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Clinical hypnotherapy for eating disorder recovery

3 Ways Clinical Hypnotherapy Can Help in Eating Disorder Recovery

by Bonnie Killip, Master Clinical & Medical Hypnotherapist 

Have you ever wondered if hypnotherapy can help with eating disorder recovery? If traditional eating disorder recovery is not progressing, it may be worthwhile considering hypnotherapy as a treatment option.

As a Dietitian and clinical and medical hypnotherapist, often my consults start with addressing people’s questions, concerns, and often skepticism around what hypnosis is. Let’s start by clearing up the common misconceptions. 

Hypnotherapy is not a trick nor is it mind control and it is also much more than meditation or relaxation.

Full disclosure: I’ve been one of the skeptics 

Until a few years ago hypnosis was not a part of my life. It wasn’t even on my radar. A no-nonsense biomedical scientist, I was only interested in evidence and randomized controlled trials (RCTs). 

I did not believe in using personal stories or anecdotal evidence. I believed in nothing that lacked piles of peer-reviewed literature and meta-analyses. 

In fact, if I’d even heard the word hypnosis, I’d have most likely tuned it out. Now, I cannot imagine my life without what hypnosis has brought and continues to bring to my world both personally and professionally. Actually, I can, but I’d rather not!

After 15 years of living with anorexia nervosa, clinical hypnotherapy not only saved my life – it gave me a life. 

And that’s no longer the most interesting part of my story. Because I now work daily with others who have fallen out of touch with their inner guidance. These people are in positions where all else has failed and they’ve all but resigned themselves to their eating disorders. To live a life of attempting to maintain pseudo-physical health while never being entirely well. 

Hypnotherapy for eating disorder recovery

I now have the daily privilege of facilitating people of all ages and life circumstances. I work with all types, from anxious and confused 10-year-olds to perfectionist and overachieving 16-year-olds, to successful 65 year CEOs and 87-year-olds. All of them want to begin the part of their lives where they are finally free to be themselves. 

I have both personally experienced and seen first-hand how hypnotherapy can help with eating disorder recovery.

Clinical and medical hypnotherapy offers a direct means by which we can bring about change in an area a person could not change through education, willpower, threats, or motivation alone. The profoundness of what this means in terms of someone’s day-to-day experience of life is high. Because information and knowledge is only part of the picture. It is not until we can put this into practice that we can experience the true benefits. 

Clinical and medical hypnotherapy is an effective eating disorder treatment because it:

  1. Treats the non-logical brain. Eating disorders are non-logical, so it can help to treat them on that level.
  2. Rewires neural pathways. Eating disorders can create rigid neural pathways that need to be loosened in order to recover.
  3. Feel good now. Recovery typically feels like chaos, so any method of feeling good during the process helps.

How does hypnotherapy work for an eating disorder?

Hypnotherapy is individually tailored to each person. It can be a powerful way to change beliefs and disruptive behaviors. The focus is on building the skills people need to function at their best versus rehashing past trauma or searching for a cause.

In hypnotherapy, a person is empowered to work on an unconscious and conscious level to change beliefs and behaviors that are interfering with their life. For example, if a person is afraid of food, we would work on decreasing the fear response both subconsciously and consciously. By experiencing the fear and moving through it in the safety of hypnotherapy, the person acquires confidence and fear patterns are reduced or eliminated over time. 

This works because the brain cannot tell the difference between an imagined scenario and a scenario that is taking place in the physical world. While it could take months of careful psychotherapy to get a person to face a fear food at the dinner table, we can face the imagined fear food in hypnotherapy rather quickly.

If a person is struggling with binge eating and/or purging behaviors, we could explore the unconscious fears underlying those behaviors. We would practice facing them in a safe, secure environment. 

The actual practice of hypnotherapy may include: 

  • Trance induction (direct or indirect)
  • Suggestion
  • Metaphor
  • Conversational hypnosis
  • Neurolinguistic programming

Hypnotherapy is specifically outcome-focused. We precisely target exactly what it is a person wants to change and then go about bringing about that change.  

Here is some more detailed information about the benefits of hypnotherapy:

1. Treating the non-logical brain

An eating disorder is not a logical problem.

Ask anyone with an eating disorder if they are choosing to feel those feelings or do those behaviours. I can guarantee they’re not. There are powerful emotions driving them to not eat, to binge, to over-exercise or whatever it is for them.

If the eating disorder was something you could fix through logic, information and understanding you’d have done so.

Clinical hypnotherapy offers a means by which we can re-establish rapport with the unconscious mind. In more science-y terms, we work with our autonomic nervous system. The goal is to restore back to what your body has known how to do all along before the outside world made you question the innate wisdom of your body. 

We’ve all had the experience of being children, and as children, we had no problem connecting to our bodies’ messages. And we have no problem communicating this. As a baby, we don’t think “I’m hungry but I can see mum is tired and busy at the moment, so I’ll just wait”. Nope, we scream and yell until we get that need met! 

Reconnecting with our bodies

If we want to be a successful adult, we have to at some point move on and meet those fundamental human needs for ourselves. If we do not, we become disconnected from the signals our body is sending. The body may even stop sending signals. Because, after all, “what is the point of telling her to eat if she will not do it, anyway?”

When we get out of the way, our body is free to do what it has evolved to do. It will steer us towards health naturally and without our micromanagement. You don’t have to think about when and how quickly you want your heart to beat or your lungs to breathe, do you? There are things your unconscious knows how to do much better and with much more ease than your conscious mind. 

2. Rewiring neural pathways

Hypnosis offers a direct means of altering neural networks and neural rewiring.  

When it comes down to it, this is the crux of eating disorder recovery, and it’s why hypnotherapy can help. 

At some point, recovery becomes recovered. And recovered is an entirely fresh way of not just behaving but also, crucially, of thinking and feeling.

The behaviors of an eating disorder often begin as a coping strategy. They are compensation or an attempt to meet a need (to be healthy, good, more confident, or better liked. But with time it turns from conscious choices into unconscious patterns. Hence why it is a disorder. Because the thoughts, feelings, and behaviors are no longer under the conscious volition of the person. 

The eating disorder then persists at an unconscious or habit level because neurons that fire together wire together. 

In recovery we change the structure, not just the function, of the mind. And there are many ways in which we can do this. Exposure therapy and cognitive behavioral therapy are the most well-known treatments. But hypnosis often offers a means of changing the structure more quickly and safely than either of these. 

Bypassing the habits of an eating disorder

Hypnotherapy bypasses the need for the involvement of the conscious mind. It goes right to where the issue is being maintained: the unconscious mind. The eating disorder thrives not in our prefrontal cortex but in our lower brain areas such as the amygdala. 

When I was sick I’d been told by so many therapists and doctors that my brain had changed because of the illness. That I’d been sick so long it most likely wasn’t possible that I could ever fix the damage or recover. What I know now is that the very fact that my mind changed to accommodate the illness meant it was more than possible for it to change back. It could even improve and rewire in all the ways it needed to to be not just free of the illness, but healthier than ever before.

 I just needed the means by which to do this. It turned out clinical hypnotherapy helped me recover from my eating disorder. 

3. Feel good now

Take a moment to answer this question:

If your child could feel great or good about eating, would they have a problem eating?   

The answer is always a resounding yes. And this is why recovery can be so hard for loved ones to understand. It may be hard to imagine, but choosing recovery from an eating disorder is choosing chaos and pain. 

To everyone outside of the disorder, recovery is short-term chaos with long-term rewards. But the person in the disorder doesn’t feel like the chaos will ever end. It feels like you are choosing indeterminate chaos and pain with no guarantee that it will have been worth it. 

The resistance to the chaos and pain is why recovery can go on and on and on for many people. I know this was my experience until I did eventually find the help that could help. And a lot of this has to do with the fact that it never feels good. If there are no wins, we lose heart, back down, and find ourselves back in old behaviors.  

How motivated, inspired, and excited are you to jump into shark-infested water just because someone tells you the island on the other side is incredible? Not much, I imagine. And that’s what it feels like for someone with an eating disorder. Eating feels unsafe, and we are asking them to do it 6 times a day as though it is nothing. Therefore, the way to truly help someone is not by focusing on all that is wrong. Instead, we must increasingly allow them to experience wins that show how recovery is worth it.

Achieve a relaxed, calm state

In hypnosis, we experience eating in a relaxed and calm state. We support the circumstances and situations which in their everyday eating disorder state of consciousness produce extreme anxiety and panic. This teaches the nervous system that they can get through these things safely and feel less panic when eating.

The power of hypnosis is that our minds produce exactly the same response whether we are in a dangerous situation in real life or we imagine being in a dangerous situation on the inside of our minds. Take a moment to imagine biting into a juicy lemon to get a sense of what I mean here. If you really imagine it, you will salivate and maybe make a scrunched-up face.    

Take-home message

We don’t know all there is to know about the intricacies of eating disorders. But we know enough to know that education, shame, and blame do not heal. 

We know that eating disorders are on the rise. And even our gold-standard treatments often fail those who seek to recover. 

If you’ve tried one treatment path and it hasn’t worked, it may be time to expand and experiment with other options. Keep in mind that clinical hypnotherapy is an option. It’s a viable tool that I believe will only become more widely used as we improve our understanding of the human mind and what truly drives our behaviors. 

Thanks, Mom!

I could never capture in words just how thankful I am that my mum looked outside the box of what was offered to us for years and years and booked me into that first hypnotherapy session. 

Kids are great hypnotic subjects because they enter a hypnotic trance easily. They go farther and get a lot done when they get to be the creators of their destiny. I truly believe that building rapport with our unconscious mind is one of the greatest determining factors in how far we go in life. To re-establish this at a young age if it is lost or teetering on the verge of being swamped from ever-increasing messages from the outside world over what to eat, how to look, think, feel, and do, is inconceivably valuable.

Clinical hypnotherapy with a licensed professional offers a safe and controlled environment in which your child or yourself can try out fresh ways of being, something we often don’t otherwise get in the day-to-day rush of life.   

Eating disorders are complex, but please do not let complexity lead to undertreatment.


Bonnie Killip Fuelling Success

Bonnie Killip is an Accredited Practising Dietitian (APD), Master Clinical and Medical Hypnotherapist, and Master Neurolinguistic Programming Practitioner. She offers practical and usable nutrition education for those in recovery from eating issues. As a clinical and medical hypnotherapist, she can help kids reconnect with their inner guidance and develop the internal skills and resources to set them up for a life of emotional regulation, self-love, resilience, and happiness. Website: Fuelling Success

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Parents: get off the diet cycle and raise healthier kids

An interview with Judith Matz, LCSW

Parents really, really want to raise healthy kids. Unfortunately, we’re told that the biggest obstacle facing our kids’ health is their body weight. But this approach is harming, not helping our kids grow up healthy.

Parents who are worried about their kids’ weight are more likely to have kids who diet, and the No. 1 outcome of dieting is weight cycling, which can lead to higher lifetime weight, greater risk of eating disorders, and/or lower self-esteem.

We spoke with Judith Matz, LCSW, co-author of Diet Survivor’s Handbook and the brand new Body Positivity Card Deck, and author the children’s book Amanda’s Big Dream – a story that helps kids follow their dreams at any size. She provided us with great ideas about how parents can get off the diet cycle and raise healthier kids.

Q: How can parents help kids develop a healthy body image?

We have to keep in mind that the backdrop is diet culture, and we’ve all been immersed in diet culture. One of the most helpful things parents can do is look at their own attitudes toward dieting, food and weight.

There are a lot of messages that promote weight stigma. This is the belief that thinness is what’s valued, and that you can’t be happy, healthy and successful unless you’re a certain body size. Weight stigma presumes everyone can be thinner if they do the right things and leads to shaming people who are at a higher weight.

Parents typically have the best of intentions. They want to protect their kids from weight stigma. But they don’t realize that they are transmitting negative body image and body shame to their children. This shame becomes internalized, leading to lifelong struggles with food and weight.

It’s important to teach kids that bodies naturally come in all shapes and sizes.

The greatest difficulty facing many of my clients is healing the pain that they weren’t “good enough” because of their body size. These feelings often began in childhood with comments from parents (and other important people in their lives) about weight. Parents who see diet culture for what it is (harmful) can help their kids develop a more positive body image. They can teach kids to take care of their bodies at any size. They can let their children know that they are loved for who they are, not what they weigh.

Q: What should parents know about kids’ health and weight?

What’s helpful for parents to understand first is that weight is a characteristic, not a behavior. Genetics plays a big role in a child’s weight, just like it does in their height. On the other hand, parents can model positive behaviors in their own relationship with food and physical activity.

Socializing with friends, a good night’s sleep and honoring hunger and fullness cues are examples of behaviors that are terrific for kids of all sizes. If you have a child who is active and eats a wide variety of food (given what’s accessible to your family), there’s a good chance they’re at the weight they are supposed to be.

At the same time, if you have a child who is binge eating or hiding food, that should be of concern regardless of their weight. If you have a child who is always sedentary, that may be a concern no matter what the size of your child. It’s also important to keep in mind that’s what healthy for thinner kids is healthy for higher weight kids and vice a versa. Sometimes parents give thinner kids a pass when it comes to unhealthy behaviors that would concern them in larger kids. Using weight to determine health has the potential to hurt kids of all sizes.

Q: Should parents restrict their kids’ food?

For most people who restrict, the response is then to eventually overeat the very food they’ve been avoiding. If a food is considered “bad”, a person is likely to eat more than their body needs when they break through the restriction. It’s a natural response to deprivation. While diets almost always work in the short run, the vast majority will gain back the weight, and one to two thirds end up higher than their pre-diet weight. 

Instead, for both parents and kids, it’s more helpful to honor hunger and fullness than to weigh, measure, and restrict food. We want to raise kids who can recognize that when they eat something that satisfies them—as they’re offered a wide variety of foods—they feel good.

Attuned/Intuitive Eating

This way of eating is known as attuned or intuitive eating. Rather than following external rules and plans, both parents and kids learn trust their bodies to guide them about when what and how much to eat. In March 2020 yet another study came out showing that intuitive eating in the teenage years is linked to a lifelong relationship with food that is nourishing, satisfying and peaceful.

Many parents live with internalized weight stigma and may be dieting to lose weight or even avoiding certain food groups in the name of wellness. In this way it’s easy for parent who wouldn’t intentionally restrict their kid’s food to still model what’s valued when it comes to eating and body size. If a parent says they can’t eat that cookie because “sugar is addictive” or “it’s too fattening,” then they are teaching kids that cookies are bad, and that they should worry about their weight.

When a parent says this meal tastes delicious and feels good in my body, that is a completely different message.

It’s important to know that there’s room for all types of foods in our diets. In fact, it’s more important to raise kids who have a healthy relationship with food as opposed to only eating healthy food. I encourage parents who have dieted to think carefully about their relationship with food. They should watch for ways in which their own restriction slips into making their children feel restricted.

Q: What should parents do to raise healthy kids?

A great place for parents to start is to work on their own relationship with food and their own body acceptance. Some people who can’t do this for themselves find they are able to do it through the lens of the values they want to pass to their kids.

For example, what are your family values? How about valuing staying connected with and honoring the body? How about valuing diversity and knowing that all people are equally valuable in all different sizes, shapes, abilities, and colors?

If these are your family values, then it’s easier to see that there’s room for all types of food. It’s easier to trust that your child’s body is growing as it’s meant to. These values help kids stay in tune with their bodies and are protective against shame, disordered eating, and eating disorders.

don't talk about my child's weight cards

Q: How can I protect my child from fat shaming?

No matter what parents do at home, it’s tough out there. Kids are still going to get fat-shaming, thin-valuing messages from peers, teachers, commercials, cartoons, and our entire culture. In this environment, parents should know that it’s not unusual for a child to come home and say, “Am I too fat?.”

Don’t jump to reassurance. Regardless of your child’s body right now, you don’t want to suggest that a body is OK only as long as it is “not fat.” Ask them: what did they hear, and where is it coming from?

Find out how they feel about being fat – what does it mean to them?

Gently teach them that just like we don’t choose how tall or short we are, or what color eyes we have, we don’t choose the size of our bodies. Their job is to take good care of their body, and it will settle where it’s meant to be.

A parent can’t protect their child from fat-shaming. But parents who teach children these messages early on raise kids who are more resilient. They are less likely to fall prey to diet culture, disordered eating, and eating disorders.

Q: Shouldn’t I worry about “bad” food?

No matter what happens at home, kids are going to be exposed to all kinds of food in the world. Rather than restrict food or label it as “good” and “bad,” it’s better to teach them how to eat it in a way that serves and nurtures their body.

Food is a basic human need. It feeds us physically and emotionally, and we should never forget that. It’s better not to teach kids that they can’t eat certain foods. This approach tends to set them up for overeating or binging on that food.

We all know the kids who aren’t allowed to eat candy. You recognize restricted kids because they eat a lot of candy when it’s available since they get it so rarely. This overeating then reinforces the idea that candy is a problem. But the reason they consume so much candy at one time is that they know it’s going to be taken away again. If, instead, they know they it’s going to be available again, there’s no incentive to eat it when their body doesn’t want it.

Q: But there are “bad” foods, right?

Not really. We find that when people eat intuitively and are attuned to their hunger and fullness cues, free from diet culture, they tend to eat a well-balanced diet for their bodies. Certainly some foods are more nutritious than other, but I’ve never met anyone who only want sweets when they listen to their body, just like I’ve never met anyone who only wants fruits and vegetables. The attuned body guides us to make the choices that honor our bodies needs, while diet culture prescribes rules that are destined to fail.

When you look at young kids, they’re concrete thinkers. When they hear healthy/unhealthy, good/bad, they become super-focused on eating the right way, and this is where we see eating disorders begin. Let’s help support kids in learning how to eat all types of food. This gives them the skills to eat without shame, hiding, or eating to the point of physical discomfort.

This is where we come back to the message that parents can work on this first with themselves. If your experience is that when you eat cookies you can’t stop, then it’s not easy to trust that your child will be able to stop. On the other hand, if you’re an attuned or intuitive eater, you know that when you want something sweet you can trust your body to guide you.

Binge eating is less likely to occur for a person who trusts their body and food supply. Learning that this is true for yourself can help you trust your kid’s body.

Q: But what if I’m still committed to dieting?

You can still work on passing down positive messages around eating and body size even as you’re struggling with your own. You don’t have to be perfect first.

But if you’re caught in the yoyo diet cycle, make a commitment not to talk about dieting, label foods as good or bad, or talk about your weight or other people’s weight in front of your kids.

When talking to your child, focus on what the body can do, not what it looks like or weighs. Focus on how food feels, not its nutritional content.

For example:

  • “It feels so good to be in a swimming pool on a hot day.”
  • “Walking to school really wakes us up so we’re ready to learn.”
  • “This food is satisfying.”
  • “I love that this food crunches!”

Offer your child all types of foods. Given what’s accessible to your family, serve them fruits, vegetables, protein, carbs and fat. 

Remember that all cultures in the world have dessert. It’s natural to want something sweet after a meal. Once you allow sweets regularly, it’s less likely to be a big deal. This is because your children learn that they can have it often, so there’s no incentive to overeat or hide these foods.

Q: What can I do to be a better parent in this area?

First, keep exposing yourself to social media, books, and podcasts that are non-diet, body-positive, and working to end weight stigma. Do everything you can to end body shaming.

Parents are surrounded by fear around weight and health. But most of the fear is based on myths. The healthiest thing for kids is to be feeling good in their bodies and connecting with other people. Those are things that are worth supporting in kids.

Look for a doctor and other healthcare providers who don’t focus on your child’s weight or discuss it in front of them. It’s fine to focus on a varied diet, being physically active, and social activity. All of those things contribute to good health regardless of body size. Focusing on weight can really interfere with positive behaviors.

People talk about young kids getting diabetes, but really what we’re seeing the big increase in is eating disorders. I think that’s what we really need to be focusing on.


Judith Matz, LCSW

Judith Matz is a Licensed Clinical Social Worker (LCSW) with over 25 years of experience as a therapist, speaker and author. She received her Master’s degree in Social Work from the University of Michigan and completed a post-graduate fellowship and Michael Reese Hospital in Chicago with a focus on eating disorders. Judith specializes in Binge Eating Disorder and other overeating struggles. She uses the Health At Every Size® framework to promote wellness beyond weight and address social justice issues that affect people of all sizes. Judith is the author of three books related to eating and weight issues: The Diet Survivors HandbookBeyond a Shadow of a Diet, and Amanda’s Big Dream. Her website is https://judithmatz.com

Discount code! Enter POSITIVITY20 to get a 20% discount and free shipping through the end of 2020. 
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Parents are kids’ default body image educators

Whether we like it or not, parents are our kids’ default body image educators. This means that even if we never intentionally address body image with our kids, they’re still learning from us. It’s a little overwhelming to think about, but it’s also empowering. We can make a huge impact on how our kids feel about their bodies, and we can turn the tide on increasing rates of body hate, disordered eating, and eating disorders!

I spoke with Ginny Ramseyer Winter, MSW, Ph.D., who is the founding director of the Center for Body Image Research & Policy at the University of Missouri. She is doing important research about body image. Her work is designed to help shape policy, education, healthcare and how we parent our kids, all with the goal of improving body image.

“You’re educating your children about body image even when you’re saying nothing,” says Ramseyer Winter. “When you skip over important topics like diet culture and fatphobia, that’s a message. It can be difficult, but I really would like parents to understand that it’s healthy to acknowledge and talk about body issues.”

body image for girls ebook

Kids and negative body image

Body image is something we all have, and it’s heavily shaped by environmental factors. The way the media, industries, teachers, doctors, families, and peers talk about bodies is typically very harsh. Bodies are most often presented as something to be controlled and restricted.

As a result of our cultural messages about bodies, kids as young as three years old are reporting the desire to lose weight. Toddlers already know that larger bodies are “bad” and smaller bodies are “good.”

Parents are often caught up in a war with their own bodies, which makes it difficult for them to address their kids’ fears. As a result, parents may inadvertently reinforce cultural body-shaming beliefs.

Some things parents often do is:

  • Complain about their own bodies and restrict their weight
  • Criticize other people for being too heavy (often couched as “not healthy”)
  • Not educate kids about the value of every body, regardless of its size
  • Fail to point out that fat-shaming and weight stigma are discriminatory and harmful to a significant portion of our population
  • Respond to fears of being fat with reassurances like “you’re not fat, you’re beautiful!”

These responses are natural and normal in our society, and yet they are harmful to our kids’ self-esteem and self-worth. They can accidentally lead to lifetime struggles with body image and eating.

Why is body dissatisfaction so prevalent in kids?

The intentions behind body shaming are typically well-meaning. People believe that the way a body appears and what it weighs indicates its level of health. They also believe that everyone should restrict their body weight and feel bad about a body that is larger. These beliefs are not an accident.

Fatphobia has been around for over a century. But we have experienced a massive increase with the rise of the $70 billion diet industry. This industry funds our media outlets with powerful advertising. Most media outlets would not be able to survive without fatphobic advertising messages.

Together, the media and the diet industry have shaped our cultural beliefs about bodies and weight. They have impacted the way doctors and teachers talk about weight. Even scientists approach weight studies with the implicit bias that fat is bad. And yet science has not concluded that higher weights increase mortality, in fact, there is evidence to the contrary. Yet almost everyone believes that being in a larger body is deadly.

The belief that fat is bad directly supports the diet industry, despite the fact that not a single diet has been proven to be safe or effective. Almost all people regain any weight lost intentionally, and most people gain more weight and begin weight cycling, which is health-damaging.

How can parents educate their kids about body image?

Body hate is running rampant through our society. It’s based on beliefs that were placed in our psyche by the highly profitable diet industry and supported by media, researchers, governments, teachers, doctors, and peers. But fear of fat is not doing any of us any good. In fact, our current generation of kids is displaying higher than ever rates of body dissatisfaction, disordered eating, and eating disorders. Our war against bodies is hurting our kids.

Parents can help their kids have a better body image by teaching them that all bodies are worthy of respect at any size. Ramseyer Winter has the following suggestions for families who want to support positive body image for kids.

parent coaching

Support positive body image:

  • Banish diet culture from your home. No diets, restrictive food programs, or trying to manipulate weight
  • Focus on the body’s function rather than its appearance or aesthetic. Talk about what our bodies do for us, not how they look.
  • Limit/manage social media. Take a look at both the time they’re spending on social media and the content. Help kids fill their feeds with things that make them feel good about their bodies. Follow people who are spreading fat activism and positive body images.
  • Practice Intuitive Eating. Or at least model mindful eating, self care, and self compassion.
  • Engage in activity that makes you feel good. Try not to think about exercise as something that you do to burn calories. Find things that you enjoy, and do them together when possible.
  • Eat meals together. Even if they are just snacks, or dessert. Try to get together to eat and enjoy food regularly.
  • Use fat as a neutral term. Don’t use fat as either positive or negative. And the same goes for the euphemisms for being fat, like “not healthy” or “too big,” etc.

“Some parents have heard some of these ideas,” says Ramseyer Winter. “For others, these are new concepts. I really like working with parents on this issue. We can come up with innovative ways to interact with kids differently when it comes to their bodies. And I’m really interested in making sure that dads (as well as moms) are included in these conversations.” 

You can follow Ginny Ramseyer Winter on Twitter, Facebook, and Instagram.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of More-Love.org and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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Low self-worth and eating disorders: what parents need to know

by Beth Mayer, LICSW

There is a high correlation between eating disorders and low self-worth. Because of this, when I’m working with clients who have eating disorders, I’m watching carefully for self-worth, self-compassion, and perfectionism. The more my clients build the first three and limit perfectionism, the greater their chance of entering recovery from their eating disorders. 

What is self-worth?

When you have self-worth, you believe that you are inherently valuable regardless of what you do or how you look. People who have low self-worth tend to look outside of themselves to feel worthy. This is really common among people who have eating disorders, and many of them are using their bodies as a way to pursue worthiness.

Unfortunately, low self-worth is pretty rampant. And what may be surprising is that often the people who look like they have high self-worth are actually suffering the most. These are the great students, powerful athletes, and leaders who get tons of accolades, yet many of them feel bad about themselves.

I worked with someone who was the top of her class, named the class president, and looked as if she should have been on top of the world. But she was depressed and had an eating disorder. The world just couldn’t see what she was feeling about herself.

These are tough cases, because we have to find a way to meet the person where they are while gradually supporting them in seeing their inherent self-worth, which must exist regardless of grades, awards, weight, or any other external measurement.

Parenting for positive food and body

How parents can help kids develop higher self-worth

Lots of parents want to help their kids by jumping in with positive messages. But unfortunately this can exacerbate the problem, especially if they are focused on external measures of success.

For example, saying things like “you’re beautiful,” “you’re perfect,” “you’re a huge success,” can really backfire. This is because the person may come to believe that their parents’ love is dependent upon being those things.

What we need is for our kids to know that they are worthy for who they are, not what they look like or what they do to meet conventional standards of success.

This can be really hard for parents, but there’s a side door that can help. Start by recognizing them for their kindness rather than their appearance or accomplishments. For example, notice that they showed up for a friend when it was difficult, or they smiled at a child, or they gave a lovely hug.

The job of parents who want to increase their kids’ self-worth is to not try to convince a child that they are meeting conventional standards of success. Because that will just keep them on a hamster wheel forever, desperate to keep succeeding. Instead, parents should take tiny snippets of everyday kindnesses and work to feel good about them.

Self-worth and social media

People have always had low self-worth – it’s not a new thing. But something I’m seeing in my practice is that it’s easier than ever to fake happiness and self-worth. Social media makes it easy to seek social approval and look like you are successful. This can make it easy for people who are suffering to look like they’re living a great life.

On social media you can fake a vacation, fake happiness, and fake success. This makes it really easy to fake self-worth even when you feel completely empty.

At the same time, kids can see everyone else who looks like they’re living an even better life. The constant access to curated views of other people’s lives right at our fingertips means it’s hard to turn the volume down on the feeling that we’re not doing enough or good enough. 

Self-compassion and recovery

Possibly the best antidote to the low self-worth is self-compassion. The work that Kristin Neff has done to bring awareness to self-compassion is amazing.

Self-compassion means that even when the entire world seems to be screaming that we are not enough, we can reach inside and treat ourselves as we would a good friend.

I love this quote from Elisabeth Kübler-Ross:

People are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in, their true beauty is revealed only if there is a light from within.

Elisabeth Kübler-Ross

Lots of the people I work with are looking for the light to come from outside of themselves, when the light they need is already inside of them. Building self-worth and self-compassion are the keys to help them light up and see their value without the external measures.

Our society keeps telling people that they are not enough. This is leading to massive increases in all sorts of problems, including depression, anxiety, suicidality, and eating disorders. All of my colleagues who are eating disorder specialists are seeing an influx of patients – and at younger ages – than ever before. We are definitely struggling as a society, and I think that if we can address self-worth, we will make some progress.

body image for girls ebook

Perfectionism is the enemy of self-worth

Perfectionistic tendencies are highly correlated with both eating disorders and low self-worth. Perfectionism is a personality trait in which a person strives to be flawless. They set very high performance standards for themselves. Unfortunately, they also are highly self-critical and are overly concerned with others’ evaluations of their performance.

It’s easy to see how this relates to eating disorders. It may be hard or out of reach for a person to achieve perfection in many areas, but most people believe that if they just work hard enough and control their behavior enough, they can have a “perfect” body.

So many people who have eating disorders feel they aren’t smart enough or good enough, but they can have a good enough body. They mistakenly believe that if they look good, they are good. That becomes their focus, and everything else becomes non-essential. They aren’t able to celebrate who they really are.

Of course, there is no such thing as a “perfect” body, and in my practice I see the damage done by the pursuit of bodily perfection every day.

One of the things I see a lot is that when people are feeling out of control, one of the things that they perceive that they can control is their body. They feel like if they can fix their bodies they can fix their lives. Our society has promoted the idea that bodies can and should be changed. But the truth is that nobody is going to like you any more or less with a different type of body.

Parents against perfectionism

One way that parents can help their kids avoid the trap of perfectionism is to let their kids have issues. Don’t protect them from everything, because that suggests to them (subconsciously) that they need to get things right to be safe and valued.

Parents should give their kids responsibilities, and not always protect and advocate for them. This builds up resilience. The fact is that nothing and nobody is perfect. Unless we model to our kids that it’s natural and safe to make mistakes – even to fail – they may lean towards perfectionism.

What I wish parents knew

If there were one thing I could pass along to parents, it would be to pay attention to how willing you are to get messy. We have become a very driven society that avoids mess. We want everything to be clean and straightforward, but that takes away our creativity and our very humanity. 

We’re teaching our kids to avoid getting messy, which keeps them in a tight box of right and wrong, good and bad, perfect and not-perfect. The world just isn’t organized that way, and it really limits our resilience when we believe it is. 

I would love to see parents get comfortable with, model, and encourage their kids to embrace the messiness of our lives. To embrace the fact that we don’t need to be perfect to be loved. In fact, most people love us most when we are most authentic and least perfectionistic. 


beth mayer meda

Beth Mayer, LICSW, has been working in the eating disorders field for 35 years. She is nationally recognized for her clinical work with eating disorders and has spoken at conferences around the country. In addition to eating disorders, Beth specializes in treating adolescents and families. Beth has served as an adjunct professor at Simmons College, Boston University, Boston College, Lesley University and Salem State College, supervising MSW and LMHC graduate student interns. She is currently the co-chair of the NEDA network and serves on many local and national committees. Beth holds a B.S. in Clinical Psychology from Quinnipiac University and a Master of Social Work Degree from Boston College. She can be reached at  bethmayerlicsw@gmail.com / 617-325-1013

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How to raise a child with better body image

By Alex Raymond, RD, LD, CEDRD

Most parents hope their child will grow up with a positive sense of self and a positive body image. And most parents wish the best for their children and dread the day their children believe there is something “wrong” with their bodies. Or the day some kid at school makes fun of them for the way they look.

But our culture is drenched in diet talk and negative body talk. And kids are learning about weight loss at much younger ages. Mass media and social media expose kids to diet talk and weight stigma early and often. The tricky part is, parents can’t prevent any of this from happening. 

However, parents can absolutely promote a positive body image in their kids. I’m going to discuss a bit about what body image is and how loved ones can foster a positive self-image in children. 

What is body image?

Body image is how we perceive ourselves when looking in the mirror or when thinking about how we feel in our bodies at a certain moment. It can also be how we think others perceive our bodies. Body image has little to do with what we actually look like. It can also change in an instant. Think about it. Have you ever had a day where you woke up feeling great and loved how your body looked? But then maybe a co-worker makes a comment or you see yourself in a certain angle, and then you feel terrible about your body? In reality, your body hasn’t changed much (or at all), yet it suddenly seems “wrong.”. 

body image for girls ebook

What is positive body image?

I often hear positive body image described as liking the way that you look. While that may be part of it for some people, body image is more about how we feel in our bodies than how we actually look. Positive body image is knowing that your body is good no matter how it looks. And knowing that you are not defined by how your body looks. That your worth is actually not based on your body at all. This is so important to remember because it allows us to find peace outside of our physical appearance. 

Why is positive body image important for kids?

Kids are becoming concerned about their bodies younger and younger. It makes sense with the culture we live in. Having a positive body image is important for kids, teens and young adults because feeling good about one’s body leads to more positive mental health, physical health and confidence. It allows individuals to feel empowered and comfortable in their skin.

Do parents influence body image? What can parents do to support positive body image in their kids? 

Parents absolutely influence their kids’ body image! I read a quote recently by More Love’s founder, Ginny Jones. It reads “We don’t need to have a perfect relationship with our own bodies to raise kids who are free from body hate.”

I love this. I think so many parents put pressure on themselves to be the perfect role models. Parents put blame on themselves if children struggle with mental health issues. And I feel this is even more common in eating disorder treatment. So many parents ask me if the eating disorder was “their fault.” Spoiler: it’s not. There are many reasons why an eating disorder develops and parents are not to blame.

Parents cannot control exactly how their kids will experience their bodies. And parents may struggle with body image themselves. Despite these facts, it’s still 100% possible for parents to foster body confidence. 

Tips for raising a child with better body image 

All kids:

  • Talk about what you like about your body, even if you have to fake it a bit. “I love my legs because they help me to dance!”
  • Give personality-based compliments, not appearance-based ones. For example, say “I love the way you light up when you start singing,” instead of “you’re so pretty.”  

Little kids:

  • Answer questions about your own body with neutrality and positivity (if you can). For example, maybe your child comments on your “big belly.” Or maybe they mention you have bumps on your legs. Say why you appreciate these things. (Yes, I do have a big belly and it allowed me to have you!)
  • Answer questions about other people’s bodies with neutrality and positivity. 
  • If your child calls someone else “fat,” resist the urge to say “that’s mean! Don’t call people that word!” Because in reality, many people are fat. Fat is a descriptor, like eye color and height. Don’t make “fat” into a bad word, but do educate your child about using the word “fat” respectfully.
  • Help your child write a thank you note to his/her body. What does his/her body do that’s so cool?!
Parenting for positive food and body

Adolescents and teens 

  • If your teen says, “I’m so fat (or ugly)” Resist the urge to say, “no you’re not, you’re beautiful!” This can be so hard to do! I think it’s a gut reaction for most of us. If you respond with “no, you’re beautiful,” that implies that fat is bad and not beautiful. It also implies that looking a certain way is important (reminder: we are worth more than our looks). Instead, respond with curiosity about what they mean when they say that. 
  • Have conversations about body ownership and consent. This is SO important for teen girls AND boys.
  • Encourage them to follow a diverse set of body-positive activists on social media to diversify their feeds and help them gain exposure to people in a variety of body sizes, shapes, colors, and abilities.
  • Encourage self-care and listening to the body for cues about when to rest, eat, move, and more

Young adults

  • Check in with them about body image. How do they feel about their bodies? Would it be helpful to talk to someone about body image? 
  • Encourage them to get involved in social justice movements that interest and excite them and give them experiences with people in different bodies.
  • Encourage your young adult to express themselves through art, fashion or music so they can express themselves and learn to feel comfortable being themselves.

Want more ideas? Download my free Body Image Workbook


Alexandra Raymond

Alex Raymond, RD, LD, CEDRD is an eating disorder dietitian in private practice in College Park and Columbia, MD. Alex specializes in treating individuals struggling with anorexia, bulimia, and binge eating disorder. She practices from an intuitive eating model and enjoys working with individuals to improve body image. She is a passionate Health at Every Size © advocate and anti-diet dietitian. Alex provides eating disorder nutrition counseling in College Park and Fulton, MD. Alex’s College Park office is walking distance from the University of Maryland. Contact Alex by visiting www.couragetonourish.com/contactus or follow her on Instagram: @courage.to.nourish

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5 Ways a Dietitian Can Help Parents Feed Their Kids

Adapted from an interview with Gina R. Mateer, RD

Most of the time when a parent reaches out to a dietitian for help feeding their kids, it sounds simple. They say “I just want my kids to be healthy.” But feeding our kids has become surprisingly complicated since we live in a culture that is obsessed with being thin, restricting food, and moralizing food behaviors. 

Suddenly, feeding our kids, which seems so simple, becomes a major task. Our kids can pick up on our discomfort, and they often respond to a parent’s stress about food by developing some problematic food behaviors. Here are five ways that I work with parents to help them raise healthy kids.

1. Problematic food behaviors

Problematic food behaviors include picky eating, labeling foods as good or bad (and not wanting to eat “bad” food), maybe even dieting. If you’re noticing these behaviors in your child, then I encourage you to consider your own relationship with food. 

Is it possible that you have a difficult relationship with food? Do you avoid certain foods or restrict food? Do you weigh yourself daily and adjust your behavior based on your weight? Do you make comments, both positive and negative about other people’s weight?

How parents feel about food and weight impacts how kids feel about food and weight. Almost all parents are doing what they think they are supposed to be doing – promoting healthy foods and “watching” weight. But it turns out that these behaviors, and the internal pressure they create, can have negative outcomes in our kids. 

So when a parent comes to me and says their kid has a problem with food, I want to consider whether the parent needs some support with food, too. In fact, I’ll often consider whether we can work with the parent instead of the child. 

Of course, if your child has a very clear eating disorder, there is another path. But if it’s early, and you sense something, see what you can do about your own food fears, weight stigma, and biases that may be trickling down to your kids. 

2. Childhood weight gain

A lot of times parents worry about their child gaining weight, and I see that the weight gain is fine for the child, but uncomfortable for the parents. The parent thinks there is a problem to be fixed, but what’s really going on is internalized fatphobia and fear about what’s going to happen for a child who is in a larger body. 

I get it – parents are worried that a larger child will experience more bullying, be less healthy, and have a less fantastic life. Those are the messages parents are receiving all the time, but it’s not true. Parents can help kids avoid or deal with bullying, be healthy, and live a fantastic life, regardless of whether their kid is thin or fat. 

This is an area that I think parents need a lot of support in. Parents need to know that it’s enough to raise your child in a healthy environment and to allow the child to grow up naturally in the body they were meant to grow up in. So many parents want their kids to be in smaller bodies, and I get it, but it’s also really harmful to carry those beliefs if your child is meant to be in a larger body. 

I can definitely help parents figure out how to feed their kids. I can help them figure out if they are being too restrictive and putting too many rules around food. We can also work together to structure meals for optimum success – nutritionally and emotionally. But the first step is for parents to accept that body diversity is a real thing, and to release their child from thin expectations.

3. Dietitian or therapist?

I think therapy is great, and it’s wonderful when I can work in tandem with a therapist. A therapist can work on issues of self-worth and confidence, while I can work on food behaviors. 

If I’m working with a child who has a serious eating disorder then I’m typically working alongside a therapist and a medical team. Together, we can address the many aspects of eating disorder recovery. 

When a child has disordered eating or just an uncomfortable relationship with food, I can do a lot of work around normalizing all foods and encouraging the child to gain confidence with, and trust in their body. 

Sometimes it seems like parents are more comfortable sending their kids to a dietitian than a therapist. When the focus is food, vs. larger emotional issues, it can seem easier to get started. It can be a less stigmatizing treatment. It is a great place to start, and we can make a big impact on food behaviors with nutritional counseling. 

But if I’m seeing underlying conditions like anxiety, depression, or symptoms of a full-blown eating disorder, I recommend therapy as well. Eating disorders sound like they’re about food, but it’s important to remember that they are mental disorders, so we really need to bring in some psychotherapy to see solid recovery. 

4. Fear of “doing it wrong” 

It’s so common in our culture for parents to be worried about their kids’ body. We’ve been raised in a diet culture that has told us that everyone should be the “right” shape. But there is no “right” shape for bodies. 

We now know that if a parent is concerned about a kids’ body size, there’s going to be so much fear and shame. Even a child who is in a smaller body will develop fear around their body changing. And when it does, for puberty, genetics, or whatever, that can be really difficult for the child. 

Parents do need to learn to work on their relationships with food and bodies as much as possible. Even “nice” comments about other people’s bodies, your own body, and kids’ bodies can cause unintentional harm. It’s not only overt fat shaming that’s a problem. A bunch of small comments that suggest that there is a “right” way to have a body can really hurt. Kids naturally internalize this to mean that if my body is not like that, then I am wrong. 

I’d love all parents to take a good look at their own relationship with food and body. If you know you have issues with food and your body, then get some support! If you are still weighing yourself, restricting certain foods, and worrying about your weight, then now is a good time to talk to someone about that. Because you can tell your kids that all bodies are good bodies, but if you’re treating your body like it’s a problem to be managed, your kids know that. 

I’m not saying this to shame parents at all! We are all raised in this diet-obsessed culture. You’re doing exactly what you think is right. You want what’s best for your child. It’s just that the internalized diet culture that we all live with needs to stop, and we can start with ourselves. 

5. Intuitive Eating for kids

Parents are worried that they’re feeding their kids wrong because all of the conversations around us focus on an intense fear of fat and food. It’s overwhelming to think that a child can really eat intuitively, but I can assure you that I see it happen all the time. 

It can be really scary for parents because when they accept Intuitive Eating and allow all foods in the house, the kids can go a little crazy. It’s very true that kids (and all people) will respond to foods that have been “off limits” by eating a lot of them at first. Parents often think this is evidence that they need to control the food. But it’s actually that the kids are just overcorrecting. 

Kids will eat a lot of the restricted food when it first comes available. They may even eat all of the food when it first appears. They may keep eating it until they really believe – on a deep level – that the food is allowed. And then, once they truly trust that it’s OK, they will not only want the play food. They will naturally balance it out with a whole variety of food. That is the beauty of Intuitive Eating. The body hates it when Doritos are not allowed, but it also doesn’t want to live on Doritos. 

This is the work I do with parents during the Intuitive Eating process. I can help parents trust that their kids will figure out the right balance for their body and grow into the size that they are naturally meant to be. It can be scary because it’s so different from what we’re told in society, but it’s also incredible because it works so much better!


Gina R. Mateer, RD, LD, CEDRD-S, RYT 200 is a registered dietitian, licensed dietitian in the state of Texas, and is recognized as a certified eating disorder registered dietitian. Gina studied nutritional sciences at the University of Texas. After completing the required internship hours and passing the registered dietitian exam in 2010,  she began working at an intensive outpatient program treating eating disorders and providing individual nutrition therapy. She has a virtual practice serving individuals in the state of Texas as a CEDRD and nutritional coaching/counseling as an intuitive eating counselor worldwide. Website

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Five ways to promote body acceptance in children

promote body acceptance in children

by Jillian Lampert, Ph.D.

Over 30 million individuals in the United States suffer from an eating disorder. So it’s important to understand ways to combat disordered eating and promote body acceptance in children. For parents who are hoping to teach body appreciation and food acceptance, it’s important to understand eating disorders and to foster a household of gratitude.

Promoting body acceptance in children could be a protective barrier against developing an eating disorder. Body acceptance is an important way to help children be resilient in the face of tremendous societal pressure to engage in disordered eating, eating disorders, and body hate.

1. Be honest

One way parents can promote body acceptance in their household is to be open and honest about the reality of the overly prevalent messages about body and appearance.

Teach children about how these unattainable fantasy images can put people at risk for eating disorders. By explaining eating disorders to children in an age-appropriate way, you can make sure they are getting the truth about the illnesses.

In addition, teach your children to have a critical eye when it comes to advertising, movies, and more. Emphasize that changing our bodies to be skinny or muscular can make us sick and that often, models of all genders are altered to look thin or lean because those images compel people to buy products that will help them feel valued by society. 

Make sure your children know that these narrow depictions of appearance do not reflect everyday people. Share what you value about bodies and all the amazing things they can do.

Keep an open dialogue about societal body messaging – point out digitally altered ads or ridiculous messaging, and let your children know they can always bring questions or concerns to you.

2. Avoid body-talk

Parents are role models for their children. Children watch and see everything their parents do and it can have an effect on them. If a young child watches their parent talk negatively about their body, it’s likely that the child may view this as normal or copy the behavior. If a child’s parent looks in the mirror or the fridge and says they look fat or shouldn’t eat that, the child may learn that behavior.

Additionally, it’s recommended that parents avoid commenting negatively or superficially on their child’s appearance. It can be tempting to say things like, “You look so thin in that homecoming dress!” or “I can tell you have been working out.” However, these statements can misplace value on appearance instead of character and gratitude. They may also enforce disordered behaviors in children.

Instead of commenting on looks, try to praise personality, character, and accomplishments. You can replace, “You look so thin in that dress” by saying, “I am so proud that I raised a daughter that is succeeding in school and able to attend homecoming. I’m so happy that you have a great group of friends to go to homecoming with.”

3. Speak about what your body can do, not what it looks like

By focusing on what our bodies look like, we often demonstrate to children that how our bodies look to others is the most important thing about them, which is not true. Our bodies can accomplish great things and the importance of the amazing things our bodies can do is what we should be emphasizing to our children. It’s important to express these positives in a way that your children can witness and understand.

Easy examples of incorporating positive body messaging include praising your body for allowing you to go to your children’s soccer game, saying you are grateful that your body keeps you alive, or to play catch in the backyard.

It’s also important to teach children that ability does not equal worth. All bodies, regardless of size, shape, or ability, have value. They keep our hearts beating, our bodies warm, and allow us to move throughout the world in a way that works best for us.

4. Make food neutral

It’s important to model the fact that all food has a place in a healthy diet. Explain to your child that no food is “better” than another. Explain that just like only eating cake for two days in a row isn’t healthy for your body, just eating carrots for two days in a row isn’t healthy either.

Tell your children that bodies need balance and empower them to make food choices that serve their body’s needs.

A great activity to help you talk about the importance of food is to cook family dinner and get your children involved in the process of making healthy choices for themselves. Avoid classifying food as “good” or “bad” or set a particular order in which foods need to be eaten.

Try this

Try this instead with children: If you are having dessert at a meal, put everything offered at that meal on the table and let kids practice choosing what and when they want to eat certain foods. You might not like to eat your peas and your cookies at the same time, but your child might! Plus, it teaches them that peas and cookies are both food – that one is not inherently more powerful than another and that they both have value in a balanced diet.

Working to make food neutral helps kids to stay in touch with their internal hunger and fullness cues and not rely on external messaging about what they “should” want to eat. Help them to find the “just right” amount for them – are they hungry? How do they know? Are they full? How do they know? Listening to our bodies provides the wisdom we need to fuel our bodies well. 

5. Encourage gratitude

By planting seeds of gratitude into young children, you can encourage body acceptance and appreciation. Work to incorporate one or two moments of gratitude into your children’s day.

You could say thanks before dinner or you could have a goodnight routine where you say one thing you are grateful for that day.

Make sure that you are sharing what you are grateful for, too. Some examples could include, “I am grateful for my body which let me go to the grocery store with my family” or “I am thankful for my strong arms because they let me hug my children.”


Eating Disorder Basics

Promoting body acceptance in children can help them be resilient when faced with the pressure we put on bodies in our society. Endless comments about weight and food can create the perfect storm for eating disorders.

Here is a quick overview of the eating disorder basics so you can keep an eye out for any warning signs in your child.

Eating disorders are complex biologically-based mental illnesses that can cause severe harm. They are often marked by extremes, such as dramatic weight changes or uncontrollable thoughts and behaviors. Eating disorders are not a choice, phase, or fad. Luckily, eating disorders are treatable by professional teams made up of a therapist, doctor, and dietitian.

Types of eating disorders and their related signs and symptoms include:

Anorexia Nervosa. Anorexia revolves around the desire to lose weight and reduce calorie intake. It also includes an obsession with size, shape, weight, and appearance. Typical signs include a desire to lose weight, food restriction, over-exercise, and seeing one’s body as larger than others do.

Bulimia Nervosa. Bulimia is characterized by a cycle of overeating followed by purging, fasting, laxative use and/or over-exercising. Individuals suffering from bulimia may purge in secret several times a day. Warning signs include food that disappears, overeating, frequent bathroom use after meals, and signs of purging.

Binge Eating Disorder. BED is defined by repetitive and uncontrollable consumption of large amounts of food. This food consumption is often used to soothe negative emotions. Warning signs include compulsive eating, excessive eating without hunger, relying on food to ease negative feelings, and feeling a lack of control around food. Often, those with BED experience sickness, shame, or guilt following binge eating.

Other Specified Feeding or Eating Disorder. OSFED includes eating disorders that don’t meet the criteria for Anorexia, Bulimia, BED or Compulsive Overeating. Signs of OSFED include weight fluctuations, changes in food behavior and intake, negative self-talk, and more.

Avoidant/Restrictive Food Intake Disorder. ARFID is a disturbance in eating that involves  the consumption of a very limited variety of food, resulting  in substantial weight loss, nutritional deficiency and/or difficulty engaging in day-to-day activities. Warning signs may include weight loss, fear of choking on food, fear of food causing illness, a lack of interest in food, but with the absence of body image concerns.

Look for warning signs

Common warning signs of eating disorders in children include:

•    Weight changes

•    Strange food behaviors

•    Avoidance of food or particular food groups

•    Restricting food or engaging in purging behaviors

•    Compulsive behaviors

•    Personality changes

This matters

Teaching and modeling body acceptance to your child is important and could be a protective barrier against developing an eating disorder. If you are concerned about your child’s relationship with food or body, it’s important to bring your child in for an eating disorder assessment and possibly treatment. If you aren’t sure where to start, you can call The Emily Program or research eating disorder treatment options near you.


Jillian Lampert, Ph.D., M.P.H., R.D., L.D., F.A.E.D, is the Chief Strategy Officer for The Emily Program, a specialized eating disorder treatment program with locations in Minnesota, Ohio, Pennsylvania and Washington. Jillian is a long-time advocate for eating disorder recovery and hopes that one day, all individuals can experience a peaceful relationship with food and body. Jillian’s main goal in life is to raise her daughter to accept and love her body.

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Get answers to your questions about eating disorder treatment

We held a Q&A webinar with eating disorder therapist John Levitt, Ph.D. on May 5, 2019. Here are some important questions he answered for us.

1. Do you have any advice about FBT for eating disorders?

Answer recap: FBT (family therapy) is one of the evidence-based therapies available for eating disorders. It’s effective for a certain group of patients. Its primary outcome is to cause weight gain.

2. Should I send my child to residential treatment for an eating disorder?

Answer recap: The purpose of a program is to stabilize and refeed to manage the critical side effects of an eating disorder. I’m concerned about sending a child away from their family and recommend asking: how is the family involved, and how does the family sustain recovery when they return home? Often a local treatment program can achieve the same goals.

3. What should I do if my child is in treatment for an eating disorder and the behaviors aren’t stopping?

Answer recap: If your child is in a treatment center and their behaviors aren’t stopping, it’s important to understand why that is. Ask questions, and understand the goals and treatment plan.

4. Parents are doing their best, why isn’t child recovering from their eating disorder?

Answer recap: Your child not recovering doesn’t mean you’re doing anything wrong. Most people recover from an eating disorder, but it can take time. Recovery depends on many factors, including how long they have had the eating disorder. It’s OK to sit down with the therapist and ask how treatment is going. You should have some sort of treatment plan to guide the process.

5. What is evidence based treatment for an eating disorder?

Answer recap: Evidence-based treatments have been tested with group studies in which there have been random assignments to different treatment types. Certain therapies have been statistically proven to be more effective. It’s important to ask the therapist or treatment center what it means to use “evidence-based” treatment and how do they use it?

6. Why, if the eating disorder behaviors are under control, does my child still need therapy?

Answer recap: When someone recovers from an eating disorder, they may still have trauma symptoms, anxiety, depression, self-harm, and other residual symptoms that existed in addition to the eating disorder. These conditions and symptoms can be a good reason to continue therapy beyond eating disorder treatment.

7. If my child has trauma and an eating disorder, will an eating disorder treatment center treat both?

Answer recap: If possible, find an integrated treatment approach that addresses eating disorders and other challenges like trauma, self-harm, etc. Be sure to ask your treatment team or therapist whether they are using an integrated approach.

8. How do I find a good therapist for my child who has an eating disorder?

Answer recap: Ask a lot of questions! The therapist is a guide, and it’s their job to facilitate recovery with the child and the parents. We should be available to answer parents’ questions. If your child is not responding to treatment, it’s not always because the therapist isn’t “good,” but it is important to talk to the therapist about the treatment plan and that they can communicate with you and your child.

9. Our therapist told me to be patient with my child who has an eating disorder – what does that mean?

Answer recap: I’d ask “what does ‘patient’ mean?” and try to find out what the therapist is asking for. Yes, treatment takes time, but you should see some results. If your child is medically compromised, you don’t have time to be patient. But if you’re talking about therapy, it’s a process. It does take time. Ask what you should be doing while you’re “being patient.”

10. My child’s in treatment for an eating disorder, what should I be doing?

Answer recap: Ask your child’s therapist! You should receive suggestions from the program or therapist regarding what they think will be helpful. Your outpatient therapist should regularly give you recommendations about what to do. I suggest parents provide support, love the child, supervise the food, weight, eating, and be mindful of purging. If the child is at a more acute stage of eating disorder behavior, parents may need to be more active in preventing the behaviors.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.

She’s the founder of More-Love.org and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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How to feed a child who is “overeating” and “addicted to food,” by Alexandra Raymond, RDN

As a parent, you want your child to grow up happy. You want him or her to make (overall) smart decisions and be successful. You probably also want your child to grow up “healthy.”

The pressure to raise healthy kids

There is no denying that health and wellness are at the forefront of our minds. We are constantly bombarded by health and wellness information and trends. Celebrities are talking about it. Friends and family are talking about it. Doctors are talking about it.

We’re encouraged to eat certain foods and stay away from others. We’re told that certain foods “speed up metabolism,” while others “slow it down.” We have detoxes and juice cleanses pushed on us. And it seems if you don’t try to follow some of these food trends, you’re doing something wrong. Food and diet culture is huge! After all, the diet industry is worth almost $70 billion.

Because of the pressure society puts on us to be “healthy,” many parents worry about their child’s eating habits. Whether he/she is eating too much of one food and not enough of another. Parents worry their child is gaining “too much” weight. Or even worry their child might be “addicted” to food. And who could blame these parents. They are constantly made to feel they aren’t “good enough” as a parent if they aren’t making sure their kids are eating perfectly.

Impossible food standards

I’ve found that many parents become hyper-aware about what their child is eating. Especially if they feel like their child is eating “too much” and their child lives in a larger body. Hyper-awareness surrounding foods may include:

  • making comments about good foods and bad foods,
  • commenting on the amount of food a child is eating,
  • comments on weight, and
  • asking a child to eat certain foods before other foods (veggies before dessert), etc.

I completely understand why a parent may do this because of the ridiculous amount of pressure they feel to raise “healthy” families. But, unfortunately, this often backfires. I’ve found this hyper-awareness surrounding food causes children to become more obsessed with their bodies, begin dieting at an earlier age, and possibly sneak/hide food from their parents, especially those foods they consider to be “junk foods.” (PS: I personally don’t use the words “junk foods” with my clients because I believe all foods should be placed on the same playing field. “Good” food / “bad” food language is often harmful for people of all ages).

Overeating and addiction

In my office, I often hear parents’ concerns about children “overeating” or being “addicted” to certain foods. In these situations, as hard as it might be, I ask parents to do their best in avoiding comments and to continue to allow their child to self-regulate.

It’s important we don’t think of any foods as “bad” or “addictive” but instead recognize food as a substance like oxygen and water. You most likely don’t worry about your child overconsuming either of those, and food is equally natural and necessary.

First, children are the most intuitive eaters out there. More often than not, your child is actually not “overeating,” but is fueling his/her body with the nutrients he/she needs. We need to be careful and avoid pathologizing certain eating patterns, to avoid the possibility of a child internalizing that guilt and shame.

Second, food is not an addictive substance and we have research that shows this. People may feel addicted to certain foods if they have been deprived of eating them. For example, you tell yourself you’re not going to have sweets. Maybe you don’t eat sweets for a few days or even weeks or months. But, eventually, you’ll be presented with the opportunity to eat sweets again. The moment you eat sweets, it’s totally possible you may feel like you can’t stop.

But this isn’t because you’re “addicted” to sugar. It’s because you have been physically and emotionally deprived from sugar. This same thing happens with kids. It’s important we allow kids to have a wide variety of foods.

How to feed a child

You may be thinking, but what if my child needs to eat healthier? Or what if I feel like my child is eating too much? How can I promote balanced and nutritious eating without triggering negative body image or food thoughts?

Here are my tips:

1. Feed their appetite: Appetites vary for many different reasons for different people and in different stages of life. Sometimes children will feel more hungry and eat more food than “normal” for no apparent reason. On the flip side, sometimes children won’t feel hungry at all and will eat way less than “normal.” It’s important to let your child eat how much or how little they want according to their individual hunger cues, not an arbitrary perception of what they “should” eat. This will help them to stay more in tune with their hunger and fullness signals and support long-term health.

*There is one caveat. If you notice your child is eating significantly less and cutting out foods they previously used to love, this definitely is a concern. Please talk to a health care provider about this.

2. Have a wide variety of foods available: I recommend having a wide variety of foods in your kitchen for your child to eat. You can present these different foods during snack time. For example, you may want to consider putting out some food for when your child gets home from school. The key here is allowing your child to choose what he/she is in the mood for. So whether they choose animal crackers, chips with guacamole, or carrots with hummus, it’s their choice.

3. Monitor emotional changes: If you notice a change in your child’s eating or weight, I recommend you consider whether you notice a change in their emotions. Is your child more withdrawn than usual? Is he/she stressing about things they may not normally stress about? Are they hanging out with friends less? Are they exhibiting increased anxiety around food? Sometimes a change in eating and weight is a sign that something else is happening. I recommend avoiding commenting on food/weight and instead ask them about feelings. If your child is happy and acting as they always do, then weight gain is typically not a concern.

4. Talk less, model more: Children learn how to eat from the adults in their lives. They also learn how to either appreciate or criticize their bodies. Do your best to eat a wide variety of foods along with your child. This includes meat, fish, veggies, fruit, dessert, fried foods, grains, and dairy products. Also, please be mindful about the negative comments made about your body or someone else’s. Negative body comments are easily internalized by children. It’s important to model body appreciation and respect. You can do this by talking about how much your body does for you and by being compassionate toward the physical aspects you may not like about your body.


Alexandra Raymond

Alex is a Registered Dietitian at the private practice Courage to Nourish in Howard County and College Park, Maryland. Alex’s goal is to assist her clients in discovering a life-long healthy relationship with food and their bodies. Alex is a proud and passionate anti-diet and Health At Every Size © advocate. Outside of counseling clients, Alex enjoys cooking (especially Italian foods), journaling, hiking and exploring Washington, DC. Website

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What I want parents to know about eating disorder recovery, an interview with Kristie Amadio CEDC

We interviewed Kristie Amadio, Certified Eating Disorder Coach and Founder of Recovered Living. Kristie is recovered from an eating disorder and now coaches people who are in recovery and their families. She even lives with families 24-7 as they navigate recovery, making her an excellent resource for what really goes on during recovery and what parents need to know about the process.

1. What do you wish all parents knew about eating disorders?

That it’s not their fault. Every parent I’ve ever met feels this way but the truth is, the cause of eating disorders is a combination of genetics and environment.

I think parents look at the word ‘environment’ and blame themselves, but I’ve worked with many people in recovery who were teased at school, or read a magazine about weight loss and that triggered their eating disorder. Environment doesn’t necessarily mean ‘home environment,’ it means the world we live in. Right now, we live in a weight-centric society. It is impossible to protect against it but we can help shift it by taking a stand against body shaming and having an inclusive attitude towards food.

I also want parents to know that getting support for themselves is so important. It can be scary and overwhelming to help a child navigate recovery, and having someone who is dedicated to supporting your needs can really help.

Parenting for positive food and body

2. Are there any particular books or learning materials you recommend to parents who have kids who are in recovery?

Absolutely! Carolyn Costin has some excellent books on eating disorder recovery that are easy to read and super informative. Her book 8 Keys to Recovery from an Eating Disorder: Effective Strategies from Therapeutic Practice and Personal Experience is designed for people in recovery, but I often recommend parents/friends read it because it can help them gain a better understanding of the world of eating disorders.

The great thing about the digital age is there is a veritable wealth of information out there that help to create an understanding of the recovery process so parents don’t feel quite so in the dark. I encourage parents to read as much as they can about eating disorders, and also to reach out and find a support group if possible where it is safe for them to express their own feelings about the process.

One of the services I love providing is Support Space, which is a free online support group for family and friends of people with eating disorders. It runs for an hour each month and people attend from all over the world. I like the idea of it being a place where people can ask questions, work through difficult situations and get the support they need. An eating disorder doesn’t just affect one person in the family, it affects the whole family. Feel free to jump on the website and come along!

3. What do you think kids who live at home need most from their parents during recovery?

Everyone’s recovery is different, but in general, I think kids living at home need their parents to be their parents first and foremost. It is so easy for parents to fall into the role of therapist/dietitian/and food police – it is a hard line to walk. People living at home need a duality of things – they need boundaries but also grace, they need support but they also need to learn how to stand on their own. They need closeness and they need space. There isn’t a perfect way to parent someone in recovery – it’s going to be messy!

An eating disorder is a disordered relationship with food, a disordered relationship with the body, and a disordered relationship with the self. People consciously or unconsciously use their eating disorders to communicate in relationships but the rest of the world doesn’t speak that language! Part of the recovery process is learning new ways of being in relationships, using words rather than their eating disorder, and weaning themselves off the ‘safe’ relationship of their eating disorder and onto healthier but ultimately changeable relationships with other people.

This is why I think that kids need help articulating what they need from their parents as a very first step. Most kids don’t know, which can make it hard to parent them! Learning to articulate needs is something they need to learn from a therapist, a mentor, coach, etc. … or it could just come with time. Deep soul work isn’t an easy process, but slow change is sustainable change.

body image for girls ebook

4. What would you say to a parent who is feeling hopeless about their child’s recovery?

The first thing I want to say is, ‘I hear you.’ Eating disorders are scary and can have very very bleak looking prospects at times. I don’t want to bullshit anyone and say ‘it’s going to be OK,’ because I can’t guarantee that. What I can guarantee is that while there is life, there is hope.

Provided someone’s body is willing to continue sustaining life, there is a part of them, (even if it is a cellular part) that wants to live. That is the part I focus on. I always take the stance that just because an eating disorder is stubborn and persistent doesn’t mean it is impossible … it just means it is stubborn and persistent.

I think it is important to make a distinction between hope and attachment. Carolyn Costin says, ‘don’t be attached to the results.’ What this means is that recovery – whether they take the road to recovery or not – is the individual’s choice. No one chooses to develop an eating disorder but they can choose to recover. Sometimes I feel like 70% of my work with clients is going through the process of making that choice. I don’t know that everyone will choose it but I know that everyone can.

If someone doesn’t want recovery, I’m not going to force it on them. Some people want to live the rest of their life with their eating disorder because it feels safer or more comfortable than recovery. I feel sad about the life they are missing out on but I also respect their choice. I hold hope that they will choose differently in the future, but I’m not attached to what they choose – they have free will.

Here’s what I really want parents to know: I’ve seen too many miracles to give up, so I don’t give up, not on anyone. Ever.

To those parents who feel hopeless right now, please remember that while there is life there is hope. A huge part of recovery is getting to the point of being brave enough to want a different life, so being in a difficult spot could be a good thing – sometimes hitting rock bottom is what instigates change.

5. What do you think is the hardest part about living with someone who is in recovery?

So many things! Feeling shut out, feeling helpless, struggling to see your person in pain but knowing the pain is necessary to recover. I’ve had an eating disorder and I’ve lived with people with an eating disorder. Both are equally hard in different ways – I mean that. A family’s support role is JUST as hard as having the eating disorder itself.

My best advice is to keep the three tenants of recovery in mind:

  1. You can’t make your person want to recover
  2. You can’t do it for them
  3. You can set your boundaries about what you will and won’t tolerate

As much as it is important for your person to be communicating about what is going on for them, the same goes for you. No more walking on eggshells, no more ignoring the elephant in the room – an eating disorder thrives in secrecy and isolation but once it is brought to the table, it can’t survive in secret anymore.


Kristie Amadio is a Certified Eating Disorder Coach and Founder of Recovered Living. She is also a certified life coach and eating psychology coach. A former elite athlete, she worked as a counselor in both Australia and New Zealand before beginning Recovered Living as a solution to the gap between recovering in a treatment center and continuing recovery when back at home. She uses the same strength she required in her own recovery to guide and inspire others while her genuine compassion allows her to connect easily with clients.

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What’s new in eating disorder treatment? An interview with Jennifer Rollin, MSW, LCSW-C

We sat down with Jennifer Rollin, an eating disorder therapist and founder of The Eating Disorder Center based in Maryland, to find learn what’s new in the treatment of eating disorders.

1. What do you think has changed about the way we treat eating disorders in the past 10 years?

I think there have been a lot of changes in eating disorder treatment, and we still have a ways to go. One of the big things is a shift towards more evidence-based treatments. We now have a higher emphasis on treatments that have been demonstrated by research to be effective. This will hopefully lead to improved care.

We have also seen the incorporation of Health at Every SizeⓇ (HAESⓇ) principles into eating disorder treatment. We’re experiencing a push towards more weight-neutral care, and are reducing the fat phobia that has been deeply steeped into so many treatments in the past. Providers are finally recognizing is that eating disorders impact people of all body sizes. We’re working hard to eradicate fat phobia in the eating disorder treatment space because it is incredibly harmful.

I think some residential treatment centers are lagging behind, especially in terms of supporting males who have eating disorders. We have two local treatment centers, and only one of them accepts males. Residential treatment has a long way to go in terms of equalizing eating disorders in terms of gender, race, size, and abilities. We are seeing a shift in terms of providers being more welcoming to people of all shapes and sizes, but we still need a lot more education that people who have eating disorders can be any body size, race, class, and gender.

We still need a lot more progress in terms of being welcoming to people in all types of bodies. A lot of people who have eating disorders don’t ever seek treatment because they don’t fit the stereotype and don’t seek treatment or when they do, they are not treated appropriately. Diet culture has completely normalized disordered eating so people don’t even realize they have a problem. Larger people who have eating disorders are often seen as someone who’s trying to “be healthy” and “lose weight.”

2. How do you work with adolescents who have eating disorders?

The first thing that’s most important when working with anyone, but especially teenagers, is building a relationship. It can be hard to earn teens’ trust, especially if they don’t feel a connection with their therapist or healthcare provider. We can have all the best clinical skills in the world, but if we can’t connect with a teen, we won’t get buy-in or trust, and then we won’t be effective. Personally, I think it helps that I’m younger, and I work to keep in touch with teen trends so that they feel I can relate to their world and, therefore, their deepest struggles.

When we’re working with a teenager, we have the benefit of being able to work with the family, which can really help treatment. I will utilize the family in the treatment process as much as makes sense. We have to look closely at the family dynamic and determine the best way to work in partnership for optimal treatment.

Sometimes I will use modified Family Based Therapy (FBT), especially if I’m working with a younger child and it’s a purely restrictive eating disorder. I find it’s most helpful to modify treatment for each child and each family system. Anybody who says that any one treatment is a panacea for eating disorders is problematic – we must look at each case individually. Not everything is appropriate for everyone, and not every family can or should take on FBT.

3. How do you involve parents in a child’s eating disorder treatment?

This totally depends on the person and the situation. I always share with parents that they can be involved as much or as little as they want. Sometimes I need to push for more involvement if I feel it will serve the child’s recovery. I am the child’s therapist, but I will send weekly email updates to parents, and I encourage parents to email updates to me so that I can be aware of what’s going on at home. I will invite parents into sessions and sometimes do family sessions, depending on what makes the most sense. But I always remain aware that my client is the child.

It can be very tricky to navigate fat phobia and diet culture. Parents are so well-intentioned and love their kids, but I can still see that they are trapped in our societal expectations regarding weight. A HAES-informed recovery process involves accepting the body as it is, but I still have great parents asking whether they can help the child lose weight in a healthy way. This is where we still have a lot of catching up to do in terms of educating people about the futility and dangers of intentional weight loss.

When treating a child who has an eating disorder, I become very aware of parents’ thoughts about weight. I take a gentle educational approach and tell parents that in my professional opinion, any focus on weight loss is not helpful for anyone, especially someone who is in recovery for an eating disorder. I know parents want what’s best for their kids, and diet culture has convinced them that certain foods are bad or higher weights are bad. Parents just want to do the right thing, but unfortunately, even though they are trying to help, they don’t understand that it can hurt.

I sometimes recommend that parents meet with a HAES-informed dietician who can help them understand these concepts. The analogy is that having diet foods in the house, talking about dieting, and focusing on weight loss is like going on an alcohol bender while living with someone who is in recovery for alcoholism. We have to be mindful of what we do when we live with someone who is in recovery.

4. What do you think parents most commonly misunderstand about a child’s eating disorder?

I think the most common misunderstanding is that an eating disorder is a choice. Even if parents have been told that it’s not a choice, it’s hard to accept that. We naturally want to understand responsibility and want kids to recover. Well-intentioned parents may feel upset when a child doesn’t follow a recovery plan exactly, they will say things like “you have all these skills, why aren’t you using them?” But this is where it gets tricky. An eating disorder is not a choice, but recovery is. This means that the eating disorder can slip in at any time and take over, and a person who is in recovery has to exert tremendous effort to constantly make the choice to recover. It’s so helpful to know that recovery is a process, not an event. And recovery looks different for every single person.

Of course you’re concerned about your child, and of course you’re disappointed when you see them struggling. But parents need to understand that they are going to have these feelings, but they don’t always need to say them out loud, especially with their child. Disappointment is normal, but parents can unintentionally make kids feel they are disappointed in them for struggling.

I have some clients who feel very guilty for making their parents’ life complicated and scaring them. And it’s true that parents do have to work harder when a kid has an eating disorder, but if the child had cancer, the parent would do it and recognize it wasn’t the child’s fault that they have cancer. That’s what I’d love to see when a child has an eating disorder.

I see some parents who are resigned to the idea that their child will always be sick. Then I have parents who think that if the weight is fine, the child is fine. We have to find a balance and recognize that you can’t judge an eating disorder based on someone’s physicality. Ultimately it’s a mental illness, and we can’t tell how healthy someone is based on how they look or their behaviors.

5. What is advice would you give a parent who has a child who has an eating disorder?

First, have compassion for yourself. A lot of parents blame themselves for a child getting sick. It’s natural to think about what could have been done differently, but ultimately parents have to move forward. Make time for your own self-care. Helping someone in recovery can be emotionally draining.

Second, have compassion for your child, and have compassion for the eating disorder behaviors. Sometimes eating disorder behaviors are the best way your kid can cope in the moment. The eating disorder is serving a purpose for them, otherwise they wouldn’t’ have it. Your child is trying to help themselves – they’re just going about it in a way that is not helpful.

Clearly, I’m passionate about helping people to recover from eating disorders, but I also believe in starting with radical acceptance, which is a concept in Dialectical Behavior Therapy (DBT). Acceptance doesn’t mean you like it, it just means you acknowledge it’s there and you don’t have to make it the enemy. The eating disorder is currently a part of your child. When we make it the enemy, it can feel disapproving or critical to the person. Instead, seek ways to reduce anxiety and help your child meet the needs that their eating disorder is currently meeting, in other more life-affirming ways.


jennifer rollin eating disorders

Jennifer Rollin, MSW, LGSW is a Psychotherapist specializing in eating disorders and body image. In addition to her psychotherapy practice, she also offers recovery coaching via phone or Skype. She has published numerous articles regarding children, adolescents and eating disorders. Website

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Understanding therapy for eating disorders – an interview with Colleen Reichmann, Psy.D.

We interviewed Dr. Colleen Reichmann to find out more about what it’s like to be a therapist who specializes in eating disorders. 

Q: Why did you become a therapist?

I became a therapist because, quite simply, I wanted to give back! I have struggled with my own mental health issues, and have seen first hand the healing power of therapy, which inspired me to pursue a career in psychology.

Q: What made you decide to go into eating disorder treatment as your specialty?

I mainly made this decision because of my own past history-I struggled with an eating disorder for around a decade. I was told that I would be a “chronic” patient and felt so hopeless at times. When I finally began to really recover, I realized that I wanted to use this journey to help others who are struggling with eating disorders. This is not to say that I understand your eating disorder, because everyone is different. My past history simple gives me what I like to call an “empathy chip” for this particular illness and journey.

Q: What training have you received to be an eating disorder specialist?

Unfortunately, I did not receive much specialized training in the core parts of my graduate program, as it was a generalist program. I sought out research experiences (assistantships and my masters thesis and dissertation) that focused on eating disorders. I also attended conferences and trainings outside of school as much as I could. I completed my predoctoral and postdoctoral internships at inpatient eating disorders units, which were huge training experiences. Currently, I am pursuing my CEDS specialist, and expect to be finished within a year or so!

Q: How do you pursue ongoing education as an eating disorder specialist?

I attend conferences. Specialized eating disorder conferences are absolutely crucial. I make it a point to find training opportunities that offer an inclusive, Health At Every Size perspective on issues within the ED community.

Q: How do you typically approach treating a child (up to age 18) for an eating disorder?

Typically I utilize family based therapy (FBT) if at all possible. (I have received some specialized training in FBT). If parents are invested, involved, and ready to learn, I find it is ALWAYS best to include them in the treatment process. After all, you know your child far better than I do! If this is not possible, I offer interpersonal/feminist-relational therapy, with cognitive behavioral therapy techniques threaded throughout. I believe that insight-focused work AND behavior/action-focused work is necessary when it comes to recovery from an eating disorder.

Q: What treatment format do you typically recommend for a child (up to age 18)? For example, how often do you like to meet, for how long, and do you involve family members? Do you involve other caregivers like doctors and nutritionists?

I recommend at least weekly individual session, (50 minutes each), and every other session would ideally involve parents. I also recommend monthly (or more if needed) meetings with an eating disorder-informed MD, and weekly meeting with a dietitian (pediatric dietitians are very helpful for children under 12/13), and non-diet, fat-positive dietitians for everyone else!

Q: What would you like parents to know about having a child who has an eating disorder?

I would like parents to know that this is not your fault. This is a serious mental illness with research-proven genetic underpinning. You cannot “give” your child an eating disorder. You can, however, be a powerful piece of their recovery. I would also like to remind parents who feel helpless/powerless that you likely fed your child successfully for many years. You have the power and the knowledge to help your child-all you need now is guidance and support in how to apply that power now that your child is struggling with an ED.

Q: What mistake(s) do you think parents make when parenting a child who has an eating disorder?

I commonly see parents trying to “appease” their child when it comes to recovery. This is understandable-if your child is begging you not to eat something, to make something different, or to eat less, it is so common and human to want to comfort your child by giving in. To this I say, much like other aspects of parenting, the most comforting action for your child is not what will be best for him/her/them in the long term. Empathic firmness works best here.

I also see parents trying very hard to understand the eating disorder or rationalize what is happening to their child. Often times, it is impossible to find the rationality in someone who is struggling with an eating disorder. Please know that this is an illness with a largely fear-based brain component. Meaning that, neurochemically, your child’s brain is likely reacting similarly around food to someone who struggles with an extreme phobia and is being asked to confront it. So please do not feel hopeless if explaining the rational need for food/eating does not get through to your child.

Q: Do you see any promising new research or techniques that you think will make an impact on the future treatment of eating disorders?

I have recently seen some research that involves “bridging the gap” between research and field work when it comes to family based therapy. (This “gap” refers to the difference between the great outcomes that we have seen in controlled studies, versus the less-powerful outcomes that we see when this research is applied to real-life clients). I think this idea of focusing on the gap and how to close it will be very helpful to the field.

Additionally, we are seeing more and more providers discussing the role of intersectionality, identity, oppression, and marginalization when it comes to eating disorders. This is helpful because it allows us to begin addressing and confronting the environment that leaves some people vulnerable to eating disorders.  (Versus acting as if recovery happens in a vacuum).


colleen Reichmann psyd

Colleen Reichmann, Psy.D. is a licensed clinical psychologist who specializes in the treatment of individuals with eating disorders and body image issues. She has worked at various inpatient eating disorder treatment facilities and is the blog manager for Project HEAL. She lives in Virginia Beach with her husband and golden doodle and currently works at a group practice.

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Social Justice, Fatphobia, and Eating Disorders, by Meghan Cichy, RDN

Dismantling fatphobia and weight stigma, as well as other systems of body oppression at a systemic and institutional level, will be necessary if we are to put an end to eating disorders.

The discrimination facing larger bodies is serious: weight stigma has been shown to impact mental and physical health by increasing risk for elevated blood pressure, unhealthy weight control and binge eating behaviors, bulimic symptoms, negative body image, low self-esteem, and depression among children, adolescents, and adults (Tylka et al., 2014). Rebecca Puhl’s research indicates a 66% rise in weight-based discrimination over the past 10 years.

Our society reinforces and maintains the toxic hierarchy of acceptable bodies, while openly and aggressively criticizing the vast majority of people who fall outside the confines of socially acceptable body size. Meanwhile, bodies that meet or conform to the cultural beauty and health ideals enjoy increased power, privilege, status, and access.

It is simply impossible for every body to meet the socially constructed ideals of beauty or health in regards to body size, skin color, physical ability, neurological presentation, gender identity, etc. This leads to the oppression and discrimination of those who do not conform and increases the risk of mental and physical health consequences. In attempts to free themselves of these cultural aggressions people experiencing weight stigma may engage in dangerous, harmful behaviors in order to change their body’s weight or shape.

Social Determinants of Health

Social Determinants of Health take into consideration the broader factors in the context in which we live and the way those factors impact population health. These factors include things like income and wealth distribution, education opportunities, unemployment and job security, food insecurity (regular and reliable access to food), housing, social exclusion and inclusion, social safety, health services (access to quality, unbiased, safe care), race, gender, disability, and indigenous status.

There are many factors that impact our health and not all of them are within our individual control. Actually, the factors that are within our control, or our individual responsibility, represent only a small proportion of the total factors that impact our health.

Yet public health campaigns, individual healthcare providers, and wellness gurus reliably target individual behavior as the pathway to help. This not only limits the impact that these interventions can have on health, but also increases the risk of shame and stigma being experienced by people who do not align with culturally defined acceptable behaviors or physical presentation of “health.”

This brings us back to the importance of applying a social justice lens to health. Our current systems and institutions perpetuate a structure of privilege, status, and access to some bodies while restricting it from others. This is not health promoting. It is actually causing mental and physical harm and worsening the health of our society and its individuals. It narrows our view of what impacts our health and erases our lived experiences. Shifting to a social justice framework and considering social determinants of health helps us to tailor our care to be more equitable and makes space for all bodies to exist with respect and free from prejudice and discrimination.

Health at Every Size®(HAES®) is an approach to both policy and individual decision making that is grounded in a social justice framework and considers social determinants of health.

Focusing on well-being by broadening perspective on health

It has been my experience that the more fraught a person’s relationship with food and body is, the more time, energy, and focus they spend on food and body. These efforts can result in negative impacts on health (i.e. greater body dissatisfaction, obsessive thoughts about food, weight cycling). In contrast, the more at peace a person is with food and their body, the more time, energy, and space they have for other, often more fulfilling thoughts and activities that positively impact health and well-being.

First, as a woman with many privileges (thin, white, without illness or disability, etc.) my actions of being radically counterculture around food and body are met with little resistance in the world as compared to those who do not possess these privileges.

By giving myself permission to eat with pleasure and in attunement to what feels good and supportive of my overall wellbeing I am able to remove the restrictive, external rules of diet culture. I am also able to rid my food choices of morality thereby creating freedom from the cycle of shame that so often drives disordered eating behaviors.

I talk about food and my experience of it with curiosity and without judgment. Food is never tied to earning or deserving, to compensation or punishment, nor to moral superiority or failing. Our bodies are born with an innate need for nourishment and our food provides us with pleasure in order to ensure this nourishment is consistent. Enjoying food is not a flaw nor something to be fixed or controlled. In fact, in honoring our appetite and learning to listen to and honor our body’s needs we are best positioned to take care of it.

Taking this radical approach to food provides us with an alternative to the sea of diet culture in which we swim. Some people have been swimming in the sea of diet culture for so long they don’t even realize it’s there. However, if we can provide a contrast to what they are used to, a safe harbor of body liberation and intuitive connection, they can start to do the work of sorting out what is actually most healthful for them.

Preventing eating disorders

To prevent eating disorders, we must dismantle fatphobia and diet culture and bring awareness to social justice and social determinants of health. We must recognize and celebrate body diversity and dismantle the hierarchy of acceptable and respectable bodies.

We must provide better training to our healthcare professionals, educators, coaches, caregivers, and parents around the factors that increase the risk for developing an eating disorder (genes, trauma, illness, culture and environment, weight stigma and bias).

We must move away from a binary system and towards a space of plurality along the continuum of human experience. Humans are not just fat or thin, black or white, gay or straight, feminine or masculine. We exist at the intersection of multiple identities. Bringing awareness allows us to engage in helpful vs harmful ways and set us up for the best chance of eating disorder prevention.

Cultivating an environment of peace with food and body at home can look like:

1. Nurturing body trust through curiosity and connection.

2. Supporting autonomy and independence in eating by providing regular and reliable meals and snacks which contain a variety of nourishing and pleasurable food, and then, without pressure, allowing the child to be in charge of whether and how much they eat.

3. Exploring and celebrating human body diversity with intention and making space for curious questions and observations without shaming.

4. Avoiding judgments and morality when discussing food and body whether you are with your kids or not.

Important leaders in this space

Desiree Adaway describes a social justice approach as “focusing on the unequal social power between groups that leads to some groups having privilege, status, and access while other groups are denied these things.”

Carmel Cool describes body liberation in a social justice context as “honoring the fundamental rights of fat people to exist without prejudice and discrimination and believing that people’s bodies are not problems to be solved.”

Jes Baker describes body liberation as “freedom from expectations. As recognizing the systemic issues that surround us and acknowledging that perhaps we’re not able to fix them all on our own.”


Meghan Cichy

Meghan Cichy, RDN, CEDRD, CSP, CD, Creating Peace with Food, LLC

I work with clients of all ages who are on the spectrum of disordered eating from weight control dieting to eating disorders. I work to meet them where they are while supporting them in identifying and moving towards their value-driven life. Meeting clients where they are means making space for, trusting, and validating their lived experiences, acknowledging their fears and anxieties, and recognizing their tools for protection and self-preservation. It means giving them a place to explore their body story and how it relates to the way they nourish themselves with food, movement, and self-care. My clients’ body stories are all unique. Some contain a few pivotal moments that have shaped the way they move through the world. Others express more subtle but deeply ingrained threads of overt or covert expectation. Either way, when these experiences occur in childhood they set off a cascade of learning and adapting that lead to a lifetime of practiced survival behaviors. Getting to a place of safety where one can start to let go of the behaviors that are no longer serving them and begin to practice other life-enhancing and value-driven behaviors can take years. I am dedicated to coming alongside my clients as a resource as they do this challenging and valuable work.

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What to do when you are told or suspect that your child has an eating disorder, by Beth Mayer, LICSW

No parent wants to hear that their child has a problem, and eating disorders, like all mental disorders, carry a stigma that can be especially hard to handle. I wish we lived in a world in which we treated mental health disorders in the same way we do physical health. If your child had a sprained ankle, you would know exactly what to do and could trust that they were going to receive the care they needed. Unfortunately, that is not the case with mental disorders like eating disorders, so parents need to be provided with more information so they can come to terms with what’s going on and navigate the healing process.

Every person will have their own experience and their own specific needs, but there are some steps that apply to almost every parent who has just found out that their child has an eating disorder:

1. Don’t panic

A lot of times parents find out about a child’s eating disorder from teachers, friends, or coaches. Depending on the reporter who is sharing the news with you, this may not be handled very well. Ideally, we would like reporters to approach a parent with gentle compassion and some informed questions rather than abrupt and scary statements.

No matter what the reporter says, take a deep breath and ground yourself. First, address the shame storm that may engulf you with this news. Many parents notice that their first reaction is fear, shame, and judgment. Be gentle with yourself. First of all, it may not be true. Second of all, even if it is, it’s not your fault you didn’t know – most parents don’t!  People who have eating disorders typically work hard to hide the symptoms from their parents, so it is not a surprise that you needed to be alerted to a possible problem.

Ask the reporter some questions about their suspicions. For example, what have they seen or noticed? Try to get specific details if possible. This will help you as you begin doing your own investigation into your child’s health. For example, some kids who have eating disorders eat fairly normally at home but engage in their disorder everywhere else. Ask questions, and write down what you hear so that you can think about it some more. You’re likely to be in a high state of stress during the conversation, so writing things down can really help you focus and move forward.

Don’t be afraid to call the reporter back or set up a time to meet in person so that you can ask questions when you have calmed down a little more. Reporters are typically more than happy to provide as much information and support as you allow them.

I realize you may feel a lot of shame right now, but please know there is so much you can do to help your child recover if they do have an eating disorder. You didn’t cause this. It’s something that has happened, and you have tremendous power to do the next right thing.

2. Look for patterns

Once you suspect or have been told that your child may have an eating disorder, look for patterns. One of the biggest warning signals is an abrupt change in body weight. This may be a significant weight loss or gain. We live in a culture that applauds people of higher weights when they lose weight, but any weight loss in an adolescent should be considered a red flag.

Your child’s healthiest body is typically along a fairly even weight trajectory that begins at birth, and a big spike or dip is cause for concern. Be very careful about the assumptions you make about your child’s body – we live in a society that mistakenly believes that people living in larger bodies are unhealthy and that intentional weight loss is healthy. It simply isn’t true, and the more you learn about this, the better position you are in to help your child.

But eating disorders go beyond weight gain and loss. A person who has an eating disorder often has distorted beliefs about their body and food. Often a child who is heading for, or already has an eating disorder talks about hating their body. They may mention that they’re “cleaning up” their eating, which typically means removing certain foods like sugar, carbs, and animal products. These changes don’t always lead to eating disorders, but they are cause for concern.

Notice patterns during and after eating. A child who is flirting with or has developed an eating disorder may often say they “already ate,” or “aren’t hungry” at the dinner table. Or you may notice that they go to the bathroom or out for exercise immediately after eating.

Look for behavioral changes outside of eating and body size, like anxiety, defiance, and changes in who they spend time with. These signs are often not immediately identified as eating disorder symptoms, but they often occur at the same time as an eating disorder is building strength.

Overall, observe your child. See if you can notice patterns around eating, body, behavior, and mood. Notice if your child is eating more or less, losing weight, going to the bathroom after dinner, and otherwise behaving in a manner that is different than before. Write down your observations and talk to someone else – ideally a professional – before you approach your child so that you have a clear message and approach.

3. Approach with inquiry, not accusation

Eating disorders are very tricky and secretive. Parents who want to approach a child about a possible eating disorder must tread carefully and look for ways that will not be scary. This is really important, because when an eating disorder is driven further underground by poorly executed confrontation it may morph into other disorders and/or become even more embedded. It is natural for your child to become defensive, so it’s good to be prepared.

Once you have clarified patterns that are worthy of concern, you want to voice your concerns with your child – don’t wait for your child to come to you or for some other dramatic confirmation of your fears.

Rather than diving in with a direct “I think you have an eating disorder,” present some information about the patterns you have observed. Say things like “I notice you are going to the bathroom after you eat, and I’m feeling concerned.” Focus on the facts and the behaviors, not your child’s physical appearance. You don’t want to say “I’ve noticed you’ve lost a lot of weight,” but instead say “I’ve noticed that you’ve changed your eating patterns.”

The most important thing to do is to not accuse or pass blame. You need to be calm and confident when you tell your child what you have observed and state your concerns. Then listen to your child. Ask questions to open up the conversation. If your child has an eating disorder they will most likely be resistant to getting help. Eating disorders feel like lifesavers when a person is in them, and your child is probably terrified that you’re going to take it away.

Say something like “you may not feel like it’s a big deal, but we are keeping an eye on this because I am concerned because your eating patterns have changed dramatically. We want you to enjoy your body and enjoy your food, and clearly, that’s not what you’re experiencing.” Then tell your child what the next step is.

4. Get help

A good next step is a meeting with a physician. Call the physician in advance and tell them your concerns. Make sure the physician has experience with eating disorders and is informed about them. Unfortunately, few physicians have training in this area so you may need to ask for a referral to find someone who will provide a good assessment. One challenge you may face is the bias that all eating disorders look the same (i.e. underweight). Some physicians will even praise a child who has lost a dangerous amount of weight. A child who has been considered “overweight” for their whole lives, may get applause from a doctor whose only goal is to get that child into the “normal weight” range. But that is misinformed and dangerous.

You can also go to a therapist first, with the understanding that the therapist will likely recommend a physical exam as the first step in the diagnosis and treatment of a possible eating disorder. Again, you want to speak with the therapist in advance and make sure the therapist has experience with eating disorders. In both cases, you should attend the meeting with your child. Bring your list, and share your concerns in a non-accusing way.

Your child may be in the early stages of an eating disorder, or they may be what I call “fiddling.” The symptoms you are observing may be more heavily linked to anxiety or depression than a full-blown eating disorder. Regardless, immediate treatment is necessary. The earlier we start treatment for any mental distress, the better our chances of success in treatment. Your child’s eating disorder could be what I call a “blip” – it comes into your life, it’s used as a coping mechanism, and it can be treated. The longer it stays, the higher the likelihood that it will become persistent and even lifelong.

Seek support for yourself. Talk to a professional who understands body image and eating disorders. Read up about what to do and what not to do. Assess and treat your own fear as a parent. This is a tough situation for any parent. You deserve compassion and understanding. If you feel as if everyone is blaming you for the disorder, seek help immediately. You need to be treated for your own trauma in this experience.

What I really want parents to know about eating disorders is that they work. They are a very effective way for your child to deal with a tremendous amount of pain. For eating disorders to stop working, your child needs to relearn how to feel pain. Learning to go through pain is a big part of treatment. Our kids have to learn that they can tolerate pain and get through it without their eating disorder. This is entirely possible, and parents can be wonderfully helpful when they are empowered to help.


beth mayer meda

Beth Mayer, LICSW, has been working in the eating disorders field for 35 years. She has been the Executive Director of MEDA for 16 years. She is nationally recognized for her clinical work with eating disorders and has spoken at conferences around the country. In addition to eating disorders, Beth specializes in treating adolescents and families. Beth has served as an adjunct professor at Simmons College, Boston University, Boston College, Lesley University and Salem State College, supervising MSW and LMHC graduate student interns. She is currently the co-chair of the NEDA network and serves on many local and national committees. Beth holds a B.S. in Clinical Psychology from Quinnipiac University and a Master of Social Work Degree from Boston College. She can be reached at  bethmayerlicsw@gmail.com / 617-325-1013

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Yes, we can help prevent eating disorders! Recommendations for parents, educators and healthcare practitioners

By Laurie Dunham, MS, RD, LD, CEDRD

I’d like to help empower all parents, educators and healthcare practitioners to take an active role in preventing eating disorders. Right now we are seeing an increase in eating disorders in certain younger age groups. I believe that with proper education of adults, we could help reverse this trend.

On a large scale, it would be helpful if parents and adults who work with and care for children (from age 0-21) were aware of warning signs and risk factors involved in eating disorder development. For example, family members should be aware of whether they have any family history of eating disorders, addiction, depression, OCD and/or anxiety, all of which can be risk factors or co-occur and therefore should be monitored. Healthcare professionals and educators should be aware of the complexity of eating disorders and learn to avoid triggering language and messages when working with children and adolescents.

Healthcare Professionals

Pediatricians need to be reminded that Body mass index (BMI) is just a screening tool and that not every body fits nicely into the “recommended” healthy norms. A child/adolescent should be measured against his/her own growth curve. For example, if someone’s BMI has always been at the 90th percentile and a pediatrician recommends the child lose weight to stay within the guidelines of having a BMI within the 15th-85th percentile, this could trigger dietary restriction or over exercise and lead to an eating disorder, when the child may be perfectly healthy. The focus should always be on healthy lifestyle choices, not weight. Health care providers can talk about being physically active and including more fruits and vegetables in the diet. They can also refer to a registered dietitian for further nutrition counseling.

Educators

Schools should never take a role in weight education or any form of nutrition counseling with weight loss in mind. School is for educating about various subjects, but we just don’t find that most health teachers are qualified to speak about weight and eating without extra training, and thus can unintentionally contribute to eating disorders. Health teachers can talk in general about healthy practices but don’t need to get specific about “healthy” weights. The size of adolescents differs so much, that you can’t even say what “normal” is.

The classroom and gym are sensitive areas, and many teachers and coaches may not realize the impact of their words. Sure, many kids can hear general comments such as “you shouldn’t eat fast food” and be okay, but if you have just one child in the classroom that tends to be more perfectionistic or has family history of an eating disorder or anxiety, this could be what sends them over the edge into disordered eating behavior. Unless a teacher has been trained in the importance of language monitoring around weight and nutrition, they should avoid discussing both topics.

Parents

Parents should be educated about eating disorder prevention in much the same way they are educated about Internet safety, seat belt and bike helmet use, etc. In other words, the parent sets expectations for safety and health, and monitors the child’s behaviors to ensure both.

We know that having family history of mental illness, personality traits of perfectionism, anxiety, OCD, etc. places one at a higher risk for an eating disorder. We also know that the more a parent encourages dieting, the higher the occurrence of disordered eating behaviors. If a child/adolescent has any risk factors, this information should be shared with all parents without any suggestion of shame or blame, just fact. Having family history of certain illnesses or certain personality traits is nothing to be ashamed of or feel guilty about. We need to talk about it more to decrease the stigma.

Children look to their parents as role models. If parents have issues with their own weight or body image, they may need to get help, . Many adults have disordered eating patterns, if not outright eating disorders, and it’s important to get treatment in order to be a parent who can model healthy eating and positive body image.

I recommend talking in non-specific terms about food. For example, instead of saying this food is good or bad, teach kids at an early age that there are foods we should eat every day and there are foods we have occasionally. When I talk to elementary aged kids I use the terminology “every day foods” and “sometimes” foods.

Additional nutritional guidelines to help prevent eating disorders:

  • stress that all foods can fit into a healthy style of eating
  • don’t comment on calories or weight
  • model healthy eating practices such as sitting at the table to eat, eating without distractions, putting food on a plate or in a bowl as opposed to eating out of a bag or box.
  • provide regularly scheduled meals so your child knows when to expect food
  • associate food with physical growth and development, not weight
  • adolescents should be eating more than their parents in most cases as they are going through a period of rapid growth
  • keep wholesome foods in the home. If parents purchase fat free, sugar free, low carb varieties of foods, kids learn that they too, should eat diet foods
  • teach kids to honor their own hunger and satiety cues
  • establish normal, healthy eating practices early on to help an adolescent feel confident in his or her eating abilities later in life
  • encourage cooking at home; you don’t need to cook gourmet meals, but try to have 4 food groups (protein, grains, vegetable, dairy & cook with healthy fats).
  • try to eat out less
  • don’t use food as a reward or punishment

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Laurie Dunham, MS, RD, LD, CEDRD, is Registered Dietitian II at the Eating Disorder Program at Cincinnati Children’s. The Eating Disorders Program serves all adolescents, male and female and gender nonconforming, with significantly unhealthy eating behaviors including anorexia nervosa, bulimia nervosa and binge eating / overeating. Cincinnati Children’s provides outpatient treatment to children, adolescents and young adults through age 21. Website