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How To Love Your Eating Disorder

Written by: Lee Thomas

Time to read: 10 minutes

Note: This blog post contains descriptions of disordered eating behaviours. A content warning is listed prior to that section.

When it comes to eating disorders, there is no shortage of fighting imagery. Beat it, conquer it, destroy it, defeat it. And before you read another word here, I first want to say: if those approaches work for you, or your loved one, or your client? Then keep doing them. I’m not trying to take this from you. 

But for a lot of people, this approach isn’t working.

We know that many people never get treatment. And for those who do, they often don’t complete treatment. And even for those who do, there is a high rate of “relapse.” There’s no universally agreed-upon definition of recovery or relapse, so articles vary wildly in the numbers they quote, but everyone seems to agree that eating disorders are often a long-term struggle.

So, clearly, something isn’t working here. But why?

Maybe it’s because the eating disorder isn’t actually evil.

Enter IFS, stage left. Internal Family Systems therapy, or IFS, is based on the concept of multiplicity — that your mind isn’t all one thing, even though that’s what you’ve probably been taught most of your life. Instead, your mind is made up of a bunch of different subpersonalities, or “parts.” Sort of like the movie Inside Out, but for real. In IFS we divide these parts into 3 categories:

Exiles are generally young parts of us that hold a lot of big emotions, especially pain. This might be the part of us that says “I feel worthless”. 

Managers are the proactive parts of us that try to prevent this exiled pain from overwhelming us. This might be the part of us that says “I have to do everything perfectly, otherwise I’ll feel worthless.”

Firefighters are the reactive parts of us that leap into action when the exiled pain is overwhelming us. This might be the part of us that says “I can’t handle feeling this way! I have to make it stop!” And will do whatever it takes to rescue us in that moment.

[Content warning: disordered behaviours. Skip this italicized section if you’d like to avoid]

In real life, this might look something like this: I might have an exile that believes that my body is bad and wrong, and feels a ton of shame whenever anything body-related comes up. In order to prevent this shame from flooding me, I might have a manager that says “if you just lose weight, then you won’t need to feel that shame.” And maybe it works, for a moment…

…But then, maybe I am rejected by a potential romantic partner, and I assume (rightly or wrongly) that it’s because of my body. The exile comes screaming out and starts to flood me with feelings of shame. It’s like an emotional fire that’s burning me up inside. It feels intolerable. So then a firefighter comes in to rescue me from this fire, and I scramble to the cupboard to eat anything I can get my hands on, whatever it takes to numb this horrible feeling. And maybe it works, for a moment…

…But then the manager voice comes back online and is horrified and critical: “I can’t believe you ate all of that! You’re disgusting! You’re a failure! No wonder nobody likes you!” This makes my exile start to feel shame again, and a firefighter comes back in to put out this new fire: get rid of the food. And maybe it works, for a moment…

…But then the manager criticizes me for throwing up and pledges that tomorrow we won’t let ourselves eat so much, because that’ll make up for today being such a disaster. And on, and on, and on.

So as you can see, the parts are trying desperately to help keep things stable in their own way — even though the ways in which they’re trying to help aren’t, in fact, helpful. Like many elements of disordered eating, it’s like being stranded in the middle of the ocean on a raft and drinking salt water to try to quench your thirst, even though it ultimately makes you more dehydrated. It’s an act of desperation that, despite being unhelpful in the long term, is entirely understandable given the circumstances. And, despite being entirely understandable given the circumstances, is also not helpful long term. Just because it hurts doesn’t mean it’s malicious, and just because it’s not malicious doesn’t mean it doesn’t hurt. 

There’s another element at play as well, something that’s not exactly a part — your Self. One of the things that I like about IFS is also one of the things that I have struggled with the most about it, which is that it is unabashedly spiritual. IFS believes that everyone has a Self, which is sort of like a soul, or a core You.

This Self is like a compassionate, curious, loving parent figure. It knows that your parts are trying so hard to help you, that they actually kind of hate the job that they’re doing right now, and that they’re only doing it because they feel like they have to. We say there are No Bad Parts because the parts aren’t evil or malicious. They’re just extremely misguided. They are so good in their hearts, they are trying so hard to help, but they have very hard, and sometimes very harmful, jobs.

In our italicized example above, the exile part is holding onto so much pain related to shaming experiences around my body. The manager part wants to help prevent this pain, so they criticize me harshly before anyone else gets a chance to, even though they know it’s hurtful. The firefighter part doesn’t want to see me incapacitated by pain, so they try to help using the only tools available to them, even though this job earns them nothing but criticism from all the other parts (not to mention everyone else in my life). These parts are so profoundly dedicated to helping me, even at the expense of their own wellbeing. So then when outsiders like therapists and family members label these parts as “monsters” and “enemies,” no wonder they push back. 

So if we’re not fighting them, what do we do instead?

It’s not easy, but it is simple. We love them. 

If you rolled your eyes here, I feel you. There’s a part of me that genuinely can’t believe the type of therapist I am now. I can hear my younger self saying incredulously, “A key component to healing from an eating disorder is love? Grow up.” But unfortunately, it is true. I sometimes joke that I became an IFS therapist because at my heart I’m actually an ACT therapist — it’s all about workability for me, and this loving approach works.**

At its heart, IFS is about building community. Imagine if you felt like you belonged, and were safe, and unconditionally cared for. Imagine the sort of healing you could do if you felt like you were deeply loved no matter what. Imagine if someone saw the good in you even when you yourself can’t see it. That’s the power of community. IFS helps you to create that world internally, which can help you create it externally, too.

So what does that look like in real life?***

I might have an exile that feels a huge amount of shame about my body. I might work with this exile in therapy to help it to release the beliefs that burden it. I might help it get un-stuck from the past. I might let this exile know that I’m delighted by it, and that not only am I able to take care of them, but in fact I would be thrilled to take care of them.

I might have a manager that says “if you just lose weight, then you won’t need to feel that shame.” And I might sit with that manager and say “It makes so much sense to me that you feel that way. Thank you so much for trying to protect me.” I might help that manager to understand that I’m not a little kid any more, that they don’t need to take care of me. I might let this manager see that I care about my future and that they don’t need to be harsh in order for us all to be safe.

If my exile gets triggered and my firefighter comes in to rescue me, I might say “Wow. You are working so hard. Thank you so much. I’ve got it from here. I love that exile part, and its distress isn’t too much for me to handle.” I might let the firefighter see that I’m still engaging in pleasurable activities even when things aren’t on fire. I might tell them how much I appreciate all the things they’ve done to try to protect me over the years.

I do want to reiterate that being compassionate doesn’t mean that we’re enabling these parts. Loving a child doesn’t mean that we let them drive the car. But it does mean that we respond to them with compassion and kindness rather than with cruelty and punishment. We’re not fighting them because they’re not our enemy. We appreciate how hard they’re trying to help, and we recognize that they’ve been trying to help us for a long, long time. As Sam Dylan Finch wrote in this excellent blog post, “To relate to my ED as something I have to ‘fight’ or ‘beat’ is a betrayal of all the younger versions of me that conspired to protect my life and my future. I wouldn’t be here without them.”

Our parts love us deeply, and it’s about time we love them back.

If you’re interested in working with an IFS therapist, I recommend using the IFS directory or searching out someone who has received a minimum of Level 1 training from the IFS Institute. As of the time of writing this article I am not currently accepting new clients for individual therapy, but you’re always welcome to check my availability here to see if that’s changed. I do have spots available for clinical consultation. 

* For the record, I think that the blog post on externalization that I pulled this quote from was very thoughtful and well-done, so I don’t mean for this to be perceived as a criticism of the blog post itself

** IFS is not a new therapy, but it is having a very hot moment right now, so lots of people are hearing about it. In some ways, I love this — I think IFS is great, and I have personally and professionally experienced how powerful it can be. But I feel like it’d be remiss not to note that so many therapies have had this same arc. Therapeutic modalities can be trendy just like anything else. So do I think IFS is amazing and a therapeutic modality well worth considering? 100%. But do I think it’s a perfect panacea and the only possible route to healing? Absolutely not.

*** If these examples sound trite or corny, I get that. Taking this stuff out of the individual therapeutic context has that effect, but I felt like I should include some examples anyway. Please trust me when I say that if you do this work with your own parts, the compassionate statements you come up with will not feel corny at all.

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Eating queerly

Author: Raquel, adapted from TransCare+

Last year, Raquel and Lee contributed to the “Queerly” project in collaboration with TransCare+. We wanted to share this very cool resource with you and summarize our specific contributions:

Queerly Volume 1 is an anthology exploring the intersections of queer identity, community, and ecology through the themes of “Grow,” “Eat,” and “Live.” Developed by queer and gender-diverse voices across Canada, the book combines storytelling, art, activities, and poetry to celebrate the resilience and creativity of 2SLGBTQIA+ communities. With contributions ranging from tattoo art and gardening guides to reflections on communal care and food as resistance, the collection fosters a sense of belonging and encourages readers to engage with nature and their surroundings in radical, affirming ways.

Queerly Volume 1 is an anthology exploring the intersections of queer identity, community, and ecology through the themes of “Grow,” “Eat,” and “Live.”

open resource

(if you’re having difficulty accessing the resource, email us thealeocollective@gmail.com and we’ll email you a PDF version!)

“Eat”, the section that begins on page 55, is the section Raquel and Lee contributed to:

Page 60: “Queering food and eating” audio recorded conversation
This conversation between Lee Thomas and Raquel Griffin explores the intersections of queerness, food, and eating practices, focusing on how queering food systems can foster inclusivity, and challenge societal norms. The dialogue emphasizes the cultural, political, and personal dimensions of food as a site of resistance and identity. 

Page 61: Visual ecosystem map (by Lee Thomas)
Walks you through creating your own visual ecosystem map of your relationship with food/eating

Page 64: What do you really want to eat? (By Raquel)
Using Intuitive Eating principles, Raquel walks you through a mindful eating experience, exploring the sensory aspects of food to assist you in exploring the question “What do you really want to eat”? Available through multiple mediums: a guided audio practice, transcript from the audio practice, or through provided journal prompts.

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What is Structured Eating?

Written By Courtenay Vickers

Time to read: 5 minutes

As a dietitian focusing on eating disorder care, I’ve worked with individuals with many different challenges with food. And a common theme we focus on, especially early on in our nutrition counselling together, is this idea of structured eating.

If you’ve ever struggled with disordered eating, an eating disorder, or years of dieting, you know that hunger and fullness cues can become unreliable. Maybe you’re not sure when you’re hungry, or you wait until you’re starving, which can sometimes lead to overeating or binge eating. Sometimes those cues are absent completely, making it difficult to eat anything. Other factors like gastrointestinal issues, medications, low mood, and more can greatly impact our ability to tune into our body and know how to feed it. This is where structured eating comes in.

Also known as scheduled eating, mechanical eating, or nutrition rehabilitation, structured eating helps to support regular eating patterns to meet your body’s nutritional needs (even when you’re unsure of your hunger and fullness signals).

Why Structured Eating?

This is my favourite analogy: think of structured eating like a cast on a broken arm. When your body is healing, you need extra support to keep everything in place. Over time, the cast comes off, and in time, you may start to use your arm more intuitively again. The same is true for your eating habits. When you’ve been struggling with an eating disorder of any kind or even chronic dieting, we’re probably going to need some sort of structure to support you nutritionally while you are working on healing your relationship with food and body. Structured eating provides the foundation you need while you heal, helping you establish a rhythm of consistent meals and snacks so that eventually, you can tune back into your body’s natural hunger and fullness cues.

The Basics of Structured Eating

Structured eating doesn’t mean following rigid rules or feeling restricted. Instead, it’s about creating a pattern of eating that allows your body to trust that it will be fed regularly and adequately. Think of structured eating like a blueprint, or rough guideline to support regular eating for recovery. Some people may require more details with their structured eating plan, and for others, it will be more flexible. Here are the key elements I like to focus on with my clients:

  • 3 meals a day
    Aim for three meals, or “eating moments”, every day. For some, this might look like breakfast, lunch, and dinner. Focusing on getting at least 3 eating moments can help anchor your day and give your body regular fuel.
  • 2 – 3 snacks a day
    Include smaller eating moments between your main meals. These snacks help keep your energy stable and prevent feeling overly hungry by mealtime. Snacks can help sustain you and keep blood sugar levels more stable between meals.
  • Include 3 or more food groups at meals
    Generally, a meal should have representation from several different food groups in order to provide us with a combination of carbohydrates, protein and fat (our three macronutrients). Try to include at least three different food groups at each meal (or larger eating moment).
  • Aim to eat roughly every 3 hours
    All human bodies will do best when fed regularly and adequately. Consider the timing of when you eat, aiming not to go beyond 3 hours between eating moments. It is absolutely okay to eat more often than this if that’s what you body needs and wants. Going many hours between eating can be harder physically on the body, and can negatively impact things like mood, blood sugar levels, energy, and sometimes perpetuate disordered eating behaviours.

Getting Started with Structured Eating

Starting structured eating can feel like a big change, especially if you’ve been stuck in a cycle of restriction or binge eating. Here are a few gentle tips to ease into it:

  1. Start small
    You don’t have to change everything at once. Pick one aspect to focus on at a time, such as aiming to eat 3 times/day. Once that feels comfortable, add in snacks and consider the timing.
  2. Set reminders
    It’s easy to forget to eat, especially if you’re used to skipping meals. Set alarms or reminders on your phone to help keep you on track with regular eating times.
  3. Plan ahead
    You don’t need an elaborate meal plan, but having a list of go-to meals and snacks can make eating regularly much easier. Keep it simple and focus on what feels doable for you.
  4. Track your progress
    Notice how you feel as you start to establish these regular eating habits. Are you more energized? Less likely to binge? If you miss a meal or snack, or have a binge, this doesn’t take away the fact that you are taking steps forward with your recovery. Healing is a process (and not a linear one at that). It’s often about baby steps!
  5. Be kind to yourself
    If things don’t go perfectly, that’s okay! Self-compassion is HUGE when working on your nutrition for recovery.
  6. Get support
    Structured eating is a powerful tool, but sometimes having guidance from a trusted support can be help. Working with a dietitian or healthcare provider can make the process easier and give you the support you need.

Remember: Food Has No Morality

One of the most important things to understand is that food has no moral value. There are no “good” or “bad” foods. Whether it’s kale or a cupcake, there is nutrition to be had and it doesn’t define your worth. Every food has its place, and structured eating helps you embrace a diverse range of foods with less guilt and more confidence that you are giving your body what it needs.

What would it be like to start working on implementing structured eating today?

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Yes, You Do Work With Eating Disorders

Written by: Lee Thomas

Time to read: 8 minutes

Note: Many Aleo blog posts are meant to be read by clients who are struggling with disordered eating or body image concerns. This one, though, is specifically for clinicians. (But of course anyone is welcome to read it!)

In my therapy practice, many people I work with have sought me out specifically because of my eating disorder specialization, which is probably not super surprising. Want therapy for an eating disorder, see an eating disorder therapist.

But a lot of clients I’ve worked with over the years didn’t come in initially for eating disorder therapy. They came in for other concerns — alcohol use, relationship problems, childhood trauma, work stress, ADHD management, you name it — and then in our work together we discovered that they have a disordered relationship with food. My secret strategy for uncovering this? I ask.

“What is your relationship with food?” is a pretty standard question for me to ask within the first session or two. If the client answers in a way that suggests a disordered relationship with food, usually my followup question is “have you ever talked about this with a therapist before?” What I’ve found surprising is that the answer is almost always no… even when it’s a client who had already been in therapy for many years.

Now, to be clear, this isn’t meant to be a shaming “gotcha!” to you or any other clinician. Clinicians are fallible, myself included. We all bring our own lenses into this work — and we don’t tend to find what we’re not looking for.

“I don’t work with eating disorders” is a common thing for me to hear therapists say. But this creates a vicious cycle where clinicians believe they don’t work with clients with eating disorders, and so don’t ask their clients questions about eating disorders, and so they don’t hear about their clients’ eating disorders, and so they continue to believe that they don’t work with clients with eating disorders.

And obviously nobody is required to change their practice in any way just because I wrote a blog post. But what I’m hoping to do here is to help clinicians recognize that 1) yes, you can work with clients with eating disorders, and 2) you don’t have to do it alone. 

To start with, let’s name some concerns that you, as a clinician, might have about working with clients with eating disorders.

“I need to work through my own food stuff first!”

You might have your own disordered relationship with eating and not feel like you’re in a place where they can effectively work with others around this topic. Even though you’re a clinician, you are a person first, and it’s absolutely okay to be selective about your work in order to keep yourself well. That being said, I don’t think your own disordered relationship with food inherently precludes you from being a good therapist to others. My own early work in the mental health field was as a “person with lived experience” (as we called it back then), and there’s lots of good work by Dr. Jennie Wang-Hall on this topic as well. Having support through something like a clinical consultation group can help you to explore things like countertransference to help ensure you’re taking care of both yourself and your clients.

“Clients with eating disorders don’t want to change.”

There’s still, unfortunately, a lot of stigma around people with eating disorders. Clients with eating disorders are still sometimes portrayed as manipulative, untrustworthy, unmotivated, and resistant. Can they be those things? Sure. They are human beings. We are all capable of being those things, sometimes. But a lot of this stigma is based on carceral beliefs about mental health care provision, and it’s not true. 

In defence of most clinicians, in my experience the percentage of clinicians who don’t work with clients with eating disorders because of overt stigma is actually pretty low. (Or maybe that’s the circles I run in, because the research definitely reflects that stigma is still very much present.)  But none of us are infallible, and it can be easy to slip into stigmatizing beliefs if you’re not surrounded by a community of clinicians who can support you when you’re feeling discouraged, and lovingly hold you accountable when you start to veer off course.

“There’s too many liability concerns.”

I’ve been in a lot of clinician consultation groups, and a common thread that I hear is that we as clinicians are terrified of getting in trouble, whether that’s with our college or with the legal system. In a lot of ways this can be a good thing — we have a lot of power in the therapeutic relationship, and having the college as an institution to protect the public helps to ensure that health care professionals are behaving ethically. However, I do think that sometimes the fear of getting in trouble becomes a sort of boogeyman that causes clinicians to be more risk averse than is necessary, even when it’s to the client’s detriment. We’re so afraid of doing the wrong thing so we end up doing nothing! And eating disorders can exacerbate this risk aversion because of the physical health concerns involved. Part of the benefit of a consultation group is that you can explore your concerns with other professionals, who can help you to figure out which risks feel worthwhile.

“It’s outside of my scope.”

I think there’s a both/and to be had here. On the one hand, it’s really important to practice within our scope and training. Like, I don’t have any EMDR training, so it would be wildly unethical if I were to just start doing EMDR (especially if my only motivation was that some random person wrote a blog post telling me that I should). But on the other hand, I think it’s also important to acknowledge that part of how we expand our scope is by pushing into new areas where we are not yet an expert.

I think this is especially true for clients where you already have an established relationship. Research consistently shows that the biggest predictor of positive therapeutic outcomes is the relationship between the client and the clinician. You might not be an eating disorder expert, but you might be a Therapeutic Alliance With This Specific Client expert, and that’s a really, really important element to consider.  If you’re considering expanding your scope in order to support an existing client, consultation (whether individual or group) is definitely something you’ll want to pursue to help you increase your clinical skills and steer clear of potential pitfalls.

“I only work with trauma (or anxiety, or substance use, or…)”

This is a variation of the “scope” concern, I think. And, again, if you really want to stay in your specific wheelhouse, nobody is stopping you. But there’s a ton of comorbidity with eating disorders and other conditions. If you’re working with trauma, or anxiety, or substance use, or almost any other area, you are almost certainly also working with clients with eating disorders. And that’s even before we consider the subthreshold eating disorders, aka disordered eating. Food is one of the basic building blocks of the human experience — it’s going to influence, and be influenced by, other conditions in a client’s life. If someone has experienced trauma we aren’t shocked when it impacts their relationship with romantic partners, friends, work, or many other elements of their life. We should expect that it would impact their relationship with food, too.

So all of this to say: the reality is that you’re already working with clients with eating disorders. The choice you have now is what you want to do with this information.

If you’re open to suggestions, I think the Confident and Competent Clinician Consultation Group could be a good place to start.

As a clinician in a private practice, I’ve made a point of investing in consultation throughout my career, and I truly can’t overstate the impact that it’s had on my practice. A consultation group is a soft place to land when you’re feeling discouraged, and it’s a reality check when you’re way off track. It’s a place to learn strategies and phrases that your colleagues find helpful with their clients. It’s a source of reassurance and guidance. And, as a bonus, it’s often counted as continuing education credits. 

Courtenay Vickers is a registered dietitian and member of the Aleo Collective. She and I decided to start this group because we’ve both found consultation to be unbelievably valuable to ourselves, our practices, and our clients — and we want to share it with you!

Registration for our group closes January 31, 2025. We would love for you to join us!

Confident and Competent Clinician Consultation Group with Lee Thomas mSW & Courtenay Vickers RD February 11 - March 25 2025 Tuesdays from 11-12pm EST/12-1PM AST
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Sin, Snacks, and Self-Control: Revelations on the denial of pleasure and reclaiming satisfaction with food

Written by: Raquel Griffin MSW RSW
Time to read: 5 minutes

Sinful snacks, cheat days, and junk food— oh my!! These phrases probably sound pretty familiar; they demonstrate some of the ways in which diet culture’s flavours of puritanism, morality, and virtue are baked into our common discourses surrounding food and eating.

Historically, religion has long shaped the way we think about food and our bodies. Religions issued warnings about gluttony, engaging in fasting practices and avoidances of what could be seen as indulgent. These practices weren’t about weight loss for its own sake or the effects of eating on a person’s size, but about how bodily pleasure was thought to compromise the soul. It was penance: a way of making up for all the times you had screwed up that year, rather than a way of punishing your body for being too large.

Early Protestant Christianity associated bodily pleasure with moral weakness, emphasizing restraint and self-discipline as pathways to spiritual purity. Protestant Christian clergy and leaders like Sylvester Graham and John Harvey Kellogg were pioneers of so-called “healthy eating”, linking bland diets to moral and sexual chastity; this included their own inventions of the Graham Cracker and Cornflakes. Graham believed that all of America’s moral failings could be traced back to “unholy” ways of eating, which could be cured with a strict diet. Graham’s list of “excess” of sinful indulgences included: meat, spices, caffeine, alcohol, and warmed/heated food, to name a few. He even instructed his followers to abstain from dancing (“Footloose” style), to take cold baths, and sleep on hard beds. These practices weren’t merely about health—they were about control and conformity. 

While some of these diets would be seen as overkill today, their legacy persists in modern diet culture’s manifestations, emphasizing individual responsibility which equates thinness with virtue and fatness as a moral failing. In practice, this looks like promoting restrictive eating as a marker of self-worth, abstaining or using “caution” with demonized foods, and pathologizing fatness as inherently diseased and wild. Diet culture’s obsession with categorizing foods as “good” or “bad” not only distorts our relationship with food but also fuels systemic oppression. It marginalizes those who don’t fit its narrow ideals, often targeting women and femmes, racialized folks, queer folks, disabled and those in larger or fat bodies. These standards are rooted not in health but in control—diet culture is a system of oppression, in all its facets.

Reclaiming Pleasure with Intuitive Eating
Intuitive Eating principles offer a roadmap for this reclamation like rejecting the diet mentality, honouring hunger, making peace with food, and discovering the satisfaction factor.

  • Unconditional Permission to Eat
    Instead of viewing food as an enemy, allow yourself to enjoy it— label guilt as such when you notice it. You’ll notice that when you embrace variety and remove restrictions, food eventually loses its “forbidden fruit” allure.
  • Discover the Satisfaction Factor
    Tune into your senses: what flavours, textures, or aromas do you truly enjoy? Eating with intention—savouring each bite and minimizing distractions—can transform meals into moments of joy.
  • Create Joyful Food Memories
    Food doesn’t solely meet physical needs but also serves as a source of emotional and social connection. It brings people together, creates traditions, and tells stories. Recognizing these facets helps us see food as more than calories or nutrients—it’s a part of life’s richness. Make meaningful connections to memories involving food that were joyful. Who were you with? What made the experience special?


Reclaiming pleasure in food is an act of resistance against diet culture and the oppressive systems that sustain it. By rejecting rigidity, embracing flexibility, and reconnecting with ourselves, we can rediscover the joy and pleasure that eating was always meant to bring. A parting invitation: take that treasured creation of Sylvester’s Graham cracker and squish between two of them a warm, toasted marshmallow and melted chocolate square… Mmmm… what a delicious “Fuck you” to diet culture.

References:

Carlton, G. (2022, February 2). Meet sylvester graham, the religious health nut who thought white bread was evil. Retrieved from: https://allthatsinteresting.com/sylvester-graham

Look, M. (2024, February 12). Why was cereal invented? A brief history of corn flakes. Retrieved from: https://history.howstuffworks.com/american-history/why-was-cereal-invented.htm

Harrison, C. (2019). Anti-diet: Reclaim your time, money, well-being, and happiness through intuitive eating. Little Brown: UK.

Harrison, C. (2019, May 20). Episode#196: diet culture’s racist roots with Sabrina Strings. Food Psych. Retrieved from https://christyharrison.com/foodpsych/6/the-racist-roots-of-diet- culture-with-sabrina-strings-sociologist-and-author-of-fearing-the-black-body 

Harrison, C. (2018, August 10). What is diet culture? Retrieved from: https://christyharrison.com/blog/what-is-diet-culture

Smith, A. F. (2009). Eating history: 30 turning points in the making of American cuisine. New York: Columbia University Press.

Strings, S. (2023, May 6). Fatphobia as misogynoir: gender, race & weight stigma. Body Talks Conference, Untrapped Academy. 

Strings, S. (2019). Fearing the black body: the racial origins of fatphobia. New York University Press: New York.

Tribole, E., & Resch, E. (2020). Intuitive eating: A Revolutionary Anti-Diet Approach, 4th ed. St Martin’s Publishing Group: New York.

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

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“But What Do I Say?” A Clinician’s Guide to Navigating Conversations About Eating Disorders

Written by: Courtenay Vickers RD
Time to read: 6 minutes

For many healthcare providers, the thought of working with a client who has an eating disorder can be daunting. Questions like What if I say the wrong thing? or What if I make things worse? are common, and this uncertainty can make clinicians hesitate or feel stuck. With some practice and guidance, effective communication and building rapport can be life-changing for that client sitting across from you! 

This blog post offers some helpful strategies for having compassionate conversations with eating disorder clients, integrating self-reflection, examples of what to say and what to avoid, and actionable steps for clinicians to build their confidence in this area.

Before we dig in, an invitation to remain curious rather than judgemental about your current/past self! Wherever you are at on your learning journey, that is ok. And I’m so glad you stumbled upon this post today.

First, what’s the difference between an eating disorder and disordered eating?

It’s important to recognize that there is a difference between an eating disorder and disordered eating when working with clients:

  • Eating Disorders are diagnosable mental health conditions outlined in the DSM, including:
    • Anorexia Nervosa (AN)
    • Bulimia Nervosa (BN)
    • Binge Eating Disorder (BED)
    • Avoidant/Restrictive Food Intake Disorder (ARFID)
    • Other Specified Feeding and Eating Disorders (OSFED)
  • Disordered Eating refers to a broader range of harmful eating patterns or behaviours that don’t meet diagnostic criteria but can still significantly affect physical and emotional health. Disordered eating can be a precursor to an eating disorder. Sometimes disordered eating looks like someone going on a diet, actively pursuing weight loss through dietary restriction, or even being “watchful” of what they eat. It’s not something to ever brush past.

With nearly 2 million Canadians affected by eating disorders—and the second-highest mortality rate among mental health conditions—it’s critical for clinicians to be prepared to address these complex issues with care and sensitivity.

Self-Reflection: Starting with Yourself

Let’s take a moment to do a little self-reflection. You might want to pull out a pad of paper for these questions. Before we get started, it’s important to know that how you approach eating disorder clients can be influenced by your own relationship with food, body image, and assumptions about health. Now, take a moment to reflect on these key questions:

  1. How has your relationship with food and your body influenced how you view and work with clients as a healthcare provider?
  2. Have you ever made assumptions about a person’s health or behaviours based on their weight? How could this affect your care?
  3. How do you interact with patients in larger bodies? Do you notice any differences in how you approach patients in smaller or very thin bodies?

Self-awareness is vital. Recognizing and addressing personal biases is an important step toward creating an environment of trust and support for your clients.

Let’s explore some examples of what to say (and not to say)

Compassionate communication can make a significant difference in how clients feel about their care and recovery. Here are examples of what to avoid saying, along with alternatives that foster trust and understanding:

Instead of: “Just eat!”

Try: “It seems like eating is difficult for you. Tell me more about what challenges come up for you with eating.”

Instead of: “You don’t look like you have an eating disorder.”

Try: “Eating disorders can affect anyone, any age, any gender, any body size. Your experience is valid.”

Instead of: “You’re just going through a phase. Everyone feels insecure about their body sometimes.”

Try: “I imagine what you’re going through is incredibly difficult.”

Instead of: “Your vitals and blood work are fine; you don’t need to worry.”

Try: “Your body is working hard to keep things medically stable right now. I know other behaviours are going on, so let’s explore ways to better support you and reduce harm.”

Instead of: “I wish I had your self-control!”

Try: “The eating disorder is not your fault. It’s a complex brain-based illness, and you deserve to receive supportive care.”

Instead of: “You look healthy/better.”

Try: “How are you feeling about your recovery journey so far?”

Instead of: (silence)

Try: “I’m concerned about your eating. I’m wondering if we can explore your relationship with food a bit more together.”

Instead of: “Don’t worry, you’re not fat! You won’t get fat.”

Try: “I can imagine the idea of gaining weight feels scary for you. That makes sense, given how focused our society and healthcare system are on weight loss. Regardless of your body size, you are deserving and worthy of recovery.”

Instead of: “You have an eating disorder? Sorry, I can’t help you.”

Try: “It sounds like you’re having some real challenges with food and eating. You deserve proper care and support. Are you okay if we talk more about some options to help you?”

Actionable Steps for Clinicians

Working with eating disorder clients doesn’t mean you have to know everything, but there are clear steps you can take to provide meaningful support:

  1. Learn About Eating Disorders
    Expand your knowledge by reading books like Sick Enough by Dr. Jennifer Gaudiani, Life Without Ed by Jenni Schaefer, and The Body Is Not an Apology by Sonya Renee Taylor. Food Psych by Christy Harrison is a wonderful podcast to learn more from. A great Canadian website about eating disorders that we often recommend is the National Eating Disorders Information Centre (NEDIC).
  2. Practice Active Listening
    Listening without judgment or a need to immediately “fix” can be a powerful tool. Validating a client’s feelings and experience can make them feel seen and understood.
  3. Collaborate with a Care Team
    Eating disorder treatment is often multidisciplinary. Work with dietitians, therapists, and medical professionals to ensure comprehensive care. If a client doesn’t have a team, help build a team or consult with other professionals on behalf of your client.
  4. Refer When Necessary
    Know the options for higher levels of care and how to connect clients. If waitlists are long, continue supporting your client with compassion and harm-reduction strategies while they wait.
  5. Advocate for your clients
    Advocacy can make a huge difference, whether it’s within the healthcare system, with family members, or through education about eating disorders in your community.

Building Confidence Through Practice

Feeling confident in conversations about eating disorders takes practice and support. If you want further guidance, consider joining Confident and Competent: Eating Disorder Clinician Consultation Group, starting in February 2025. This program offers group calls, practical skills, and a supportive community to deepen your expertise. Email us at thealeocollective@gmail.com to learn more and get on the waitlist.

Remember, you don’t have to be perfect or have all the answers to make a positive impact. By showing up with compassion, humility, and a willingness to learn, you can help clients feel supported and valued on their recovery journey.

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Befriending Your Body Part 1: The Gift of Giving Up

Written by: Lee Thomas
Time to read: 9 minutes

What’s your body image like?

If you’re like most people, that question makes you think about how your body looks. We tend to boil it down to good body image = I think I look good, and bad body image = I think I look bad. But our body image is about so much more than how our body looks, or even how we feel about how our body looks.

When we use the term body image, we’re talking about the entire relationship that you have with your body. So that can include things like how you look, how you feel about how you look, health issues, the way that you take care of your body, your experiences of pleasure or discomfort, the way other people treat your body, experiences of oppression, your personal and family histories… it’s a lot.

We’ve had a relationship with our body our entire life, but we’re not really taught to think about it as a relationship. And for a lot of us, that’s where the troubles begin. 

Relationships are learned in the same way that we learn pretty much everything else: from other people. We learn about what makes a good family relationship, a good work relationship, a good romantic relationship, a good friendship. But most of the time, this learning is not direct. People don’t necessarily sit you down and say “a good romantic partner should always be interested in sex” or “a good friendship should never have any boundaries” or “a good employee should never call in sick.” I suspect that’s because if we said these rules out loud, we might be able to notice that they seem…. Not great. So instead of saying them out loud, we learn these rules indirectly and implicitly, where they get to operate from the shadowy corners of our psyche. 

And in this same way that we’ve learned other relationships, we’ve learned criteria for what makes a good body. A good body is thin, able-bodied, usually white, cisgender, has no acne, has hair in all the right places and none of the wrong places, etc. This sort of learning happens explicitly and implicitly, and it happens everywhere: in classrooms, in conversations with our parents, in the grocery store checkout line, on the playground, in the lunchroom at work, at the doctor’s office.

And usually, through these many different avenues, we’ve learned all the ways in which our body is bad. It’s not the right shape, or not the right colour. It has acne. It has hair in the wrong places, or doesn’t have enough of it in the right places. It wants sex too much, or not enough. It needs to pee even though the teacher says no. It needs sleep, even when it doesn’t fit into our busy schedules. It feels anxious at inconvenient times. It wants delicious food, even though we’re taught that that delicious food is bad (or even sinful — check out Raquel’s webinar on this later this month!).

So we learn to distrust our body. We learn that our body is sneaky and undisciplined and needs to be kept quiet. When we’re tired, our first question is usually not “how can I get more rest?” but instead “how can I stop feeling tired?” When our body refuses to lose weight our question is not “how can I accept and celebrate my body’s size” but instead “how can I force it to change?”. We learn that our body signals are not supposed to be honoured, they are supposed to be overruled.

And of course, along the way, we learn a ton of shame. How could we not? We learn that our body is gross and shameful and bad, and that that must mean that deep down, we are also gross and shameful and bad. And so because our body is so awful, we criticize it and punish it and hide it and mistreat it.

You can see how it becomes a vicious cycle very quickly. We feel shame about our bodies, so we criticize and mistreat ourselves in order to fix our bodies so we can feel less shame. Instead, we feel more shame, because someone (us) is criticizing and mistreating us all the time. And we try to fix that shame by (you guessed it!) heaping on some more criticism and mistreatment.

We shame ourselves to try to stop feeling shame, like a desperate person alone in the ocean drinking salt water to relieve their thirst. Our solution to the problem makes things worse.

An essential element of changing your relationship with your body is something that Acceptance and Commitment Therapy (ACT) calls “creative hopelessness.”  Which is basically a fancy way of saying “giving up.” Not giving up on everything, but specifically giving up on the stuff that we do that doesn’t actually work for us. Because let’s be real: if shaming ourselves was going to fix things, it would have by now.

So… now what? If we accept that shaming ourself isn’t the solution, then what?

The “creative” part of creative hopelessness is the idea that when we become hopeless about our current approach and give up on it, we open up the door to creativity about what else might be possible. When we accept that what we’re doing right now doesn’t actually work, we can commit to trying something different. 

Imagine for a moment that you have a coworker who you’d like to become friends with. What you probably wouldn’t do is go “I’m going to be really critical of this person until they’re perfect, and then we will be best friends.” What most of us would (hopefully) do is start by treating them kindly. There’s no guarantee that treating someone kindly is going to result in a friendship, but it is a prerequisite for a friendship to develop. If you’re waiting until you’re already friends with someone before you start treating them well, you’re going to be waiting a long time.

The same is true in our relationship with our body. If we want to start having a caring, respectful, trusting relationship with our body, we need to be caring, respectful, and trusting toward it. And we have to start with actions, not emotions. We can’t wait until we feel positively toward our body before we start treating it kindly — instead, we have to treat our body kindly as a prerequisite to feeling positively toward it.

This is where we might notice our brain protesting. If I stop counting calories, then I’ll hate my body even more! If I stop criticizing myself, who knows how awful things will get! If I start trusting my emotions, my whole life will fall apart!!!

If you notice your brain doing that, I’ll encourage you to come back to our creative hopelessness — you’ve tried to make yourself feel better by counting calories and criticizing yourself and distrusting your emotions. Has it worked? Has it brought you long-term fulfillment? Is that why you’re reading this blog post, because your relationship with your body is so great?

This is often where grief gets involved. Most of us have spent huge amount of our precious time on this earth at war with our bodies. We’ve missed out on culturally important foods, joyful social occasions, potential romantic relationships, maybe even job opportunities because we disliked our bodies. We’ve spent countless dollars on trying to make ourselves feel better about our bodies with special foods, slimming clothing, or exercise equipment. We’ve done things that have significantly deteriorated our physical health, like smoking cigarettes, taking shady supplements, or drinking too much to try to ease our insecurity.

The biggest grief for me, when I started this befriending process many years ago, was realizing the mental energy I’d wasted. I used to spend my days entirely consumed by thoughts about my body and food — I didn’t even realize it was a problem, at the time. In fact, I thought it was a good and virtuous thing that I was doing, trying to tame my unruly body.

They say it takes ten thousand hours to become an expert at something. Without even being aware of it, I’d become an expert at hating myself. I suspect, if you’ve read this far, you might also be an expert at this.

It’s an immense thing to grieve the time and energy lost to body hatred. And so lots of people don’t. I think of the Carl Sagan quote, “If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken.”

Giving up means acknowledging that we have been bamboozled. We have spent our precious lives at war with someone who was never our enemy in the first place. And when we can really recognize that, we can finally stop fighting.

The good news here, one reassurance that I would like to offer, is that our bodies are remarkably gracious. They’re apprehensive sometimes, understandably, but they don’t hold grudges. Like the Nayyirah Waheed poem says: 

and i said to my body. softly. ‘i want to be your friend.’ it took a long breath. and replied ‘i have been waiting my whole life for this.’

Give yourself the gift of giving up. You might find that your whole life is waiting for you.

If you are ready to start changing your relationship with your body, registration for our Befriending Your Body group closes Tuesday. It is a professionally-facilitated six week group based in the principles of Acceptance and Commitment therapy. If you’re interested in registering for this group, or would like to be kept in the loop about future group offerings, send us an email!

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Beyond Self-Acceptance

Written by: Dustin LindenSmith

Time to read: 9 minutes

Trigger warning: In this article, there are references to abuse and trauma (with no details described or disclosed). There are also sensitive emotional topics discussed which could trigger an emotional reaction in you if they resonate strongly or if they make you recall painful events from your own life. Please be mindful of your own state of mind right now, and exercise healthy boundaries around engaging with this article if you don’t feel emotionally safe, secure, and stable at this time.

My first blog post was tied to my first Aleo webinar about what it’s like for fat people to live in a fatphobic world. I suggested four specific actions we can take to find some peace of mind within that reality: (1) changing the way we think (and act) about fatness and our bodies; (2) cleaning up our social media feeds; (3) working on our boundaries; and (4) seeking professional support to work with any or all of the above. My second webinar was focused on how I started doing real work on that first step through the illuminating and inspiring work of the American Black fat activist Sonya Renee Taylor through her book, The Body Is Not An Apology. In this blog post, I will share some of the insights I learned from her powerful writing.

On developing the mental and emotional skills to enter recovery in the first place

Like any fat person, I have experienced various forms of discrimination and negative judgments from others—even from within my own family. But my suffering in that regard has also been strongly mitigated by the fact that being an affluent, cisgender White man affords me many privileges that help me overcome that bias in the external world. Even so, that privilege hasn’t insulated me from developing my own internal shame and self-loathing about the size and shape of my body, and for how poorly it has always fit into our culture’s apparent standards for attractiveness.

In order for me to enter recovery from my binge-eating disorder, I first needed to overcome that shame and self-loathing, develop accurate self-awareness and attunement to my own body’s internal states, and then adopt a more intuitive approach to food and movement that was driven by my body’s in-the-moment needs, as opposed to that of my emotions alone. I had to start that by changing my mind.

A reminder about how and why we arrived here

News articles abound on “the obesity epidemic” and how much our numbers are increasing year over year throughout the entire world. The traditional medical model for “treating obesity” has failed in almost every respect, and most of us have also experienced some form of fat-shaming at a doctor’s office at some point. The medical field has also been convinced by recent pharmacological innovations in satiety hormone re-regulation (i.e., GLP-1 inhibitors like Ozempic) that pathologizing the mere state of being fat and taking a drug to fix it will save all of us fat folks from our certain morbid fate.

Many fat people have also had a love-hate relationship with food and movement (i.e., diet and exercise) for much of our lives—not to mention our bodies themselves. We have often developed a distrust in our own judgment about what our body actually needs or wants at any given time. This is a natural result of having successfully lost weight so many times on a calorie-restricted diet, only to gain it all back—with interest—months later. Many of us also have trauma histories, relational issues, and self-image and body-image problems which all increase those feelings of disconnection, dissociation, disavowal, shame, and mistrust towards ourselves. Shame and trauma work together to convince us that our bodies are not good enough, not small enough, not strong enough, or not attractive enough. Dr. Becky Kennedy has also written about how common unresolved ruptures can be in parent-child relationships, but that many of us in larger bodies are likely to have experienced more of them by virtue of our family often trying to get us to diet or address our fatness.

Developing a new way to look at ourselves and our fatness

It was Sonya Renee Taylor’s writing that first truly awakened me to these five essential truths:

  • at our basic, human essence, we are all perfectly good, and normal —no matter what size we are, or whatever number comes up when we step on a scale;
  • for perfectly valid reasons (often arising from childhood trauma or adverse events), many of us have used food for emotional self-regulation since childhood—and this may have resulted in our eventually becoming fat;
  • given those valid underlying reasons and our dysregulated eating habits and relationships with our bodies that resulted from them, many of us who now live in fat bodies are faced with inexorable pressure from all directions to lose weight, and we’re encouraged to think of ourselves as failures if we can’t manage to follow a weight-loss diet to get smaller;
  • this process develops within us an adversarial relationship with our bodies; and
  • no matter what size you are, you deserve to have a peaceful relationship with food and your body. You also deserve to eat full, delicious, nutrient-filled meals that will nourish your body and mind to accomplish all of the important things you do in your life each day. You also deserve to each those meals without feeling the crushing weight of internalized shame, blame, or negative judgment that makes you feel like a bad person inside.

Inquiry # 7, 9, and 12: Body shame origin story

Sonya Renee Taylor’s book is peppered with thoughtful journal and meditation prompts to propel you along this path to self-discovery. Three of those inquiries focus on the body shame origin story. She explains that this developed in our youth in response to rapid or unexpected change—often arising from puberty. It occurred when we became aware of difference, and it made us assume there was some “should” about our body which then became attached to our feelings of value and worth. If we happen to have experienced abuse, that complicates our body shame even further because of how we may erroneously perceive our bodies to have incited that abuse.

Here are some of her prompts for you to consider about your own body shame origin story:

  • When did you first become aware of difference, and when did you first start to feel different from others?
  • When did you first become aware of something your body should do/have/look like?
  • Who in your life is most affected by your body shame, and how is it impacting them?

Sonya Renee Taylor also encourages us to make peace with not understanding all of these differences we notice. She asks us to make peace with those differences, and then to make peace with our bodies.

Inquiry #19: The fog of living in body shame

Sonya Renee Taylor asks: In what ways has the fog of living in body shame hindered your most amazing life? What is incomplete, unexplored, ignored inside you because of your belief that something about you and your body is wrong?

Personal Note: I noticed real grief arise within me when I did this inquiry. I experienced grief for the years I had spent harming myself with food, and for all the opportunities I had missed out on being mindful and happy with my family and friends because I had spent so many years living in a chronically dissociated state from being in that fog of body shame. I encourage anyone who does this work to be gentle, loving, and graceful with yourselves as you contemplate what you may have lost as a result of this way of living. Take solace in the fact that you are recognizing where you are now, and that you are ready to inhabit your body and your life in a much more open and embodied way than you ever have before.

You are not your thoughts

As we continue to reflect on these prompts, Sonya Renee Taylor encourages us to reflect on the differences between thinking, doing, and being. She reminds us that:

  • we are not our thoughts;
  • not every thought we have is true; and
  • many of us are caught in negative thought patterns about ourselves and our bodies that are simply not true.

She asks us to notice the next time our actions are not in alignment with our thoughts or our beliefs, and to ask ourselves: what is our body trying to tell us? And how can we listen to what our body has to say if we’re not used to doing that or don’t have the first clue of how to start?

On the challenges of becoming embodied

Many of us are unskilled at listening to what our bodies have to tell us. Not coincidentally, if we have engaged in chronic weight-loss dieting, we have trained ourselves to ignore our body’s calls for food that arise from being in a state of caloric deficit so often. Listening to our body and noticing what comes up simply does not come naturally to those of us who can’t even stand the sight of themselves in a mirror or who feel like they will never find love because they’re fat. We are simply too accustomed to living in a disconnected state from our bodies during most of our waking hours. Extend some forgiveness and grace towards yourself, and see if you can gently extend a helping hand to your own self to guide yourself out of the fog.

As I bring this article to a close, I would like to invite you to experience the gift of your own body right now through this short mindfulness exercise:

take a few moments to let your body settle gently into a relaxed and comfortable position

observe yourself take three… deep… breaths…

bring your attention to your body, starting with the feeling of your feet in contact with the ground

let your attention flow naturally up through the tops of your feet, your ankles, your calves, your knees, your thighs, and your hips

let your attention keep flowing naturally up through your belly, your chest, your back, and your shoulders

let your attention flow down your arms, all the way to the tips of your fingers, and then back up to your shoulders

as your attention moves up from your shoulders to your neck, let all of the tension in those muscles release…

and as your attention continues to flow upwards through to the top of your head, let the tension in your head, face, neck and shoulders release

now

let your attention rest on your breathing

and let yourself sit in silence for as long as you are comfortable

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Taking Up Space: How to honour and connect with our bodies in a fatphobic world

Written by: Dustin LindenSmith

Time to read: 12 minutes

Please allow me to introduce myself: I go by Dustin, my pronouns are he/him, and I’m grateful to live with my wife and three children on a lake situated on the unceded ancestral territory of Mi’kmaqi and the Mi’kmaq people, at Punamu’kwati’jk (”Boonamagwaddy”), known in modern times by its colonialist name of Dartmouth, Nova Scotia (across the harbour from Kjipuktuk (Chebucto), now known as Halifax). I am a White, cisgender man, a stay-at-home dad, a jazz musician, a recovering IT professional, and a peer supporter for people in recovery from eating disorders. I am also currently studying for my Master’s in Counselling Psychology to become a psychotherapist.

I come to this work by way of my own lived experience and my ongoing recovery from childhood trauma and an eating disorder.1 I first started eating for emotional comfort and stress relief at age 7, and I was always known as a “husky” child. I went on my first weight-loss diet in my pre-teens, and by the time I reached high school, I had “dieted my way up to” a very high weight. After another couple of weight-loss cycles followed by longer periods of weight gain, I became very fat by the halfway point of my undergraduate degree. I would go through about eight large swings of weight-cycling from that point until I entered recovery some 30 years later.

What I needed to recover from was an eating disorder. When I entered recovery, I estimated that I had gained and lost the equivalent of four times my adult body weight throughout my life—truly an epic, lifelong cycle of yo-yo dieting. Once I really connected the dots between my childhood trauma and my decades-long, food-based emotional coping habits, I was finally able to stop my weight-cycling behaviours by never starting another weight-loss diet again. However, in the fatphobic, diet-obsessed culture we live in, refusing to go on a diet is itself a quasi-revolutionary, countercultural act.

SOTU (State of the Union) for Fat People Today

First, a word about the word “fat”. People “of size” are reclaiming the word fat as a simple descriptor for our bodies that is stripped of its usual negative and pathologizing connotations. I will use the word as a non-judgmental reference term for people like me who live in larger bodies, and whenever I use the word, I do not imply that there is anything inherently wrong or unhealthy about merely being fat.

Second, our status: our numbers seem to be increasing every year, with the causes being multifactorial, complex, and interrelated with one’s socio-economic, cultural, and intersectional positioning within their community. In healthcare, the medical community certainly treats obesity as inherently pathological, but there is no consensus on how to “solve the problem of obesity” or even how to clearly define what “the problem” is in the first place (recent pharmaceutical developments with GLP-1 inhibitors such as Ozempic notwithstanding).

Third, how fat people might present today is multifaceted, but many of us share similar backgrounds and experiences. For years—likely dating back to our childhoods—many of us have had a dysregulated relationship with food, movement, and our bodies. Many of us have experienced chronic and severe weight cycling throughout our lives as a result of chronic weight-loss dieting, and many of us have experienced adverse childhood experiences that involved trauma, neglect, or abuse. Once more for the people in the back: Fat people are themselves often survivors of trauma and abuse.

A Primer on Anti-Fat Bias and Toxic Diet Culture

Anti-fat bias is rampant in our culture, and it is a force which is colonialist, misogynist, and racist in origin. It arises from holdover imperialist ideas about man’s apparent dominion over our mind and our bodies, and of mind over matter. It clings to the ill-conceived notion that we should all be capable of keeping the body “in line” through the rigours of our own mind and willpower, and this has cultivated a learned distrust within ourselves about our bodies. Many of us have lost faith in our own judgment about what is “the right thing” to do for our bodies.

Fat stigma is shot through our families, popular culture, our society, and in our physical spaces (e.g. restaurants, airplanes, and public seating areas which cannot comfortably accommodate fat people). In healthcare settings, it shows itself through the relentless pursuit of thinness for its own sake (+ the inanity of considering one’s BMI on its own as a diagnostic indicator for anything clinically useful on its own merits). We are also all involved (willingly or not) in a multi-billion-dollar dieting and weight loss industry that is deeply pervasive in our popular culture, news and social media, and within many of our friends and family groups.

Why Are We Fat, Anyway?

With apologies to any medical folks in the crowd, I’d like to start with a disavowal of our collective and cultural drive to be thin in the first place. It is simply not necessary to be thin in order to be happy or healthy, and just like anyone else, fat people deserve to be loved and to feel joy.

There are also well-established links between trauma, adverse childhood experiences (ACEs), and disordered eating behaviours 2. Some of us have that history + a personality type or an entrenched pattern of behaviour that derives emotional comfort or stress relief from eating or overeating, and this has led to weight gain over time.

Dieting for weight loss also contains a painful, intrinsic paradox: people can easily become fat by dieting for weight loss. Dieting has a 95+% failure rate for long-term, sustainable weight loss because of how our biology thwarts long-term weight-loss due to its protective metabolic functions against famine and starvation2. There is almost always an unhealthy rebound effect with dieting and weight-cycling, which can best be described as the result of a restrict*-then*-binge cycle (and not a binge-then-restrict cycle—i.e., the restricting comes first).

Being fat in this culture also brings with it body shame, self-loathing, a lack of self-trust, and pervasive feelings of failure and worthlessness resulting from years of “failing” at weight-loss diets. Shame is a physical manifestation of the existential fear that we might become excluded from our group, and this can often lead to dysfunctional and maladaptive behaviours and relational patterns3.

Many of us also deprive ourselves of food (and/or we have an adversarial relationship with it), and this can result in caloric restriction which then incites binge-eating behaviours. The truth is, *we all deserve to eat—*but not all of us believe that we deserve to eat (and/or not all of us believe that we deserve to eat what we want to eat and when we want to eat it).

In my observation, there are also certain factors that do not usually contribute to our fatness: these are a lack of self-insight, a lack of awareness, a lack of motivation, a lack of information, or a lack of knowledge. What we are missing is something much different than those things.

So What Do We Do Now?

So far, I’ve set some of the context for what it’s really like for fat people to live in a fatphobic world. But what can really do about all of that? I have four concrete things to suggest: (1) changing the way we think (and act) about fatness and our bodies; (2) cleaning up our social media feeds; (3) working on our boundaries; and (4) seeking professional support to work with any or all of the above.

Let’s get into each one in some detail.

1. Changing the way we think (and act) about fatness and our bodies

Here are some ways we can start to adjust our mindset and self-view about our own fatness and how we deserve to show up in the world.

  • cultivating accurate empathy and self-acceptance towards ourselves by working with our shame and forgiving ourselves for our past behaviour with food and movement
  • acknowledging our inherent sense of goodness and self-worth: acknowledging that we are all perfectly good, worthy people and we deserve to exist, to eat, and to take up space in this world—no matter what size we are or what number comes up when we step on a scale or whether we think “society” finds us attractive or whether we’ll find a partner or have a family
  • personal self-development and embodiment work: practicing personal self-development work that gets us into our bodies and cultivates mindfulness and self-acceptance (e.g. journaling, art, writing, crafting, singing, dancing, playing, music, acting, movement, or other embodiment exercises such as sports, yoga, tai chi, swimming, strength training, martial arts, walking, working out, golfing, racquet sports, sports in the water, hiking, camping, bouldering, landscaping, and more)
  • radical self-love: learning how to transform our adversarial relationship with our bodies into what Sonya Renee Taylor calls radical self-love

2. Cleaning up our social media feeds

Extensive research has confirmed that the use of social media has been linked to various poor mental health outcomes (e.g., Gioia et al., 2020; Keles et al., 2020). Here are some suggestions for how to mitigate those harms for yourself:

  • acknowledge SM’s real potential harms to our self-image, body image, and self-worth when we drench ourselves in comparisons with the beauty and health content online
  • initiate some accurate (but compassionate!) self-inquiry about your usage habits and about what you really want to “get” from your social media (e.g., if it’s for entertainment but the end result is that the images you’re exposing yourself to are harming you and making you feel terrible about yourself, is it really giving you what you’re looking for?)
  • revisiting privacy settings, posting/reading frequency, screen time settings
  • unfollowing accounts focused on weight loss, dieting, “clean” eating, excessive exercise, and anything that otherwise appears to promote toxic diet culture or misogynistic beauty standards
  • adding new accounts that pass your new fat-positive vibe check (e.g., the beautiful Black yogini Jessamyn Stanley (@mynameisjessamyn) (and don’t miss this guest reel by @funkingafter50); the ineffably happy Toronto gay bear Lukas (@bearlyfriendly); and the photographer and artist Sugar McD (@shooglet), who has taken some of the most beautiful pictures of fat people experiencing joy that I have ever seen)

3. Working on boundaries

This is the one I have personally found the most difficult; throughout my entire life, I have pre-emptively made self-deprecating fat jokes about myself in social settings in a misguided attempt to make everyone comfortable. I now understand that this habit was causing me more harm than I knew, and it was also giving everyone in my life implicit license to speak disrespectfully about my own weight.

It takes real courage (along with possibly a previously-unknown self-respect) to build up the confidence to start the challenging but worthwhile work of informing the people in your life that you’re no longer willing to put up with a certain type of discussion or judgment about your body weight, your diet, your food choices, or your health.

The best introduction to the topic I can suggest is Aleo’s own Lee Thomas’s 2-part blog post on this topic. When you’re ready to go deeper, I recommend looking at Black psychotherapist Nedra Glover Tawwab’s excellent work (e.g., her website, her Instagram, her book, and her workbook are all excellent resources).

4. Professional support

One of the sweetest gifts you can give yourself is the gift of professional support for what you’re struggling with. If you want to take a fresh new approach to your recovery, working with anti-diet, anti-oppressive practitioners such as the ones you will find at The Aleo Collective would be a great start. Lee and Raquel are MSWs; Courtenay is a Registered Dietitian, and I am a Peer Supporter who works with people in recovery from disordered eating and self-image issues.

  1. i.e., Binge-Eating Disorder (BED); see APA, 2022, p. 392 ↩︎
  2. Bakalar et al., 2018; Brewerton, 2022; Hemmingsson et al., 2014; Schiff et al., 2021 ↩︎
  3. Freire, 2020; Spreckley et al., 2021 ↩︎
  4. Doran & Lewis, 2012; Noll & Fredrickson, 1998 ↩︎

References

American Psychiatric Association [APA]. (2022). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text rev. (DSM-5-TR). https://doi.org/10.1176/appi.books.9780890425787

Bakalar, J. L., Barmine, M., Druskin, L., Olsen, C. H., Quinlan, J., Sbrocco, T., & Tanofsky‐Kraff, M. (2018). Childhood adverse life events, disordered eating, and body mass index in US Military service members. International Journal of Eating Disorders, 51(5), 465–469. https://doi.org/10.1002/eat.22851

Brewerton, T. D. (2022). Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. 1–20. https://doi.org/10.1186/s40337-022-00696-6

Doran, J., & Lewis, C. A. (2012). Components of Shame and Eating Disturbance Among Clinical and Non-clinical Populations: Shame and Eating Disturbance. European Eating Disorders Review, 20(4), 265–270. https://doi.org/10.1002/erv.1142

Freire, R. (2020). Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets. Nutrition, 69, 110549. https://doi.org/10.1016/j.nut.2019.07.001

Gioia, F., Griffiths, M. D., & Boursier, V. (2020). Adolescents’ Body Shame and Social Networking Sites: The Mediating Effect of Body Image Control in Photos. Sex Roles, 83(11–12), 773–785. https://doi.org/10.1007/s11199-020-01142-0

Hemmingsson, E., Johansson, K., & Reynisdottir, S. (2014). Effects of childhood abuse on adult obesity: A systematic review and meta-analysis. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 15(11), 882–893. https://doi.org/10.1111/obr.12216

Keles, B., McCrae, N., & Grealish, A. (2020). A systematic review: The influence of social media on depression, anxiety and psychological distress in adolescents. International Journal of Adolescence and Youth, 25(1), 79–93. https://doi.org/10.1080/02673843.2019.1590851

Noll, S. M., & Fredrickson, B. L. (1998). A Mediational Model Linking Self-Objectification, Body Shame, and Disordered Eating. Psychology of Women Quarterly, 22(4), 623–636. https://doi.org/10.1111/j.1471-6402.1998.tb00181.x

Schiff, M., Helton, J., & Fu, J. (2021). Adverse childhood experiences and obesity over time. Public Health Nutrition, 24(11), 3205–3209. https://doi.org/10.1017/S1368980021001804

Spreckley, M., Seidell, J., & Halberstadt, J. (2021). Perspectives into the experience of successful, substantial long-term weight-loss maintenance: A systematic review. International Journal of Qualitative Studies on Health and Well-Being, 16(1), 1862481. https://doi.org/10.1080/17482631.2020.1862481

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What to Expect When Working with an Eating Disorder Dietitian

Written by: Courtenay Vickers RD

Time to read: 6 minutes

What comes up for you when thinking about working with a dietitian? Many people might say they feel anxious, or perhaps express fear that they’re going to be weighed, or maybe they’re worried about getting “lectured” to by the dietitian.

Navigating the journey of recovery from an eating disorder can be overwhelming, but understanding the role of an eating disorders dietitian (ED RD) can help illuminate the path forward. Let’s explore what a dietitian is, what you can expect when working with an ED RD, and practical steps to get connected with one. And, hopefully, leave you feeling less unsure and more confident about getting started with an ED RD.

What is a Registered Dietitian (RD)?

Registered Dietitians are healthcare professionals who provide evidence-based nutrition and food information to help individuals lead sustainable and enjoyable lives. To hold the professional title, a dietitian must:

  • Obtain a degree in nutrition from an accredited university.
  • Complete a one-year internship with rotations in clinical and community nutrition, and foodservice.
  • Pass a national registration exam.
  • Register with their provincial dietetic regulatory body.
  • Meet annual continuing education requirements.

Dietitians take a holistic approach, focusing on the overall well-being of their clients. In the context of eating disorders, this often involves specialized training and ongoing supervision to address the unique challenges of these conditions.

A note on “nutritionists”: In some provinces, the term nutritionist is a protected title that can only be used by Registered Dietitians. Currently, only applies to Alberta, Quebec, and Nova Scotia. Other titles, such as holistic nutritionist, nutrition coach, etc. can mean different things, but they are NOT the same as an RD. Educational background and ongoing education, level of competence, and regulations can vary drastically. 

When an RD says they are eating disorder specialized, this means the RD has specialized training and supervision in addition to their required schooling. Unfortunately, most university nutrition programs have very little to no training on eating disorders, which means many eating disorder-specialized dietitians have gone on to complete many additional trainings and hours in supervision to build their competence and confidence to support those seeking recovery from an eating disorder.

ED RDs are a critical part of the professional care team for ED recovery, alongside a therapist & primary care provider. Many ED RDs have also adopted weight-inclusive, anti-diet, and HAES-aligned perspectives.

The Role of an Eating Disorders Dietitian

Eating disorders dietitians are a vital part of the recovery team, working alongside therapists and primary care providers. Their responsibilities include:

  • Conducting comprehensive nutrition assessments and regular follow-ups.
  • Developing personalized nutrition care plans.
  • Assisting with the implementation of these plans.
  • Addressing dysfunctional thoughts and emotions related to eating, food, or body image.
  • Collaborating with other healthcare providers and, when appropriate, family members.

What will come up in sessions with an ED RD?

Generally, the top nutrition priorities when working with a dietitian for recovery will be working towards nutritional adequacy and regularity with eating. Along the way there will likely be many other themes to explore and areas to work on, such as:

  • Exploration of weight stigma
  • Understanding set point theory, metabolism, and energy needs
  • Challenging diet culture and internal beliefs about food
  • Meal planning and grocery shopping
  • Pacing of meals
  • Fear foods / trigger foods
  • Body image
  • Intuitive and mindful eating practices
  • Managing gastrointestinal issues and nutrient deficiencies
  • …and many other things!

Most ED RDs will be bringing in tons of compassion and validation along the way, and an acknowledgment that the eating disorder is not your fault. Sessions generally should provide you with a supportive environment and a non-judgmental space to explore these complex issues, as you take these brave steps forward in your recovery.

What to Expect in Your Sessions

Initial Sessions

The first few sessions typically involve a nutrition assessment to understand your current nutritional status and recovery needs. This helps set the foundation for your personalized care plan.

Follow-Up Sessions

Subsequent sessions usually start with a check-in, where you can share your progress, challenges, and reflections. Together with your dietitian, you will work on breaking down the next steps toward your nutrition and recovery goals. Sessions can be conducted virtually or in person, depending on your dietitian’s practice setup.

Duration of Treatment

The length of time you will work with a dietitian varies based on individual needs, the availability of the RD, financial considerations, and accessibility. Many individuals see their RD every 1-2 weeks and continue until they can sustainably manage regular and adequate eating patterns, often spanning several months to a year or more.

How to Get Connected with a Dietitian

Free Options

  • Referral: Your primary care provider or specialist can refer you to a clinic with a dietitian on the team.
  • Family Health Teams, Primary Care Networks, and Community Health Centres: These often have dietitians available and offer free workshops, education programs, and counseling.
  • Home & Community Care Services and Hospitals: Ask your case manager or hospital staff about dietitian services.
  • Telehealth Services: Call 8-1-1 or visit the website to ask dietitians questions for free.

Finding an Eating Disorder Specialized Dietitian

  • National Eating Disorder Information Center (NEDIC) – Find A Provider
  • Dietitians of Canada – Find A Dietitian
  • EDforRDs – Find A Dietitian
  • Association for Size Diversity and Health (ASDAH) – Healthcare Provider Listing
  • International Association for Eating Disorder Professionals (IAEDP) – Member Search
  • Intuitive Eating Counselor Directory

Tips for accessing and picking your RD

Note – if you are part of a hospital-based program, you generally won’t get a say in who your dietitian is.

  • Consider your options based on where you live and financially: In-person vs virtual, Private practice vs a free option, sliding scale and/or direct billing to insurance providers, etc.
  • RDs with eating disorder knowledge may or may not highlight the extent of their expertise online, so ask about their knowledge and comfort level of working with EDs
  • Some ED RDs will specialize more specifically with a certain type of ED (ex, ARFID or BED). Consider your symptoms and ask the RD if they have additional training/experience with what you’re struggling with.
  • Consider what values the dietitian has, and if they are in alignment with yours
  • Ask if you can meet with the RD for a free initial call to see if you’re a good fit
  • It’s okay to say if you’re nervous!

Working with an eating disorders dietitian can be a transformative step in your recovery journey. By understanding what to expect and how to get connected with the right professional, you can take proactive steps towards a healthier relationship with food and your body. For those living in Nova Scotia, New Brunswick, or Ontario, virtual nutrition counseling options are available through the Aleo Collective.

For more information or to schedule a free discovery call with the dietitian at The Aleo Collective, visit courtenayvickersrd.com and follow on social media at @courtenayvickersrd.

Remember: you are worthy of reaching out for help 💕

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