EDeology: The People Behind Today's Eating Disorder Treatment Landscape

Does weight affect health?

For many years, the scientific and medical communities assumed the answer to this question as an obvious yes. After all, studies show correlations between higher BMI (body mass index) and various medical conditions, one of which—PCOS—is the topic of today’s episode.

When we look at studies showing a correlation between weight and PCOS or other medical conditions, two key questions arise:

1. Does weight cause the condition, or is there a third variable that influences both weight retention and the condition?

2. Are the treatment recommendations based on this association helpful or harmful to the patient?

In this episode, Lauren Hirschhorn-Tieu shares her experience as someone diagnosed with PCOS and prescribed a rigid weight loss diet. She discusses the negative impact of the diet on her quality of life, eating patterns, social life, and self-perception. She describes the shame, the belief that her body was somehow “different”, and the lack of substantiated impact the diet had on her PCOS.

When Lauren talks about the meal plan she was prescribed, we also briefly touch on censorship, trigger warnings, and the impact of sharing specifics about food restriction. We settle on sharing the specifics and allowing you, the listener, to decide whether you want to listen and to process your reactions if you choose to engage. 

I debated whether to cut this from the episode. On one hand, in the context of our conversation, the particular snack Lauren was prescribed was legitimately not important. On the other hand, it touches on a broader question about the recovery environment we create: To what extent are we responsible for monitoring ourselves to shield one another from potentially painful or triggering information, versus sharing our stories openly and in enough detail to bring them to life while also validating, owning, and processing our reactions to each other?

Lauren is a non-diet, HAES-aligned registered dietitian and owner of Note to Self Nutrition LLC. Lauren started her career in the clinical side of nutrition, working in hospitals and skilled nursing facilities, which provided her with a solid medical foundation and a deep understanding of the complexities of the body and the medical field. She now combines that experience with her HAES®-aligned approach to help clients navigate medical conditions like diabetes, chronic kidney disease, and hormonal imbalances, all while supporting their relationship with food and their bodies.

Having her own history of struggles with nutrition and body image has shaped Lauren’s gentle approach to nutrition therapy. She deeply understands the grief that comes with a changing body and the pressure to fit into societal ideals. She also recognizes that her own lived experience is just one part of the story, and she continues to learn from the diverse clients she works with.

At the heart of Lauren's work is a desire to help clients reconnect with their authentic selves—the person they were before diet culture took hold. She believes that the joyful, carefree parts of ourselves are still within us, waiting to be rediscovered.

Lauren’ nutrition practice: https://www.notetoselfnutritionllc.com/ 

Elka’s binge eating recovery program: https://elkacubacub.com/ 

There’s a stereotype that eating disorders are a young woman’s illness. Many treatment centers cater primarily to young people, and even adult treatment centers often have a predominantly young adult population.

As a result of this, when someone experiences an eating disorder in midlife or later, they may face not only the challenges and stigma of the diagnosis but also a sense of isolation, feeling as though others in their age group don’t share their struggle. The reality, however, is that eating disorders can affect people of any age. 

In this episode, Betsy Brenner shares her story of confronting and recovering from an eating disorder in midlife. She discusses her experience living parallel lives—outwardly maintaining her image as the happy, perpetually positive person she was taught to be, while secretly struggling deeply, and what it was like to finally confront painful emotions after decades of suppression. 

Betsy is a recovery speaker, peer support mentor, and author of the memoir The Longest Match: Rallying to Defeat an Eating Disorder in Midlife.

Betsy is a former hospital attorney and longtime high school tennis coach. She has also been a hospice volunteer and speaker on grief and end-of-life decision-making. For the past decade, she has led a bereavement group in her community. Now, her primary focus is on speaking, mentoring, and leading support groups in the eating disorder field. She has shared her story at treatment centers, conferences, and through webinars and podcasts, offering hope and guidance—especially to women in midlife facing similar challenges.

Betsy holds a bachelor’s degree in psychology from Brown University and a Juris Doctorate from American University Law School. 

https://betsybrenner.com/

Periodically, I come across social media posts or comments questioning the legitimacy of work by a non-credentialed author, healer, or influencer. These questions stem from the fact that, as mental health becomes increasingly recognized as its own discipline, standards are developed to monitor and legitimize it. Academic degrees and clinical licensure help ensure credibility, ethical standards, and accountability. Scientific study moves therapy from the subjective experience of the practitioner to empirical observations of an intervention’s effectiveness. Seeking mental health treatment puts a person in the vulnerable position of sharing their most raw and painful experiences with a stranger. All of these measures can inform who to trust to provide safe and effective care

And yet, while modern psychotherapy is a relatively new invention, psychosocial and spiritual healing have been part of societies perhaps since the beginning of human civilization. The complexity of the human mind makes it impossible for any one group to claim a monopoly on understanding how we heal.

Many people in recovery encounter the limitations of professional fields like therapy or dietetics, raising the question: What is the role of coaches, spirituality, and alternative paths to healing? How can we open our minds to healing in all its forms—wherever it may be found—while also protecting ourselves and others from the harm caused by unskilled or unethical practice?

In this episode, Haley Schiek and I discuss the role of coaching, spirituality, and alternative paths to healing. Haley shares her journey encountering the limitations of traditional treatment, then on the advice of her dietician, seeing an alternative healer with initial skepticism, and finally experiencing the profound effects of this type of work firsthand. Haley shares how she now integrates energy healing, emotional frequencies, and chakra yoga into her work, using what helped her to support others. 

Haley Schiek is a Certified Professional Coach (CPC), Yoga Teacher (E-CYT 250), & Peer Educator (CPE) who specializes in eating disorder recovery and psycho-spiritual wellness. She is the owner and founder of Cosana Coaching, “co” meaning “with” and “-sana” meaning health, wholeness, and healing. Cosana speaks to Haley’s belief that the deepest healing happens in community, when we work together. 

Having overcome anorexia, binge eating, and bulimia herself, Haley integrates her professional training in western psychology & eastern spiritual practices with her lived experience in eating disorder recovery to empower clients to overcome self-hate, reclaim their health, and achieve tangible recovery goals that enable them to live a pleasurable, present, values-driven life free from the horrific cycle of dieting for weight loss and the fear of losing control with food.

Haley’s work focus on restoring hope and personal power. She uses a holistic, systemic lens, taking particular care to understand how her clients’ socio-cultural status, gender, and identity intersect with external power structures to impact their wellness. 

Haley has a decade of experience teaching yoga and facilitating classes and workshops across the United States, from the Coral Pink sand dunes of southern Utah to oceanfront classes in Puerto Rico. Understanding that each individual is a source of divine knowledge, Haley facilitates classes that encourage students to connect to the teacher within. 

Finding your groove in Ed recovery (group coaching – starts April 9th)

https://www.yoga4eatingdisorders.com/finding-your-groove-in-ed-recovery

Chakra Yoga Group Program (2025 Dates TBD)

https://cosanacoaching.com/embodiment-activities/chakra-yoga-energy-healing-group-recovery-coaching-program/

Summer Body Support Group (2025 Dates TBD, 4-week & 8-week options available, usually mid June- mid August)

https://cosanacoaching.com/product/summer-bodies-group/

Cosana Coaching Instagram

https://www.instagram.com/cosanacoaching/?hl=en

As we learn and grow, we also begin to recognize the inadequacies of what we once believed. For healthcare professionals, this realization comes with the added weight of knowing that our past lack of knowledge may have hurt the people we worked with and cared for. 

In the eating disorder recovery field, there is an increasing movement away from restrictive dieting as research emerges showing that restrictive diets are unsustainable and often damaging. For a dietitian, the challenge of making this shift is often twofold: both personal and professional. How does a person navigate a shift that involves not only their relationship with their own body but also their professional identity?

In this episode, Jenna Talleda shares her story of being shamed for her weight, engaging in restrictive dieting and weight loss, training as a dietitian in a weight-centric health model, ultimately discovering intuitive eating, and beginning to share it with her clients. Jenna reflects on her feelings about the work she did before discovering intuitive eating and gives us insight into the challenge of shifting one’s professional approach while also coming to terms with the past.

This is a real, raw, and honest conversation—one that does not whitewash the difficulty of change but instead embraces it as part of what it means to be an evolving, growing person and professional.

Jenna is an anti-diet dietitian and Certified Intuitive Eating Counselor with nearly 20 years of experience in the field. She works with women, female-identifying, and nonbinary people who struggle with feeling comfortable in their bodies, emotional eating, and the fear of body shaming in medical or family settings. A strong LGBTQ+ ally and weight-inclusive provider, Jenna encourages people to take up space and reject the idea that weight defines worth or health.

Jenna also leads a group called Permission to Exist, which helps people in larger bodies navigate living in a fatphobic world.

Work with Jenna

https://your-nutrition-ally.com/

Learn more about her group:

https://permission-to-exist-prof.my.canva.site/permission-to-exist

Eating disorders can be deadly. They have some of the highest mortality rates among mental illnesses, both as a direct result of medical complications and the increased risk of suicide. Because of this, clients with severe symptoms often require continuous support and medical monitoring that can only be provided in higher levels of care. Active suicidality and severe malnutrition can warrant hospitalization, sometimes involuntary hospitalization.

But what happens when patients have experienced treatment trauma in higher levels of care? This question is especially painful in light of stories of abuse emerging from some of the larger treatment facilities. How do we support someone who has been traumatized by the very treatment they are now being recommended? How do we help a client who refuses higher levels of care despite engaging in life-threatening behaviors? And how do we balance the need for treatment without pushing someone into a place that has deeply hurt them before?

In this episode, Sandi James shares her experience cycling through hospital stays and higher levels of care, being subjected to a "tough love" approach while struggling with opioid misuse and disordered eating, and ultimately finding recovery through purpose and harm reduction rather than abstinence and containment. Sandi discusses how she now works with high-risk clients in outpatient settings. She explores how to navigate suicidality while creating an environment where clients can share their deepest, most painful experiences without fear of hospitalization as an immediate repercussion.

This episode contains some heavy topics that elicit strong feelings for anyone who supports someone with an eating disorder. Please take care of yourself and, as always, feel free to reach out with any reactions.

Sandi is a registered psychologist with over 20 years of experience in mental health, eating disorder treatment, substance abuse recovery, and trauma care. She takes a harm-reduction, client-centered, inclusive approach to healing.

Her primary focus is trauma recovery, especially in individuals with co-occurring substance use, food-related challenges, or compulsive exercise behaviors. She integrates evidence-based therapies with family coaching, and somatic and experiential therapies where appropriate. She is also a Certified Eating Disorder Recovery Coach through the Carolyn Costin Institute, and provides real-time support for recovery challenges. 

Sandi is currently pursuing a PhD on the intersection of eating disorders, substance use, and trauma. She brings both professional expertise and lived experience to her work, offering compassionate, informed guidance through recovery. 

You can find Sandi at https://www.sandijames.com.au/ or on instagram @sandi_in_the_world and @surfing_diving_psychologist

Does food choice affect mood, energy level, and quality of life? Are some foods healthier than others? Do whole foods, processed foods, and ultra-processed foods impact the body differently? What constitutes a healthy diet—if such a thing even exists?

In the eating disorder recovery community, these questions have become highly charged and controversial. Many professionals in the field, having seen firsthand the harm caused by restrictive weight loss diets, adopt an "all foods fit" approach, emphasizing that any and all foods can provide nutrients and fuel for the body. Others argue that ignoring the potential negative effects of highly processed foods—and the ways in which profit-driven motives, rather than consumer well-being, influence their production—does a disservice to those whose bodies are sensitive to excessive food additives.

In this episode, Rebecca Prolman approaches these questions with nuance and compassion. She shares her experience of altering food choices to manage small intestinal bacterial overgrowth (SIBO), a rare condition that significantly compromised her ability to function in daily life, and left her unable to remain awake past mid-day. She discusses making dietary adjustments while staying in touch with your body's signals rather than overriding them—and approaching these in a way that is wholesome and kind rather than anxiety-provoking.

Rebecca is a licensed marriage and family therapist specializing in complex trauma and eating disorders. She approaches eating disorder treatment from a holistic, trauma-informed perspective.

As a survivor of the troubled teen industry, Rebecca specializes in working with other survivors and serves as an expert trauma consultant for an attorney seeking justice for those affected. She also provides educational courses on healing from complex trauma, which can be found on her website,

https://www.rebeccaprolman.com/

Articles referenced in episode:

On food additives banned in European countries that are allowed in the US: https://www.everydayhealth.com/diet-nutrition/why-are-some-food-additives-that-are-banned-in-europe-still-used-in-the-us/ 

Ultra-processed foods and addiction:  https://www.scientificamerican.com/article/food-can-be-literally-addictive-new-evidence-suggests/

GMOs:  https://pmc.ncbi.nlm.nih.gov/articles/PMC3791249/ 

Pesticides:  https://pmc.ncbi.nlm.nih.gov/articles/PMC11664077/ 

Seed Oil Health Risks:  https://health.clevelandclinic.org/seed-oils-are-they-actually-toxic

Food Dyes and ADHD:  https://pmc.ncbi.nlm.nih.gov/articles/PMC9052604/

Dissociative identity disorder (DID) is a condition in which an individual's personality fractures in response to extreme trauma. It is often portrayed in its most extreme and obvious iterations and is thought to be so rare that a clinician is unlikely to encounter it throughout their career. Because it has been designated to the realm of niche expertise, very few clinicians recognize DID when they do encounter it. As a result, people with comorbid dissociative and eating disorders may cycle through treatment centers without receiving appropriate care.

In this episode, registered dietitian Annie Goldsmith shares how she became aware that DID is, in fact, much more prevalent and less obvious than mainstream rhetoric suggests. We discuss how, as providers, when we don't understand the protective function of symptoms, we can unintentionally perpetuate a dissociated person’s tendency to disconnect from internal experiences and create a dynamic that mirrors power structures from their past. Annie shares how recognizing dissociation in clients impacts the way she approaches treatment.

Annie has an undergraduate degree in Brain and Cognitive Sciences and has completed graduate coursework in Human Nutrition. Her work has always been guided by a strong curiosity about how biology and psychology interact to shape human experience. Before pursuing a career in nutrition, Annie worked in a neuroscience research lab. She has experience treating eating disorders in PHP, IOP, and outpatient settings.

Annie now runs Second Breakfast Nutrition, an outpatient group practice centered on weight-inclusive, social justice-oriented, and trauma-informed eating disorder care. She studied somatic and polyvagal-informed approaches to nutrition therapy at the Embodied Recovery Institute, where she now serves as faculty.

Annie has presented on the intersection of eating disorders and dissociation at the ISSTD World Conference, EDRD Pro, and the Healing Together Conference through An Infinite Mind. She recognizes that her clients—many of whom are survivors of complex trauma and live with dissociative identities—are her greatest teachers. She is passionate about working with clients from a bottom-up approach, centering and supporting the wisdom of the body and its innate capacity for healing.

To find Annie, visit https://www.secondbreakfastnutrition.com/

In eating disorder treatment settings, meal plan compliance is often used as the objective measure of safety and recovery, which then determines readiness to step down to lower levels of care. It follows that meal plan non-compliance is assumed to be a form of treatment resistance.

The reality, however, is that meal plan non-compliance is not always a sign of resistance but can also indicate a mismatch between the meal plan and the unique characteristics of the person prescribed it.

In this episode, registered dietitian, Brenna Veles, discusses how traditional eating disorder recovery expectations often fail to acknowledge the unique ways people on the autism spectrum experience the world. She explores how sensory sensitivities and differences in black-and-white versus nuanced thought processes, can affect recovery.

Brenna shares her personal experiences and professional insights on creating environments that foster healing, rather than encouraging masking and conformity.

Brenna is a registered dietitian with advanced training in treating eating disorders through the International Association of Eating Disorder Professionals. She works with clients to manage nutrition concerns that arise with ADHD, autism, anxiety, PTSD, depression, and eating disorders, whether these are physiological, like nutrient deficiencies or high/low blood pressure, or psychological, like guilt, and anxiety.

As someone who is autistic, ADHD, and queer, Brenna is deeply connected to her work. She regularly attends neurodiversity and anti-racist trainings to ensure a healing space for all clients. Brenna currently practices in Texas and Wisconsin, with plans to expand to more Midwest states, and she is accepting new clients. She can be found on her website, https://www.breadbutternutrition.com/

Traditional medical and dietetic rhetoric around the relationship between food, weight, and health emphasizes correlations between BMI range and medical conditions. However, it often fails to consider how these correlations are interpreted and how they subsequently impact individual patients and society. In this episode, Laura Cohen shares her personal journey as a former registered dietitian trained in a weight-centric environment and parent of a loved one with an eating disorder who was harmed by many of the messages she was taught would promote health and well-being.
Laura serves as a lead family mentor with Equip, which provides evidence-based care for eating disorders. She is also a board member of F.E.A.S.T, an organization that supports families of people affected by eating disorders. Laura is also an eating disorder recovery coach and shares insights on her website, https://noweighway.com/.

Can a clinician treat eating disorders while themselves in active recovery? Many of us in the eating disorder recovery field have our own lived experience. It follows that, just like for our clients, recovery is often nonlinear, clinicians are no exception.

What happens when a clinician experiences a relapse? Can they still be trusted to effectively treat clients whose symptoms, in some ways, mirror their own? Will they be triggered by their clients' symptoms?

In this episode, psychotherapist Lucie Waldman shares her experience grappling with these questions and the conclusions she has reached.

Intro music: Isolated" Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 4.0 License
http://creativecommons.org/licenses/by/4.0/