walking the hall with ten thousand bags drawing attention to me. I just wanted to leave quietly and not make a big deal about it.

I had to stop at my PACT teams office for my meds. I have a therapist, psychiatrist, case manager and a nurse on my team there. My nurse packs my meds for me in a weekly pill organizer. I’ve always told my IP doctor to not discharge me with a months supply of meds and it just so happened to work out that with PACT they offer the weekly medication pickup. So I went straight there and then headed home because I had a virtual appointment with my therapist at 4.

After that me and my Nana drove my nephew back home in NH cause he had been staying at my Nana’s. On the way back home I stopped to get groceries and was panicking so much in the store. I still remember what stoplight we were at when it became 8:00. Staring at the time I kept thinking I should be back at McLean, this is the latest time you have to return from a pass. This isn’t right. I shouldn’t be outside right now. It’s too dark. That day felt like a pass. I remember freaking out in my kitchen that night, hyperventilating and trying to calm myself down saying “you’re going to be back on the campus tomorrow, less than 24 hours, it’s going to be okay, it's going to be okay”.

Anyways, Jesus, if I write so much nonsense these updates are going to be essays. Stick to the important stuff!! Okay so I started PHP the next day on Friday. I’ll add these in the tags but I’ll post a warning here too. There’s going to be talk of drinking and self harm and restricting. So partial was Friday and then Saturday night I got drunk and self harmed for the first time in over 6 weeks. I bought a 6 pack of White Claw and the whole 6 was just the right amount to get blissfully drunk and escape for a bit. Alcohol affects me differently after having weight loss surgery so I honestly don't know if 6 is the standard or way too much?

Monday I told my program psychiatrist and she wanted to look at my arm but I didn’t have extra bandaids so she told me to bring some the next day. I also met with my program therapist and we talked about starting a diary card and what to track. I told her how since I’ve been home I’m not hungry/eating and I’m not complaining. Saturday when I got drunk all I had that day was applesauce around lunchtime. So I mentioned the word “restricting” and tried to give the short version of my fucked up body image, losing (necessary) weight, losing it in a healthy way and also unhealthy ways at times, that I’ve never been diagnosed with an eating disorder but I know I have a fucked up relationship with food and my body….

So later that evening I got a phone call from disability. I should have applied back in September but instead I didn’t apply until April. They said it could take 6 months before I get a decision on my application. For months I kept checking online to see how much of my application had been looked at it. I needed money and felt like such a financial burden on my Nana. I had just borrowed money from her to pay my phone bill and an hour later disability called asking more questions that I’ve already answered in the past. She said she was the final person to review my application and that she’d be making a decision soon. If my application gets approved then I could be seeing a check within the next 4 weeks...

The following morning I checked my bank account and saw an ungodly amount of money, like two months worth of paychecks from my old job. I could actually pay my Nana back for all the money she’s given me while inpatient and afford to buy stuff to redo my apartment. And after seeing this money in my account I cried, not tears of joy but because I realized that even with this financial issue being lifted it still didn’t change how badly I wanted to end my life. Obviously money doesn’t buy happiness but like that money lifted a huge weight off my chest and it still didn’t matter. My passive SI, self harm urges and depression was shit when I discharged and it was just slowly getting worse.

So back to the timeline. So that "money thing" happened Tuesday morning. I brought bandaids to PHP and mind you I didn’t know what my arm looked like. I didn’t know if it was bad, I just slapped bandaids on it Saturday night and never looked at it again until that day when my doctor looked at it. It was so triggering seeing it. I'm going to get real descriptive here but I've never been able to cut over scars before. Maybe it's what I use but still I've basically run out of room on my go to arm. But drunk I was able to do it and deep. Two cuts, and obviously too much time had passed for me to get stitches but she still wanted me to go to Urgent Care after the program just to make sure it wasn’t infected. I felt like I was wasting their time. Going 3 days later just to get it re-bandaged… the nurse was so nice but the doctor seemed irritated. I think I spent almost 2 hours there, so pointless. They gave me a prescription for an ointment for my arm and they put in my chart that it “could have used stitches”. I never picked up the ointment.

Wednesday when I met with my psychiatrist she brought that up and said that if it happened again she wanted me to get seen right away.

11:19am Wed “I feel strange today. Maybe strange is the wrong word, disconnected? Empty, low, low energy. I can stare at the floor and get lost in my head.”

I started “seeing” my new therapist in the beginning of July but it was always virtual until that day. At 4 I had my first in person appointment and after the day being weird and shitty I was looking forward to it. But it was horrible.

So on the way home I went shopping. Dropped a couple hundred at Aerie and American Eagle and this was the start to my spending sprees. I FaceTimed with that friend I texted and it was a nice ending to the crappy day.

[rihan01]

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Hi I'm an adult (23) how did you talk to your doctor about weight loss medicine? Mine just consistently tell me to eat better/exercise more & that I've already dropped a good amount (which is true but I'm still bordering on obesity and feel stuck & I already exercise and eat healthy shit so like 💀) it's honestly really frustrating and probably contributes to my e/d that I do all this and haven't lost any more lol

Hello there! I’m from Australia! And I went the way you’re not supposed to go -aka buying it from an online pharmacist that makes you answer a internet questionnaire and then ships it to you. I lied about my weight in order to obtain them.

I believe if you’re in America you may be able to by Ozempic or Alli over the counter?

But you sound like you’re going through something similar to my partner - so I’ll give you some suggestions! (My partner does not have an ED but they are on weight loss medications)

I do apologize in advance if you’re non-binary, trans, genderfluid, etc as I will use the medical terms for biological sex down below purely for anatomical purposes only!!

But I hope this helps!

A)if your biological sex at birth is female, and you found that you lost easily with a lower caloric intake, and but that you plateau easily and remain the same weight - as you mentioned, borderline obese- no matter what you’re doing diet wise and exercise wise then I have some questions:

1) do you have irregular / or painful periods? Or no period at all?

2) are you lethargic consistently?

3) did you find that while you may have been bigger than average, that the weight ballooned on?

4)have you had a diagnosis of biopolar or bpd/depression and anxiety in the past?

5) do you tend to have more body hair (face etc)

6) do you get very emotional at random times?

7) if you get cravings are they mainly sugar indulgent and sodium dense? (Think like ice cream, chocolates and French fries)

If you answered yes to multiple of these (especially for the periods) - there is a high chance you may have a) Polycystic Ovaries Syndrome, endometriosis. These two can mimic each other but both are different despite the similar symptoms.

PCOS (Polycystic ovaries) is a medical condition where your body produces too much testosterone, and puts your hormones out of level. When it does this, it spikes your insulin and your body doesn’t absorb it like it is supposed to - but it stores it. It’s also one of the medical conditions that accidentally causes misdiagnosis of Mental illness‘s because if your hormones aren’t regulating - then you’re gonna be emotional and distressed!

This condition causes cysts to build up over your ovaries and it’s very painful if they burst. They will continue to grow and burst, and this condition is very difficult to have children with. Your doctor would need to prescribe you metformin or a similar diabetic medication as it also helps with fluid retention and it helps your body produce the insulin correctly! The best exercises for PCOS is HITT, and weight training - because with the imbalanced hormones and the testosterone levels - the sprints of exercise and weight training will also boost your metabolism and help regulate those issues as well. Cardio doesn’t work very well for people suffering from PCOS.

Endometriosis is a condition where the uterus lining forms outside the uterus and is very painful! There are three types and this forces your body to hold more fluid and weight in a survival instinct. This also throws your hormones out of sync too!

You can still lose weight on Endo but it does make it harder and if you get out on certain medications it will also make you gain weight - however having extra weight with both of these conditions makes it worse.

You may also have a thyroid issue or a generalise glucose problem where your body can’t turn sugar into blood sugar so it stores it as fat instead.

If you were born biologically male -

Then if you find yourself constantly thirsty and hold swelling in your ankle or lower legs (if you press on the skin, and it has an indent or stays white where you pressed it for a while) then this could be an inclination of diabetes, hyper thyroidism or liver/kidney issues which are the main organs we need to remove toxins from our body. This would also cause you to hold a lot of water in your body and muscles.

My best bet would be to go to a different doctor, and if you match with any of these demand a blood test, or ultrasound if you suspect you have Pcos or endo!

Because if there is an underlying medical issue - that will need to be addressed first before being put on weight loss medication.

Otherwise if you don’t match with any thing I listed, I would still go see a different doctor and explain that you’ve been dieting and eating healthy - but it just won’t budge (if you have to, use a pity trick and say it’s really affecting your mental health and intervening with your study/work)

And be honest, do some research about what type of weight loss pill you’d like to be on or you think would be the right fit for you, and ask to be on it. If they say no then tell them you want it noted in your patient file that you asked for this treatment and they denied it with no probable cause as you fit into the demographic for this medication. Most of the time, doctors will do it if you demand that this be kept on record.

I hope this helps and sorry for the long message!!

Stay safe and drink lots of water!

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There are currently more than 200 public groups and channels on Telegram that explicitly mention selling abortion pills in their name or description, a WIRED investigation found. At the end of May, the last month for which we have complete data, 57 of the 211 groups we uncovered were active, with at least one message sent in that month.

Activity found on the platform related to selling abortion pills traces back to at least 2016, and many of the channels and groups cater to customers around the world. In the year since the US Supreme Court overturned Roe v. Wade in June 2022, though, there’s a new focus on marketing to people in the United States, according to WIRED’s review of roughly 47,000 public messages scraped from these channels. And in general, public activity on Telegram related to abortion pills has been exploding since last summer.

“Since its creation, Telegram has actively moderated harmful content including the sale of medications,” says Telegram spokesperson Remi Vaughn. “Telegram's moderators use a combination of proactive monitoring of public chats in addition to accepting user reports in order to remove content that breaches our terms of service.”

Shady drug sellers and scams are nothing new on digital platforms. A nearly universal experience of the early consumer internet, after all, was receiving spam emails claiming to offer penis enlargement pills. And in the decades since, dark web markets have fueled illegal distribution of drugs globally. Like other prescription drugs, though, abortifacients are legal in some countries but not others. Furthermore, in some places they can be prescribed for certain purposes but not others, leaving patients to potentially seek ways to fill in the gaps for their own care. In the US, access to reproductive care, including abortifacients, varies widely from state to state.

Despite the clear uptick in activity on Telegram related to abortion pills, researchers say that they don’t see evidence of a massive new movement to illegally sell abortifacients to Americans. Kat Green, an abortion access researcher and founder of the online data analysis platform Endora, says that illegal sales of abortifacients, and corresponding questions about legitimacy and safety, aren’t currently central topics in US abortion access work. In part, this is likely because it’s still legal in many US states for patients to get abortion pills by mail. And prescribed use of these pills, also known as medication abortion, is markedly on the rise in the US. But as new and pending legal challenges threaten to further curtail access, illicit sales could eventually expand.

Analysis of frequently used phrases in the Telegram message trove WIRED collected shows that a large number of these groups and channels don’t just claim to sell abortion pills. Phrases like “weight loss,” “muscle mass,” and “erection pill” were among the 10 most popular two-word phrases that appeared in the data set. And thousands of additional messages mentioned “benzos,” “painkillers,” “Xanax,” “weed,” “coke,” and “guns.” In all, at least a quarter of the channels appear to be hawking more than just abortifacients.

Hundreds of messages from the data that contained pricing information indicate that the average cost of purchasing a purported pack of abortion pills on Telegram is currently $135.

WIRED’s investigation also indicates that the abortion pill ecosystem on Telegram is likely a small world. Analysis of the members and administrators who send messages in the groups and channels shows that many of the accounts are likely controlled by the same individuals. For example, a user going by the name Dr. Pooja Gupta has sent 1,500 messages across nine channels or groups advertising the sale of abortion pills. Dr. Pooja uses a WhatsApp number that is referenced by administrators in 14 additional channels. And some of them use similar names like Doctor Jain and Doctor Reenu. Many of these messages also referenced the same website.

After joining several of Dr. Pooja Gupta’s channels, WIRED reporters received a private Telegram message from a user known as Manisha Gupta offering medication abortion for $90. When WIRED reporters expressed interest in making a purchase, a person prepared the order and sent an image showing a blister pack of pills, and an envelope with that day's date as well as the address WIRED provided for shipment. The return address written on the envelope was a location in Mumbai, India.

Still messaging on Telegram, a person then sent account information for Punjab National Bank and directed WIRED to submit payment through a service called Remitly. WIRED reporters did not complete the transaction. When asked whether they have had more US-based customers in recent months, the person said, “since new laws I am send to America much more.”

Some groups on Telegram have US-specific names or descriptions, like “Abortion Pills in Republican States,” but most have more generic names and claim to deliver to dozens of countries. For instance, one of the largest and most active channels in the data set dates from August 2021 and is apparently specifically geared toward delivering abortion pills to Dubai, Kuwait, Qatar, and the Philippines—all countries where legal access to abortion is restricted.

Last June, researchers from the security firm DarkOwl noticed a sharp increase in discussions on the dark web about connecting abortion-seekers in the US with abortifacients and other resources. Some vendors that already sold illegal drugs said they would begin selling medication abortion as well. At the time, though, the researchers said that they didn’t actually see abortion pills widely available for sale on most dark web markets, but that “they are available for purchase via threads in discussion forums, as well as classified-style advertisements on transient paste services.”

Ian Gray, director of analysis and research at the security firm Flashpoint, says that turning points like the Covid-19 pandemic or the fall of Roe for the US can spark trends in digital scams and illicit online sales. But a survey Gray conducted for WIRED of dark web advertising targeted at the US over the last year did not reveal a dramatic spike in content related to abortifacients.

“At a high level, it's difficult to identify a significant increase in chatter related to abortion pills due to Roe v Wade being overturned last year,” Gray says. He notes, though, that “there are a limited number of posts within the past year in marketplaces, which may indicate demand. Most posts, at least on Twitter and some within Telegram, are in Brazilian Portuguese, likely due to a ban on abortion pills.”

As with many medical procedures, the stakes are extremely high in medication abortion. But the patchwork of laws and access in the US could make the landscape particularly fraught for patients in need who may eventually turn to illicit markets out of desperation.

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