Intuitive Eating, 4th Edition by Evelyn Tribole and Elyse Resch

The go-to resource––now fully revised and updated––for building a healthy body image and making peace with food, once and for all.

When it was first published, Intuitive Eating was revolutionary in its anti-dieting approach. The authors, both prominent health professionals in the field of nutrition and eating disorders, urge readers to embrace the goal of developing body positivity and reconnecting with one’s internal wisdom about eating―to unlearn everything they were taught about calorie-counting and other aspects of diet culture and to learn about the harm of weight stigma. Today, their message is more relevant and pressing than ever.

nurture by Heidi Schauster, MS, RD, CEDS-S, SEP

There is so much confusing information about feeding families out there. Nurture: How to Raise Kids Who Love Food, Their Bodies, and Themselves is an expanded follow-up to Nourish, my first award-winning book. Nurture is a compassionate guide for parents and caregivers about feeding, eating, and discussing bodies with children and teens. I write from my nearly 30 years of experience treating clients with disordered eating, my own lived experience as a recovered person, and as a parent of two young adults. I weave stories from my clients’ and families’ experiences with sound advice based on current research. The book reads like a conversation with a kind fellow parent who has happened to do decades of fieldwork on the topic. It’s a sane and sound read that everyone who spends time with kids will benefit from reading.

This book is a life-enhancing tool for:

  • Parents and caregivers who have had their own food and body issues and don’t want to pass them on to the next generation

  • Parents and caregivers with kids exhibiting body image concerns

  •  Parents and caregivers with kids exhibiting disordered eating who want direction

  • Parents and caregivers with kids in larger bodies who feel unclear as to how to help them in the fat-phobic culture we live in

  • Parents and caregivers with picky eaters who don’t want to create dynamics around food that might lead to eating and body issues later in life

  • People who spend time with children and teens and want to create an inclusive health-and-well-being-enhancing culture around them

parents' guide to supporting a child through eating disorder recovery
parents' guide to supporting a child through eating disorder recovery

A Parent’s Guide to Support Their Child Through Eating Disorder Treatment

This brief guide strives to assist parents in supporting their child through treatment.

Do I Have an Eating Disorder?

You are the best at knowing yourself and the degree to which your preoccupations with food and body image interfere with your life. If you answer “yes” to any of the questions in this questionnaire, it may be an indication that you may benefit from support around food, weight, and/or exercise.

Exercise and Eating Disorders

Exercise and movement play a complicated role with eating disorders. While exercise certainly has its benefits, when taken to the extreme, it may be a sign of destructive coping. This resource discusses healing one’s relationship to compulsive exercise.

Eating Disorder Warning Signs and Symptoms

Since early detection of an eating disorder is a predictor of sustained recovery, it is important to know ED warning signs and symptoms. If you notice several of the symptoms listed below, please seek an evaluation with a professional trained in treating eating disorders.

So Your Child Has an Eating Disorder – 5 steps to Get Started

Finding out your child has an eating disorder may be some of the most difficult news you’ve ever received. Eating disorders are clouded in misunderstanding and misinformation, and having one in the family can feel very isolating.

As you organize treatment and recovery for your child, here are five things you can do to set yourself up for success.

The Body Liberation Project: How Understanding Racism and Diet Culture Helps Cultivate Joy and Build Collective Freedom By Chrissy King
The Body Liberation Project: How Understanding Racism and Diet Culture Helps Cultivate Joy and Build Collective Freedom By Chrissy King

The Body Liberation Project: How Understanding Racism and Diet Culture Helps Cultivate Joy and Build Collective Freedom By Chrissy King

From author and wellness personality Chrissy King, an exciting, genre-redefining narrative mix of memoir, inspiration, and activities and prompts, with timely messages about social and racial justice and how the world needs to move beyond body positivity to something even more exciting and revolutionary: body liberation.

The Body is Not an Apology: The Power of Radical Self-Love
The Body is Not an Apology: The Power of Radical Self-Love

The Body is Not an Apology: The Power of Radical Self-Love

The Body Is Not an Apology offers radical self-love as the balm to heal the wounds inflicted by violent systems of oppression

The Art of Body Acceptance: Strengthen Your Relationship with Yourself Through Therapeutic Creative Exercises By Ashlee Bennett
The Art of Body Acceptance: Strengthen Your Relationship with Yourself Through Therapeutic Creative Exercises By Ashlee Bennett

The Art of Body Acceptance: Strengthen Your Relationship with Yourself Through Therapeutic Creative Exercises By Ashlee Bennett

Ashlee Bennett will teach you how to reclaim your creativity and make amends with your body using art.

Fearing the Black Body: The Racial Origins of Fat Phobia By Sabrina Strings

An important and original work, Fearing the Black Body argues convincingly that fat phobia isn’t about health at all, but rather a means of using the body to validate race, class, and gender prejudice.

whitneytrotter.rd

Whtiney Trotter, MS, RDN/LDN, RN, RYT (she/her) is a Registered Dietitian and RN, Anti-racism Educator/Consultant and Human Trafficking Activist

your.latina.nutritionist

Dalina Soto RD LDN (she/her) is an anti-diet dietitian. She founded Your Latina Nutritionist because she’s passionate about building nourishing new narratives for us that don’t include depriving ourselves of the foods we grew up eating. Her work is about supporting you to reclaim the flavor and enjoyment of your life by celebrating the foods you love and incorporating them into your daily life with education and awareness.

your_body_is_good

Amanda Martinez Beck (she/her) is a fat activist, body image coach, & author of More of You: The Fat Girl’s Field Guide to the Modern World

yrfatfriend

Aubrey Gordon (she/her) is an author, columnist, and cohost of Maintenance Phase. Her work has been published in The New York Times, Vox, Literary Hub, SELF, Health, Glamour and more. Her first book, What We Don’t Talk About When We Talk About Fat was released in November 2020. Her second book, “You Just Need to Lose Weight” and 19 Other Myths About Fat People, is a New York Times and Indie bestseller.

"You Just Need to Lose Weight": And 19 Other Myths About Fat People By Aubrey Gordon
"You Just Need to Lose Weight": And 19 Other Myths About Fat People By Aubrey Gordon

You Just Need to Lose Weight: And 19 Other Myths About Fat People By Aubrey Gordon

The co-host of the Maintenance Phase podcast and creator of Your Fat Friend equips you with the facts to debunk common anti-fat myths and with tools to take action for fat justice

Fat Talk by Virginia Sole-Smith
Fat Talk by Virginia Sole-Smith

Fat Talk by Virginia Sole-Smith

Fat Talk is a stirring, deeply researched, and groundbreaking book that will help parents learn to reckon with their own body biases, identify diet culture, and empower their kids to navigate this challenging landscape. Sole-Smith draws on her extensive reporting and interviews with dozens of parents and kids to offer a provocative new approach for thinking about food and bodies, and a way for us all to work toward a more weight-inclusive world.

Reclaiming Body Trust: A Path to Healing & Liberation
Reclaiming Body Trust: A Path to Healing & Liberation

Reclaiming Body Trust: A Path to Healing & Liberation

Informed by the personal body stories of the hundreds of people they have worked with, Reclaiming Body Trust delineates an intersectional, social justice?orientated path to healing in three phases: The Rupture, The Reckoning, and The Reclamation. Throughout, readers will be anchored by the authors’ innovative and revolutionary Body Trust framework to discover a pathway out of a rigid, mechanistic way of thinking about the body and into a more authentic, sustainable way to occupy and nurture our bodies.

thenutritiontea

Shana Minei Spence,MS,RDN,CDN (she/her) is a non-diet, weight inclusive dietitian who created this platform for an open discussion on nutrition and wellness topics considering all the information circulating around these days.

v_solesmith

Virginia Sole-Smith (she/her) writes about diet culture, anti-fat bias, feminism and health. She is a journalist whose latest book is, Fat Talk: Parenting in the Age of Diet Culture

thrivewithmeg

Meghan Watson (she/her) is a licensed psychotherapist, writer & consultant. She is the founder of the group practice Bloom Psychology & Wellness — a therapy collective of Black, Indigenous, South Asian, and Multi-racial therapists with a focus on building connection and fostering emotional growth in communities of colour. She shares reflections, skills and tools on how to show up as your whole self through a self compassionate and growth focused lens on her Instagram page

thethicknutritionist

Natasha Ngindi is a non-diet nutritionist helping you find peace around food, love your body, and move in ways that bring you joy!

thefriendIneverwanted

Nia Patterson (they/them) is a queer, fat body Liberation Coach, consultant, writer, speaker, activist, and author

thefatdoctor

Dr. Asher Larmie is a fat doctor campaigning for an end to medical weight stigma so that everyone can access fair and equal healthcare irrespective of the number on the scales.

nic.mcdermid

Nic McDermid (she/her) is a fierce activist, feminist, advocate and content creator whose work focuses on disrupting the dominant discourse around weight and bodies, and challenging the ways in which certain types of bodies are both idolised and idealised.

newmoonrd

Meghan McGann, RD (she/her) is an anti-diet dietitian who advocates for inclusive care.

nalgonapositivitypride

Non-conventional eating disorder awareness organization run by Gloria Lucas (she/her). Her work focuses on eating disorder harm reduction.

melissadtoler

Melissa Toler (she/her) is a former wellness coach turned writer, speaker, and educator

jessicawilson.msrd

Jessica Wilson, MS, RD (she/her) is a clinical dietitian, consultant and author, whose work focuses on her experiences navigating the dietetic fields as a Black, queer dietitian

heysharonmaxwell

Sharon Maxwell (she/her) is a speaker; weight inclusive consultant; and fat activist

ragenchastain

Ragen Chastain (she/her) is a Speaker, Writer, Researcher, Board Certified Patient Advocate, ACE Certified Health Coach and Functional Fitness Specialist. She primarily writes about the intersections of weight science, weight stigma, health and healthcare at the WeightAndHealthcare substack

bodyliberationwithlindley

Lindley Ashline is a body liberation photographer, writer and activist

Sunny Side Up Nutrition

A Letter to Your Child’s Doctor

bodyhonornutrition

Kimmie Singh is a fat and fat-positive dietitian-nutritionist

bodyimage_therapist

Ashlee Bennett, AThR is an art therapist and artist and the author of The Art of Body Acceptance. Her areas of special interest include body image, internalized weight stigma/fat phobia, disordered eating/eating disorders, chronic dieting, and trauma.

bodyimagewithbri

Bri Campos is a body image educator who teaches body acceptance through grief

bodyjusticetherapist

Allyson Inez Ford is an eating disorders and OCD therapist. Social justice is an integral part of her work and she operates from a HAES lens.

decolonizingfitness

Ilya Parker founded Decolonizing Fitness in an effort to help dismantle toxic fitness culture. It is an online resource hub for coaches, gym owners, personal trainers and anyone who is invested in cultivating movement spaces that are more affirming and supportive to diverse bodies.

dietitiananna

Anna Sweeney, MS, RDN, CED-S is a relational nutrition therapist who specializes in eating disorders, disordered eating, and chronic illness

dr.jenniewh

Dr. Jennie Wang-Hall is a liberatory eating disorders psychologist creating community spaces for anti-carceral and agentic care

drcolleenreichmann

Dr. Colleen Reichmann is a clinical psychologist whose writing and work focus on body image, eating disorders, motherhood, and feminism.

drrachelmillner

Dr. Rachel Millner is a psychologist, Certified Eating Disorder Specialist and Supervisor, and a Certified Body Trust® provider. Her work is trauma-informed, fat-positive, anti-diet and rooted in feminist theory, relational theory, social justice, and body liberation

edadhd_therapist

Stacie Fanelli, LCSW is an AuDHD eating disorder therapist who discusses neurodivergence, EDs, intersectionality & treatment reform

encouragingdietitian

Christyna Johnson, MS, RD, LDN is a non-diet registered dietitian specializing in eating disorder, disordered eating, intuitive eating, and body image. She sees the world through a liberation lens and advocates for collective care to move us forward.

The Association for Size Diversity and Health (ASDAH)

As a non-profit organization with an international membership committed to the practice of the Health At Every Size® (HAES) Principles, ASDAH envisions a world that celebrates bodies of all shapes and sizes, in which body weight is no longer a source of discrimination and where oppressed communities have equal access to the resources and practices that support health and well being.
ASDAH provides ongoing opportunities for development, including educational resources, vetted referral opportunities, and an extensive network of like-minded advocates and professionals.

Can I Have Another Snack?

Can I Have Another Snack? podcast is an exploration of appetite, identity, and bodies. We talk about how we feed ourselves and our kids (in all senses of the word!), and the ingredients we need to survive in diet culture. We’re sitting with the questions: who or what are we nurturing? And who or what is nurturing us? Hosted by Laura Thomas – anti-diet nutritionist and author of the Can I Have Another Snack? newsletter.

The Body Grievers Club

Brianna Campos is changing the cultural conversation from diets and rules to acceptance and freedom. This is a podcast that explores the ins and outs of body image, self-esteem, diet culture, self-love, and finding peace as you come home to your body.

Maintenance Phase

Debunking the junk science behind health fads, wellness scams and nonsensical nutrition advice.

Recovery Bites

Karin Lewis, MA, LMFT, CEDS welcomes voices in the field and voices of lived experience, to get real about recovery

Navigating Weight & Scale-Neutral Conversations With Your Doctor

Navigating Weight & Scale-Neutral Conversations With Your Doctor by Sara Remus, MEDA Social Media Manager

While the concept of Health at Every Size (HAES) is slowly making its way into the medical field, finding HAES practitioners remains a struggle. While they do exist, they are still few and far between. That makes it all the more important to know how to advocate for yourself when moving through the health care system, especially as it is very likely that many of your providers will not be HAES informed. In Massachusetts, there are just 14 healthcare practitioners on the official HAES registry.

This doesn’t mean that your provider may not share HAES values. It does mean that you should be prepared to champion your needs when visiting your doctor, and that goes well beyond your physical health. We’ve compiled some tips  to help you guide your interactions with your health care team to a place that is safe for your body and mental well-being. Read on for some ideas for having a weight and/or scale neutral conversation with your doctor.

If you have the opportunity to communicate with your provider through a digital platform, use it to start the conversation. 

Many health care facilities use secure digital patient portals to schedule appointments, provide test results, and offer payment options. This can also be a great resource for setting expectations when you request an appointment with your provider. Usually, these programs will give you the ability to submit a note when requesting to see your doctor. You can disclose as much or as little as you feel comfortable with. This is an example of how you could potentially make the request:

“Hello, I’m looking for an appointment to be seen for (insert issue and any details here). Please add a note in my request that I would like for this appointment to not involve any discussions around weight, and would prefer to not be weighed. If I must be weighed, due to something like medication whose dose is weight dependent, I request that the nurse and doctor allow me to be weighed with my back to the scale and not share any of my weight information with me.”

If you are comfortable doing so, you can share that you are recovering from an eating disorder, and that these sorts of conversations and having information about your weight tends to be triggering and not helpful in your recovery process. However, you are certainly not obligated to provide this information!

If there is not a patient portal available for communicating with your doctor’s office, you can also offer this information over the phone. If you’re not comfy doing so, you could also draft a hand-written or typed note that you can fax to the office ahead of time or hand deliver to any medical personnel when you arrive for your first appointment. You might find it handy to keep several copies of this note in your wallet or bag, so that you can hand it to a provider in a pinch. If, for example, should you end up in an emergency or last-minute situation where there isn’t time for the conversation to be had ahead of time.

If you have a behavioral health provider, ask them for help.

If you have a counselor, therapist, or social worker that is helping you through your recovery, ask them for advice in navigating your specific needs with a medical doctor. In many cases, your behavioral health provider will be happy to communicate with your doctor directly, with your written permission to do so. These communications typically happen over the phone or hrough a secure platform. You can ask to see what is being communicated between your providers (or not!). Your counselor, therapist or social worker can handle discussions with your provider that you may not feel comfortable having.

If you feel you are being diagnosed incorrectly due to your size, be vocal. 

It is a sad truth that some health care practitioners blame weight as the culprit for illness or injury before investigating and addressing other potential causes. We know that weight is usually not the cause of problems that typically lead us to visit our doctor.

If you feel that your doctor is attributing your pain or condition(s) to your weight, try asking them the following questions:

  • “If weight were not a factor, how would you go about treating me?”
  • “Would you give the same advice to someone who was in a thin body?”
  • “It is important to me that we look at all the potential causes for why I am experiencing these symptoms. Can you think of any other causes aside from my weight?”

If they insist that the issue is weight related and refuse to talk to you about any other potential causes, you can request to see a different provider. Having these sorts of conversations with your doctor can be quite uncomfortable, so if you decide not to push back on your provider, walk away from this appointment without answers and go elsewhere, that is completely understandable. It is important to remember that you are entitled to look for other doctors. When looking for a new provider, make sure to ask if they’re willing to have a weight-neutral discussion.

Lastly, if you have ever worked with a specialist for an eating disorder, they can be a great resource in helping you find educated medical practitioners suited to provide you with quality care that doesn’t revolve around weight. You may also find that asking around in your recovery group is a great way to find a doctor you can trust. Don’t be afraid to advocate for yourself. If that sounds a little scary, remember that it’s OK to lean on others for support!

The Role of the Dietitian in Eating Disorder Treatment

The Role of the Dietitian in Eating Disorder Treatment

By Timberline Knolls Staff

Treating a person who has developed an eating disorder can be a complex process that requires the dedicated service of a multidisciplinary team of professionals.

Dietitians are among the many experts who can play a vital role in helping people establish a solid foundation for long-term eating disorder recovery.

Depending on a person’s specific needs, their comprehensive treatment for an eating disorder may address the medical, psychological, behavioral, and social concerns that contributed to or were exacerbated by their struggles with disordered eating. Services provided by dietitians can contribute to positive outcomes in each of these areas.

In an article that was published Nov. 17, 2020, on the Journal of Eating Disorders website, authors Shane Jeffrey and Gabriella Heruc wrote that dietitians’ contributions to eating disorder treatment include identifying “the severity of malnutrition, the presence of disordered eating habits, and deficits in nutritional skills and knowledge that inhibit the attainment of adequate nutrition.”

In other words, dietitians at eating disorder treatment facilities may work with patients to help them achieve improved health by expanding their understanding of vital nutrition-related concepts, eliminating self-defeating behaviors, and developing a better relationship with food.

Accomplishing these efforts may involve services such as:

  • Assessing patients’ eating behavior patterns
  • Providing nutrition counseling and education
  • Creating individualized meal plans for patients
  • Helping patients develop more effective coping strategies

A dietitian’s work in eating disorder treatment can involve both providing valuable information and dispelling myths or misconceptions.

For example, one unfortunately common misunderstanding about nutrition is that following a “healthy diet” somehow means abandoning enjoyable foods, sacrificing choice, and limiting variety. Not true! As dietitians help patients develop their meal planning skills, they will introduce them to the wide range of delicious options. Patients learn that, truly, all foods fit.

The concepts of balance and choice can also be key elements in a dietitian’s work with patients in an eating disorder treatment facility.

People who receive treatment for eating disorders may have a wide range of problematic behaviors from restricting to bingeing to compensatory methods. In all cases, a dietitian can help the patient develop a meal plan that provides necessary structure while also offering appropriate amounts of choice, variety, and flexibility. The dietitian can also help the patient understand the nutrition and behavioral concepts that are fundamental to a healthy relationship with food. For many people this creates the foundation for moving towards developing interoceptive awareness and eating intuitively.

As a result, patients won’t merely follow a schedule that tells them when, what, and how much they should eat. Instead, they will have a firm grasp on the reasons for their new behaviors. This can help them take ownership of their continued recovery and escape the fear- or frustration-based patterns that had previously characterized their eating behaviors.

To support patients in following their new meal plans, dietitians may also work with them to develop healthier coping skills. This may be especially beneficial for patients who had previously engaged in disordered eating behaviors in an attempt to punish themselves for perceived failures or numb themselves from emotional pain.

Regaining control of one’s thoughts, decisions, and actions is a vital part of eating disorder recovery. Through continued personalized service, dietitians help patients develop the knowledge, skills, and capabilities that can allow them to achieve long-term recovery and experience improved quality of life.

Fatphobia is probably something you’ve heard about but didn’t have a name for.

Fatphobia is probably something you’ve heard about but didn’t have a name for.
Written by Meagan Mullen, Clinician and Community Outreach Specialist

It is no secret that our society can be judgmental, competitive, and appearance-obsessed. So it’s no surprise that people in bigger bodies can be treated poorly. Most people are probably aware of the fact that being in a bigger body comes with a certain stigma, and having negative attitudes or thoughts about these people is called fatphobia. Similarly, weight stigma is stereotyping people based on their weight.

These types of thoughts and beliefs can often lead to chronic dieting, disordered eating, or full blown eating disorders!

There have been plenty of articles (here and here) that highlight the dangers of fatphobia (and weight stigma!) and showcase how present it is in our society, but what do we do to work against this type of discrimination and unhealthy belief?

There are a few steps we can take to address this issue, and they might be easier to achieve than you think.

1. Recognize your own bias.

Just like with any type of discrimination or unfair treatment, it’s important to be aware of our own biases. It can be hard to live in a society with such apparent judgments on appearance and not catch ourselves slipping up. In a way, we’ve been taught to think certain things that we hear from others, from the media, or even from parents, friends, and family. That being said, acknowledging our own biases is the first step in changing our thought patterns and beliefs.

2. Challenge fatphobic thoughts you have or words you use.

When you catch yourself saying things that might have a negative connotation in relation to someone’s weight or size, STOP! Be patient and kind to yourself as you work against these beliefs that have been ingrained in so many of us. Try using language that is more neutral like “bigger-bodied,” or just drop the body descriptors all together!

3. Read up/learn more about Health At Every Size® (HAES) or body positive movements.

Research and engage with communities/resources online or in person to learn more about how toxic diet culture is! Not only will this information help to challenge some of your own biases, it will also provide you with the necessary language and information to educate/share with others.

4. Set boundaries with others in regards to their language.

If you hear someone else making comments that are fatphobic or degrading about someone’s weight or size, speak up! You can always try to educate others about the Health At Every Size® (HAES) movement, or you can simply tell people that commenting on appearance isn’t appropriate and can lead to negative body image and disordered eating. You can also talk with a trusted friend, adult, family member, or therapist to strategize ways to set these boundaries. My personal favorite: reminding people that there are more interesting things to talk about than someone’s body, diet, exercise, etc.

5. Advocate for and work towards body acceptance.

This is a lifelong goal! So many people are affected by negative body image, chronic dieting, and eating disorders. Helping others realize that a lot of what we’ve been taught about weight and size is false can continue the growth of body positivity.

While no single person can change the world alone, there are plenty of likeminded individuals who see the harm that fatphobia does. Working on these small steps in your own life can begin to change your thought patterns, beliefs, and might even improve your own body image!

The Tools of a Nutrition Therapist

The Tools of a Nutrition Therapist

Written by Jenn Burnell, CEDRD, Regional Director of Clinical Outreach for Carolina House

Every day, individuals seek professional nutritional help in implementing the “perfect diet” that is blowing up their social media feeds.  To make it even more confusing – and potentially dangerous – is that there are varying levels of nutrition experts marketing their services, and knowing who to trust can be just as daunting.  Nutritionist? Dietitian? Medical Nutrition Therapist? Nutrition Coach?  What does it all mean? It can mean everything and/or nothing at all – and if someone is seeking help for eating behaviors that have become life intrusive and are impacting their health, seeking a properly qualified professional is even more crucial.  So… just to make this even more murky, I’m going to add one title more to the mix: Nutrition Therapist.

First off, I must acknowledge that using Nutrition Therapist is not an accredited term nor a certified title- in fact it is not even 100% used among Certified Eating Disorder Registered Dietitians (CEDRDs), which are considered the most experienced practitioners in the eating disorders field.  “Nutrition Therapist” technically can be freely used by anyone, so it is be important to check that the provider also is a Registered Dietitian or Registered Dietitian Nutritionist (RD/RDN).

 

A nutrition therapist provides (want to guess?) nutrition therapy to clients seeking eating disorder recovery and help around chronic dieting patterns.  Nutrition therapy is different from the typical pictures of a dietitian in a lab coat telling a person what to and not to eat.  Instead of focusing on nutrition education and standardized meal plans, a nutrition therapist guides a client along on a self-discovery journey around their beliefs around food.   By dispelling myths with sound nutrition information, and providing a non-judgmental space for clients to discuss, explore, and challenge the “whys” of their thoughts and behaviors, the nutrition therapist helps move an individual towards a life enhancing relationship with food.  On top of this, a nutrition therapist also must provide clinical nutrition interventions to aid in the medical complications associated with eating disorders.

Sounds simple enough, right?  Actually, as many seasoned nutrition therapists will tell you, it takes a long time to hone in on these skills, which often means attending various trainings that are not typically provided in most didactic nutrition programs. Understanding counseling approaches such as motivational interviewing (MI) is integral to help guide clients through the resistance and ambivalence around their detrimental behaviors.

A nutrition therapist must also have a strong understanding of therapeutic modalities that mental health clinicians use when treating eating disorders, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), family-based therapy (FBT), and internal family systems (IFS) to name a few.  Incorporating the language and principles from these approaches not only help create cohesive messaging within one’s treatment team, but it also makes the nutrition therapist more effective in helping their clients.

What about specific nutrition-focused approaches that are best practices for nutrition therapists?  Effective nutrition therapists understand, embrace, and embody the principles of both Intuitive Eating (IE) and Health at Every Size (HAES), and discuss nutrition using a non-diet approach.

I first discovered the book Intuitive Eating back in 1997 at my first job out of grad school.  I credit that book, written by Evelyn Tribole and Elyse Resch, for changing my life both professionally and personally, and plotting the course that led to where I am today.   Their first edition shattered my world as a way to “Make Peace with Food”, and its Ten Principles around breaking the diet mentality served in working with all of my outpatient clients, especially those coming in for weight loss.

Where some aspects of the book may be challenged by staunch non-diet proponents, the overall message embraced by nutrition therapists around the IE model is that of body trust: that the vast majority of individuals have an innate ability to sense hunger, satiety and what food will best honor your needs in that moment.  However, as idyllic as it sounds, it is that simplicity and freedom that can make it seem inaccessible to eating disorder clients.  Also, it could leave individuals (especially those black-or-white thinkers) feeling like a “failure” if they ate when not hungry or past satiety, which are what we as humans and social beings all do from time to time.  Cue Ellyn Satter…

Ellyn Satter is another pioneer in creating guiding principles for nutrition therapists.  Her simple handout called “What is Normal Eating?”, which was penned in 1983, still resonates true today.    Where much of her work revolves around child feeding dynamics, her Eating Competence Model (also known as ecSatter) is based on two key elements: 1) the discipline of providing yourself with regular, reliable, and rewarding meals and snacks and paying attention while you eat and 2) the unconditional permission to eat what and as much as you want at those regular eating times.*  These principles require more structure around eating, which differs from IE, yet both can be important tools for eating disorder clients at different points in their journey.

A component of both Intuitive Eating and the Eating Competence Model, and often discussed in nutrition therapy, is the concept of mindful eating (ME).  Some people may confuse Intuitive Eating and mindful eating on the surface, but they are quite different.  The idea of mindfulness is all about being present in the moment and fully aware of the experience (in this case the meal or snack).  Mindful eating does not suggest anything about your physical state (i.e., whether you are hungry or full) in order to do it, just the ability to notice all that is happening in that moment.  An objective and curious awareness is often the best approach in implementing ME in nutrition therapy work.  Some ideas include: Notice the color of the plate…What do you notice about the temperature of the food/how does the weight of the food feel on in your hand or on your utensil?… and one of my favorite questions: If I was an alien that came from outer space, how could you describe it to me?  If a client does or does not like a food (which is completely okay), a nutrition therapist might ask what is it about the food that objectively is not their preference – notice what specifically about the taste or texture is not appealing, or is one aware if a thought versus or past experience is making that decision.

Lastly, where not a nutrition specific strategy, I would be amiss if I didn’t discuss the importance of Health at Every Size® in nutrition therapy for eating disorders.  I was first introduced to this platform at the Binge Eating Disorder Association (BEDA) conference in 2012, where it created this landing space for the things that inherently made sense from my experiences in weight management and eating disorder work, and shared solid and pivotal research to support it all.  At that time, the take-home messages I assimilated were that 1) one cannot determine anything about one’s health based on a person’s body size, 2) the shame and stigma our society creates around larger bodies is the true health crisis and 3) weight cycling and chronic dieting are the culprits related to poor health versus size or weight.   What I have grown to truly understand over the years is that HAES is really a social justice movement advocating for safety and inclusion of bodies of all sizes (and colors and gender identities and abilities).  In order for a nutrition therapist to be effective in their work, they must truly embody size diversity acceptance, and have done a thorough assessment of their own weight biases.  This can be hard and uncomfortable work, especially because dietetic education provides so many guidelines around weight management.

If you are looking to work with a nutrition professional on eating disorder or chronic dieting struggles, do not be afraid to ask them about their qualifications and approaches to working with clients.  Are you a registered dietitian?  What do you know about Intuitive Eating or Health at Every Size?  What is your approach to weight management?   If you are an RDN hoping to learn more on how to effectively work with clients seeking the above help, there are several resources listed below.  Also – seek out the support and supervision of the many amazing CEDRDs and Nutrition Therapists that are available to mentor and share their vast knowledge with you, and help our world break free from the frivolous search for the perfect diet.

Online Resources:

Where to find a qualified nutrition professional (CEDRD/ Nutrition Therapist)

 

Jenn Burnell is a regional Director of Clinical Outreach for Carolina House, an eating disorder program in Raleigh/Durham, NC.  She is a Certified Eating Disorder Registered Dietitian Supervisor, and owns CEDRD Nutrition, where she helps RDNs in becoming Nutrition Therapists.

Tips for Talking to Your Doctor About Their Weight Stigma and Your Eating Disorder

Written by Monique Bellefleur, Ed.M, LMHC, MEDA Director of Community Education

I hear time and again from clients that they are afraid to go to the doctor’s office. I don’t blame them when I hear their stories: The doctor told them they were eligible for gastric bypass surgery (even though they had not asked about it and have an active eating disorder); They had a heart rate in the low 40’s and the doctor told them they were perfectly healthy (even though they had a BMI of 17 and an active eating disorder); They went to the doctor’s for a sinus infection and the doctor told them they need to lose weight. The list goes on…

However, it remains important to receive medical care. Although we wish the medical community understood more about eating disorders, we unfortunately have to learn to be our own best advocates until the medical community catches up.

Here are MEDA’s 5 tips for speaking to your doctor about their weight stigma and/or your eating disorder:

  1. Don’t be intimidated: Remember, doctors are just people who have gone to medical school. Yes, they have spent years studying the human body, but that does not mean that they are perfect, all-knowing beings. Even though eating disorders have the highest mortality rate of any mental illness (Smink et al, 2012), a 2014 national survey found that out of 637 internal medicine, pediatric, family medicine, psychiatry, and child and adolescent psychiatry programs, 514 did not offer any scheduled or elective rotations for eating disorders (Mahr et al, 2015).
  2.  Use your Voice: Doctors are often overbooked, overworked, and rushing to the next appointment. We all know the overwhelming feeling that comes from listening to your doctor rapidly firing off questions while simultaneously directing you to stick out your tongue, say “ahh”, take deep breaths, cough three times, undress, redress, on and on. It may seem impolite to interrupt this process to ask your own questions, but you deserve to be heard, especially when it comes to your health. Speak up and express your questions and concerns about your care and your body until you feel satisfied with the information you have received. It is not your fault that you have an eating disorder. It is a serious mental illness that deserves appropriate care, and you may need to be very upfront with your doctors regarding your ED. Learning to use your voice is an important part of eating disorder recovery- think of it as an opportunity to practice.
  3. Confidence is Key: It’s a natural response to respect a person of authority’s opinion, but you are the expert on yourself. If something doesn’t feel right, let the doctor know, including when you feel dismissed. For example, if not seeing your weight is helpful for your recovery, tell the doctor and medical staff directly. If they happen to let that information slip (which seems to happen frequently!), bring it to their attention. If you feel like your doctor is dismissing your condition due to your body size or eating disorder diagnosis, tell them. Doctors take the Hippocratic oath to “do no harm”. It may be uncomfortable, but if their comment or behavior harmed you, you can let them know. By educating your doctor on how they made you feel, you may be saving another patient from a similar experience.
  4. Come Prepared: Have you created a plan with your treatment team for how you will handle your doctor’s appointments? Have you done research of your own on a suspected condition? Bring this information with you. Write your questions and symptoms down in advance. Bring along a friend or loved one if you need support. When you are prepared, you will be less likely to panic and forget your questions. If you have literature to share with your doctor about eating disorders, weight stigma, or any other condition, share it with your doctor and express how important it is to you that they consider the information. They may not have had a chance to learn about these topics in their medical training.
  5. Connect them to MEDA: MEDA offers free trainings to the medical community on eating disorders and weight stigma. If you feel like your doctor could benefit from a training, connect them to MEDA at education@medainc.org or at 617-558-1881.

Resources to bring to your doctor’s office on eating disorders and weight stigma:

Citations:

Mahr, F. , Farahmand, P. , Bixler, E. O., Domen, R. E., Moser, E. M., Nadeem, T. , Levine, R. L. and Halmi, K. A. (2015), A national survey of eating disorder training. Int. J. Eat. Disord., 48: 443-445. doi:10.1002/eat.22335

Smink, F. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports,14(4), 406-414.