When The Only Choice Left Is Not To Eat

Asaf started losing weight in the hostel about six months after he moved in. At first, his weight loss was subtle and hard to pinpoint. I visited him regularly and noticed how much thinner he was becoming.

I raised my concerns with the staff, asking them to pay closer attention to what he was and wasn’t eating. I also insisted that they start weighing him weekly. Each week, I anxiously waited for the report and each time the number on the scales dropped further.

Around the same time, he was caught in a relentless cycle of gastrointestinal issues. He alternately suffered from diarrhea and constipation. He endured two bouts of a tough bacterial infection that required two rounds of antibiotics to clear. In hindsight, these infections completely misled everyone, myself included, about what was happening.

It wasn’t until much later after he was hospitalized with a 95% blocked rectum, I understood that the majority of the “diarrhea” wasn’t actually diarrhea at all. It was overflow diarrhea — a result of acute constipation where the body breaks down stool into liquid to push it past fecal blockages. Although he was in horrendous pain I felt such relief to finally have some answers. Once we managed to deal with the constipation, I was hopeful that we had finally found the source of his weight issues and that he would begin to gain weight.

Unfortunately, his weight continued to drop. There was no clear pattern to his eating habits. One day, he’d eat one full meal; the next, nothing at all. Some days he’d eat three meals, then he’d go without food for days. The food itself seemed arbitrary. He’d eat meatballs one day and refuse them the next.

I grew increasingly desperate as his weight continued to drop. At this stage, he had lost 17kg (37.5 lbs) and he started looking like a walking skeleton. I was petrified that he might collapse or something worse might happen to him. Unfortunately, the doctors didn’t seem to share my urgency. “His blood work is good,” they said. “He’s strong.”

I knew in my gut that something wasn’t right.

One day, Asaf typed these words:

 “I don’t remember the time in life that I chose anything for myself. 

I ask to make my own decisions.”

That sentence hit me like a ton of bricks.

The only thing Asaf has control over in his life is what he puts into his mouth. Every other aspect of his existence is decided for him:

• What time he wakes up.

• What he wears.

• What he eats and when.

• When takes a shower.

• What he does during the day.

and the list goes on.

For three years Asaf has lived a life devoid of choice.

In the simplest moments, choosing whether to eat or not, he is exercising his right to make a decision. His refusal to eat wasn’t about hunger; it was about reclaiming control in a life where he had none.

This realization has forced me to confront something deeply painful: How the heck had I missed this?

When I chose this hostel for Asaf, I thought I was giving him the best possible environment. Everything was in-house, so he wouldn’t be exposed to constant transitions. The same team would always be looking out for him, offering continuity and stability. He wouldn’t need to attend external daycare centers, where I feared he might feel lost or unmotivated.

The very things I thought would protect him were the things that trapped him.

I see it now: Asaf was living in a prison. A prison I had unknowingly helped build. How could I have gotten it so wrong?

This realization has forced me to confront an uncomfortable truth: institutions provide Asaf with safety, structure, and medical care, but they often strip away autonomy. They reduce people to a schedule, a system, and a series of checkboxes. In that system, Asaf’s humanity — his desires, his preferences, his ability to choose — has been overlooked.

Free choice is fundamental to our identity. It’s how we express who we are and what matters to us. Without it, life becomes a series of imposed actions.

For Asaf, this lack of choice is suffocating. It’s not just about the big decisions, it’s about the small ones that define daily life; and when these basic decisions are taken away, so is dignity.

Asaf’s words “I ask to make my own decisions” are a plea for something every human being deserves: the right to control their own life.

It’s easy to overlook the importance of choice when you have it, but imagine a day when every decision is made for you down to the smallest detail. Now imagine three years of that.

For Asaf, this is reality. And his refusal to eat was a powerful act of resistance — a way of saying, “This is the one thing I can still control.”

Unfortunately, Asaf’s story is not unique. Many people in institutional settings face similar struggles. Their needs are met but their humanity is often ignored.

This needs to change. We must reimagine care systems to honor autonomy and presume competence.

We must listen to the voices of those we think cannot speak; and above all, we must remember that choice is not a luxury. It is a fundamental part of being human.