#fried chicken which... interesting choice brain... and then we were in my high school?? and it gets blurry for a bit.. at some point I was

[hazyturmoil]

Why did I have a Second fucking dream about high school smh

[ssa-babygirl]

Out of My League [Part 1]

Pairing: High school!Spencer Reid x Popular!Reader

Word count: 3.7k (god i don’t shut up do i)

Summary: Spencer begins tutoring you in chemistry, and the two of you bond (I would say no pun intended but fuck it that was GOOD so I’ll say pun intended)

Warning(s): Mentions of bullying, mental illness, some swearing, I made one joke about herpes??? sorry if thats a sore spot with anyone, light angst and pining, Reader POV

Author’s Note: Here it is, folks!! The first official part! I’ so grateful for all the feedback I got on the prologue, I’m glad y’all are liking it, I hope you like this part just as much!! Next part I’m gonna have some baby spencer, and by that I mean whole ass adult spencer that just looks baby

[Previous Part] [Series Masterlist]

You absolutely despised chemistry. It’s boring. It’s simultaneously stupid and ridiculously complicated. You weren’t dumb, you were a decent student in all your other classes, but science was never your strong suit. You preferred literature over litmus paper any day. Unfortunately, your failing grade was bringing down your entire GPA, just below the requirement for you to stay on the cheerleading squad. Your coach recommended you get a tutor, or else you were off the team. So you went to the library to see the peer tutoring program, and all of them were booked. The next best thing would be the kid genius in your class. He was probably a better first choice, honestly, but you figured he’d be booked with other students too.

He wasn’t like other kids in your class, not just because he actually cared and was a good student, he was also twelve years old. The kid was a prodigy. He was bullied a lot because of this because no one really understood him. That’s probably why he looked so terrified when you approached him after class one day.

“Hey, Spencer!”

His eyes grew wide as he stared back at you, saying nothing.

“I was just wondering if you were available for tutoring?”

“Oh, uh, um, y-yeah, in chemistry?”

“Yeah, what are your rates like? Like say we do an hour every other day, how much would that be?”

“Oh! N-no charge.”

“Really?”

“The first couple of sessions can be a trial run, I don’t want your money if you’re not benefiting from it.”

That made you smile, this kid was so nice and you just wished that people actually cared about that instead of the dumb shit they bullied him for. Sure, he was skinny and short and dorky and you know, a literal twelve-year-old boy, but if someone would take time to know him, they’d see he’s a good kid.

“That’s sweet of you, but I don’t wanna waste your time if you have other students.”

“I don’t, so that shouldn’t be a problem.”

“Great! Are you free after school today?”

He nodded and avoided all eye contact before scurrying out of the room to his next class.

~~~

You met up later in the library. You greeted each other politely with simple hi’s and hey’s and nothing more. Then it was time to pour over your books for an hour and try to force the puzzle pieces into place and hope something finally clicked. Balancing molecular equations physically hurt. Just when you thought you got it all right, Spencer reminded you that you still had to balance the oxygen, which was always bonded with something else, which threw off the whole equation. Every time you made a mistake you just let out a groan and set your head on the table.

“It’s a lot of math, a lot of people have a hard time with it, don’t feel bad.”

“I’m so fucking stupid.”

“You’re not! It’s an easy mistake.”

“You don’t make mistakes like that.”

“That’s because I’ve been taking advanced math classes for the past two years, I’m good at this stuff.”

“You’re good at everything, you're a literal genius.”

“There are people who aren’t geniuses who are good at this sort of thing, just look at Johnny Abrams in our class. He answers every question Mrs. Gustin asks and I once saw him put his backpack on his car’s roof and start driving ‘cuz he forgot it was there. He’s just been practicing. That’s why we’re here, right?”

He always reassured you. Always told you that you weren’t stupid. You weren’t dumb. He always smiled when you got questions right and told you you were doing a good job. When your hour was up, you said goodbye and went home. 

Spencer’s mini lectures aside, most of your sessions were sparse in the conversation department. The first time he went off on a side about some chemistry facts, you couldn’t keep up. You just sat there, jaw hanging while he went into detail about saponification, which wasn’t even in this lesson.

“Sorry, I’m rambling.”

“Did we learn that in class? Cuz if we did, I’m screwed.”

“No, not yet at least.”

“How do you just… know that?”

Spencer avoided your eyes once again, something he did more than spouting random facts, “I read a lot.”

That’s how it happened the first time. All it took was you asking one question about different types of reactions for him to launch into another spiel. You figured you’d have to know it at some point, so you started writing down whatever you could catch from his fast-paced speech, taking notes in bullet points.

“And that-- Oh. Y-You don’t need to do that, that’s not even on the curriculum.”

“Well, I gotta keep up with you somehow, right?” You glanced up from your page and flashed an almost challenging smirk as you saw him stifle a smile as he avoided all eye contact with you, as per usual. He then cleared his throat and got back to the actually assigned chapter.

The more he went off on tangents, the more he realized you weren’t stopping him. He was actually able to make chemistry sound interesting to you, which is strange, but it was easier to understand through how he explained it all. Something told you that he wasn’t used to having someone listen to what he said, because he just lit up when he talked about this stuff. He was clearly passionate about it, so why would you make him feel bad about it? He always apologized, but you always reassured him it was no big deal. 

You didn’t know it at the time, but the kid was falling hard. This pretty, older girl was paying attention to him and didn’t think he was annoying? The bar may have been on the floor for young Spencer, but you were perfect to him. Eventually, he was able to look you in the eyes when you spoke to one another, he even smiled at you when you joked with him. That was another thing: you joked with one another now. You both warmed up to one another as your sessions continued. You said hi to each other in the hallways, you ruffled his hair as a greeting, he accepted your high-five requests every time you got something right.

You still didn’t talk outside of class much, which is why he was caught so far off guard by you calling his name from across the cafeteria as you approached his table.

“Hey, dude! Is it cool if we squeeze in an extra session today? I got a test tomorrow.”

“Y-Yeah, no problem, but, uh, it’s Thursday. Don’t you have practice after school?”

You did. And you had to be there because you had a competition this weekend.

“Yeah, I was wondering if we could meet after?”

“When does it end?”

“Five.”

“Library closes at four.”

“I know, but would it be too much of a hassle if I just… Pick you up tonight and we head back to my house to study?”

You could physically see his brain shut down in his eyes. After he realized he needed to respond, he picked his jaw up off the floor and gulped hard.

“Or you can stay after and hang out at practice and I can just drive you home?”

“Y-Yeah, um, yeah, tha-that works, I can, uh, yeah, we can do that.”

Spencer brought his books and homework and tried his hardest to not make it obvious he was staring at you while you danced. You looked like you were having so much fun and he loved seeing you happy and smiling with your friends like that, it was hard for him to look away and focus long enough to read a sentence, which is saying something, considering it does not take him long to read a sentence. 

After practice wrapped up, you told him to go wait by your car while you changed out of your uniform. The girls in the locker room were talking just as loudly as always, only this time, it was about something you actually cared about hearing.

“I mean, really, what was that little creep doing watching us today?” You heard one girl sneer.

“So fucking gross, I don’t wanna know where his prepubescent head was.” Another girl laughed.

You had to step in. You had to say something.

“I’m his ride home. He’s my chemistry tutor and I have a test tomorrow, so back off the kid, he didn’t do shit to you anyway.”

The squad learned to watch their mouths around you after that.

~~~

The neon glow of the golden arches shone through your car’s windows as you pulled into the McDonald’s drive-thru line.

“This isn’t your house,” noted Spencer, sounding confused.

You grinned, “Oh, shit… no way! Wow! I’m so glad my tutor is a genius! I would have never guessed this was not my family home!”

He let himself laugh for a moment, “Okay, okay, fine. Why are we here?”

“Uh… to get food? Duh.”

“But what about your food at home?”

“My mom’s visiting my dad, he works in D.C., and I haven’t gotten a chance to go grocery shopping this week, so I can’t cook for you. What do you want?”

“You don’t have to get me anything.”

“No, I insist, it’s almost dinner time. Lemme get you something. As a thank you for squeezing in an extra cramming sesh?”

“It’s fine! Really.”

“Hey, Reid, come on,” you attempt to stifle a stupid giggle as you gesture to the rather large window displaying the playroom inside, “you are a guest in my home!”

Spencer shakes his head and chuckles, but doesn’t dare let you think he found you funny, “I’ll have chicken nuggets.”

“Happy meal?”

He tried to look offended at your clarification, but he quickly dropped the facade, “Yes. Extra fries, please.”

“Of course, buddy.” You pulled up further to the ordering station, catching a glimpse at the menu and the ads they had displayed on it, “Oh no way! They have Strawberry Shortcake toys! I used to collect those when I was a kid!”

Spencer saw the look on your face and couldn’t help but smile at your childlike excitement, “Do you want my happy meal toy?”

You bit your lip and hesitated before throwing all shame to the wind and saying yes. Because it was Spencer. He got excited over chemistry, he had no right to judge you on your old Strawberry Shortcake doll collection.

After you got your food, you drove back to your house, and you ate together at your kitchen island while Spencer quizzed you on the last chapter. He had asked you eighteen questions so far, and you had answered all of them correctly. 

“Okay, this last one is for the Strawberry Shortcake--”

“Her name is Orange Blossom.”

“Whatever, this last one is for the Orange Blossom toy: Which type of reaction is represented by this equation?” He showed you his notebook where he had written a molecular equation.

“Substitution.”

“Correct! Now balance it.”

Your shoulders slouched as the pride drained from your body.

“Please don’t make me.”

“This is going to be on the test, Y/N, you have to know it.”

“What’s one wrong question, really?”

“You and I both know she’s not going to put just one balancing question on the test.”

“Fine.” You grumbled, grabbing a pencil and sliding his notebook closer to you. You worked it out after a few minutes, but everything looked right, and judging by Spencer’s proud grin, everything was.

He reached for the figurine, still in the plastic bag, and handed it to you, “You’re gonna do great tomorrow, Y/N.”

You took Orange Blossom from his hands and danced around the kitchen with it, overwhelmed with the sudden feeling of confidence you gained from nailing this practice session. You heard Spencer’s small laugh from behind you, causing you to turn around and face the boy as he lovingly mocked you.

Studying at your place became a regular thing after that, even when your mom was home. She loved him. She always invited him for dinner if she was home. He rarely took her up on the offer, but it was nice having him around the house with you. Study sessions turned into just plain hanging out. You spent more time bonding over Doctor Who than chemistry some nights, and he wouldn’t have it any other way.

~~~

When Alexa Lisben invited him to meet her at the football field you were skeptical. You had good reason to be. She was never very nice to you or Spencer. You were able to be civil with her for the sake of the cheerleading squad, but something about her just didn’t sit right with you. You tried to warn him, but he wouldn’t listen. He seemed offended at the notion that Alexa would do something horrible to him. How dare you imply that the only reason someone would be interested in him would be to pull a fucked up prank?

“I’m not like you, Y/N, I don’t have a line of people waiting around for a date, no one’s ever had a crush on me before, and-and now that someone other than you is being nice to me, you’re telling me that they have some sort of ulterior motive?”

“Spencer. I know these girls, I’ve seen the guys they go for--”

“And I’m not like them?”

“No! You’re a sweet kid, you’re nothing like those guys and they’re gonna take advantage of that.”

“I really wish everyone would stop saying I’m just a kid!”

“You’re not! That came out wrong--”

“Listen, Y/N, I’m going whether you want me to or not, so if you really want to keep babying me, by all means, stay after and wait with me.”

“I don’t wanna baby you!”

“So stop it!”

You didn’t want to fight with him anymore, you weren’t his mother. “Ok, Spencer, fine. I’m sorry. You should go. How about you meet me in the library after and you can tell me all about it over McDonald’s? My treat.”

He warmed up and agreed.

So you waited in the library until four, and then you started to get worried. You went to grab something from your gym locker before you left to look for him and heard some girls from the squad gossiping about “the little dork.” Your blood started to boil as you heard the way they talked about Spencer. Your jaw only clenched harder as you recognized one of the girls’ voices as Alexa Lisben’s.

You poked your head around the lockers that divided the aisles and tried to manage a calm voice, “Hey Alexa? Spencer actually said he was meeting up with you today, do you know where he is?”

She just laughed and said, “I can’t believe you actually care about that loser.”

“He’s my friend.” All attempts to remain level-headed were tossed aside, “Where the fuck is he, what did you do to him?”

You could feel yourself starting to cry. It’s your fault, you weren’t there, you tried to warn him, but now you don’t know where he is or what he’s thinking or--

“Check the field.”

You sprinted out to the football field and saw him stripped down to his briefs, blindfolded, and tied to a goal post. You could kill Alexa. You actually considered turning right around and unleashing hell on that locker room, but your friend needed help. He was crying so hard he didn’t hear you coming until you called his name. You immediately went to untie him and grab his clothes from the fence beside him.

“You were right.” He sniffled, “I’m so sorry.”

“Don’t apologize, I’m not mad, I’m sorry, I should have been there, I could have helped you--”

“No, you couldn’t. There were too many people.”

“How many were there? Who did this?”

“Y/N, please--”

“No, Spencer, tell me what happened.”

“I don’t wanna talk about it!”

You know when to stop, so you just shut your mouth while he got dressed, “Get in the car, I’m taking you home.”

You didn’t say a word to him as he buckled his seatbelt and you could tell he appreciated it. You just drove to McDonald’s and got him his usual. You parked in the parking lot and ate your food in almost silence, save for the radio in the background.

“You don’t have to tell me what exactly happened, you could pretend none of this ever happened, I won’t mind, it’s okay, but I just need you to know, Spencer, say the word and she’s dead. I have so much dirt on her, you have no idea, I can destroy her.”

“Don’t.”

“Okay, I won’t. At least give me names. I will personally make sure none of those boys ever get a date again.”

“Y/N, please.”

“I’m serious, I’ll tell everyone they have herpes.”

“I know you are and that’s what scares me, please don’t, I don’t wanna make things worse.”

You decide to drop it because if he doesn’t wanna talk about it, he needs a distraction.

After you finish your food, you ask him “Your house or mine?”

“Yours. Please.”

You drove back to your house and got yourselves set up on the couch in front of the TV, turning on an episode of Doctor Who that you had recorded. You made him popcorn as he curled up on your couch, clutching a pillow. You were mostly quiet for the rest of the night, but when you did talk, it was to ask him a question about the show or if any of the science was accurate. It was the best you could do to keep him mind off things. Eventually, he fell asleep and you felt too bad to wake him. He got up by himself around midnight, jolting awake as if from a nightmare, and considering how the last few hours had been for him, it probably was one.

“Hey, bud, I’m here, it’s me.” You didn’t touch him, knowing he got overstimulated sometimes when he got really stressed, but he felt around for you on the couch next to him, needing to know you were really there this time. You patted his hand when it reached across the cushion for you.

“What time is it?”

“Way too late for you to be here, let’s get you home.”

He nodded, slowly rising to his feet and looking for his backpack, which you reminded him he had left in the car. Your hand hovered above his head for a moment before he lazily drifted into you as he walked. You took this as an okay to touch him, so you ruffled his hair before loosely slinging an arm around his shoulders as you guided him to your car.

The drive back to Spencer’s wasn’t too long, thankfully, because you were sure his parents would be furious with him and the kid’s been through enough today. You wanted to take all the heat without making them think you kidnapped him. The lights were still on when you pulled into the driveway. They were probably worried sick about him.

When you knocked on the door, a frantic woman with short blonde hair opened it. When she saw Spencer, she grabbed him by the wrist and pulled him into the house, never breaking eye contact with you.

“Who are you? What are you doing with my son?”

“He didn’t do anything wrong, Mrs. Reid. I’m Y/N, he’s been tutoring me.”

“How do you know me? Spencer, what did you tell her?” She looked at him and back at you, “Get off my property and stay away from us!”

“Mom, she’s a fr--”

“Go up to your room, don’t come out.” She didn’t sound like an angry parent reprimanding her son, she sounded almost... scared.

A million alarms were going off in your head, and you needed to try to get through to her, “Ma’am, I’m sorry, he was helping me study and we lost track of time, it’s not his fault.”

“I don’t care, I don’t know you, get off my property!”

You decided it was best not to argue, so you hurried back to your car and drove home as quickly as possible so you could shower and go to bed and pray that Spencer would be okay tonight.

~~~

Your phone rang early the next morning. You rolled out of bed to answer it, sprinting to the hall table to take it off the stand. Checking the caller ID, you realized it was from a number you didn’t recognize. Answering it, you heard Spencer’s voice on the other side.

“Hello, this is Spencer, is Y/N home?”

“Yes, you woke me up on a Saturday morning, where else am I gonna be, kid?” Your voice was scratchy as you struggled to fight off the sleep still clawing at your throat.

“Sorry about that. I was just calling to apologize for last night.”

“No, I’m sorry, I didn’t mean to get you in trouble.”

“N-No, I’m not in trouble, I just wanted to explain why my mother was all--”

“She was worried, I get it.”

“N- she… My mother is a paranoid schizophrenic, she doesn’t do well with strangers. She doesn’t even remember what she said to you last night, she was having one of her episodes. She was just confused.”

You didn’t know how to respond. You were so shocked by his sudden revelations, you just stayed silent. You didn’t want him to think he scared you, so you had to say something. And apparently, that something was “Oh.”

“She wanted to apologize, but she’s just a bit embarrassed, so I called for her.”

“N-No, it’s okay, I…” It was suddenly so hard to say you understood because while it made sense to you, you wouldn’t fully understand what he or his mom was going through, you didn’t understand it, but Spencer didn’t seem to mind. He was just glad it didn’t bother you. After the events of yesterday, he couldn’t afford to lose you.

“Tell her I’m sorry I scared her.”

“Will do. She said you could come over so she could apologize personally and meet her if you want.”

“I’d love to. And Spence?”

You felt him take pause. You never called him that before, “Yeah?”

“Why didn’t you tell me?”

“I didn’t wanna scare you.”

“You wouldn’t scare me, dude, you can tell me anything.”

“Really?”

“I promise. I’ll see you Monday?”

Spencer nodded, but you couldn’t see him, so he spoke up through the lump in his throat, “See you Monday.”

Taglist ~~~~~~

(Lmk if you wanna be added!!)

@lawnmoa @ellvswriting @reidsmyhusband-emilysmymistress @baby-pogue @rottenearly

[leechonspeeddial]

Midnight Shift: Of Whispers and Forbidden Buns

Word count: 1283 Read on ao3

"You're that Cullen girl, right?"

I ignored their barely suppressed giggles, but gave them an acknowledging thumbs up. Sadly, that only set them off harder. It appeared one of the downsides of working at this Burger King, besides the obvious reasons, was its proximity to the local high school.

Rather than roll my eyes in their face, I made the executive decision to give them the soggiest, saddest, smallest fries. It seemed that after my — truthfully anticlimactic — departure of East Ladle High, I had become an even bigger curiosity than my "siblings". Ever since word got around that one of those 'rich and gorgeous Cullen kids' had dropped out in favour of working a shitty customer service job, I had to deal with gaggles of teenagers showing up during lunch time to gawk at me.

"We'll call out when your order is ready, you guys can sit down" I smiled widely — fakely — and handed the assholes their soda cups. At least is was just the mean girl wannabe type today, dealing with the creepy admirers was nothing short of exhausting. If only because it made Edward even more unbearable than usual. I mentally grimaced at the memories.

When it became obvious I wasn't reacting to their bait, the girls finally walked away, whispering to each other, towards the tables — but as far from Jeremiah as they could manage. They clearly hated being here; they seemed to be specially disgusted over the omnipresent stickiness that plagued each surface in the building, but fuck them. No one made them come here, their choices were theirs, and they should just suck it up.

...

I'm not projecting. I'm not.

"Only two today, Res. Think you're becoming old news"

"That's Resentment Cannibal to you, old man," one of the upsides of working at Burger King had to be None of Your Fucking Business Kevin. Living with the Cullens meant being surrounded by people who mentally stopped developing before their brains were done cooking. The aforementioned Kevin — not to be confused with Gay Kevin or Straight Kevin — was forty-none-of-your-business-kid years old and the oldest person I regularly talked to ever since we left Forks over a decade ago. It was refreshing to spend time with someone who wasn't a teenager frozen in time and who was just so painfully human.

"Ok, cool it, Edgy Annie," he rolled his green eyes but still offered me some of his jalapeno cheddar bites. I gingerly grabbed a couple and munched on the mediocre and oily cheesy goodies.

"Thought you wanted to go on a diet," a particularly loud snort made me look towards the assholes who made my day worse. They were still whispering and glancing at me, as if I was something more interesting than a Burger King employee.

I mean. I was. But, like, they didn't know that. Couldn't know that.

"Ugh. Gross. No. I said I wanted to lose weight," I looked back at the man and raised my eyebrow.

"And how are you going to do that, if not by not devouring your weight in cheese?"

"You sound just like my little brother. He's a total granola freak. Eats kale and actually enjoys it," he shuddered and this time I rolled my eyes.

A soft thud signalled that the girls' order was ready, so I grabbed their meal and put it on a tray.

"Original Chicken Sandwich and Big Fish?" The blonde with glasses approached the counter and grabbed the tray. She didn't move away.

"Yes?" I asked hoping to convey how little I wanted to help her. If Gay Kevin hadn't already lectured me this week over being rude to customers, I so would tell her exactly what I'd do with her stupid stinky sandwich and exactly where I would shove that fish patty if she didn't fucking scram.

"Is it true?" I couldn't stop myself from looking surprised.

"Is what true?" Blondie quickly looked around the restaurant — pathetically empty, as always — and leaned slightly over the counter. I resisted the urge to also lean forward, because...because fuck her, damn it.

"That your brother knocked you up"

What the actual fuck.

I blinked and barely even noticed None of Your Fucking Business Kevin choking out of the corner of my eye. For the first time in my life, I was left speechless.

Blondie took my silence as an invitation to continue talking — clearly unaware of how easily I could murder her and get rid of the body.

"That's what everyone is saying. That you dropped out because your parents disowned you after they found out"

"Are you fucking high? Am I fucking high right now?" Were the cheddar bites actually Straight Kevin's edibles? Because there was no way this was a conversation that was actually happening in real life. Were Bella and Edward right? Was this Burger King really hell?

"Which brother?" I glared at the fucker. I was taking back everything nice I ever said about None of Your Fucking Business Kevin, the traitor.

Blondie's grin widened, revealing the most evil of dimples.

"Her brother-brother. Not the foster/step ones," my eyes widened and I barely managed to repress my gagging. Of course, my fucking father. Fucking Edward.

I wanted to die.

I said as much.

"So its true?" Blondie's friend, High-Pony, apparently was now at the counter too. Fantastic.

Blondie and High-Pony both stared expectantly at me.

"Let me get this straight. Apparently, my brother," I actually gagged this time, "knocked me up and my parents decided to only disown me? Is that right?"

The girls nodded in sync, like the demons they were.

"You get why that makes no sense, right? Why not disown Edward too?"

"The patriarchy" High-Pony shrugged. I closed my eyes and slowly counted down from ten.

"Ok, this is what's going to happen" I clapped between words, trying to keep my hands from strangling two innocent teenagers in front of my coworker. "You two are going to take your crappy food to go and I promise I won't spit on your food the next time you come here" the girls scoffed and showed no signs of moving.

"Jeremiah, buddy, could you please walk these girls out? There's a pie with your name on it if you can lend us a hand" Ok, the traitor wasn't so bad after all. But he was on thin ice.

Blondie and High-Pony didn't waste a second getting out the store after hearing that. It really was disgusting how some people reacted to Jeremiah.

"Am I still getting that pie, Freckles?" I smirked and heard None of Your Fucking Business Kevin sigh. No one here had any intention of using his real name.

"Of course, Jem. Your choice" Jeremiah's smile lit up his face, the room even.

"You're not so bad, ya know. Despite your crap taste in music" And now they were arguing about old people music again. A tired argument that no one won, but amused Jeremiah endlessly.

It was moments like these that reminded me why I dropped out and got a job here in the first place. I felt more alive after spending one day with Jeremiah and the Kevins than a decade with the Cullens. The Cullens were just...unreachable.

They were so detached of humanity, despite their proximity to it. But, just like in The Creation of Adam, the divine doesn't actually touch the human. They just gaze down, firmly on different levels from each other. They cared more to attain the aesthetics and the possessions than to develop actual relationships. Why bother living among humans, faking humanity, if you were going to keep them at an arm's length?

I shook my head and joined in the argument.

[nancygduarteus]

How Therapy Can Cure Overeating

Melissa Rivera always turned off the cameras before she binged. Newly married to a husband who traveled frequently, the 23-year-old med student, who had recently moved six hours from her friends and family, comforted herself with food. “I’d get this whole pizza that I would eat myself,” she says. Each time, she turned off the house’s security system so her husband wouldn’t see the coping mechanism she’d used since she was eight years old. “At some point, I realized, ‘This is killing me. I cannot do it anymore,’” she says. She sought help from counselors at the University of Texas, where she was a student.

Rivera suffered from binge eating disorder (BED), but says the school’s experts weren’t able to help. She says a school dietitian encouraged the very behavior that kicks off the bingeing cycle: restriction. “‘You have to eat so many grams of meat, you have to eat at most a cube of cheese per day,’” Rivera recalls the dietitian telling her. “I never did what she said.” Finally, at the end of 2016, Rivera searched online and connected with Edward Tyson, a local eating disorder specialist. But after years of struggle, she was skeptical about how much he could help. “Everything sounded like a beautiful promise, but it seemed impossible that he’d get me to this nice place that he was talking about,” Rivera says. “I’m happy to say that he did.” She has been binge-free since January.

One out of every 35 adults suffers from binge eating disorder, almost twice the combined rate for anorexia and bulimia. It is characterized by repeated episodes of eating large quantities of food quickly and to the point of discomfort; a feeling of a loss of control during the binge; and guilt following the binge, but without any consistent purging behavior. Up to 40 percent of people trying to lose weight suffer from BED and up to 70 percent of patients with BED are medically obese.

The good news is that BED is highly treatable, particularly with the help of cognitive behavioral therapy: Nearly 80 percent of patients abstain from bingeing after 20 sessions. And, unlike most calorie-restricting diets, the success of CBT holds for many patients over time.

However, a 2013 study in Biological Psychiatry found that less than half of lifetime bingers receive treatment. There are millions of overweight Americans who could find actual sustainable help with their eating issues—and not berate themselves for a lack of “willpower”—if more clinicians could identify the disorder and recommend treatment.

I suffered from the disorder myself from about high school until my early 20s. Ever anxious to lose a few pounds, I’d put myself on a strict diet, then eventually give in to temptation and eat as much as I could of whatever I could get—a whole pizza, cookies nabbed from someone’s pantry, a family-sized combo of General Tso’s chicken with fried rice and egg rolls. My mentality was that the next day I’d start the diet anew, so I “might as well” eat as much as possible since who knew when I’d ever have that food again. With many ups and downs, between the ages of 18 and 25 I put on nearly 50 pounds.

BED is an equal opportunity disorder, affecting men, women, young, old, and all races. However, the recent Netflix eating disorder film To The Bone is a microcosm of the short shrift BED is given in popular culture. The movie focuses on a waifish, big-eyed anorexic staying in a residential treatment home, zooming in to ogle one patient with a feeding tube and a bulimic who keeps a bag of vomit under her bed. The presence of BED is hardly acknowledged; one overweight character, Kendra, suffers from it, but she has only a handful of lines, and is otherwise unexplored, an unexplained jar of peanut butter her main companion. At one point, Kendra tries to join a conversation with fellow patients but a rude housemate shuts her down with “Sorry: This conversation is for rexies only.” Even though in real life the bingers far outnumber anorexics, popular culture seems far more fascinated by the idea of wasting away, as Sophie Gilbert explored in The Atlantic.

Part of the issue is BED’s relative newness on the mental health scene: It was only recognized as a formal diagnosis by the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) in 2013. “People seek a level of care that’s lower than what they actually need and then they give up,” says Julie Friedman, a health psychologist at the Eating Recovery Center in Chicago. (I am a former patient of Friedman’s.) “Somebody who really should be in residential therapy goes to an individual therapist and they’re frustrated. They give up and go back to dieting. It’s like trying to treat cancer with vitamins.”

Successful treatment of BED is not always synonymous with dramatic weight loss, but eliminating the habit of consuming thousands of calories at a time on a regular basis typically results in modest weight loss. And even if it doesn’t, it’s still a major health improvement to cut back on the types of foods people typically binge on (like pizza or meaty breakfast sandwiches or ice cream), the sodium, fat, and sugar of which are hard on the body. “When you eat big volumes of food, particularly foods that are highly processed, which is what most people binge on, it causes a lot of stress on your body,” says Friedman. “The inflammation in your body affects everything from your cardiac status to your brain to your butt to your bones and your joints. It compounds any health risk.”

The psychology of addiction in BED patients is still being understood, but I remember, when I was in recovery, thinking how much easier it would be if I could go cold turkey on food. Unfortunately, bingers need their drug to live—which is why they need help modulating the way they think about it and use it. “Imagine telling a coke addict to take three large doses and then two smaller doses per day,” says Tyson—Rivera’s therapist from Texas. “‘Don’t take too much and don’t take too little.’ That is not willpower; that’s torture.”

No diet or exercise plan can fix the disorder: BED lives in the brain. “There does seem to be a difference in the brain of someone with binge eating disorder compared to someone who doesn’t have it,” says Jillian Lampert, the chief strategy officer at the Emily Program, a eating disorder affiliate of the University of Minnesota that provides residential and outpatient care. “They’re interested in food in a different way. If food is very interesting, you’re likely to want more. But then it doesn’t deliver on its promise, so we go back and eat more, because we didn’t get it right. It breeds this cycle where people overeat and feel compelled to overeat. They’re looking for the reward.” The way Lampert explains treatment to her patients is, “Your brain is wired a little differently from some people’s. It’s neither good nor bad, it just is. We can help you to have an owner’s manual and say ‘I remember on page 57 when I’m around this certain set of foods and I’m stressed out, it’s harder for me to make decisions around eating.’”

Michael Meginness didn’t acknowledge his BED until he had been at at Chicago’s Eating Recovery Center for over a week. The 35-year-old Ohio father of four figured that he was eating three meals a day, so he was perfectly fine. Except that his typical breakfast included two meaty breakfast sandwiches and a bowl of cereal. “My brain’s telling me ‘I’m eating three meals’ but in actuality I’m eating three meals per meal,” he says. Finally, he went to treatment after his wife gave him an ultimatum. After working with Friedman, he says, “I had a realization that maybe I do have an eating disorder. Going through the treatment was a new start.”

When Rivera met Tyson’s dietitian, she requested the structure she had been given at UT. “If you can give me a meal plan, that’s what I’m going to follow.” Instead, Rivera recalls, “She laughed and said, ‘That’s not the approach we’re going to take.’” For the first time, all foods were “legalized” for her—the only rule was to eat three meals a day and three snacks. “[The dietitian] encouraged me to eat protein, fat, and carbs every meal. ‘If you’re going to eat a donut and a sausage, I’m cool with that.’” De-restricting meals was a step toward stopping the restrict-and-binge cycle.

In therapy, Meginness worked on a strategy called “catching your thoughts,” he says. “When you have a thought, those are just thoughts. It’s what you do after that helps makes those decisions. I can treat it as the truth or treat it as the lie. Am I that hungry? No, I ate, I’m fulfilled. I don’t need to act on that, I can throw [that thought] out and move on.”

In therapy Meginness also addressed the difficulties in his marriage. “I had to prepare myself that when I was released, my wife might not stay with me and the kids. Could I accept that, and continue with recovery? It was really tough. [Friedman] was like, ‘You need to make the choice: Are you going to do this for yourself whether or not you go home to a family?’” Once he decided to pursue treatment no matter what, his wife recognized that he was choosing to treat his disorder. “Actually now we’re in a thriving marriage.”

Body acceptance is also a major part of BED treatment, says Lampert, especially in a culture that prizes the big reveal of “Half Their Size!” features in magazines. Her patients often say, “I don’t feel like I’ll ever be enough, so what’s the point.” But Lampert says, “You can accept your body and delight in what it does while you work on making it feel better. ‘I can take care of myself today: I don’t have to wait until I lose weight.’ Those small wins can accumulate into a mastery of ‘I can do this.’” Rivera inexplicably began to gain weight after she was in treatment with Tyson; eventually she was diagnosed with polycystic ovary syndrome, a hormonal disorder that can cause weight gain. Once that was under control, she started to lose weight again. If it wasn’t for the mental health foundation she had established earlier, she says, she may have given up. “Even though my body was changing to what I considered a negative, just being able to keep up with legalizing food and going to treatment gave me a lot of strength,” she says.

According to Tyson, a binger who stops the cycle will lose about 10 percent of their body weight. That’s not sexy enough for a reality TV show reveal, but it’s a significant health improvement, which can improve blood pressure and heart health. “It’s not a rapid 100 pounds, but what I tell patients is that the goal here is to feel in control. If you’re not eating 1200 calories three times a day during binges, will that drop your weight? Sure, but it’s not sudden.” For many bingers, weight loss is simply a nice bonus that comes with improving mental health. I may have lost 50 pounds since I first sought treatment for BED, but for me the major victory was being able to eat a cookie, or three, or seven, and let it just be that. It doesn’t mean I don’t deserve to exercise, or to eat healthily, to be loved or to love myself the next day.

So why isn’t therapy given the same amount of press as a weight loss tool that Whole30 and CrossFit receive?

First, says Tyson, clinicians need to catch up on BED in order to be the first line of defense for their patients. “If people know they’re not going to be treated like ‘Oh, another obese patient who is not going to do what I want them to do,’ that will decrease the shame,” he says. The poor success rate of calorie-restricting diets has been well-documented, and he is frustrated by physicians who continue to recommend them to their patients. He says that the arrival of the binge-cessation drug Vyvanse, a stimulant also prescribed for ADHD that Friedman says helps some bingers manage eating-related impulsivity, has helped raised the profile of BED (Tyson is on the drugmaker’s board), but he warns that clinicians must not recommend the drug alone. “As long as you also recommend the therapy and the dietitian, then they stay in treatment and they’ll see success.”

“In a perfect world we’d be screening people for their eating behaviors and not so much about their weight,” says Lampert. “Their behaviors would tell us more about the place where we make change.”

It doesn’t help that overeating isn’t always seen as a disorder. When I first began treatment I felt ridiculous admitting that I, a functional adult, could let my whole week be dictated by a bowl of tortilla chips and a pitcher of margaritas. Friedman frequently hears reluctant patients says things like “I don’t fit in—I won’t even fit into the chairs.” She says, “The issue is that people don’t associate people struggling with their weight with eating-disorder treatment. Their perception is really antiquated, all these anorexics needing to be fed.”

Sufferers of BED tend to be high achievers who can’t accept that they can’t just force themselves to stop through sheer willpower, which Tyson says is ironic. “These are patients who have done incredibly difficult things—philanthropic work, mission work, endured very difficult circumstances—so to say that it’s something about lack of willpower, that’s just not the profile of these people.”

The high functionality of most bingers points to another reason more people with BED don’t get the help they need: insurance. Friedman notes that she fights with insurance companies “every day” over patients insurers see as being too functional to receive psychiatric care. “They go to work every day, but then they come home Friday at 5 and spend all weekend binge eating, with no quality of life, no social support. When you’ve got an 18-year-old who can’t finish her first year of college—that gets authorized easily. But if you have someone who is suffering on their own time, that makes it really hard to get authorization for care.”

Lampert says that it takes a minimum of 12 sessions of CBT for a patient to see results, with the average length of stay at the Emily Program lasting a year to a year and a half. But that kind of help is not always accessible. Rivera had to pay out of pocket for her work with Tyson, which included medication for depression and ADD. She was paying $250 a month at one point for her prescriptions. Fortunately, her husband is an ER doctor. “If I didn’t have his support, I would never be able to afford treatment. I’m so grateful that I was able to get to this place but then I think how many people are there and they can’t afford it. They’re just being told how much self-control they’re lacking.”

Sometimes that stigma comes from the insurance companies themselves. “Usually when I’m asking for more intensive treatment, I’m told, ‘This patient can go to Weight Watchers,’” says Friedman, who notes that the current level of care criteria that insurers use are based on anorexia or bulimia. Insurers then say, “They haven’t lost weight, they haven’t thrown up, so they don’t need treatment.” She says therapists have been working to create a new criteria of care that addresses functional impairment and distress over weight.

I reached out to two insurers with whom Friedman and Lampert frequently work and both said that they cover CBT for eating disorders. A spokesperson for Optum said that binge eating disorder is included in that “when it is appropriate to meet [patients’] clinical needs and goals,” and a spokesperson for Health Care Service Corporation (which runs several Blue Cross Blue Shield plans) said “CBT is among the most common therapies for eating disorders and is supported by our Behavioral Health Program.”

Tyson hopes to hear more noise from groups like the Eating Disorders Coalition and the Academy for Eating Disorders to call for conferences to discuss better coverage. Friedman says that sufferers of BED should get comfortable advocating with their insurance companies for adequate care. “Patients will call and say ‘it’s not right that I’m not getting this care’ and insurance will listen to a patient a lot faster and more effectively.”

America also has a long way to come in terms of its indecisive attitudes toward diet and food. Don’t be fat, but also don’t act like you care about your weight too much. Meginness says that after treatment, he felt extra pressure managing his eating as a man. “Guys are expected to enjoy tailgates and all this man food and meats and not worry about portions.” When he goes to social occasions, he plans ahead what he’s going to eat, but he says, “It’s hard, seeing these other guys filling their plates two to three times. It makes me want to be like ‘Oh well, let’s just do it.’”

Without even going into weight management, Meginness lost 65 pounds by addressing his bingeing in therapy. Now, when he feels stress triggers at his IT job, he plays games on his phone or goes and plays with his kids. However, to him the weight is secondary to the biggest change in his life since he got treatment. “I used to yell and scream at my kids a lot. I wasn’t a very nice person. Now I’m more joyful, and I see that,” he says. When it comes to people like him and Rivera and me and everybody else like us, he says, “That’s what society doesn’t understand—they want a quick fix and get the instant gratification. If you find the root cause you don’t need Nutrisystem, AdvoCare, or any of the rest.”

from Health News And Updates https://www.theatlantic.com/health/archive/2017/08/how-therapy-can-cure-overeating/537537/?utm_source=feed

[ionecoffman]

How Therapy Can Cure Overeating

Melissa Rivera always turned off the cameras before she binged. Newly married to a husband who traveled frequently, the 23-year-old med student, who had recently moved six hours from her friends and family, comforted herself with food. “I’d get this whole pizza that I would eat myself,” she says. Each time, she turned off the house’s security system so her husband wouldn’t see the coping mechanism she’d used since she was eight years old. “At some point, I realized, ‘This is killing me. I cannot do it anymore,’” she says. She sought help from counselors at the University of Texas, where she was a student.

Rivera suffered from binge eating disorder (BED), but says the school’s experts weren’t able to help. She says a school dietitian encouraged the very behavior that kicks off the bingeing cycle: restriction. “‘You have to eat so many grams of meat, you have to eat at most a cube of cheese per day,’” Rivera recalls the dietitian telling her. “I never did what she said.” Finally, at the end of 2016, Rivera searched online and connected with Edward Tyson, a local eating disorder specialist. But after years of struggle, she was skeptical about how much he could help. “Everything sounded like a beautiful promise, but it seemed impossible that he’d get me to this nice place that he was talking about,” Rivera says. “I’m happy to say that he did.” She has been binge-free since January.

One out of every 35 adults suffers from binge eating disorder, almost twice the combined rate for anorexia and bulimia. It is characterized by repeated episodes of eating large quantities of food quickly and to the point of discomfort; a feeling of a loss of control during the binge; and guilt following the binge, but without any consistent purging behavior. Up to 40 percent of people trying to lose weight suffer from BED and up to 70 percent of patients with BED are medically obese.

The good news is that BED is highly treatable, particularly with the help of cognitive behavioral therapy: Nearly 80 percent of patients abstain from bingeing after 20 sessions. And, unlike most calorie-restricting diets, the success of CBT holds for many patients over time.

However, a 2013 study in Biological Psychiatry found that less than half of lifetime bingers receive treatment. There are millions of overweight Americans who could find actual sustainable help with their eating issues—and not berate themselves for a lack of “willpower”—if more clinicians could identify the disorder and recommend treatment.

I suffered from the disorder myself from about high school until my early 20s. Ever anxious to lose a few pounds, I’d put myself on a strict diet, then eventually give in to temptation and eat as much as I could of whatever I could get—a whole pizza, cookies nabbed from someone’s pantry, a family-sized combo of General Tso’s chicken with fried rice and egg rolls. My mentality was that the next day I’d start the diet anew, so I “might as well” eat as much as possible since who knew when I’d ever have that food again. With many ups and downs, between the ages of 18 and 25 I put on nearly 50 pounds.

BED is an equal opportunity disorder, affecting men, women, young, old, and all races. However, the recent Netflix eating disorder film To The Bone is a microcosm of the short shrift BED is given in popular culture. The movie focuses on a waifish, big-eyed anorexic staying in a residential treatment home, zooming in to ogle one patient with a feeding tube and a bulimic who keeps a bag of vomit under her bed. The presence of BED is hardly acknowledged; one overweight character, Kendra, suffers from it, but she has only a handful of lines, and is otherwise unexplored, an unexplained jar of peanut butter her main companion. At one point, Kendra tries to join a conversation with fellow patients but a rude housemate shuts her down with “Sorry: This conversation is for rexies only.” Even though in real life the bingers far outnumber anorexics, popular culture seems far more fascinated by the idea of wasting away, as Sophie Gilbert explored in The Atlantic.

Part of the issue is BED’s relative newness on the mental health scene: It was only recognized as a formal diagnosis by the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) in 2013. “People seek a level of care that’s lower than what they actually need and then they give up,” says Julie Friedman, a health psychologist at the Eating Recovery Center in Chicago. (I am a former patient of Friedman’s.) “Somebody who really should be in residential therapy goes to an individual therapist and they’re frustrated. They give up and go back to dieting. It’s like trying to treat cancer with vitamins.”

Successful treatment of BED is not always synonymous with dramatic weight loss, but eliminating the habit of consuming thousands of calories at a time on a regular basis typically results in modest weight loss. And even if it doesn’t, it’s still a major health improvement to cut back on the types of foods people typically binge on (like pizza or meaty breakfast sandwiches or ice cream), the sodium, fat, and sugar of which are hard on the body. “When you eat big volumes of food, particularly foods that are highly processed, which is what most people binge on, it causes a lot of stress on your body,” says Friedman. “The inflammation in your body affects everything from your cardiac status to your brain to your butt to your bones and your joints. It compounds any health risk.”

The psychology of addiction in BED patients is still being understood, but I remember, when I was in recovery, thinking how much easier it would be if I could go cold turkey on food. Unfortunately, bingers need their drug to live—which is why they need help modulating the way they think about it and use it. “Imagine telling a coke addict to take three large doses and then two smaller doses per day,” says Tyson—Rivera’s therapist from Texas. “‘Don’t take too much and don’t take too little.’ That is not willpower; that’s torture.”

No diet or exercise plan can fix the disorder: BED lives in the brain. “There does seem to be a difference in the brain of someone with binge eating disorder compared to someone who doesn’t have it,” says Jillian Lampert, the chief strategy officer at the Emily Program, a eating disorder affiliate of the University of Minnesota that provides residential and outpatient care. “They’re interested in food in a different way. If food is very interesting, you’re likely to want more. But then it doesn’t deliver on its promise, so we go back and eat more, because we didn’t get it right. It breeds this cycle where people overeat and feel compelled to overeat. They’re looking for the reward.” The way Lampert explains treatment to her patients is, “Your brain is wired a little differently from some people’s. It’s neither good nor bad, it just is. We can help you to have an owner’s manual and say ‘I remember on page 57 when I’m around this certain set of foods and I’m stressed out, it’s harder for me to make decisions around eating.’”

Michael Meginness didn’t acknowledge his BED until he had been at at Chicago’s Eating Recovery Center for over a week. The 35-year-old Ohio father of four figured that he was eating three meals a day, so he was perfectly fine. Except that his typical breakfast included two meaty breakfast sandwiches and a bowl of cereal. “My brain’s telling me ‘I’m eating three meals’ but in actuality I’m eating three meals per meal,” he says. Finally, he went to treatment after his wife gave him an ultimatum. After working with Friedman, he says, “I had a realization that maybe I do have an eating disorder. Going through the treatment was a new start.”

When Rivera met Tyson’s dietitian, she requested the structure she had been given at UT. “If you can give me a meal plan, that’s what I’m going to follow.” Instead, Rivera recalls, “She laughed and said, ‘That’s not the approach we’re going to take.’” For the first time, all foods were “legalized” for her—the only rule was to eat three meals a day and three snacks. “[The dietitian] encouraged me to eat protein, fat, and carbs every meal. ‘If you’re going to eat a donut and a sausage, I’m cool with that.’” De-restricting meals was a step toward stopping the restrict-and-binge cycle.

In therapy, Meginness worked on a strategy called “catching your thoughts,” he says. “When you have a thought, those are just thoughts. It’s what you do after that helps makes those decisions. I can treat it as the truth or treat it as the lie. Am I that hungry? No, I ate, I’m fulfilled. I don’t need to act on that, I can throw [that thought] out and move on.”

In therapy Meginness also addressed the difficulties in his marriage. “I had to prepare myself that when I was released, my wife might not stay with me and the kids. Could I accept that, and continue with recovery? It was really tough. [Friedman] was like, ‘You need to make the choice: Are you going to do this for yourself whether or not you go home to a family?’” Once he decided to pursue treatment no matter what, his wife recognized that he was choosing to treat his disorder. “Actually now we’re in a thriving marriage.”

Body acceptance is also a major part of BED treatment, says Lampert, especially in a culture that prizes the big reveal of “Half Their Size!” features in magazines. Her patients often say, “I don’t feel like I’ll ever be enough, so what’s the point.” But Lampert says, “You can accept your body and delight in what it does while you work on making it feel better. ‘I can take care of myself today: I don’t have to wait until I lose weight.’ Those small wins can accumulate into a mastery of ‘I can do this.’” Rivera inexplicably began to gain weight after she was in treatment with Tyson; eventually she was diagnosed with polycystic ovary syndrome, a hormonal disorder that can cause weight gain. Once that was under control, she started to lose weight again. If it wasn’t for the mental health foundation she had established earlier, she says, she may have given up. “Even though my body was changing to what I considered a negative, just being able to keep up with legalizing food and going to treatment gave me a lot of strength,” she says.

According to Tyson, a binger who stops the cycle will lose about 10 percent of their body weight. That’s not sexy enough for a reality TV show reveal, but it’s a significant health improvement, which can improve blood pressure and heart health. “It’s not a rapid 100 pounds, but what I tell patients is that the goal here is to feel in control. If you’re not eating 1200 calories three times a day during binges, will that drop your weight? Sure, but it’s not sudden.” For many bingers, weight loss is simply a nice bonus that comes with improving mental health. I may have lost 50 pounds since I first sought treatment for BED, but for me the major victory was being able to eat a cookie, or three, or seven, and let it just be that. It doesn’t mean I don’t deserve to exercise, or to eat healthily, to be loved or to love myself the next day.

So why isn’t therapy given the same amount of press as a weight loss tool that Whole30 and CrossFit receive?

First, says Tyson, clinicians need to catch up on BED in order to be the first line of defense for their patients. “If people know they’re not going to be treated like ‘Oh, another obese patient who is not going to do what I want them to do,’ that will decrease the shame,” he says. The poor success rate of calorie-restricting diets has been well-documented, and he is frustrated by physicians who continue to recommend them to their patients. He says that the arrival of the binge-cessation drug Vyvanse, a stimulant also prescribed for ADHD that Friedman says helps some bingers manage eating-related impulsivity, has helped raised the profile of BED (Tyson is on the drugmaker’s board), but he warns that clinicians must not recommend the drug alone. “As long as you also recommend the therapy and the dietitian, then they stay in treatment and they’ll see success.”

“In a perfect world we’d be screening people for their eating behaviors and not so much about their weight,” says Lampert. “Their behaviors would tell us more about the place where we make change.”

It doesn’t help that overeating isn’t always seen as a disorder. When I first began treatment I felt ridiculous admitting that I, a functional adult, could let my whole week be dictated by a bowl of tortilla chips and a pitcher of margaritas. Friedman frequently hears reluctant patients says things like “I don’t fit in—I won’t even fit into the chairs.” She says, “The issue is that people don’t associate people struggling with their weight with eating-disorder treatment. Their perception is really antiquated, all these anorexics needing to be fed.”

Sufferers of BED tend to be high achievers who can’t accept that they can’t just force themselves to stop through sheer willpower, which Tyson says is ironic. “These are patients who have done incredibly difficult things—philanthropic work, mission work, endured very difficult circumstances—so to say that it’s something about lack of willpower, that’s just not the profile of these people.”

The high functionality of most bingers points to another reason more people with BED don’t get the help they need: insurance. Friedman notes that she fights with insurance companies “every day” over patients insurers see as being too functional to receive psychiatric care. “They go to work every day, but then they come home Friday at 5 and spend all weekend binge eating, with no quality of life, no social support. When you’ve got an 18-year-old who can’t finish her first year of college—that gets authorized easily. But if you have someone who is suffering on their own time, that makes it really hard to get authorization for care.”

Lampert says that it takes a minimum of 12 sessions of CBT for a patient to see results, with the average length of stay at the Emily Program lasting a year to a year and a half. But that kind of help is not always accessible. Rivera had to pay out of pocket for her work with Tyson, which included medication for depression and ADD. She was paying $250 a month at one point for her prescriptions. Fortunately, her husband is an ER doctor. “If I didn’t have his support, I would never be able to afford treatment. I’m so grateful that I was able to get to this place but then I think how many people are there and they can’t afford it. They’re just being told how much self-control they’re lacking.”

Sometimes that stigma comes from the insurance companies themselves. “Usually when I’m asking for more intensive treatment, I’m told, ‘This patient can go to Weight Watchers,’” says Friedman, who notes that the current level of care criteria that insurers use are based on anorexia or bulimia. Insurers then say, “They haven’t lost weight, they haven’t thrown up, so they don’t need treatment.” She says therapists have been working to create a new criteria of care that addresses functional impairment and distress over weight.

I reached out to two insurers with whom Friedman and Lampert frequently work and both said that they cover CBT for eating disorders. A spokesperson for Optum said that binge eating disorder is included in that “when it is appropriate to meet [patients’] clinical needs and goals,” and a spokesperson for Health Care Service Corporation (which runs several Blue Cross Blue Shield plans) said “CBT is among the most common therapies for eating disorders and is supported by our Behavioral Health Program.”

Tyson hopes to hear more noise from groups like the Eating Disorders Coalition and the Academy for Eating Disorders to call for conferences to discuss better coverage. Friedman says that sufferers of BED should get comfortable advocating with their insurance companies for adequate care. “Patients will call and say ‘it’s not right that I’m not getting this care’ and insurance will listen to a patient a lot faster and more effectively.”

America also has a long way to come in terms of its indecisive attitudes toward diet and food. Don’t be fat, but also don’t act like you care about your weight too much. Meginness says that after treatment, he felt extra pressure managing his eating as a man. “Guys are expected to enjoy tailgates and all this man food and meats and not worry about portions.” When he goes to social occasions, he plans ahead what he’s going to eat, but he says, “It’s hard, seeing these other guys filling their plates two to three times. It makes me want to be like ‘Oh well, let’s just do it.’”

Without even going into weight management, Meginness lost 65 pounds by addressing his bingeing in therapy. Now, when he feels stress triggers at his IT job, he plays games on his phone or goes and plays with his kids. However, to him the weight is secondary to the biggest change in his life since he got treatment. “I used to yell and scream at my kids a lot. I wasn’t a very nice person. Now I’m more joyful, and I see that,” he says. When it comes to people like him and Rivera and me and everybody else like us, he says, “That’s what society doesn’t understand—they want a quick fix and get the instant gratification. If you find the root cause you don’t need Nutrisystem, AdvoCare, or any of the rest.”

Article source here:The Atlantic