The Innovative Therapist

Episode 17. We are talking all things Intuitive Eating today! What Intuitive Eating is, how it can help you, and how it relates to developing an autonomous and therefore sustainable relationship to food.

But first, did you grab my free guide yet? In the moments when you have a strong desire to eat to cope with emotions, it can feel almost impossible to do something else. I created this guide for those moments. It lists several different options for things to do instead of eating. It's all about choice, increasing confidence, and therefore feelings of empowerment. Grab it for free here for quick and simple options right at your fingertips (with links, most 100% free) for those difficult moments.

What is Intuitive Eating?

You know people who stop eating after having half of their delicious dessert and put down their fork without effort?

I'm not talking about someone who actively limits themselves to 1/2 their key lime pie because they only have so many calories left for the day, but someone who allows themselves to have it without guilt and then makes the choice to stop solely because they are satisfied, not because they are worried about weight gain.

I'm talking about someone who truly has peace with their relationship with food.

The intuitive eater.

I used to incredibly be jealous of intuitive eaters and also in awe. I used to think to myself, "How on earth are they able to stop?"

After much internal work, practice, and re-connecting with my body, I now consider myself an intuitive eater. I also think that the concept of Intuitive Eating has a lot of wisdom that we can all learn from as we work to develop a healthier relationship with food.

The concept of Intuitive Eating has been around for some time and is extremely helpful for many people. The book Intuitive Eating was written by two dietitians Evelyn Tribole and Elyse Resch and is on it's 4th edition. Despite this, relatively few people have heard of it and it is rarely discussed in the mainstream medical community (though this is changing to some extent).

My next three posts & episodes will focus on Intuitive Eating. In this 3-part series I will review:

Part 1. What Intuitive Eating is, how it relates to the Health at Every Size® movement, a summary of the research, and how it can be useful.

Part 2. Some of the reasons that Intuitive Eating and Health at Every Size® are not more widely adopted, including some alternate views and unanswered questions.

Part 3. Frequently Asked Questions I get about Intuitive Eating including: Will Intuitive Eating help me meet my goals?

Intuitive Eating Overview

"Intuitive Eating is a self-care eating framework, which integrates instinct, emotion, and rational thought and was created by two dietitians, Evelyn Tribole and Elyse Resch in 1995." - Taken from the Intuitive Eating website

It’s a personal and dynamic process, which includes 10 principles (Taken directly from the Intuitive Eating website):

Reject the Diet Mentality: Throw out the diet books and magazine articles that offer you false hope of losing weight quickly, easily, and permanently. Get angry at the lies that have led you to feel as if you were a failure every time a new diet stopped working and you gained back all of the weight. If you allow even one small hope to linger that a new and better diet might be lurking around the corner, it will prevent you from being free to rediscover Intuitive Eating. Honor Your Hunger: Keep your body biologically fed with adequate energy and carbohydrates. Otherwise you can trigger a primal drive to overeat. Once you reach the moment of excessive hunger, all intentions of moderate, conscious eating are fleeting and irrelevant. Learning to honor this first biological signal sets the stage for re-building trust with yourself and food. Make Peace with Food: Call a truce, stop the food fight! Give yourself unconditional permission to eat. If you tell yourself that you can’t or shouldn’t have a particular food, it can lead to intense feelings of deprivation that build into uncontrollable cravings and, often, bingeing. When you finally “give-in” to your forbidden food, eating will be experienced with such intensity, it usually results in Last Supper overeating, and overwhelming guilt. Challenge the Food Police: Scream a loud “NO” to thoughts in your head that declare you’re “good” for eating minimal calories or “bad” because you ate a piece of chocolate cake. The Food Police monitor the unreasonable rules that dieting has created. The police station is housed deep in your psyche, and its loud speaker shouts negative barbs, hopeless phrases, and guilt-provoking indictments. Chasing the Food Police away is a critical step in returning to Intuitive Eating. Respect Your Fullness: Listen for the body signals that tell you that you are no longer hungry. Observe the signs that show that you’re comfortably full. Pause in the middle of a meal or food and ask yourself how the food tastes, and what is your current fullness level? Discover the Satisfaction Factor: The Japanese have the wisdom to promote pleasure as one of their goals of healthy living. In our fury to be thin and healthy, we often overlook one of the most basic gifts of existence–the pleasure and satisfaction that can be found in the eating experience. When you eat what you really want, in an environment that is inviting and conducive, the pleasure you derive will be a powerful force in helping you feel satisfied and content. By providing this experience for yourself, you will find that it takes much less food to decide you’ve had “enough”. Cope with Your Emotions with Kindness: First, recognize that food restriction, both physically and mentally, can, in and of itself, trigger loss of control, which can feel like emotional eating. Find kind ways to comfort, nurture, distract, and resolve your issues. Anxiety, loneliness, boredom, and anger are emotions we all experience throughout life. Each has its own trigger, and each has its own appeasement. Food won’t fix any of these feelings. It may comfort for the short term, distract from the pain, or even numb you. But food won’t solve the problem. If anything, eating for an emotional hunger may only make you feel worse in the long run. You’ll ultimately have to deal with the source of the emotion. (Language changed from last edition. Previous principle was "Honor Your Feelings without Using Food").Respect Your Body: Accept your genetic blueprint. Just as a person with a shoe size of eight would not expect to realistically squeeze into a size six, it is equally futile (and uncomfortable) to have a similar expectation about body size. But mostly, respect your body so you can feel better about who you are. It’s hard to reject the diet mentality if you are unrealistic and overly critical of your body size or shape. All bodies deserve dignity. (Some language adaptations since the last edition).Movement - Feel the Difference: Forget militant exercise. Just get active and feel the difference. Shift your focus to how it feels to move your body, rather than the calorie burning effect of exercise. If you focus on how you feel from working out, such as energized, it can make the difference between rolling out of bed for a brisk morning walk or hitting the snooze alarm. If when you wake up, your only goal is to lose weight, it’s usually not a motivating factor in that moment of time. (Language changed since I last updated this post: From "Exercise" to "Movement").Honor Your Health - Gentle Nutrition: Make food choices that honor your health and tastebuds while making you feel well. Remember that you don’t have to eat a perfect diet to be healthy. You will not suddenly get a nutrient deficiency or gain weight from one snack, one meal, or one day of eating. It’s what you eat consistently over time that matters, progress not perfection is what counts.

Relationship to the Health at Every Size® Movement

"Intuitive Eating is aligned with Health at Every Size® (HAES®), because the pursuit of intentional weight loss is a failed paradigm, which creates health problems: including weight stigma, weight cycling, and eating disorders." (Intuitive Eating website)

Intuitive eating and HAES® proponents talk about the importance of abandoning efforts to intentionally restrict food intake for the purpose of weight loss, as this often keeps the cycle of dieting and weight cycling going, and impairs one's ability to determine true hunger and satisfaction.

One of the major components, "unconditional permission to eat," described in Principle 3, can be viewed as very counter to the mindset of someone focused on either dieting or weight loss.

What Do We Know about Intuitive Eating from Research?

Having an intuitive eating style has been associated with reduced emotional eating, less preoccupation with food, and a lower BMI, particularly in women (Augustus-Horvath & Tylka, 2011; Bruce and Ricciardelli, 2006; Gast, Madanat, & Nielson, 2012). It's important to note, however, that association does not imply cause.

When non-dieting approaches were reviewed systematically (review included intuitive eating and Health at Every Size® interventions, among other non-dieting approaches like mindful eating), these interventions were found to be associated with:

Reduced disordered eating and depression and, Increased self-esteem (Clifford et al., 2015)

When it comes to weight or other biological health outcomes, most studies found no significant weight loss with the non-diet approaches, although there were improvements in biological markers (e.g., improved hemoglobin A1c, lipid profile; Clifford et al., 2015). To be fair, this was typically seen in the "diet" comparison group as well, but given that weight regain is so common, it is possible that the improved biological outcomes with a non-diet approach would last longer if the weight is regained as it often is. As always,...

Episode 17. We are talking all things Intuitive Eating today! What Intuitive Eating is, how it can help you, and how it relates to developing an autonomous and therefore sustainable relationship to food.

But first, did you grab my free guide yet? In the moments when you have a strong desire to eat to cope with emotions, it can feel almost impossible to do something else. I created this guide for those moments. It lists several different options for things to do instead of eating. It's all about choice, increasing confidence, and therefore feelings of empowerment. Grab it for free here for quick and simple options right at your fingertips (with links, most 100% free) for those difficult moments.

What is Intuitive Eating?

You know people who stop eating after having half of their delicious dessert and put down their fork without effort?

I'm not talking about someone who actively limits themselves to 1/2 their key lime pie because they only have so many calories left for the day, but someone who allows themselves to have it without guilt and then makes the choice to stop solely because they are satisfied, not because they are worried about weight gain.

I'm talking about someone who truly has peace with their relationship with food.

The intuitive eater.

I used to incredibly be jealous of intuitive eaters and also in awe. I used to think to myself, "How on earth are they able to stop?"

After much internal work, practice, and re-connecting with my body, I now consider myself an intuitive eater. I also think that the concept of Intuitive Eating has a lot of wisdom that we can all learn from as we work to develop a healthier relationship with food.

The concept of Intuitive Eating has been around for some time and is extremely helpful for many people. The book Intuitive Eating was written by two dietitians Evelyn Tribole and Elyse Resch and is on it's 4th edition. Despite this, relatively few people have heard of it and it is rarely discussed in the mainstream medical community (though this is changing to some extent).

My next three posts & episodes will focus on Intuitive Eating. In this 3-part series I will review:

Part 1. What Intuitive Eating is, how it relates to the Health at Every Size® movement, a summary of the research, and how it can be useful.

Part 2. Some of the reasons that Intuitive Eating and Health at Every Size® are not more widely adopted, including some alternate views and unanswered questions.

Part 3. Frequently Asked Questions I get about Intuitive Eating including: Will Intuitive Eating help me meet my goals?

Intuitive Eating Overview

"Intuitive Eating is a self-care eating framework, which integrates instinct, emotion, and rational thought and was created by two dietitians, Evelyn Tribole and Elyse Resch in 1995." - Taken from the Intuitive Eating website

It’s a personal and dynamic process, which includes 10 principles (Taken directly from the Intuitive Eating website):

* Reject the Diet Mentality: Throw out the diet books and magazine articles that offer you false hope of losing weight quickly, easily, and permanently. Get angry at the lies that have led you to feel as if you we...

Episode 16. Today I chat with registered dietitian Annyck Besso, MS, RD, about Health at Every Size. This is a super important discussion because there are a lot of misconceptions about it. Tune in to learn about some of the common myths about Health at Every Size. One of the myths we debunk include "Health at Every Size professionals are anti-weight loss," among many others.

Annyck is a Registered Dietitian and the Founder of Sööma, a private practice that specializes in the treatment of eating disorders and sports nutrition located in Montreal, Canada, but serving clients in the United States virtually. Annyck has developed an expertise in the treatment of eating disorders in both private and academic medical center settings. After completing a Bachelors in nutrition and dietetics, Annyck received her Masters in dietetics at McGill University.  Annyck recently moved back to Canada after practicing at Mind Body Health in Washington, DC for the past three years. During her time there, Annyck worked in private practice and collaborated closely with medical doctors and mental health professionals. She also developed and directed a day program where people of all ages were admitted and treated 20h per week.

Want to start from the beginning? Check out the Foundational Episodes of the Motivation Made Podcast here!

* Introduction: What is this podcast all about?* Episode 1: Want to Get & Stay Motivated? A Crash Course on Motivation, Weight Loss, and Health* Episode 2: How Dieting Steals Our Motivation* Episode 3: How To Get Motivated To Improve Your Health (Motivation 101)* Episode 4: How to Transform Health Fears Into Forward Progress

Did you grab my free audio training yet? It walks you through the simple 5 steps to not diet, but respond to your body when you are stressed about weight gain or feeling out of control with your eating. Grab it here!

What We Cover:

* Annyck's personal experience with food and her body * How she got into the field of dietetics* The fact that Health at Every Size is not actually mainstream even in dietetics training* What is Health at Every Size?

Health at Every Size - What Is It?

Health at Every Size is a social justice movement.

On an individual level, the movement is trying to move away from looking at individual behaviors in a vacuum, and broadening our view of health to consider an individual's lived experience, including things like marginalization, and other factors that influence their health.

From a broader perspective, it acknowledges the privilege that comes from being able to make individual choices. It acknowledges that the higher rates of certain medical conditions in certain community and how we need to examine the larger systems that determine access to fresh foods and safe movement, quality health care, among other systemic shifts.

The movement also explores and discusses the health consequences of living in a world that is fat phobic and weight bias and that the stress of this can have health consequences that are more problematic than their body shape and size.

Interestingly, despite my bias and feel that many dietitians get this training on a more regular basis,

Episode 15. Today's episode is a little different. I'll take you behind the scenes on my journey building my two businesses as a brand new entrepreneur and the parallels I am seeing in terms of weight loss and our obsession with outcomes. I talk about the challenges of not focusing on the outcomes and the importance of doing so.

Have you grabbed my free guide all about how to clarify your values and tie them to your most important goals. If not, you can check it out here!

Insider's Peek into My Entrepreneurial Journey

I recorded part of this episode in February, right after launching my podcast. I then am re-listening and reflecting on where I am at as of early April.

The good news is, I took my own advice pretty well! That can be hard sometimes, right?

I have been in an incredibly busy season of my business as I just finishing launching my brand new program, The Body Respect Program. I'm happy to report that I have been able to mostly enjoy the journey and the process.

I attribute most of this to not being focused on the outcomes. Outcomes meaning how much money I make, or how many people respond to my posts or get on my email list. I've actually gotten increasingly better at this over time.

When Effort does not Result in Immediate Outcomes

I tell the story about how last fall I did my first (and pretty much only, haha) Facebook Live. In the only entrepreneur world it's talked about how doing live video is good. So I said, ok I can do hard things.

After doing it, I immediate found myself checking my email list. I was so ready for the validation of 100 new people signed up for my list and 500 new viral likes. I am exaggerating of course, but somehow I felt like since putting myself out there was so hard, I would clearly see some immediate benefit.

Nope, haha.

How this Ties to Weight Loss

I couldn't help but consider how this applies to weight loss. I talk often to people about how when they are making habit changes they of course want to see results on the scale. This clearly makes sense, and yet, because of biological factors and other things outside of our control, results do not always come.

How to Focus on Habits Instead of Outcomes

This is so hard, you guys. And yet, it's essential. So let's dive into tips to show up with the habits that are consistent with the person YOU want to be, with much less focus on the outcome.

First, take a deep breath. I know, I know, cliche, but it helps ground us.Ask yourself, WHY am I doing this? Why do you want to improve your health? Why does it matter? Do you want to show up differently in your life? Do you want to take care of your body so that you have the energy and vibrancy and focus to do so? Do you want to be a better parent, sister, daughter, or friend?Celebrate your wins. Ideally with someone who will help you really do so. Each time you make a habit change, soothe yourself in a way other than food, or each time you get up and move, pat yourself on the back. Feel great about it. The more we celebrate our wins, the more we feel good and continue to make progress. Remember that showing up with consistent effort is hard when you aren't seeing the outcome immediately. But you can do hard things and you can learn to enjoy the journey and the discomfort and uncertainty that comes with it. With that, you can learn to respond differently to your body and build a relationship to food that frees you up to do all the wonderful things you were meant to do in the world.

"You can control your actions but not the results. So your regret should be about the best effort and not about the desired result." - Simply Vedant

Disclaimer: This blog and podcast is for informational and educational purposes only. It is not a substitute for individual professional advice or treatment, including medical or mental health advice. It does not constitute a provider patient relationship.

Episode 15. Today's episode is a little different. I'll take you behind the scenes on my journey building my two businesses as a brand new entrepreneur and the parallels I am seeing in terms of weight loss and our obsession with outcomes. I talk about the challenges of not focusing on the outcomes and the importance of doing so.

Have you grabbed my free guide all about how to clarify your values and tie them to your most important goals. If not, you can check it out here!

Insider's Peek into My Entrepreneurial Journey

I recorded part of this episode in February, right after launching my podcast. I then am re-listening and reflecting on where I am at as of early April.

The good news is, I took my own advice pretty well! That can be hard sometimes, right?

I have been in an incredibly busy season of my business as I just finishing launching my brand new program, The Body Respect Program. I'm happy to report that I have been able to mostly enjoy the journey and the process.

I attribute most of this to not being focused on the outcomes. Outcomes meaning how much money I make, or how many people respond to my posts or get on my email list. I've actually gotten increasingly better at this over time.

When Effort does not Result in Immediate Outcomes

I tell the story about how last fall I did my first (and pretty much only, haha) Facebook Live. In the only entrepreneur world it's talked about how doing live video is good. So I said, ok I can do hard things.

After doing it, I immediate found myself checking my email list. I was so ready for the validation of 100 new people signed up for my list and 500 new viral likes. I am exaggerating of course, but somehow I felt like since putting myself out there was so hard, I would clearly see some immediate benefit.

Nope, haha.

How this Ties to Weight Loss

I couldn't help but consider how this applies to weight loss. I talk often to people about how when they are making habit changes they of course want to see results on the scale. This clearly makes sense, and yet, because of biological factors and other things outside of our control, results do not always come.

How to Focus on Habits Instead of Outcomes

This is so hard, you guys. And yet, it's essential. So let's dive into tips to show up with the habits that are consistent with the person YOU want to be, with much less focus on the outcome.

* First, take a deep breath. I know, I know, cliche, but it helps ground us.* Ask yourself, WHY am I doing this? Why do you want to improve your health? Why does it matter? Do you want to show up differently in your life? Do you want to take care of your body so that you have the energy and vibrancy and focus to do so? Do you want to be a better parent, sister, daughter, or friend?* Celebrate your wins. Ideally with someone who will help you really do so. Each time you make a habit change, soothe yourself in a way other than food, or each time you get up and move, pat yourself on the back. Feel great about it. The more we celebrate our wins, the more we feel good and continue to make progress. * Remember that showing up with consistent effort is hard when you aren't seeing the outcome immediately. But you can do hard things and you can learn to enjoy the journey and the discomfort and uncertainty that comes with it. With that, you can learn to respond differently to your body and build a relationship to food that frees you up to do all t...

Episode 14. Today I had the pleasure of talking with Dr. Afton Koball, a board certified clinical health psychologist with a wealth of knowledge in the areas of behavioral weight management, bariatric surgery, weight bias, motivation, and many other related areas. She obtained her PhD in Clinical Psychology from Bowling Green State University and did internship at Rush University Medical Center and fellowship at the Mayo Clinic.

What to Expect in this Episode

We dive into a lot of topics with Dr. Koball including but not limited to:

How she got interested in health psychology and the weight management fieldHer difficulties at times with accepting her post-partum bodyWhat is weight biasHow Dr. Koball would like to see the field improve as it relates to recommending weight loss surgeryWays to improve your relationship with food from an evidence-based approach

Who Struggles with Body Image (Pretty Much, Everyone)

Afton talks about some of her struggles with accepting her body after her third kiddo, even when she feels she "knows better" and knows self-critical thoughts aren't helpful.

On How We Are Doing as a Field with Helping People Lose Weight

"I think we are doing such a crappy job. I think we have perpetuated this idea in the media and popular culture and unfortunately even in healthcare that weight loss is all about diet and exercise so if you just eat less and exercise more you will lose weight. And if you aren't losing weight, then something is wrong with you, you're bad or you aren't working hard enough or you are lazy." (In reference to how we are doing as a field with regards to helping people lose weight)- Dr. Afton Koball, PhD, ABPP

That pretty much sums it up! Just kidding, we dive into more details in the episode.

She talked about how it of course is not bad advice to eat well and move more, but that weight is so much more complicated than we lead people to believe. She mentions our environment, physiology, our stress and yet we pin it all on diet and exercise.

What Aren't We Talking About

Dr. Koball talked about how much we emphasize "diet and exercise" as the end all be all and we rarely talk about all the other contributors to weight, like physiology, genetics, environment, stress and so many other factors.

Metaphor of Trying to Slow Your Respiratory Rate

She talked about a metaphor equating large amounts of weight loss to trying to slow down your respiratory rate. She talked about how it is possible for a period of time, but since your body was not designed to do that it takes a lot of willpower and effort and energy and you aren't able to focus on much else.

What is Weight Bias?

We talked about weight bias, which is negative attitudes and stereotypes about people solely due to their weight or body size. And how in some ways we are more stigmatized against larger bodies than every and it can still be one of the more socially acceptable forms of bias.

She discussed weight bias and its association with negative physical outcomes (e.g., weight gain over time, increased stress hormones) and the importance of sharing this information with people, particularly medical professionals.

She talked about even when controlling for all other factors, weight bias still is predictive of early mortality (Sutin, Stephan, & Terracciano, 2016).

The Way We Approach Weight Loss Undermine Key Psychological Needs for Long-Term Change?

Undermining Competence (Feeling effective, "I can do what I set out to do") and Autonomy (Freedom from excessive pressure to behave in a certain way)

The messages that a one size fits all works for everyone. This can be particularly problematic for people of higher weights, with medical conditions, or who are debilitated by their weight.Focus on what not to do makes people want the foods more.

What Do We Think about the Body Mass Index?

We talked about the very limited utility of BMI. It's quick and easy to get and we can use it to describe research that has been done in the past. That's about it.

It has very little clinical utility, and yet, we continue to use it pervasively.

We talked about how the BMI does not really tell us anything about your health, and yet we keep using it and how it can impact people's sense of self and sense of their health.

Should We Be Recommending Weight Loss Surgery More or Less?

I asked Dr. Koball what she would like the field to see change.

She surprised me by saying she would love to see bariatric surgery more universally recommended and utilized. She went on to describe that not offering surgery could at times be perpetuating weight bias and the idea that diet and exercise "should" lead to weight loss if people are doing it "right."

She talked about the importance of not tying a person's worth and body size together and working to uncouple that. She talked about how offering bariatric surgery as a treatment for medical conditions if it's causing physical disability or severe health problems. She talked about this being anti-weight bias by challenging the notion that diet and exercise is a cure all.

The Power of Differing Views

This conversation really influenced me, ironically. I worked in a bariatric surgery clinic for many years, so I never needed to bring up bariatric surgery as an option there. Everyone there was already considering it or wanted it.

This conversation made me think about how our own individual experiences personally and professionally influence our opinions in these areas. After the recording, Afton and I talked a bit more offline and I talked about how a whole foods plant based diet has been show to reverse disease at times.

How to Fully Support Autonomy

To fully support autonomy for any decision, it's important that we present options, fully inform folks of the pros and cons without pressure or judgment to make a certain choice. Perhaps we give a recommendation or a guide based on their health history and the outcomes they are likely to get, but no pressure. No message of "this is the only option for you."

Afton and I discuss how significant dietary changes might impact health outcomes, but may not impact weight.

Ultimately, to support autonomy we should de-stigmatize available options and support an individuals right to pick what feels best for them.

We do miss these opportunities to give full autonomy and choice.

Does Intrinsic Motivation Mean You Will Always Like It?

We talked about how things can get in the way of developing intrinsic motivation. Dr. Koball talked about her love for her work and how she also gets paid for her work and has an annual review coming out and how sometimes those extrinsic factors can reduce our intrinsic motivation.

She gave the example of how at times she has felt intrinsic motivation for exercise but at times desire for weight loss or training for a certain event can reduce her intrinsic motivation for the behavior itself.

We then had a discussion about how intrinsic motivation is not the only type of autonomous motivation. Since we are never going to be intrinsically motivated for everything, values-based action or behaviors that are consistently with your identity is essential.

How Can We Move Towards Improving Our Relationship with Food?

Below are some important things to remember.

Stop putting pressure on yourself to lose weight. Focus on the behaviors, not the outcome.Ask, how can you feel more in control or satisfied with the way you are eating?Remember that your weight or body size isn't a moral failure and does not say anything about you as a person.

Disclaimer: This blog and podcast is for informational and educational purposes only. It is not a substitute for individual professional advice or treatment, including medical or mental health advice. It does not constitute a provider patient relationship.

References

Sutin, A. R., Stephan, Y., & Terracciano, A. (2016). Weight Discrimination and Risk of Mortality. Psychological Science, 26.

Disclaimer: This blog and podcast is for informational and educational purposes only. It is not a substitute for individual professional advice or treatment, including medical or mental health advice. It does not constitute a provider patient relationship.

Episode 14. Today I had the pleasure of talking with Dr. Afton Koball, a board certified clinical health psychologist with a wealth of knowledge in the areas of behavioral weight management, bariatric surgery, weight bias, motivation, and many other related areas. She obtained her PhD in Clinical Psychology from Bowling Green State University and did internship at Rush University Medical Center and fellowship at the Mayo Clinic.

What to Expect in this Episode

We dive into a lot of topics with Dr. Koball including but not limited to:

* How she got interested in health psychology and the weight management field* Her difficulties at times with accepting her post-partum body* What is weight bias* How Dr. Koball would like to see the field improve as it relates to recommending weight loss surgery* Ways to improve your relationship with food from an evidence-based approach

Who Struggles with Body Image (Pretty Much, Everyone)

Afton talks about some of her struggles with accepting her body after her third kiddo, even when she feels she "knows better" and knows self-critical thoughts aren't helpful.

On How We Are Doing as a Field with Helping People Lose Weight

"I think we are doing such a crappy job. I think we have perpetuated this idea in the media and popular culture and unfortunately even in healthcare that weight loss is all about diet and exercise so if you just eat less and exercise more you will lose weight. And if you aren't losing weight, then something is wrong with you, you're bad or you aren't working hard enough or you are lazy." (In reference to how we are doing as a field with regards to helping people lose weight)- Dr. Afton Koball, PhD, ABPP

That pretty much sums it up! Just kidding, we dive into more details in the episode.

She talked about how it of course is not bad advice to eat well and move more, but that weight is so much more complicated than we lead people to believe. She mentions our environment, physiology, our stress and yet we pin it all on diet and exercise.

What Aren't We Talking About

Dr. Koball talked about how much we emphasize "diet and exercise" as the end all be all and we rarely talk about all the other contributors to weight, like physiology, genetics, environment, stress and so many other factors.

Metaphor of Trying to Slow Your Respiratory Rate

She talked about a metaphor equating large amounts of weight loss to trying to slow down your respiratory rate. She talked about how it is possible for a period of time, but since your body was not designed to do that it takes a lot of willpower and effort and energy and you aren't able to focus on much else.

What is Weight Bias?

We talked about weight bias, which is negative attitudes and stereotypes about people solely due to their weight or body size. And how in some ways we are more stigmatized against larger bodies than every and it can still be one of the more socially acceptable forms of bias.

She discussed weight bias and its association with negative physical outcomes (e.g., weight gain over time, increased stress hormones) and the importance of sharing this information with people, particularly medical professionals.

She talked about even when controlling for all other factors, weight bias still is predictive of early mortality (Sutin, Stephan, & Terracciano, 2016).

The Way We Approach Weight Loss Undermine Key Psychological Needs for Long-Term Change?

Episode 13. Today's episode is all about binge eating and emotional eating. What is it, why do we do it, and how to stop.

Stressed about emotional eating? Thinking of ideas in the moment when the urge strikes can feel near impossible. Grab my free guide for 23 positive ideas here!

Can You Relate to This?

You've eaten "well" all day. You had a sensible breakfast with lean protein, a salad for lunch, and an portioned out handful of almonds mid-afternoon. You sat down to dinner and had a "normal" amount, enough to fit in your calorie limit for the day. You are feeling good.

But then, for whatever reason you at a little extra -- Most likely because you are a human being who isn't programmed to eat an exact amount of calories.

Maybe someone offered you an extra roll and you ate it without thinking or maybe you got up and had a second portion of food.

Whatever the reason, your immediate automatic thought is "Well, I screwed up, might as well enjoy the night" and you proceed to have a lot more food until you are incredibly full. You feel out of control and frustrated with yourself. You beat yourself up and resolve to get "back on track" tomorrow.

Sound familiar?

What Binge Eating Does to Our Sense of Self

Binge eating can feel incredibly hopeless and overwhelming.

It can feel like you have zero control and destroy your self-confidence.

Today's post will go over what binge eating is, the causes of binge eating, how it's different than (and at times similar to) emotional eating, and most importantly what to do about it.

What is Binge Eating?

Technical Definition of a Binge Episode

Binge eating's technical definition according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is eating:

Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

The binge eating episodes also need to be associated with at least three of the following:

Eating much more rapidly than normalEating until feeling uncomfortably fullEating large amounts of food when not feeling physically hungryEating alone because of feeling embarrassed by how much one is eatingFeeling disgusted with oneself, depressed, or very guilty afterwards

What is Binge Eating Disorder

To meet criteria for binge eating disorder, you must have had at least 1 binge episode once per week for at least 3 months.

There are other circumstances were you might not meet criteria for binge eating disorder but still have an eating pattern that you are distressed about.

Some examples of this includes:

If you experience binge eating and are distressed by this, but it occurs less often than once a week.If you feel out of control with your eating, but you don't eat an amount that is "definitely larger" than what others might eat in a similar circumstances (e.g., you eat 3 small cookies, but feel out of control and guilty afterwards).

In these cases, assuming your symptoms are not better characterized in another disorder or category, you might get a less specific diagnosis, like eating disorder not otherwise specified.

What If I Feel Out of Control But Do Not Eat Much?

This is called subjective binge eating. This occurs if you feel out of control, but only end up eating a relatively small amount of food (e.g., 1 cookie) but you intended to make a different choice or eat less and now you are feeling guilty about it.

What Causes Binge Eating?

The causes of binge eating are multi-faceted.

Like most things, our genetics can set us up for developing any condition or behavior pattern, and binge eating is no different. Our food environment also plays a role. Food is more readily available and more processed than ever and this sets us up for binge eating. Basically, food scientists know what they are doing and are able to make "hyper-palatable designer foods" (that perfect combination of fat, sugar, and salt) that "hook" our brains and fuel eating much beyond hunger.Additionally, dieting and restriction causes binge eating for many, and the risk of this is higher with more restriction. This is due to both biological and psychological factors. Although sometimes when you go on an eating plan, binge eating maybe temporarily reduce, it often will eventually return, sometimes even more intensely the next time around.

Does Dieting Cause Binge Eating for Everyone?

Nope. Some people I work with have dieted for decades with developing binge eating, while others develop it relatively quickly.

I will say though, that subjective binge eating can be just as distressing and many folks I work with have that feeling about food (labeling foods and good/bad, healthy/unhealthy, and feeling guilt when they eat "bad") for many years before seeking help.

This would be a perfect example of where the "diet mentality" causes significant distress, but since it's SO normal in our culture, people just deal with it without knowing they could feel differently.

Overeating is NOT Binge Eating

People will often use the term binge eating when they really mean overeating. This might be your friend who tells you she "binged on cookies". However, if this friend does not have a poor relationship with food and she just meant to say she ate more cookies than she wanted today. If she did not feel out of control or guilty after, this isn't a binge.

Overeating is normal, common, and we ALL do it. The definition of overeating is simply eating more than our body truly "needs" in terms of energy to replenish what was used up. This might be eating past fullness, eating when we aren't hungry or just eating because something tastes good.

And given what I will describe below about how adaptive overeating is, we should probably come up with a new name for it. Since it's a helpful response to be able to take in extra calories when available.

Overeating is Inevitable

Although the word overeating can have a reputation of being "bad" (like so many things when it comes to weight), it's inevitable. We aren't ever going to get to a point where we eat the perfect amount of food for our body's biological needs only. That just does not make sense.

In fact, our ancestors needed to overeat when more food was available so that they could survive times when food was scare. It is adaptive.

Therefore, We ALL "overeat" and we will continue to for the rest of our lives.

Reframing How We Think of Overeating

The guilt that so many have about eating is astounding. I used to do this too. I've watched for years as men and women (mostly women) "confess" to eating a little bit extra. She might tell me "I ate 2 bowls of pasta and 2 apples, is that bad? Does that seem like a lot?" [I'm paraphrasing here].

The lack of trust in ourselves and the guilt and shame we feel about eating is causing what could just be an episode of overeating, into a binge spiral. Which often leads back to dieting. And more binge eating. See how this works?

What is the Driving Force for Binge Eating?

Dieting absolutely can and does cause binge eating. The diet and weight loss industry tells us we are not "enough" so that we need to buy their products to become so. But sometimes there are other underlying concerns if we were to remove the binge-diet cycle veil.

Binge eating can be a way to avoid stress or pain, even mild pain (e.g., discomfort with feeling bored or dissatisfied/disengaged).

Can Weight Loss Reduce Binge Eating?

There has been some research that suggests that going on a weight loss diet can sometimes temporarily curb binge eating (Grilo et al., 2011). However, the long-term data suggests that not only will these folks regain the lost weight most of the time, they will continue to be prone to binge eating in the future.

For many dieters, particularly those with a history of multiple weight loss diets including weight loss and regain, falling "off" a diet plan will spur binge eating or emotional eating.

There is likely a reason that one of the most consistently predictors of weight gain is asking the question: "Are you currently on a diet to lose weight?" (Lowe, Doshi, Katterman, & Feig).

Is Binge Eating Different Than Emotional Eating?

Emotional eating is defined as eating to cope with feelings, which could include anything from bored, to sadness, to anger, to joy. This sometimes leads to binge eating, other times does not.

Sometimes people will eat to comfort themselves, and this is not always going to meet criteria for binge eating. That is, they may not eat a large amount of food and they also may not feel out of control while doing it.

Binge Eating By Definition Means Feeling Out of Control

Someone who comes home after a long stressful day and says "I deserve a treat" and has ice cream for their dinner would be considered eating to cope with their emotions. But if they don't feel out of control then it wouldn't be considered binge eating. Even if they eat the whole ice cream gallon, they have to feel out of control otherwise it isn't a binge.

What If I Feel Out of Control but Don't Eat Much?

Many people with varying forms of eating disorders and/or "disordered eating" (a catch all category for people who struggle with their relationship with food and are very distressed by it, but don't fit into the other eating disorder categories), feel out of control while eating, but don't necessarily eat a whole lot of food or meet all the criteria listed above.

This is actually what is often seen after bariatric surgery (weight loss surgery) when folks have binge eating before and it returns after surgery. They may experience what's called "subjective binge eating" where they aren't eating

Episode 13. Today's episode is all about binge eating and emotional eating. What is it, why do we do it, and how to stop.

Stressed about emotional eating? Thinking of ideas in the moment when the urge strikes can feel near impossible. Grab my free guide for 23 positive ideas here!

Can You Relate to This?

You've eaten "well" all day. You had a sensible breakfast with lean protein, a salad for lunch, and an portioned out handful of almonds mid-afternoon. You sat down to dinner and had a "normal" amount, enough to fit in your calorie limit for the day. You are feeling good.

But then, for whatever reason you at a little extra -- Most likely because you are a human being who isn't programmed to eat an exact amount of calories.

Maybe someone offered you an extra roll and you ate it without thinking or maybe you got up and had a second portion of food.

Whatever the reason, your immediate automatic thought is "Well, I screwed up, might as well enjoy the night" and you proceed to have a lot more food until you are incredibly full. You feel out of control and frustrated with yourself. You beat yourself up and resolve to get "back on track" tomorrow.

Sound familiar?

What Binge Eating Does to Our Sense of Self

Binge eating can feel incredibly hopeless and overwhelming.

It can feel like you have zero control and destroy your self-confidence.

Today's post will go over what binge eating is, the causes of binge eating, how it's different than (and at times similar to) emotional eating, and most importantly what to do about it.

What is Binge Eating?

Technical Definition of a Binge Episode

Binge eating's technical definition according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is eating:

* Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.* A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

The binge eating episodes also need to be associated with at least three of the following:

* Eating much more rapidly than normal* Eating until feeling uncomfortably full* Eating large amounts of food when not feeling physically hungry* Eating alone because of feeling embarrassed by how much one is eating* Feeling disgusted with oneself, depressed, or very guilty afterwards

What is Binge Eating Disorder

To meet criteria for binge eating disorder, you must have had at least 1 binge episode once per week for at least 3 months.

There are other circumstances were you might not meet criteria for binge eating disorder but still have an eating pattern that you are distressed about.

Some examples of this includes:

* If you experience binge eating and are distressed by this, but it occurs less often than once a week.* If you feel out of control with your eating, but you don't eat an amount that is "definitely larger" than what others might eat in a similar circumstances (e.g., you eat 3 small cookies, but feel out of control and guilty afterwards).

In these cases, assuming your symptoms are not better characterized in another disorder or category,