Do No Harm Podcast

CW: BED, OA, Some specific amounts of food used for examples

Amy Pershing, who cowrote Binge Eating Disorder: The Journey to Recovery and Beyond with Chevese Turner, joined me on the podcast to discuss this challenging and common eating disorder that is often overlooked. Amy shares so much great information with us about BED from all sides of the disorder, having experienced it herself and recovered.

BED Recovery Program: www.thebodywiseprogram.com

Intuitive Eating Program: www.hungerwise.com

In this episode:

• Her history around dieting and BED

• BED - most common eating disorder

• BED seen as a willpower issue

• How to screen patients for EDs/BED

• What does Binging look like?

• How does shame affect our thoughts around binging?

• Trauma

• BED can manifest in any body size

• How do you start to find help

• Person in culture and how it affects eating disorders

• Advocacy for patients in the world

Amy Pershing LMSW, ACSW is the Founder of Bodywise Binge Eating Disorder Recovery Program and the Vice President of the Center for Eating Disorders in Ann Arbor. She is the co-founder of Pershing Consulting LLC, which offers training to clinicians treating BED worldwide.

Based on 30 years of clinical experience, Amy has pioneered a treatment approach for BED that is strengths-based, incorporating Internal Family Systems and somatic trauma techniques. Her approach also integrates “attuned” eating and movement and a “health at every size” philosophy. Amy is also the creator of “Hungerwise™,” a 9-week program for ending chronic dieting and weight cycling. Pershing lectures internationally and writes extensively on the treatment of BED and her own recovery journey for both professional and lay communities. She has been featured on radio, podcast, and television speaking about BED treatment and recovery, relapse prevention, weight stigma, and attuned eating and movement. She is the winner of The Binge Eating Disorder Association's 2016 Pioneer in Clinical Advocacy award, has served on a variety of professional boards, and is the Past Chair of the Binge Eating Disorder Association. Amy is the author of the book Binge Eating Disorder: The Journey to Recovery and Beyond (Routledge, 2018), and maintains her clinical practice treating BED in Ann Arbor.

Content Warning: Discussion of Weight Loss Surgery

Fiona Willer, AdvAPD, FHEA, MAICD and PhD candidate, joins us today to discuss weight science. We talk about everything from bariatric surgery to the state of research around fatness. If you are interested in weight science, you will be interested in this episode!

Hello all! I've missed you! This is a relatively quick update of the last six months or so of my life. My experience in the hospital gave me some additional insight to treating larger patients and I even talk a bit about the topic of the day, Covid-19. I personally love update podcasts, so I know some of you will be happy to listen. If you are not like me in this, I should be getting an interview or two out soon. Stay Safe!

This episode is fairly far ranging in topic and trying to pinpoint every topic was too daunting. We discuss philosophy, medicine, compassion, engaging with patients on a human level and more. Deb Burgard is such a thoughtful person who has taken a lot of time to really think about the topics surrounding not just fatness, but also social justice and how to make the world a more compassionate place. It starts with each of us individually, but I think it helps to listen to Deb and take in her joyous wisdom. I hope that you enjoy listening to her as much as I enjoyed making this episode with her.

Deb Burgard, PhD, FAED, is a psychologist and activist from the San Francisco Bay Area specializing in concerns about body image, eating, weight stigma, and relationships. She is also one of the founders of the Health at Every Size(r) model, the original BodyPositive.com website, and the Show Me the Data listserv, building communities where people can find each other and the resources to resist weight stigma, especially in medical and psychological treatment.  Her activism includes working with healthcare providers to integrate an understanding of the social determinants of health and creating interventions that address structural oppression and support stigma resistance.  She can be found at conferences sparking impromptu dance parties in the pool. 

Resources:

Poodle Science link: https://www.youtube.com/watch?v=H89QQfXtc-k

www.bodypositive.com

BodyPositivePhD on IG, Twitter

FB group for doctors: Health At Every Size Doctors

Thank you for your patience!! What a whirlwind August has been. Here is my interview with the marvelous Lesley Williams, MD. She does a lot of work talking to other physicians about why weight independent health care is so important to improving health outcomes!

In the episode (not in order):

How Dr. Williams got involved with HAES

Health Equity and health access

How access and respect are due to all patients, regardless of their health goals

Talking to doctors about the fear of having harmed patients unknowingly

Are there fat old people? (answer: yes)

Surgery on fat people

Why hospitals should make sure to recognize that they have fat patients

And more!

"Everyone deserves to pursue their own level of health, or lack thereof,...regardless of that pursuit, they deserve respect and access to whatever it is they need." 

- Dr. Lesley Williams

About Dr. Williams:

Lesley Williams, MD is a Certified Eating Disorder Specialist and board certified Family Medicine physician. She received her Doctor of Medicine degree from the University of Kentucky College of Medicine and completed her Family Medicine residency training at Mayo Clinic Arizona. She has worked exclusively with eating disorders for over 15 years in the full spectrum of treatment settings. Dr. Williams recently established Williams Wellness Medical Group, an outpatient eating disorder focused medical practice in Phoenix, AZ. She is also currently the Medical Team Lead for Banner Behavioral Health Hospital in Scottsdale, AZ. Her areas of special interest and expertise include: Health Equity and Health at Every Size Advocacy. Dr. Williams is a member of the American Academy of Family Physicians. She was recently appointed to the Academy of Eating Disorders Diversity, Equity and Inclusion Committee. Due to her hard work and dedication to the field, in 2018 Dr. Williams was named as one of the Top 80 Female Eating Disorder Leaders in the United States.

lesleywilliamsmd.com

www.medicalgroup.com

CW: Specific calorie amounts mentioned at these points in the show:

• 15:49:15:52

• 17.26- 17:38

• 46:12-46:13

Hypothalamic Amenorrhea (HA), or a lack of menstruation caused by the disfunction of the hypothalamus, affects many people in the world. It happens often when someone is under-fueling their bodies. It is a common condition with atheletes, but can affect anyone who menstruates and does not take in enough energy. While it might sound nice to not have a period, the hormones that cause menstruation affect many aspects of health and can lead to infertility if not addressed. Nicola Rinaldi, PhD has done a lot of research on HA, and experienced it herself. She now spends her time spreading the word about the causes and treatments for HA.

In the episode:

• Nicola's story

• Calorie Intake in relation to menstruation

• Calorie Intake in relation to bone density

• PCOS vs HA

• Using OCP to “jumpstart” menstruation (and why it doesn't work)

About Nicole:

Dr. Nicola Rinaldi has a PhD in biology from MIT. Since experiencing hypothalamic amenorrhea (missing periods) herself, Dr. Rinaldi has been on a mission to spread awareness of the condition and how to recover. In 2016 she published the book "No Period. Now What?", updated March of 2019 to be more Health At Every Size aligned. This book is a comprehensive resource that includes much of the medical and scientific research that underlies our current understanding of the triggers for amenorrhea, what steps to take for recovery, and treatments to use for recovery and pregnancy as needed. In addition, Dr. Rinaldi performed the largest survey to date of women who likewise experienced amenorrhea, and includes results from the survey answering many of the common questions women have, such as "How long will it take to recover?" "Will I be able to get pregnant?" and "Will I resume cycling after pregnancy?". Finally, the book includes Dr. Rinaldi's own story along with those of hundreds of other women, providing hope and reassurance to women following in their footsteps. Since publishing "No Period. Now What?" Dr. Rinaldi has been on a mission to spread awareness about hypothalamic amenorrhea and recovery, appearing as a guest on dozens of podcasts, attending and presenting at industry conferences, as well as continuing to participate in ongoing academic research studies. She now also works with clients on period recovery and getting pregnant.

Resources:

Information sheet on HA, and first chapter of No Period. Now What? - free download: http://noperiod.info/HA

Information sheet on HA versus PCOS, and relevant chapter of No Period. Now What? - free download: http://noperiod.info/HAvsPCOS

New research on HA versus PCOS: http://noperiod.info/HAvsPCOS2

Time to recovery is not correlated with length of amenorrhea: http://noperiod.info/time

FB support group: http://noperiod.info/support

EBook + paperback: http://noperiod.info/book

Personal recovery/fertility support: http://noperiod.info/appointments

The Fast Track Trial is a trial in Australia that is being done to determine the efficacy of intermittent fasting for weight loss in teens. My amazing guest, Louise Adams, has spent the last year actively trying to get the trial stopped because it is unethical. The connection between dieting, especially fasting, and the development of eating disorders is quite strong. This is particularly concerning in relation to young people. She has collected studies, letters of support from medical professionals and organizations in Australia, as well as over 20,000 signatures from around the world on a change.org petition opposing the trial. Unfortunately, her efforts have been unsuccessful and the trial is proceeding.

Content Warning: This episode includes information about fasting, eating disorders, weight change, and a brief discussion of normal adolescent weight gain.

In this episode, we discuss:

• A bit about who Louise is and how she started working with eating disorders and the HAES movement

• A description of the Fast Track Trial

• Reasons why dieting can lead to eating disorders, particularly in teens

• How Louise has been fighting against the trial going forward

• What risks are not being fully explained to participants

• What the initial results of an initial study mean in practical terms

• Who the people behind the trial are

• And much more!

Resources:

Untrapped website

FB group for Stop the Fast Track Trial

Parent information for the Fast Track Trial 

That Time I Was in a Child Weight Loss Study link: 

About Louise: Louise Adams is a clinical psychologist, the founder of Treat Yourself Well Sydney and the creator of the UNTRAPPED online program and community. She has written two books, Mindful Moments and The Non-Diet Approach Handbook for Psychologist and Counsellors (with Fiona Willer, APD). She has been practicing in this field for more than 20 years. Louise is Vice President of Health At Every Size Australia.

She has a special interest in problematic eating, body image, and weight struggles. Louise fights to educate people about the cruel trap of dieting, which only sets us up to fail. She uses an evidence-based anti-dieting approach to empower people to achieve permanent lifestyle change.

Louise is wholly committed to the Heath At Every Size (HAES) movement, and to spreading the word about shifting our attitudes about weight and health. Louise is determined to make a difference in changing society’s perceptions about health, diets, weight loss, and bodies. Louise believes that people can approach health and happiness without attaching it to weight changes. She is for body diversity and against fat prejudice.

As well as her work with individual clients at her private practice, Louise conducts workshops and conferences for the general public and health professionals interested in changing their approach to weight issues. Louise is the host of the popular podcast All Fired Up!, and often turns up in magazines, newspapers, radio, and on television to spread her message. She blogs, she tweets, and she never shuts up about these issues!

Interview with Ragan Chastain, an activist and dynamic speaker about Fat Acceptance, weight stigma in health care, and Health at Every Size®. The conversation ranged across a broad array of topics and I really recommend listening to all of it. The bit that really stood out to me is the idea that practitioners and fat people should be on the same side an asking how to break down barriers to health, including bias.

www.sizedforsuccess.com

Michelle May, MD joined me to talk about mindfulness and health during this episode. We ended up talking about a few other things as well! Dr. May is a recovered yoyo dieter and the founder of Am I Hungry? Mindful Eating Programs and Training (www.AmIHungry.com) that helps individuals resolve mindless and emotional eating and senseless yo-yo dieting to live the vibrant life they crave. Over 800 health and wellness professionals from 30 countries have been trained to facilitate Am I Hungry? mindful eating programs worldwide. Dr. May is also the award-winning author of the Eat What You Love, Love What You Eat book series.

Find more information at the show page at www.donoharmpodcast.com.

During this episode, Dr. Jennifer Gaudiani joined me to talk about eating disorders and her experiences with them. She recently wrote a book: Sick Enough: A Guide to the Medical Complications of Eating Disorders. She has been working with patients with eating disorders for 11 years and has also incorporated Health at Every Size and weight inclusive principles into her practice over the last few years. She has found that it has made a great deal of difference, not only in recovery, but also in identifying patients who might have otherwise had a delay in diagnosis, or not been diagnosed at all.

In this episode:

• How Dr. G got involved with eating disorder patients and HAES,

• How starvation affects patients’ bodies.

• Things to be aware of as a physician who might be encountering patients with eating disorders and “atypical” eating disorders.

• Metabolism and fertility.