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Five Stages of Lifelong Recovery

Reprinted from Eating Disorders Today
By Lee Kern, LCSW
Summer 2005 Volume 3, Number 3
©2005 Gürze Books

My experience working at an obesity treatment center suggests that recovery is a dynamic, integrated, lifelong process. There are five core stages for success that can function as a map, providing steps and strategies in the healing journey.

Stage 1: Starters
Often a crisis moves people to change, as though they are driving in a thick fog and have to pull over. The fog lifts and they realize they have come to a fork. They can continue down the same road, or turn down the unfamiliar one. By starting treatment, they take a chance on the new road, launching healthy habits and routines.

Marsha is a typical starter. During a period of marital stress in her 20s leading to divorce, she began binge eating, and by age 49 entered treatment for morbid obesity with complications of diabetes, joint pain, and immobility. During intense work periods, she ate frequent large restaurant meals, a diet high in fat, and relaxed by snacking. MarshaÕs lifestyle was sedentary and her main hobby was playing bridge, which led to social eating and drinking. Her treatment goals were to reach a healthier weight and to end the binge eating. She sought improvements in her diabetes control, more energy, and improved functioning at work.

Tasks for starters include: 1) Clarifying priorities and motivation 2) Practicing conscious eating by planning three to five balanced meals a day 3) Discriminating between eating for nutrition versus using food for habit, boredom, and stress 4) Experiencing physical activity as safe and beneficial 5) Developing a lifestyle that includes time for relaxation and exercise.

Stage 2: Sustainers
Barry, who also suffered from obesity, has been at his goal weight for over a year, maintaining in a range of 10 pounds. He is dedicated to self-monitoring techniques that provide feedback, and is an accomplished sustainer of the nuts and bolts strategies he learned on the program.

Since his initial treatment, Barry sends progress reports at 9-week intervals consisting of weight graphs and selfevaluation comments. Admittedly "not much on analysis," his comments are sparse and to the point. Socially, he has learned to enter situations with a vision of how he wants to behave, countering the urges to binge. He has discontinued medication for hypertension, and his self-esteem and sexual satisfaction have been enhanced. As a sustainer, he is committed to effective strategies to protect recovery: anticipating, planning, monitoring, and reframing.

Stage 3: Renewers
Recently, I planted a rosebush in my yard, mixing compost and bone meal into the soil. As the months go by, I will fertilize and water the new bush, enjoying a bounty of flourishing pink flowers. Recovery works much the same way; without renewal it may wither into relapse.

Ruth and Jason are examples of effective renewers. Jason uses periodic visits to the program as a way to manage his weight. In contrast, Ruth has not been back to the program after her initial stay, but she maintains her goal weight with a diverse support system, including OA, individual and group therapy, mailed in diaries, and a network of colleagues. Renewers utilize groups, experts, mentors, friends, and family to establish a supportive foundation for their recovery.

Stage 4: Progressionals
While recovery will always require mental focus, progressionals are clients whose healthy behaviors become stable and automatic, and who devote energy to personal growth and new challenges.

Donna has maintained her healthy goal weight for almost three years. In a recent letter she wrote: "The routine I started at the program gets easier over time. I have allowed myself certain foods and eating styles that are different than at the program. My relationship with food has changed. It's just food—it's not comfort or a hobby. I'm not on a diet. This is the way I eat, period."

Ron recognized the need to broaden his exercise program to include strength training and challenged himself to set goals in hope that the improved fitness will enable him to play basketball, a sport he had to stop. Progressionals nurture themselves through meaningful activities that enable them to let go of destructive food patterns, and, as in Donna's example, they personalize and internalize the treatment experience.

Stage 5: Re-engagers
Unfortunately, not everyone has initial success. Mike relapsed and returned to the program after a 3-year hiatus, having begun binge eating and undoing the progress he'd made earlier. Discussions with Mike revealed that a fear of rejection led to avoiding contact with old friends. During isolated evenings he numbed himself with TV and snacks. In therapy he worked on communication skills and risk taking, and eventually made a connection with an OA member. Mike's relapse became a "prolapse"— it led to insight and growth.

When re-engagers start again, they do so at a deeper level, having tested their recovery in the real world. Re-engagers use relapse as a vehicle for learning how they remain caught up with food.

Stage 5: Re-engagers
While these examples are drawn from obesity treatment, the stages apply to all eating disorders recovery. The methods of change will vary, but common pathways link these successful journeys.

Lee Kern, LCSW, is the Clinical Director at Structure House, Inc., an obesity treatment center in Durham, North Carolina.

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Additional Resources:
National Conference Aims to Increase Awareness of Eating Disorders
Night Eating Syndrome: A Unique Eating Disorder
Nourishing Connections: Controlling Your Biology versus Honoring Your Hunger
Nutrition Care for Clients with Diabetes and An Eating Disorder
Nutrition Hotline - Determining a 'Healthy Weight'