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

“Food is Love (But Don’t Eat Too Much!)” Eat less. Eat clean. Avoid these foods. Eating is a life-giving pleasure, but confusing messages from the diet and nutrition industries may leave you wondering what to eat. Do you find yourself: Eating food that doesn’t nourish or energize you? Munching mindlessly or emotionally? Flipping between feeling “good” and “bad” about your eating? Thinking about food and your body more than you’d like? Discover how to trust your body, and to eat with love and common sense. Learn how to: eat without deprivation or overeating; accept your body and trust its wisdom; deal with setbacks, destructive thoughts, and self-defeating attitudes; create healthy habits to nurture yourself; and ditch dieting so you free yourself to live a life you love. Nourish will guide you to transform your eating from self-control to self-love, using a 10-step healing process.

Joan’s Story

I remember flipping through the Peace Corps brochure at the end of college, looking at it and wondering, “Could this be a way out?” I had been struggling with bulimia since my senior year of high school and was just starting to get a handle on recovery, but if I wanted to serve in an overseas assignment, I was going to need a clearance letter from my therapist.

Over the next 12 months, I doubled down on my efforts to overcome my eating disorder. Moving out of the dorms and into my own apartment after graduation helped immensely. I was away from the triggers I so often encountered within friend groups and family with whom I’d never learned–or felt safe–establishing boundaries. Being on my own helped me discover my natural cycles of energy, fatigue, and hunger as well as intuitive eating. It helped me to escape the compulsive binging and purging that had been the result of trying to live my life on other peoples’ terms.

By the Fall after graduation, my doctor was ready to sign off on my recovery and I was accepted for a Peace Corps in rural Niger. Living and working in a remote village proved not only to be a life changing experience but it cemented my ED recovery as well. Getting to escape my home environment and western media was a unique godsend. Life in Niger completely eliminated the constant low hum of guilt and shame; the guilt of feeling like I should always be trying to work out more or eat less–neither being an option in the village–and the shame of binging and purging, also not an option at the time.

Now, I’m not telling anyone to run away to the middle of nowhere in order to treat an ED. Not only is it not an option for most, but it did not magically solve my body image issues. You see, I came home from my two-year service, enrolled in grad school, and immediately relapsed from the stress of school and work. I went back to a therapist and was beside myself, asking questions like, “Why didn’t my time away solve this problem? Why didn’t medication and therapy fix all of this? I thought I was better.” The answer was that my first therapists and I had never really explored the underlying issues of my binging. What they, and perhaps I, thought was purely a superficial issue (i.e., body image, self-consciousness, etc.) was actually rooted in much deeper fears I had not recognized or felt safe naming when I was first being treated for bulimia at 18 years old.

Back then, I believed the doctors when they said that the problem was a “lack of self-love” but I struggled to find the metaphorical light switch in my mind, the one that would allow me to experience gratitude and pride in my body. So, I piled the shame of not being able to love myself on top of the shame of my binging and purging. I also tried my hardest to believe those doctors when they claimed societal expectations were “bogus” or that since I could not “prove” people were judging me, I should let go of perceived judgment. But I failed at that, too.

In fact, therapy back then always felt like a low-level gaslighting. I knew what I was seeing in magazines and movies and hit TV shows. All the A-list actors, clothing models, and successful performers seemed to have an obvious thinness in common. Did my doctors expect me to believe that none of that was real? That it was all in my mind? It felt real. The world felt real and my fear felt real. It all created a real lack of trust on my part. I started to wonder how, if they were that blind to reality, they could possibly help me. I was also getting frustrated by what I felt was a need for me to engage in performative self-confidence during therapy. It felt like they were trying to check some metaphorical box of “treatment” but I didn’t feel like I was experiencing improvement. I felt hopeless for wasting my parents’ money on the appointments–they were paying for whatever insurance didn’t cover–and quickly began to grow skeptical of the whole recovery process.

I realize now that recovery isn’t, and wasn’t, hopeless, but that the approach which was taken was not the right one for me. Framing recovery as a journey to self-love might work for some people, but it was, and still is, never going to work for me. The truth is, there are parts of me that I still do not love, and that I may never “love”, whatever that means in terms of body-positivity.- a movement and mindset that never really sat right with me. Essentially, that if you are not comfortable in your own skin then you must not love yourself, and that if you’re not 100% proud of yourself 100% of the time then you’re at fault or not trying hard enough. It was just compounding shame on top of shame. Almost like telling ED suffererers that they want recovery badly enough or that they’re trying to resist getting better– For me, the inability to express body positivity did not feel like a choice I was making, I was merely living-surviving-in a society that shames people for certain physical features and/or over-sexualizes certain body parts. A society in which I never felt safe loving myself in the first place. In fact, I’m still scared. I still ask myself the questions I always have, like, “Will I lose out on things in life because I look a certain way? Jobs? Relationships? Opportunities?” Or “What if a man isn’t attracted to me because of my curvy body?” Or worse, “What if a man is too attracted to me because of my curvy body?”

I feel silly even typing those questions out, but for transparency’s sake, I must admit that they have been the white noise of my life, even during therapy doctors laughed them off and downplayed my fears. It was a disillusionment that led me to stop attending sessions altogether sophomore year of college. And I might have been lost for good, had one of the volunteers in the college health clinic not shared with me a news story at the time. It was that of a young woman found dead in her car in a shopping mall parking lot. The cause of death: a ruptured esophagus. She had been bulimic. I suddenly realized how dangerous my addiction was and the life-or-death consequences of not seeing recovery through. Even though I was still scared of being in my skin and scared of continuing to gain weight during recovery, the potential of dying, especially at my lowest point, was far more terrifying. It was the turning point that saved my life.  

PRECIPITATING FACTORS

When people ask me about the origins of my eating disorder it’s hard to know where to begin. There was no singular event that was the genesis for my way of thinking or behaving. It was more like a slow growth over time. Like a snowball that kept gaining mass and momentum. Or like the metaphor of the frog in the boiling water. The story goes that if you place a frog in boiling water, it will immediately leap out. But if you set a frog in warm water and slowly turn up the heat, it will not jump out. That’s because the frog adapts to the increase in temperature. It grows used to the heat. It knows only the heat. It does not realize there is any other way of existing beyond the heat, even when it is burning and frantic to get out. That’s how dysfunction works. It’s not always obvious, or acute. Sometimes it’s more subtle. Hidden. Insidious. Designed to intimidate people into silence. But I finally have the courage to say it out loud: environmental factors matter. And what goes unspoken, goes untreated.

I grew up in what I could consider a stable home environment: two loving parents, roof over my head, no physical abuse, no obvious addictions, or obvious signs of co-dependencies. Sure, there were fights and tension, but we just learned how to dance around it. How to let things pass. Or how to hold on to them. Inside. How to use passive aggressive behaviors to express emotions like confusion, fear, and anger until it boiled over into the next fight. And the next one. And the next one. Perhaps that’s why doctor after doctor, therapist after therapist, would go on to tell me that I grew up in a “chaotic home environment”, even though it is a phrase neither they, nor I–would have ever relayed back to my parents.

And why would I want to? What right did I have to criticize them back then? How could I blame the two people that had worked so hard to keep it all together: to pay the mortgage, to get me and my siblings into a good school system, to but my expensive racing suits for swim team, to get my brother the best treatment for his ADD, to get my sister help for her mood swings, to get my father treatment for his PTSD? Who the hell was I to criticize them for how it all turned out? I didn’t have those problems. I didn’t have any problems. In my mind, I was blessed. Lucky. Fine. I honestly thought that if I felt any ounce of frustration at the situation, it would have made me look ungrateful.

I realized early on that the only way to deal with my feelings of discomfort and helplessness at home was to stuff it down inside until I could figure out how to get away from it. As a teenager, the only escape I saw was college. And so, I consistently enrolled in the hardest classes and got involved in as many extracurriculars as I could, even when I was overwhelmed. “Perfectionism”, “all-or-nothing thinking”, and “catastrophizing,” may not have been terms I was familiar with at the time, but they were the operating system with which I was hard-wired. All I knew was that any budging on course load or any attempt to take it easy on myself was a threat to my potential escape plan, and so I took on the weight of it all. I was balancing the stress of applying to as many out-of-state reach schools as I could while also going through puberty; gaining weight and curves as a tomboy whose whole identity had been that of an athlete, now trying her hardest to conceal wide hips, big breasts, and a round tummy that didn’t look the way her friends did in crop tops, low rise jeans, or swim team racing suits.

As college rejection letters trickled in and the weight piled on, I became a mess of desperation and failure. Feeling completely helpless and ashamed, I cried in secret in my room, asking myself questions like, “What was wrong with me? Why can’t I win? Why am I so cursed?” And I remember using the word ‘cursed’ because that’s how I viewed my genetics. My DNA. While my mother and my twin sister were thin and slight, I had developed a huge chest and huge hips and so I figured I was taking after my father who was in a larger body his whole life. I was afraid I was becoming that, afraid that maybe people would look at me like how I figured people looked at him. And since I could not make that fear disappear, or the weight disappear, I became bitter and full of anger. Another feeling I did not have a name for at the time. Besides, anger wasn’t something I was supposed to feel. I was the one in my family who avoided conflict. I was the “good” child. I was “better” than that. Better than anger. Or so I thought.

Again, I did not realize I was angry at my father at the time. I just knew that it felt like my skin was stinging and my insides were on fire every time I heard him sneak into the kitchen at night to graze on a box of cereal for 15-20 minutes at a time. His fist pummeling into Honey Nut Cheerios, the sound of his hand drawing a mouthful to his lips, the loud crunching that pierced the air and taunted me in me in my bedroom down the hall, curled up pressing my hands so hard to my ears I didn’t care if I burst my eardrums by accident. To this day my blood pressure goes from zero to sixty if I hear someone crunching hard food like cereal or chips. To this day, it’s still the sound that triggers me the most.

I know now that I was upset with my father but had no way to verbalize it. I remember the questions I asked myself: Why is he doing that to himself? Why can’t he stop? Why can’t I just say something? Why do I feel like Mom would just get really angry at me if I did? I asked those questions every night, in as ritual a fashion as his midnight snacking. And even though I could appreciate that he had been through traumas in his life, and that perhaps he was as helpless to his weight and food issues as I was, I was still upset that he could not stop eating. I thought that people were judging him and I was angry that he couldn’t make it stop, because I didn’t want anyone judging my dad from the outside. He was a good guy. He was my hero. What if they can’t see that? I thought. What if they can’t see past the fat? What then? What if he has a heart attack right now? I suppose I was frustrated that he wasn’t fighting harder to stop that from happening. Or perhaps I was as scared of being judged by others as I perceived them to be judging him.

At the end of the day, my desperation to get away from home and to get out of my “cursed” skin became too much to bear and that’s when I discovered a “way out”. Or so I thought. A high school teacher showed us a movie about the dangers of eating disorders during health class sophomore year. The film she chose was about a thin woman with bulimia and featured a very svelte, very popular actress at the time. And while I cannot blame my teacher or that actress, I do remember it being the first time I considered the possibility of purging as a way to contain all of the things I felt were spinning out of control around me. I talk about this time of my life in a book I am writing about overcoming my bulimia. This excerpt encapsulates the genesis of my ED and what I was feeling at the time:

“It was the late 90’s and the height of “heroine chic”. She [actress] was but one in a whole generation of [women] skyrocketing to fame the more they could make themselves look like skeletons in slip dresses, skin and bones in silk and backless gowns, spaghetti-strap tank tops pasted to their emaciated bodies. I was surprised my health teacher thought any teenage girl could possibly accept the idea that trying to be skinny will make your life worse when the media was bombarding us with the message that trying to be skinny will make your life better.

That resonated with me as an insecure 16-year-old. I was thick and muscular, with large breasts and wide-set hips that had invaded my body overnight the summer after eighth grade. Puberty came late but had struck with a vengeance, dealing the tomboy in me a humiliating defeat. I thought that losing weight would make my life easier, undo some of that embarrassment, turn the dial down on the fear that came along with being curvy. I reasoned that if I could change my body then I would look like I controlled it, and if I could look like I was in control, then no one would dare take advantage of me. In my mind, being skinny offered protection.

WHAT DID IT FEEL LIKE TO HAVE AN ED? WHAT WAS I TRYING TO SAY?

Purging became something that made me feel powerful. Not necessarily in control. In fact, I intentionally do not use the phrase “in control”, which I feel is one overused in treatment. It’s an easy tag, a simple way to label the sufferer and say, “This person just wants to control things and if we can address the need for control then we can fix them.” But this was never about control for me. I never wanted to be in control. I just didn’t want to feel helpless and I think it is an important nuance that often gets misdiagnosed. After all, isn’t it a lot easier for a clinician to tell someone “You need to accept not being in control,” rather than “You need to accept feeling helpless”?

Hurting myself by binging and purging was a way to counteract that helplessness. To express my pain. Hurting myself was a way to express, to expel, the hurt I felt at not being able to express my anger and fear at home. The things I told myself in those moments, the hate and the disgust I hurled at myself in the mirror were really exaggerations of things I wanted to say to the people around me but could not. Years of frustration boiling over. Years of being told to “just drop it” if I spoke up about problems in the family. Years of being told that it was “my fault” if I was distressed over someone else’s inappropriate behavior. Years of feeling so hopeless that at some point I just threw my hands up and thought, “Screw it, I don’t even care how badly I’m hurting myself because what’s the point? I’m trapped in this home dynamic and I’m never going to get out. Or get to be like my friends. Or like the successful people in this world: light and pretty and blessed. Not heavy and ugly and cursed.”

And that’s how it felt for those years from high school into college. Like being the frog in the boiling water without having the permission to say it out loud. Maybe that’s why doctors did not pick up on how bad it was. Or thought the answers lie in simply telling me to journal about my feelings or to “go for a walk instead of binging.” They thought I was a frog in warm water looking for some options, they didn’t understand that I was burning up, reacting to pain and deep-seated compulsions, not acting on reason or making decisions in a vacuum.

The good news is, when I graduated college and moved into an apartment alone it was like all of the hot water drained away. It wasn’t that treatment–i.e., medication, therapy, self-work–had not worked, but more so that it had always felt like ice cubes tossed into the boiling water, helping some, but not fully healing. Which is not to dissuade anyone from seeking help or trusting the process, but rather a call to clinicians and parents to acknowledge how much environmental factors do feed into eating disorders. And I’m not blaming my parents for my actions or my “chosen” coping mechanism. I don’t think they had any idea how bad my eating disorder was. Or how bad my people-pleasing was. Or that I was learning how to do that instead of learning to set boundaries. That my being “a good little girl” was symptomatic of how I was just trying to keep the peace in what I felt was an unpredictable space. That my habit of going along to get along ended up bleeding into my first friendships, some of which were not borderline toxic–a trait doctors would tell me I sought out in order to recreate familiar dynamics, a way to reach for safety and security by proving my loyalty to others.

Note: If you are not aware of what people- pleasing looks like or how detrimental it can be, here’s an example of some typical thoughts that crossed my mind on a daily basis back then: “My friend wants to hang out but I have a paper due? I guess the paper will have to wait. I don’t want my grade to suffer but I also don’t want to get in a fight right now. Best to just give in to what she wants, even if I end up punishing myself with a binge later.” Or, “My friend wants to order pizza but I already ate? I guess I’ll have to just eat again and find a bathroom because that’s the lesser of two evils. It’s much easier to punish or hurt myself than to hurt her feelings by saying, ‘No’.”

Again, all of these things were swirling around in my head and I don’t think I had a true ability to recognize them or the courage to combat them because I had convinced myself that I was fine. Because I had to be. Because not being fine might draw attention to problems at home and then what? Would my parents get angry? Would there be retaliation? They had spent hundreds of dollars for me to go say things to psychologists in private, to brainstorm “behavioral changes” only to walk right back into an environment where it didn’t feel safe or good to put any of that into practice. If it’s not obvious by now, what I was trying to say through my eating disorder was that everything was not fine. That I was not okay. And at the same time, I am lucky that my mother finally recognized it.

WHAT DID RECOVERY LOOK + FEEL LIKE?

I’ll never forget that day in May, senior year of high school, two weeks before prom. The day my mother stopped me on the way out of the bathroom and said, “You have a problem. Can I take you to the doctor?” Apparently, she had overheard me purging more than a few times and had already researched and contacted an eating disorder specialist. Although I was mortified to have had my secret revealed, I was relieved to no longer be alone in my shame.

While I struggled to reconcile those feelings of frustration at home with gratitude for my mother’s care, I began seeing the psychologist once a month. Things started off alright. It felt good to talk to someone about all I had been hiding. However, when I headed off to college, a few months later, things went off the rails and I began bingeing more to deal with the stress of school and socializing all while trying to look good and impress all of these new strangers. Everything felt like a crushing wave of defeat, like there was no way out for me and that I was going to be stuck forever in that state of unbearable stress and fatigue.

For better or worse, the physical and mental loads became so high that I could no longer deny their existence. I had to face it, I–the perfect student, the perfect child–was overwhelmed and failing. When I checked in with my therapist over Christmas break, I finally started using words like stress, confusion, fear, exhaustion, etc. Words my younger self, so desperate to get out of my house and away from my hometown, would never have uttered for fear of those emotions standing in the way of my success and my escape from it all. Before returning to school in the Spring, the doctor prescribed a high dose of medication to help with Generalized Anxiety Disorder, the first time anyone had officially used the diagnosis with me.

After a few weeks, I could feel it starting to work and take the edge off, but I can’t say it made me feel “good” or “better”. It just kind of numbed my brain. And made me really tired. And  hungry. It was like a double-edged sword: enough to slow the racing thoughts and allow me to better rationalize with myself yet zapping me of the energy I needed to succeed in school, and more importantly, to keep up with a regular exercise routine. I gained weight and by the end of sophomore year felt like I had gone all the way back to square one: mortified and hopeless. At some point, I just resigned myself to the mantra that “the only way out is through”; that I might have to endure the discomfort of body changes and fatigue short term if it meant a way out of the 24/7 bulimia cycle in the long run.

It was around this time that I heard about the young woman who had died from the ruptured esophagus and it just reassured me that I needed to keep going. I researched survivor stories and found strength in those, too. I sat with my fear, my shame, and discomfort, and found a lot of gray areas among my black and white thinking. I accepted that I could not just magically wake up one day and stop. And that I wasn’t weak or a failure for that. I was able to find some room for permission, and grace, to go at my pace of recovery. I started to set small goals around behavior usage. By senior year, I had made great progress. By the time graduation rolled around, I was able to see light at the end of the tunnel. For the first time, I had faith in my ability to manage my life and create a future for myself.

Likewise, I learned to be very cognizant of the living and working environments in which I choose to remain or those of which I choose to leave. And while I sometimes feel ashamed that old triggers and fears and shame still follow me, I am proud of how fiercely I have protected my peace and gotten myself out of situations that threatened to disrupt my years of recovery. I may not be perfect, I may still struggle to set boundaries, I may still struggle to talk to my fear and my all-or-nothing thinking, but I know I will never put myself back in a position where I’m taking all of that out on myself. I have learned to stand up for myself. I have learned to communicate my fears. I have learned to be more honest with those around me. I know that what I have gained in finding my voice is far more than anything I have lost.

The truth is, I have gained understanding with family members, even if we need more space at times. I have gained healthier friendships, even if it has meant letting go of others. I have found jobs that align with the work-life balance I need to maintain recovery. I have gained faith in myself and a wealth of pride and confidence to replace the years of shame and confusion. I have gained a pride in surviving and getting to the other side of my fears, to the other side of a wall I never thought I would scale. I have gained these words and I want them to be heard. I want someone else who may be feeling similar fears or struggling with similar things to not feel so alone in that. I want you to know that I feel you, I see you, and that there is goodness waiting for you in recovery.

The Intuitive Eating Journal: Your Guided Journey for Nourishing a Healthy Relationship with Food by Elyse Resch

Based on the popular anti-diet program, Intuitive Eating, this guided companion will help you pay attention to your body’s natural hunger cues, and develop a healthier relationship with food. 

The Intuitive Eating Workbook for Teens by Elyse Resch

A new, non-diet approach to adopting healthy eating habits! Drawing on the same evidence-based practices introduced in Intuitive Eating, this workbook for teens addresses the ten principles of intuitive eating to help you listen to your body’s natural hunger and fullness cues.

Do you struggle with stress eating, overeating, emotional eating, or binge eating? You aren’t alone. Sometimes, when we’re not feeling so good, food can seem like a great comfort. The problem is that over time, overeating can lead to several physical health problems, as well as depression and lowered self-esteem. So, how can you put a stop to unhealthy eating behaviors before they become ingrained, lifelong habits?

With this breakthrough workbook, you’ll learn to notice and respect your body’s natural hunger and fullness signals, find real eating satisfaction, cultivate body positivity, and build a profound connection to your mind and body for years to come. Each chapter includes an important principle of intuitive eating, and includes worksheets and activities to help you connect with and deepen your skills.

Whether you’re a teen, a parent, a clinician, or a certified intuitive eating counselor, this proven-effective workbook is an essential resource.

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

Unapologetic Eating by Alissa Rumsey, MS, RD
Unapologetic Eating by Alissa Rumsey, MS, RD

Unapologetic Eating by Alissa Rumsey, MS, RD

In her new book, Unapologetic Eating: Make Peace with Food & Transform Your Life, registered dietitian and certified intuitive eating counselor Alissa Rumsey helps you explore your history with food and your body and question societal expectations to get to the bottom of the complexity and find a clear path forward—forever free from diets! Using a relatable four-step approach, Rumsey teaches you how to reconnect with your body using your relationship with food as the entry point. She provides actionable tools you can use to confidently nourish yourself physically, mentally, and emotionally. You’ll learn how to make peace with food, improve your body image, trust your intuition, and reclaim the space to eat and live unapologetically. Say goodbye to the constraints of dieting and hello to the freedom and empowerment to live your most fulfilling life.

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.

How to Raise an Intuitive Eater by Sumner Brooks and Amee Severson
How to Raise an Intuitive Eater by Sumner Brooks and Amee Severson

How to Raise an Intuitive Eater by Sumner Brooks and Amee Severson

A manifesto for parents to help them reject diet culture and raise the next generation to have a healthy relationship with food and their 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.

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!

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

Food Psych

Helping people make peace with food since 2013. Registered dietitian nutritionist, certified intuitive eating counselor, and journalist Christy Harrison, MPH, RD, CEDS talks with guests and answers listener questions about making peace with food, healing from disordered eating, learning body acceptance, practicing intuitive eating, escaping harmful wellness culture, and more–all from a body-positive, anti-diet perspective. Along the way, Christy shares her own journey from disordered eater and dieter to food writer and anti-diet dietitian. This podcast challenges diet culture in all its forms–including the restrictive behaviors that often masquerade as wellness and fitness. Food Psych® is designed to offer safe and non-triggering support for listeners in recovery from eating disorders, weight stigma, and body shame.

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.

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.

Mindful & Intuitive Eating for BED Recovery

Mindful & Intuitive Eating for BED Recovery

Written by MEDA undergraduate intern, Stephanie Wall 

Binge Eating Disorder (BED) is the most common eating disorder in the United States (NEDA, 2018). About 3.5% of American women, 2% of American men, and 1.6% of American adolescents currently suffer from BED (ED Referral, 2018). It is characterized by recurrent episodes of eating large quantities of food, often very quickly and to the point of discomfort. Those who suffer from BED tend to feel a loss of control during the binge and experience shame, distress, or guilt afterwards. Further, compensatory measures, such as using laxatives or forcing oneself to vomit, are not enacted to counter the binge. In addition to typical therapy for eating disorders, such as Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT), using both intuitive and mindful eating techniques can be quite powerful in helping those struggling with BED.

A common symptom of BED is engaging in any new practice with food or fad diets. This contributes to body dissatisfaction, food and body preoccupation, and weight stigmatization (Tribole, 2017). The fallout from this mindset is mandating what and when one eats, regardless of one’s biological needs. In those with BED, this rigidity can lead to a binge, and thus feelings of a loss of control. This is known as the binge/restrict cycle.

Intuitive eating can be helpful in breaking this cycle. Intuitive eating is a personal process of honoring your health by responding to your body’s biological signals (Tribole, 2017). Here at MEDA, the EmbodiED Group focuses on self-compassion in their sessions, emphasizing this idea. Because a major idea in intuitive eating is listening to oneself and meeting one’s needs, the individual undergoing this change must be ready for it. This is a key factor for therapy to work, which is why intuitive eating works best for those who have the internal motivation to recover.

One major component of intuitive eating is “legalizing all food” (Hirschmann, 158). This means viewing all food in the same way, in order to remove the idea of “good” vs. “bad” calories. Because namely “junk food” is consumed during a binge, removing the negative connotation associated with that food may help alleviate some of the guilt felt after a binge. This also destroys the idea of “trigger foods” because all food is seen as the same. Many individuals who suffer from BED believe that even the slightest consumption of a certain kind of food will automatically invoke a binge session. According to Dr. Sandra Aamodt, a neuroscientist, hunger and energy use are controlled by the brain, mostly without one’s awareness. Thus, if we truly listen to our bodies and eat without guilt, the more we will naturally crave nutritious food.

Moreover, the idea of the “clean the plate club” has to be disregarded for intuitive eating to work. Being sure that everything on a plate is eaten disconnects us from our bodies and our feelings of fullness (Tribole, 2017). The basis of intuitive eating is to eat when hunger strikes. By legalizing all food as well as ending adherence to rigid rules, intuitive eating can be achieved.

Often those with BED eat when they are overwhelmed and stressed. To eat both intuitively and mindfully, we must ask ourselves how we are feeling and thus why we are eating. As a therapy, having the patience to sit with their feelings instead of eating to quell them is very effective (Tribole, 169). This coincides with mindful eating, based on concepts in the Buddhist faith, which involves being fully aware of what is happening within and around you in the moment. In addition to learning how to eat intuitively, learning how to eat mindfully is important.

Staying present and mindful while eating “allows you to feel the direct experience of your body and the many sensations of eating” (Tribole, 137). Someone who eats mindfully acknowledges that there is no right or wrong way to eat, varies their degree of awareness surrounding the experience of food, accepts that their eating experiences are unique, directs their attention to eating on a moment-by-moment basis, and gains awareness of how they can make choices that support health and wellbeing (The Center for Mindful Eating, 2013). A common method for eating mindfully is eating with one’s non-dominant hand. In one study, participants were instructed to eat popcorn while watching a movie. Unknown to them, the popcorn was a mix of fresh and stale. Those who ate with their non-dominant hand recognized the stale popcorn, and ate less of both the stale and fresh popcorn. Their counterparts didn’t recognize the stale popcorn and ate more (Tribole, 2017).

Experts suggest starting gradually with mindful eating by eating one meal a day or week in a slower, more attentive, manner. Thinking about the flavor, texture, temperature, and aromas of what you want to eat before you settle down to eat will help you eat in a mindful manner (Tribole, 135).

Intuitive and mindful eating are quite useful for re-establishing one’s relationship with food, however these concepts will not address all components of the eating disorder. Typical forms of therapy proven to work include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and interpersonal psychotherapy. By working on both the physiological and psychological aspects of Binge Eating Disorder, recovery can be achieved.

Citations:

Aamodt, S. (2013, June). Why Dieting Doesn’t Usually Work. Lecture presented at TEDGlobal 2013. Retrieved August 2, 2018, from https://www.ted.com/talks/sandra_aamodt_why_dieting_doesn_t_usually_work/transcript

Baer, R., Fischer, S., & Huss, D. (2006, March 03). Mindfulness-based cognitive therapy applied to binge eating: A case study. Retrieved August 2, 2018, from https://www.sciencedirect.com/science/article/pii/S1077722905800574

ED Referral. (2018). What is Binge Eating Disorder? Retrieved August 7, 2018, from https://www.edreferral.com/binge-eating

Harvard Health Publishing. (2018). Mindful eating may help with weight loss – Harvard Health. Retrieved July 31, 2018, from https://www.health.harvard.edu/healthbeat/mindful-eating-may-help-with-weight-loss

Hirschmann, J. R., & Munter, C. H. (2010). Overcoming overeating. Place of publication not identified: OO Publishing.

McQuillan, S. (2014, October 21). Mindful Eating Helps Prevent Overeating. Retrieved July 31, 2018, from https://www.psychologytoday.com/us/blog/cravings/201410/mindful-eating-helps-prevent-overeating

NEDA. (2018, February 22). Binge Eating Disorder. Retrieved July 26, 2018, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed

The Center for Mindful Eating. (2013, August). Introducing Mindful Eating. Retrieved July 31, 2018, from https://www.thecenterformindfuleating.org/

Tribole, E., & Resch, E. (2017). The Intuitive eating workbook: Ten principles for nourishing a healthy relationship with food. Oakland, CA: New Harbinger Publications.