ARRS Role Spotlight: Luke Sadler
We often do case studies surrounding our ARRS roles in order to better understand the many ways they engage with our patients and how we can improve on the services we offer.
We plan to share some of these studies with our patients to help them better understand our ARRS roles, the many services we offer, and how they can benefit from them.
This month, we would like to shine a spotlight on our Health & Wellbeing Coach Luke Sadler and the terrific work he’s been doing.
Patient Case Study: Overcoming Bulimia After 20 Years
Introduction
This presentation explores a remarkable case of overcoming bulimia nervosa. Our patient faced daily purging, chronic fatigue and compulsive weighing (six times per day). They had struggled with disordered eating since age 30, leading to extreme dietary restrictions and binge-purge cycles. Through personalised support and small, manageable steps, they embarked on a transformative journey towards recovery.
Key Challenges
- Metabolism & Fatigue - The patient expressed a deep fear of weight gain, which led to prolonged undereating, a significantly slowed metabolism, and malnutrition. This has led to fatigue and reduced physical activity.
- Compulsive Weighing - This can lead to feelings of guilt, often accompanied by a strong desire to purge, which can be incredibly difficult to navigate.
- Skeletal Muscle - Lack of proper nutrition and physical activity leading to deterioration of muscles and overall health.
Support Strategy
Instead of forcing immediate behavioural changes, Luke focused on validating the patient's emotions, explaining the physiological effects of undereating, and emphasising the importance of metabolic recovery.
- Metabolism & Fatigue - Luke explained that prolonged undereating signals the body to conserve energy, resulting in fatigue and less physical activity. Instead of introducing new foods, he asked the patient to identify what she could eat without triggering purging. The patient shared that they could have a pot of oats in the morning but would then fast until evening, leading to extreme hunger, guilt, and purging. To help, Luke suggested adding another pot of oats in the afternoon to prevent excessive hunger and reduce anxiety around eating.
- Compulsive Weighing - Instead of telling the patient to stop, which could lead to distress, Luke chose to let them continue and focused on making other gradual adjustments. He also managed their expectations by informing them that a slight initial weight gain might occur. However, the patient was reassured that this would stabilize quickly because their caloric intake was insufficient to lead to fat accumulation.
- Skeletal Muscle - Emphasized the significance of resistance training and proper nutrition for muscle retention and overall quality of life. Luke also suggested including a whey protein shake to enhance muscle protein synthesis and support metabolic function.
Outcome
By the end of the first session, the patient felt heard, validated, and optimistic about the small, manageable steps they had committed to.
Moving forward, they successfully incorporated oats and a protein shake into their daily routine. The patient continued to weigh themselves but approached it with a healthier mindset, no longer fearing small fluctuations. Without any external prompting, they reduced their weigh-ins from six times a day to three. To the patient’s surprise, avoiding purging did not lead to weight gain, which reinforced their trust in the process. They also shared their first meal out with their partner without purging—a significant milestone for them.
Patient Progress
- Purge-Free Streak – Achieved a significant milestone of being purge-free for 15 weeks to-date, by far their longest streak in 20 years. Leading to enjoyment of family holidays and 3lb weight gain over Christmas without panic.
- Increased energy – Reported higher energy levels and returning hunger signals, indicating metabolic recovery.
- Resistance training – Started noticing positive body changes and became interested in resistance training, enjoying physical and mental benefits.
- Return to work & public sharing – Patient returned to work after being on sick leave to focus on their recovery. They stood up in front of 30 staff members, shared their journey, and moved them to tears with their courage and honesty. The patient also revealed their struggle with bulimia to their son, describing the experience as “freeing.”
Conclusion:
This patient’s journey highlights the power of validation, small achievable steps, and a personalised approach to recovery. By avoiding pressure and allowing the patient to feel heard, they were able to make profound, sustainable changes. Their transformation from daily purging and fear of food to embracing balanced nutrition and resistance training is a testament to the importance of compassionate, individualised support.
In the patient’s own words, they “could not have done it without feeling heard and not pressured into big changes too soon.” Their resilience and commitment to recovery remain an inspiration, and Luke will continue to support them as they progress on this journey.
To see an interview with this patient and hear more about her inspirational journey and outstanding achievements, please watch the video below.