Eating Disorders - What You Need To Know

Welcome to the Anxiety Society Podcast.

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Elizabeth Mackinbell and.

Cali Werner, both therapists and individuals that have navigated our own anxiety journeys.

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Welcome back to the Anxiety Society Podcast.

I'm so thrilled to have Emily Han here with me today to talk about all things eating disorder related.

I've wanted to talk about this topic for a long time because Liz and I are not experts on food or nutrition, but we've talked about it enough to where I'm like, we probably should have an expert.

So can't wait for you to join us and teach us all the things.

Thanks for being here.

Thank you for having me.

I'm excited.

Well, we always start every episode with an anxious moment, so I was wondering if you wanted to go first or if you wanted.

Okay.

I did prep you a little bit.

You warned me that I would have to share this.

Yeah.

So a couple things actually came to mind whenever you asked me about this.

And the first one is I'm coming back from maternity leave.

So this was my second maternity leave.

Stepping away from the practice for a little bit, spending with my new little girl, which is exciting.

And coming back as someone who owns a private practice and is seeing clients and rebuilding my caseload and stuff, there's just some anxiety with, like, oh, my gosh, are there people gonna call?

Is anyone gonna schedule?

And we had a really slow week, and I was talking to my husband one evening, and I was like, oh, my gosh.

Like, I don't know, like, how long is it gonna take me to rebuild my caseload?

Is anyone ever gonna call again?

And he's like, it'll be okay.

And the next day, two people called and scheduled, and I was like, okay, we're good.

That's how it.

That was a good one.

That's such a private practice thing.

Because I did private practice for a while too.

And I just remembered always having a slow week and my husband saying the same thing.

It's gonna pick right back up.

And it always did.

And it stinks.

Cause we can't really enjoy the slow week.

Oh my gosh.

Like wanting a slow week and then we have it and then we're back at it again.

Oh, there's so many people are like, just enjoy it.

Go get your nails done, something.

And I'm like, I can't.

There's stuff to do.

So I'll share that one.

That was fun.

That was a good one.

Did you say you had a part two?

You know, having an infant, there's so many things that you're like, is this wrong?

Is this abnormal?

Is this.

You know.

And she spiked a fever, ended up being okay, but it was.

And she's in a good place now.

She's good, she's healthy, everything's fine.

But as a parrot, like, it's an anxious moment for sure.

For sure.

Or moments all the time.

So I think very relatable.

Okay, I have to have an anxious moment now too.

I was thinking this morning has just been an anxious moment for me because one, we have some kind of insane coffee beans in our coffee makers right now at the clinic because I feel like every time I drink them, I am wired.

And so even just like my energy right now, it's a little abnormal.

I felt kind of bad for my 9am patients that I had this morning.

But yeah, so I think that the way that this coffee hits me when I'm back to back, I just feel like, oh, you can't mess up kind of mentality.

But I feel like I'm always on the verge of messing up when I have too much energy.

And so, yeah, heart rate's higher.

Just overall general feeling of anxiousness.

And once the coffee wears off, I'll be fine.

Well, I tell you what, that's why I switched to Matcha is because I couldn't handle it anymore.

Yes.

Smart girl, smart girl.

But.

Well, I'm going to introduce Emily Han.

And so Emily is an eating disorder dietitian in Houston, Texas.

She owns a private practice called We All Eat Nutrition Therapy.

We All Eat specializes in intuitive eating non diet approach and eating disorder recovery.

Emily is a certified eating disorder specialist, supervisor through the International association of Eating Disorder Professionals, and a board certified specialist in sports dietetics.

Ugh.

Can't wait to talk about that.

Emily is currently serving as president of the board of the Houston Eating Disorder Specialist and lastly is contracted with the Houston Ballet Academy where she offers dietary support to professional dancers.

What a cool bio.

I love this.

Yeah, thank you.

So I think the first thing I wanted to ask about, just from reading your bio that I didn't give you a heads up on.

Yeah, yeah, that's right.

Is the non diet approach, like to listeners, just what does that mean when you're working with an eating disorder specialist?

Yeah, sure.

I think when people think about dietitians, the first questions I usually get is, can you make me a meal plan?

And can you help me lose weight?

And the non diet approach allows us to shift and just focus on behavior change.

So it's not about numbers, it's about you as an individual.

What do you value, what are your goals and how can we achieve that in a sustainable way that isn't going to be damaging to your relationship with food or your body image?

Yeah, I love that so much because you probably know it better than anyone.

But just the diet approach always seems to have long term effects that I don't think people will know that they're signing up for.

Yeah, I love that so much.

So let's kind of just go through some of the most common eating disorders.

Again, not being a specialist, I know anorexia, bulimia.

I don't know if bulimia nervosa is different from bulimia.

Just some clear the air terminology would be amazing to set the pace for.

Yes, yes, of course.

So I think when people think about eating disorders, they picture this thin, white teenage girl who doesn't like her body and decides that she doesn't want to eat.

And that's just not what eating disorders are a right or look like.

And I know we'll get into like myths and things like that in a second, but just to kind of name the main eating disorders that I'm seeing in my office are anorexia nervosa, bulimia nervosa, binge eating disorder, and arfid.

So it's avoidant restrictive food intake disorder.

But I also see a lot of people that don't have a diagnosis either or fit maybe into more than one category.

And there is technically a category for that.

But you know, sometimes the diagnosis matters, sometimes it doesn't.

Right.

But just to kind of name those as like the most common ones that I'm seeing.

Yeah.

And like behaviors that they want to change when you notice that they don't fit a certain diagnosis is that usually what they're coming in for?

Yes.

Yeah, it's in.

Is it affecting your physical health or your mental health or your social well being or like it's impacting some part of their life that they're not happy with?

Right.

And that's usually what brings them in.

Yeah.

We often talk about how in ocd, anxiety, it's more ego dystonic, meaning the individual doesn't like the behavior.

Would you say that eating disorders are a little bit harder to treat because they might be more egosyntonic?

Or am I just left field here?

Both.

Okay.

Both.

It depends on the situation.

Yeah.

Sometimes, especially with my teenagers, they're there because their parents want them to be there.

Right.

Sometimes they're there because they want to be there too, but other times not as they get older, then I think sometimes there's a little bit more, I don't want to say self awareness, but just owning their own recovery.

Yeah.

And so it looks different.

What is that approach?

Like when there's hesitance, when they don't want to be there?

How do you even go about it?

Yeah, well, I'm not afraid to name it, first of all.

Yeah.

I'm like, look, I know you don't want to be here.

It is what it is.

Like, let's make the most of this time.

And I think building rapport with our clients is the most important thing that we could do before we do anything else.

Because they don't know me, they don't know to trust me, you know, and.

So, so you can't just lay it on them like, look, these are the things that you are setting yourself up for.

You have to build that rapport in order for them to trust you.

And then maybe educating them after.

Yeah, yeah.

And I think helping them identify parts of their life that it is impacting, even if they're not aware of it too.

What are your values?

And that's where I work really closely with therapists on, you know, multidisciplinary team is important.

But why, why do you think you're here and why do you think it could impact your life if you recovered?

Yeah.

No.

One of my favorite cases that I will cherish forever was someone who came to me for anxiety.

And we worked on that, but was also working with another provider for the eating disorder side of things.

And this client just thrived.

And I know that's not always the case.

I know it can be really hard and challenging, but it was just like such a rewarding experience because it actually debunked A lot of the myths that I held about individuals struggling with eating disorders.

So I feel like we're learning from those experiences every day.

What are some of the behaviors you see that might not necessarily just fit into one category of this is anorexia nervosa.

Restriction.

Just in general, people don't realize that.

And when I say restriction, I mean like limiting calories or limiting food groups or maybe it's limiting times of day that they eat.

I would say across every diagnosis that I just mentioned, we see restriction.

Yeah.

And we get kind of, I guess, gutsy in this podcast.

So, like, when you see things like intermittent fasting or does that stuff just make you cringe?

If I'm being honest?

A little bit, yeah.

Because.

And I'll get into this probably later, but it's so hard because there are so many nuances within nutrition and there's not this one size fits all approach for everybody, or we would all just eat the exact same thing at the exact same time every single day.

And it doesn't work like that.

It's just not that simple.

And so I might have two clients in front of me.

And intermittent fasting works great, great for somebody.

And for somebody else, it triggers a full blown eating disorder.

So the part that people don't realize is with dieting, one in four people who diet will become obsessive with their dieting.

One in three people will go on to have an eating disorder.

That is wild.

I did not realize that was as significant as it is.

Yeah.

Dieting is one of the top risk factors for having an eating disorder.

And so when people are doing kind of these name brand diets or these like quick fix diets, I'm like, like, let's hold on because like, that's really risky and I don't know that it's going to benef benefit you long term.

And I am going to jump around here just because I love talking to you about all of these things.

But what if a friend of mine that I have has this approach often when we have gatherings and get togethers and she will say, well, I do not want this in my house anymore, so we need to eat all of it.

I have my own history with eating disorder recovery that I am in now that for me it doesn't.

I wouldn't even say trigger is the right word, but it's more of this, like, oh, I'm angry because you could have a better relationship with food than that.

But I don't know how to approach it with this friend.

I don't want to offend her or I don't know if she knows her relate.

So we're not close enough for us to be able to actually have a deep conversation about it.

But what would I do in that situation?

I'm treating you like you're on the hot seat.

No, it's so hard because it's everywhere.

It's not just these extremely severe cases that we see that are hospitalized.

Like, it is also the girls night you went to and somebody made cookies and she is not comfortable with them being in her house.

So she needs you to take them out or she needs to throw them away or something because she doesn't have control and that's okay.

But also, like, what.

What do we do with that?

Right?

Like, is that affecting her life so much that she needs help and, like, needs to talk to someone, or is it kind of just like a thought in passing and something she learned from her mom that she said?

And that's just like the way that it's always.

And it doesn't super impact her life, but it's just normal to say.

That's a good point.

Like, it doesn't have to be.

This is an eating disorder.

This could be a characteristic that's been carried down for her too.

She could go out and have a cookie the next day and not think twice about it.

You know, we don't know the inner workings of her relationship with food.

But saying things like that, especially to people who are in recovery or know to look for that kind of thing, can kind of be like, I don't know.

Did you hear that?

What does that mean?

Like, do you need help?

Where's the red flags?

Right?

You can just kind of like, raise awareness, I guess.

And so it's hard because if you were to approach that conversation with her and be like, hey, I think you need some help?

She might be like, what are you talking about?

Yeah, for sure.

Or it could be like, yes, thank you so much for saying something like, it's hard.

You don't know.

Yeah, yeah.

Like, often I think it's that.

Callie, are you trying to therapize me kind of.

No.

Which I get.

But that's really helpful.

And I think especially just the way that culture and society and social media is right now that you're so right.

Those comments are everywhere.

And sometimes I get frustrated with, like, your thoughts on this too.

But I like to talk about food and, like, the things that are coming out today, especially with how our political system is working around.

Hope you're going there today.

Yeah, I know we won't go too in depth with it, we've already done that.

But just the culture of it.

I do think it's interesting to talk about, but I also catch myself needing to be mindful of who am I talking to about this?

Because one, I am not giving food advice.

I am just shooting the stuff.

I think I find it interesting and creative.

But then my worry is, but am I triggering someone else?

And I think in a lot of ways we want to be food positive.

Right.

Like we want to say we'd way rather people eat than not eat.

But then when I do want to discuss some of these things, I don't know, I feel like sometimes people can get offended about just talking about it.

And so it's like, you can't win either way is kind of what I'm trying to say.

And I find that to be a really challenging world to live in.

Yes.

Is that something you see?

Yes.

Okay.

Not only in my work, but in my personal life too.

Yeah.

And most, for the most part, people know where I stand with food because of what I do.

And so I don't get a lot of opportunities unless it's someone new to me to like feel it out and like, you know, handle that conversation a little more carefully.

Usually people know where I stand before we talk about it.

So it's, it's a little more one sided.

Yeah.

But to your point about like the things that are coming up in our culture and the things that are being said about food, I have had to even turn to more people that have like a PhD in nutrition that are really deep in the weeds of research because, and one of them I'm going to quote, he says it takes seconds to spew, but hours to debunk.

And it is so true because I can go to Google, TikTok, Instagram, whatever, and find any catchy quick title that is fear mongering or quick for everybody to jump on the bandwagon or believe.

And then when you start actually deep diving into the weeds of it, it's like, well, is that really what we think it is?

Is this really the cure all to what I'm looking for?

And I feel especially for parents of children because they're just trying to do the best that they can and like provide their child with the best care and support and love.

And when that comes to food, people get really opinionated and really hot really fast because they think what they think is the best answer.

Right.

And it might be the best answer for them, but it may not be the best answer for everybody.

And I think people are so closed off to that conversation and closed off to the idea that what they think is wrong, that it's like, yeah, yeah.

This, like, I'm damned if I do, I'm damned.

And then you get stuck.

I found myself doing this from a healthy place, but, oh, well, I need to make this food because that's healthier and I'll feel better today.

Oh, but I can't use this pot because that research said, don't use this pot.

And you're like, well, then what do I do?

Not eat.

Right.

It's just kind of wild.

And yeah, to the other degree, I was just talking about lattes with a friend and sometimes I like the taste of oat milk in my latte over other milks.

But that situation ended up being a triggering conversation for them.

And so, yeah, I think it is just a hard world to live in.

And I say today, I am sure it has always been challenging and different, but we are just not used to the social media, the constant.

But I totally get what you were saying about.

I love that quote.

You can spread it so quickly and it can be really damaging.

And that's the same for the world of anxiety.

Right.

CBD gummies were such a big thing for a while and I wanted to grit my teeth because of course people would rather take a quick fix over having to do some really hard work to get long term freedom.

Oh, yes, exactly what you said.

Apply it to food.

It's the same thing.

It's the same thing.

And if it was that quick, we would all be doing it.

But it's not sustainable or it's not the right answer for everybody.

And that's really frustrating for people for sure.

So what are some of the myths in the world of eating disorders or even just some of the stigma that exists around eating disorders?

Yeah, well, I named it earlier, which is like what we think eating disorders looks like because of how it's portrayed in movies.

But I think the other bit of that is, you know, eating disorders affect all ages, all races, all genders, like everyone.

And I've probably had people in my office that you would see on the sidewalk and be like, they have an eating disorder.

Like, what are you talking about?

And people in their life do that to them.

And so it is a bit of a mind F, if you will, because they're like, should I be here?

Like, should this be a problem?

And there's just like a lot of questioning with dieting being so rampant in our culture.

Right.

There's a Lot of, like, why is it okay for them to do this and not for me to do this?

Because, you know.

And is it.

Is it that there are more females than males that struggle, or has the research changed since those findings?

It's a little bit of both.

I think a lot of our screening tools are geared towards females.

I think it's more normalized in females.

Men struggle, too.

Right.

We don't have appropriate screening tools for them.

We're working on it.

I think that it's come from further than where it was at one point, but just the stigma.

Yeah.

You know, there's a lot of stigma around men having eating disorders.

And so we're working on it.

Yeah.

No, no.

But I treat men right now on my caseload, so amazing.

It happens.

Yeah.

I would say those are probably the biggest myths.

And what about some of the psychological and physical impacts of eating disorders?

I know that's a loaded question for probably, like, 10 hours, but.

I know, I know.

Yeah.

Well, it's huge.

To answer your question.

Yeah.

So when I think about the physical, it's pretty common for me to work with a physician on people who have eating disorders because it can affect our hair, our nails, our skin, our ability to poop normally.

Like, it can affect so much of the physical body psychologically.

It can make our anxiety and our depression worse just in and of itself.

It can affect our social life and, like, being able to go out to a restaurant or go on a date or, like, do things that we enjoy or want to do, travel.

So it impacts so many aspects of our life.

Because, like, my private practice is named.

We All Eat Right.

We all have to have food in some way.

And I don't think that we're taught appropriately, like, what that's supposed to look like.

And then the information that we do get just isn't really helpful.

And so it kind of leaves people questioning, like, what am I supposed to do with food?

Yeah.

I was kind of blown away through a personal experience I had.

I trained for marathons and been a big runner for a long time.

And I saw Kylie with Fly Nutrition out in Colorado because she works with endurance athletes.

And I did.

I went to her to see how I could fuel for this upcoming marathon recently.

And again, this is a place in my life, like, where I'm at in my journey.

Have a good relationship with food.

But I was so tired all the time.

So tired.

And, like, more than I knew I needed to be.

Cause I had trained for a marathon before, and my mileage was higher, but I had done that all through college.

And so it wasn't anything new.

And it was something as simple as, I have dogs now and I have a lot of dogs that we find and home.

And so I was going and doing these workouts, but then I had this routine of going to the dog park afterwards before grabbing a smoothie or something.

And the only thing we really changed in that specific moment, along with supplementation, all other important things, but was having a protein shake right after.

And I know we don't need to get too specific, but my fatigue totally changed because I was not fueling myself after the workout appropriately.

And so it's amazing that I used to have this stigma or this belief that, no, there has to be something wrong, really wrong, in order to see a dietitian or a specialist.

And my life changed with that one small thing that I just didn't have the education on to do myself.

And it was mind blowing, for sure.

Yeah, I see the same thing with people who've cut out carbs or something.

And there's a lot of B vitamins and carbs.

Not to get too sciency, but like, there's a lot of B vitamins and carbs which provide us with a lot of energy.

And same with just like the glucose we get from carbohydrates and things like that too.

It's our primary source of energy in our brain and our body.

And so when people cut out a lot of carbs, it's oftentimes that they're just not giving their body enough to work with to start out, let alone being an athlete as well.

And when people reintroduce those in a way that's appropriate for them, and the lights just come back on and they're like, I have so much more energy.

Yeah.

I felt I can do things like, it's awesome.

Like, to be able to impact people's lives in that way is just so cool.

Yeah, well, because the other thing, I got a PR in my marathon, which I was super pumped about.

But then, you know, in the back of my mind, I was thinking, like, is my iron really low?

Or all of these other things.

And it was just really nice to know that she had me in that situation.

And I want to emphasize the importance of dietitians around the world now through my own personal experience.

Dietitians everywhere.

Yes.

And then we've kind of talked about the role of diet culture.

Are there any other cringe things that you feel are just really common in today's world that we should look out for?

When you say cringe it makes me think of social media.

I know.

Which is.

Okay, like, I'm gonna go there.

Trends.

Yes.

That are coming up.

That.

So it's less of a trend and more so something to look out for.

Yeah.

I find a lot of people in the personal training, but also the nutrition field tend to lead with what their body looks like.

And it's not uncommon for clients of mine to say like, oh, I found so and so, like they had this workout I really liked and like they had this body I really aspired to look like.

So I started doing their workouts and started following their nutrition plan and I'm like, okay, that's great.

Like those things might be great.

I have no idea what those things look like.

I don't know who this person is.

But just because you do what they do doesn't mean that you're going to look like them.

And so many of these people online, these influencers that are trying to sell their supplements, their nutrition plan, their workout program, look the way people want to.

Look, or they're saying like, you want.

Abs like these do buy my 12 week workout course or whatever it is.

You know, a lot of times it's food, it's a diet plan, it's this, it's that, it's meet with me, I don't know.

And there's this promise of like lose X number of pounds in a month or something.

There's like promise like this one size.

Fits all kind of approach.

Yes.

And so I think if people can just put on a curious eye and be like, okay, are they selling their body?

Are they selling something I'm actually interested in?

Are they selling me something that they can actually follow through on that's sustainable and healthy for me?

Or do I just feel really uncomfortable in my body and think that I need to lose all of this weight?

Because a lot of times people come to us and they think that they need to lose weight to solve their problems.

And when we really dial it down, it's not about the weight, it's about their relationship with food, it's about their health, it's about their body image, it's about something else, but they just don't have the verbiage for it.

And so once we kind of name it and actually figure out a sustainable solution for them, it looks better, it looks different.

But how could they not think that way when our social media just presents it as a problem for them?

Yeah, I have just from these first few minutes of the podcast episode, I have so much more empathy now that I already did.

But for my friends that are.

I have a lot of friends that are dietitians.

And I can not imagine the furious feelings you have for some of your patients that are.

Everyone is vulnerable to being tricked by the system, which is.

Yeah, too much.

But do you.

Or I guess I've kind of named one.

But do you have any other ideas of unhealthy relationships with food, like what that would look like?

I think I mentioned this earlier.

The three things that I look for when I'm naming an unhealthy relationship with food are people's physical bodies, their mentality, their mental health, and their social life.

Those tend to be kind of like the big three.

I'm sure there's others that we could kind of dive off into.

But when I was a young dietitian, like, first starting out in this field, anytime somebody brought up the word calorie or like a branded diet or like something, I was like, oh, it's disordered.

Like, you're bad, you're wrong.

Like, we can't be doing this.

And I think as I've grown in this field, I've come to understand that it just isn't that simple.

Yeah.

And we really have to boil it down to how.

How is food impacting your physical, mental, and social life?

Is it okay?

Is it not?

Is your physical body falling apart and your hair is really brittle?

You know, you're constipated, you're fatigued, you have insomnia.

Like, how is food impacting that?

Is food impacting that mental health wise?

Are you so stressed out every time you walk into the kitchen?

Are you stress eating for comfort?

Are you losing your appetite because you're really stressed and can't eat enough food?

Are you overthinking all your food?

Is it.

You know, there's so many things there with our mental health we could think about with food and then social life.

Like, are you able to go out to eat and order what you want off the menu?

Do you feel comfortable with somebody cooking your food in the kitchen that you can't see?

Are you okay not knowing where you're going with your restaurant or your food choice or travel?

Are you okay with traveling around the world and figuring out, like, okay, they're not going to have the same brands or type of food I like?

Is that something I can do?

And I think if we kind of go through each of those and you're, like, checking off some boxes, even in just one of those categories, that would indicate to me that you need to see a dietitian.

And check in with someone, especially a non diet dietitian, who can figure out like what's gonna make sense for you and help heal those different aspects of your life.

That gave me chills.

I just think like any, if the listeners took anything away from today, it was that right there, like those questions to just kind of screen like it doesn't have to be something that impacts the areas of your life that you value.

And I'm realizing now in OCD and anxiety work, we do a lot of values work.

Right.

Acceptance and commitment therapy.

And it seems like you do on your end too.

It's just so crucial and important to have those things align.

And so I want to make a handout of those questions that you asked.

Just I'm sure one exists.

Maybe I'll make one, I'll send it your way, spread it everywhere.

That'd be great.

No, but I think it's so important.

And then what about just where eating disorders come from?

Yeah, like is it biological, is it carried down from the things we see in society today?

What do you see more of?

Well, I've talked a lot about dieting and I think that that's a big one to keep in mind.

Usually when we're at the doctor's office and there's an issue and we need to change our food, it's a handout and it's a five minute conversation.

And then it's like up to you to figure it out.

You know, in, in other cases, maybe not.

But for the most part, like that's what that looks like.

And so I don't want people to feel shameful for having turned to a diet or thinking that a diet was the right answer.

Because I'd like to think that people are just trying to do the best they can with the information that they're given.

But if there's one piece of information that I could give, it's that dieting is not the answer.

Especially fad quick fix dieting.

There is an argument that there's a genetic component that might put somebody at a higher risk.

I'll also mention that eating disorders rarely exist by themselves.

So usually when I'm treating someone with an eating disorder, they have co occurring anxiety, ocd, depression, something else is also going on.

So we kind of have that part of it.

Trauma can be a big one as well.

And I think just like the environment you grow up in with food, I screen everybody for food insecurity.

That can be a big trigger.

But also if you grow up in a household where food is really limited or there's all these rules or all this conversation or a lot of negative body image.

Like kids pick up on them way more than we think they do.

My oldest is only two and I'm like, whoa, like the words or like the actions or like it's crazy.

And so if you think about somebody who's living in a house with someone their whole life and maybe one of their parents like always talk negatively of their body or was always trying to do the next diet or they locked the pantry or.

You know, there's different things that I think people are doing with good intention or don't even realize harmful.

But that can be a really difficult environment to grow up in and then start internalizing and being like, what am I supposed to think of my body or what am I supposed to do with food?

Right.

Yeah.

And I think it's something that probably happens in some capacity in every household.

And so it's interesting to see.

Yeah, of course kids would absorb that in a certain way and probably carry out those beliefs in day to day life.

That makes a lot of sense to me.

And then how about just general stress and perfect.

Like more type A personalities.

Do you see characteristics of eating disorders with certain personality traits?

Yeah, and there's kind of, there's arguments both ways for that.

Yeah, the chicken or the egg.

Yeah, yeah.

But I will say stress.

There's two parts to it that I kind of think of when I think about stress and eating.

When I think about the stress itself, I usually see one of two things happen.

Either somebody gets really stressed out and they want to cope with food and you know, eating that ice cream at the end of the day really makes them feel better, I do it too.

There's nothing wrong with that.

But if that's the only way that you cope with something or it feels really out of control, maybe something for us to look at or does the stress make your appetite go away?

I've also lived that where your anxiety gets so bad, like you're nauseous at the thought of trying to take a bite of food and you know you need to.

And then I go back a little bit more and I'm like, what's causing the stress?

Are you a single parent of multiple kids working two jobs?

The stress is, I don't know if I'm gonna have the money or the time to cook food for myself.

Is it you're working odd hours and you're stressed and you don't know what time you're supposed to eat?

There's other aspects to it.

That I think that cause the stress that could also directly impact food that are maybe even unrelated to the stress itself.

So then what about maybe it's not stress, maybe it's a component like an allergy.

Can an allergy or a food allergy reverse reaction to food lead to eating disorder tendencies?

Yeah.

Oh my gosh.

Yes.

Okay.

Yes, for sure.

I have had people meet with me just because of that.

Sometimes an adverse reaction will happen with food.

It could even just be a one time like food poisoning incident that happens that then makes people really fearful to consume that certain food because they're trying to avoid the adverse reaction that they experience.

Oh, wow.

So that can happen.

Then there's all of these like medical things too, like we have celiac's disease or people could be lactose intolerant or that kind of thing that can affect their choices with food, their ability to go out.

I know when I was talking earlier about the social eating and like being comfortable going to restaurants, like I don't want my people with food allergies to feel like she's ignoring me because that's not what I'm talking about.

Right, right.

I know it's hard for certain people that have food allergies to go out to a restaurant and eat, especially if there's multiple, because there is an aspect of it that's out of their control and that's really frustrating and really hard.

Yeah, and you bring up a good point.

There's a vast variety of reasons someone can have an eating disorder.

Right.

Like they think the general census belief is, oh well, it's because someone wants to lose weight or it's because they want their body to look a certain way.

But it can totally be out of fear of I don't wanna feel this way.

Yes.

Okay.

Yeah.

That's really good data for me to know too.

What does recovery look like and what does treatment in the recovery process look like for treating an eating disorder?

Yeah.

So in an ideal sense, I would be treating someone with an eating disorder alongside a therapist.

Like I said earlier, eating disorders rarely exist by themselves.

So if there's anxiety, depression, ocd, like anything else going on that's outside of my scope, I want somebody else on the team that's going to be able to address all of that while I'm managing the food piece.

But as far as just the nutrition therapy goes, the first thing I'm looking at is are they medically stable?

Are they appropriate to be walking around the grocery store like doing these things or are there some things going on within Their body that are so severe that they need to be, you know, at a treatment center or in a hospital or something like that.

I would say for the large majority, we're stable enough to be walking around and doing those things.

I don't, I think a little side tangent.

It's not uncommon in eating disorders for people to feel like, well, I'm not sick enough to get help or I'm not sick enough to need a dietitian, like, this is a problem in my life, but it's really not that big of a deal.

And I want you to hear me when I say this.

You are sick enough to need help regardless of what you think.

And I think that that's really important for people.

Where was I going with that treatment?

Okay, so after they're medically stable, after we assess, like, okay, you're okay to just be walking around doing your day to day task and still need support.

Great.

Then we get to move into more of the emotional work.

Why did you think this about food?

Where you're getting your nutrition information from?

How is it impacting your life?

How is it impacting your values?

Like, what do we think?

Like, where do you want that to go and how do you want that to look differently?

So it allows us to kind of put the medical pieces piece on hold or just kind of keep it stable while we get to work on all of this.

These other beliefs that we need to.

Counter and in therapy we've talked about or we've had an episode on good versus bad therapy, are there things that for listeners that are thinking, you know, I do want to work on some of these behaviors that they should look for in a good dietitian.

Yeah.

So I think the words non diet would be pretty popular with other dietitians that kind of aligned with my style.

Haze will also be something else that you'll see and that stands for health at every size.

It doesn't mean that someone is healthy at every size.

It just means that they are going to focus on your behaviors and your relationship with food and kind of let weight be more of a secondary factor in Yalls work.

I think a lot of times when people hear about the type of work that I do, they assume like, oh, well, she doesn't care about my weight or like she's not going to help me lose weight.

And it's like we're saying the same thing in different fonts.

Yeah.

You know, you're wanting long, long term stability.

Exactly, exactly.

And if, if I can get somebody to lose weight and just cut all Their food.

And yeah, they could probably drop it in a week.

But like, that's not the solution to what's actually going on.

I've had clients that lose weight and it is what it is.

It's, you know, maybe, maybe they celebrate it, maybe they don't, depending on where they're at in their journey with their body image.

But typically it's not the actual true root of the problem that we're trying to solve to begin with.

Yeah, I feel like we have so much overlapping clinical language.

I say the same things for anxiety work, right?

Like, if you're wanting a quick fix, this isn't the place.

This is not where we're going to have long term freedom.

And so I think that's a really important message to hone in.

We don't want you.

Well, this is what you would say.

We don't want you having to yo yo through this diet culture your whole life.

We want you to have a healthy, sustainable relationship with food.

A lot of research come out that the yo yoing itself is a really big risk factor for some of these chronic diseases like diabetes and hypertension and things like that.

When a lot of blame is just placed on people being in a larger body.

But it may actually be more of the patterns that have led them up into this point versus them just existing in a larger body to begin with.

So some of that is a little challenging for people because of how it's typically talked about.

But those, those are the things I would say non diet approach, haze.

Those are going to be two things that you see.

I would say, as far as like red flags go, if you reach out to a dietitian would be if somebody's just, you know, one size fits all, here's a meal plan out the door.

They don't ask you what your values or goals are.

I think that's a really important one.

If they have their own agenda that they're bringing into the session, I'd be kind of questioning that.

Right.

Or if anything feels like misaligned with what you're experiencing, a big part of our work is becoming attuned with your body and realizing, like, when am I hungry, when am I full?

What am I in the mood for?

And being okay with, like, that's a decision for you to make.

I don't have to eat just because Cali's eating.

I can eat when I'm hungry and when it's appropriate for me.

And that has nothing to do with her and her stomach, you know.

And so I think if we can Kind of really focus on the person as an individual.

That's super important.

So if whoever you're working with, with doesn't do that would be another red flag to me.

Yeah, yeah, seriously.

And then let's say you have a loved one going through this process.

Maybe they're susceptible to treat or maybe they're accepting of treatment and maybe they're not.

But what is a supportive approach to walk along with them?

Because I think we often have this.

I don't want to trigger or I want to be really careful in what.

What we've talked a lot about is, well, if we overdo that, we're like protecting them from areas they're going to be triggered by anyway.

So just what would the journey look like to be a supportive person?

Walking alongside.

Yeah.

Oh, I love that you said that too.

Like, okay, so the first thing that comes to mind is modeling.

I think it's really difficult for someone to recover in a household where there's a lot of disordered eating.

So it's not uncommon for us to do family education or, you know, teach them things that maybe need to be brought back into the home.

Carbs, for instance, if we have dinner every night, there's not a single carb at it.

We probably are going to be talking to the family about how can we reintroduce carbs to dinner so that we can get a well rounded meal for this person.

So that's, you know, eating together, that's eating appropriate portions together.

Normalizing food is a big one.

I think our verbiage and kind of the language around food is also a really important one to touch on.

It's tricky because a lot of times I'll use parents as an example.

I know it's not always a parent figure, but parents want to be like, oh, you've gained so much weight, you look so much healthier.

And people just don't want to hear that.

Not the term.

They don't want to hear that.

Occasionally I will.

Occasionally I'll have someone that's like, yes, I feel really validated for all the work I've done.

But it's the customized approach, right?

The customized approach.

Not everything is going to work for people, and I would say for the large majority, people just don't want their weight commented on in general.

Even outside of eating disorders.

Disorder work, sure don't want their weight commented on in general.

Right, right.

So I would say that I also think seemingly helpful comments like, wow, you ate all of that.

Also not going to be helpful because this person in recovery is also battling a lot of guilt and shame around their food.

And if it's just doubled down on and highlighted, they're going to feel that even more.

So I think it's really important to pull whoever that person is that you're supporting aside outside of a meal time.

That's also very important.

I think a lot of times we think about it while we're eating and it's like, so let's talk about your therapy session earlier today.

You know, let's not.

Let's keep meal times light, but let's talk to whoever that person is outside of a meal time, outside of the kitchen and just say, like, hey, what would be a supportive thing for me to say or do?

Because it's gonna look different for everybody, and it's gonna look different depending on their.

Their stage of recovery.

Because I would argue that someone who really far into recovery should be at a place where they can tolerate being around someone that's on a diet and it not be triggering for them.

And I think realizing that, like, that might work for them in a healthy way and not for me is a really difficult thing to grasp because it can feel really unfair.

I love that asking them, though, because that's who's going to know the most about where they're at in their journey.

Whether that's them coming up with appropriate statements with their dietitian or just educating their family members.

But.

But I know it's scary for family members to ask that question, but it's scarier saying the wrong things.

So I keep thinking, remember that.

Hone that in.

Yeah, yeah.

But I've even had parents who maybe their child is getting treated, and then they come in on the side and are like, hey, can I meet with someone too?

And just.

I've realized that I've got some stuff too that I need to work on, and they're not even the ones with the diagnosis.

Oh, wow.

So it's.

That's always groundbreaking or just like kind of of warms my heart when.

And it also shows that the person working on the work, I always try to emphasize, wow, look at the impact you're having.

Right.

Like, it's educating others around you to also have a healthier approach to life, too.

Yep.

And I've had parents, I've had spouses do that.

It's been really cool.

Amazing.

So if we had to kind of summarize some of your favorite top three takeaways for all of this work and everything that we've gone over that's so tangible and helpful and I want to just say, before we do, I've learned so much, and so I'm so glad that you were here, here.

But what are some of those most important things for listeners, for you?

Sure.

Yep.

First thing first, dieting is risky.

I know they sell it well.

There's a lot of options out there, but dieting is just risky.

So being mindful of that before entering into anything that you might.

Might be doing with food there.

Secondly would be eating disorders look a lot of different ways.

And you may have it in your mind of, okay, I don't do X, Y, and Z, so I must not have an eating disorder or so.

And so must be fine.

People eat and still have eating disorders.

People can look any kind of way and still have an eating disorder.

So I think we have to really remove this stigma and idea of what an eating disorder looks like before we can actually evaluate what's going on.

Because also, I see a ton of people every week who do not have a diagnosis of an eating disorder.

They don't need one.

Wow.

You know, they may not even meet criteria, but it's impacting their life in a way that is not helpful.

Right.

And not in alignment with their values, and they want it to be different.

So those.

Those are top two so far.

The third one that I want to say is recovery is possible.

Liking your body is possible.

That one's not said enough.

Yeah.

You can like your body and that be okay.

Especially my women liking food.

Being comfortable around food, not stressing out just because food is.

Is in the room is possible.

You can be relaxed around food.

You can enjoy food.

You can not think about it all day long.

I think that we get so used to the disordered because of the conversation about food and the normal verbiage around food, we forget that it doesn't have to be this way.

Yeah.

Or we normalize it.

Or we say, like, well, this is how it has to be, or, yeah, it just doesn't have to.

Like, you can engage in a fun, fulfilled life without thinking about it 24 7.

Yeah.

Yeah.

I love that so much.

Well, amazing work on just all that you do.

The difference that you make in the field.

I think this is gonna really hit home for a lot of listeners.

I probably would love to have you back.

Yes.

I would love that.

Yeah.

This was so great.

And I think we just covered such a surface of such vast, deep information, so we might do more of a deep dive.

I'll keep politics out of it.

You know what?

It's fine.

We can't help it.

These days.

Yeah.

Well, thank you, Emily.

This is amazing.

Yeah.

Thanks so much for having me.

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