Understanding Disordered Eating: For anyone whose relationship with food feels harder than it should

We're continuing our summer throwback series with a powerful episode that's simply too important to leave behind. While we're taking a short break this summer, we'll be resurfacing some of our most impactful conversations — the ones that made us think, challenged the status quo, and sparked meaningful dialogue. Today's rerun is one of those episodes.

Originally aired as Episode 72, this conversation with Jessica Setnick dives headfirst into the controversial 2023 guidelines issued by the American Academy of Pediatrics (AAP). These guidelines made headlines — and not in a good way. Recommending behavioral interventions and even weight loss medications and surgery for children as young as 2, 12, and 13, respectively, the AAP ignited a firestorm of concern within the eating disorder treatment community.

Jessica, a fierce advocate and long-time voice in the eating disorder field, joins me to unpack what these guidelines really say, why they're so troubling, and how they reflect a deeper cultural problem rooted in weight stigma. We question authority, untangle complex motivations (hello, pharma profits), and explore what weight-inclusive, ethical pediatric care should actually look like.

In this episode, we're talking about:

• Why the AAP's new guidelines on pediatric weight management are sparking outrage in the eating disorder community.

• The alarming recommendations to introduce weight loss medications by age 12 and surgery by 13.

• The pervasive weight stigma built into these guidelines, including the problematic use of BMI as a screening tool.

• How profit motives, particularly from big pharma, may be influencing the creation of these "medical" guidelines.

• The real consequences of these interventions: malnutrition, stunted growth, cognitive impacts, and the risk of lifelong eating disorders.

• The false logic that shrinking a child's body will reduce weight stigma and why that belief is not just wrong, but dangerous.

• The importance of separating weight from health, and why any medical concerns should be treated based on symptoms, not size.

• How weight changes can be relevant when viewed contextually, but should never be the sole focus of medical intervention.

• Why trusting your gut and challenging medical advice is not only okay, but it might be necessary for protecting your child's wellbeing.

• Where to find weight-inclusive providers and what to ask when choosing a new pediatrician.

"Anyone who works in the eating disorder field at all – and probably many humans – knows multiple people, if not themselves, who have had failed weight loss interventions when they were children that then resulted in bigger problems." – Jessica Setnick

"The key is not to just single out the big kids. Any kid with an eating disorder should be evaluated. Any kid with a medical condition should be evaluated." – Jessica Setnick

"Shrinking children does not change their medical conditions." – Jessica Setnick

"'Does my child have a medical condition, or are you saying my child is too big? Because if it's a medical condition, we'd like to get treatment independent of his size. But if you're saying his size is a problem, that's not a conversation I'm willing to have.'" – Jessica Setnick

AAP Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity

News release for the AAP new guidelines

Understanding Disordered Eating, Ep. 30: Eating Disorders are the Solution Not the Problem with Jessica Setnick, MS, RD, CEDRD-S

Jessica on Facebook

Jessica on Instagram

Jessica Setnick: Understanding Nutrition

Jessica's Website

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We're kicking off our summer throwback series with an episode that's just too good not to share again. While we take a little summer break, we'll be rereleasing some of our most powerful and thought-provoking conversations—and this one tops the list.

Originally aired as Episode 73, this conversation with Dr. Judith Brisman is one of those rich, soul-stirring interviews that stay with you long after it ends. Dr. Brisman is an icon in the eating disorder treatment world. With over 35 years in the field and deep roots in psychoanalytic thought, she brings both clinical depth and human compassion to the most complex questions about food, desire, and emotion.

In this conversation, we explore why we turn to food to manage our feelings, how disordered eating often becomes the language of our unmet emotional needs, and what happens within family systems when an eating disorder is present. Dr. Brisman helps us understand not just the "what" but the "why" behind it all, offering a compassionate and grounded approach to recovery that emphasizes self-discovery, choice, and relational repair.

In this episode, we're talking about:

• How Dr. Judith Brisman became a pioneer in the treatment of eating disorders by blending behavioral work with psychoanalysis.

• How food becomes symbolic for desire and the complex ways we try to manage our wants and needs through eating behaviors.

• The link between emotional regulation and disordered eating, including compelling patient stories that bring theory to life.

• The role of family dynamics in shaping (and healing) disordered eating patterns.

• How feelings like anger, helplessness, and fear often get hidden behind food behaviors—and how therapy can bring these to light.

• Why recovery is not just about stopping behaviors, but about uncovering the inner voices and desires we've been afraid to face.

• What family-based treatment looks like and how parental roles and patterns can both support and hinder recovery.

• How to use moments of emotional overwhelm—like the urge to binge or restrict—as doorways into deeper self-understanding.

• How simple questions like "What do you want to eat?" can begin the process of helping someone find their voice again.

"Families all get into patterns, some of which work, some of which don't work. An eating disorder in the family is an opportunity to say, okay, what might need to be changed right now? What might need to be inspected?" – Dr. Judith Brisman

"We don't just see a parent in their role, and a child in their role; we see everybody in their roles, and how the dynamics come together." – Rachelle Heinemann

"Knowing [your emotions and patterns] allows for choice." – Dr. Judith Brisman

"It's not so important to identify the cause of the eating disorder… maybe it's interesting, but that's not going to end all or be the key… It's more about what's happening today, the identification, and what choice that provides." – Rachelle Heinemann

Dr. Judith Brisman's Website

Surviving an Eating Disorder: Strategies for Families and Friends

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Let's be honest—most of us would love to be the kind of person who "lives in the moment." You know, one of those magical unicorns who wakes up excited for the day, mindfully savors every bite of their avocado toast, and breathes through stress like it's non-existent. But instead, we're over here eating lunch in front of our inbox, wondering why we feel like a disembodied ghost hovering somewhere between a meeting and a meltdown.

"I just don't wanna feel like I am dissociating my entire life." - Rachelle Heinemann

"Food is inherently soothing, and it works because it's distracting and soothing at the same time." - Rachelle Heinemann

"Without practicing in very neutral low-stakes moments, it's gonna be almost impossible for us to notice when we're triggered." - Rachelle Heinemann

"We really have to think about all of this in the context of our specific lives and what we need so that we can work toward a version of ourselves that lives in however much of the present moment we actually want to live in." - Rachelle Heinemann

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If imposter syndrome were a person, most of us would be in a very toxic, on-again-off-again relationship with it. And just like any clingy ex, it loves to show up at the worst possible time—like, say, the first day of a new job, or every single time we try to feel confident about our bodies. Fun, right?

*Quick reminder that next week will be our last episode until September. Stay tuned for the re-release of some oldies but goodies to get you through the summer!

"By not talking about it, by not owning it, we sort of imply our own shame." - Rachelle Heinemann

"If we start opening up and at least being open to the fact that other people can help us through some of the imposter syndrome... we at least give ourselves a chance to find some sort of self-acceptance there." - Rachelle Heinemann

"Ultimately, what we're telling ourselves is 'I can handle a little bit of human vulnerability', which is the exact opposite of imposter syndrome." - Rachelle Heinemann

"Working through imposter syndrome requires a lot of courage and alot of work." - Rachelle Heinemann

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Today, we're diving back into the murky waters of secrets with none other than the incredible Dr. Katheryn Zerbe. If you've been around the UDE fam for a while, you'll remember her from our earlier episode on secrets and eating disorders (if not, press pause and go listen to that one first—we'll wait). This time around, we're exploring what secrets do to our bodies, why we keep them, and how they might just be fueling more than your midnight snack cravings.

Kathryn Zerbe, MD, FAED, FABP, is a psychiatrist, psychoanalyst, and author of over 150 clinical papers, book chapters, reviews, and 4 books. Her publications include the landmark volumes: The Body Betrayed: Women, Eating Disorders, and Treatment (1993) and Integrated Treatment of Eating Disorders: Beyond the Body Betrayed (2008).

"Your secrets tell us who we are, but too many secrets with huge content areas that we keep out." - Dr. Kathryn Zerbe

"Eating disorders are often hidden in plain view." - Dr. Kathryn Zerbe

"Secrets may be the greatest problem of all. We don't look at the toll they take on the mind or the body." - Dr. Kathryn Zerbe

"Secrets also make us very aware of where our boundary lies." - Dr. Kathryn Zerbe

" Transparency and sharing the content of a secret or information that might be private is not the point here. It's not about the content. It's not about people knowing. It's about what happens to you and your internal state and your relationships when the secret happens." - Rachelle Heinemann

"We all need somebody to talk to." - Dr. Kathryn Zerbe

Learn More About Dr. Kathryn Zerbe Here!

Get access to Dr. Zerbe's newest book: Secrets in Psychotherapy: Stories that Inform Clinical Work. Use code 25AFLY1 for 20% off!

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**We will be taking a summer break at the beginning of June! Stick around for the next few episodes before we're off for a couple months!

This episode is all about what happens when you combine years of working with people navigating eating disorders, a healthy dose of sarcasm, and way too many personal run-ins with perfectionism. I'm unpacking the idea I'm calling The Perfectionist Paradox—where striving for perfection actually gets in the way of the thing you're trying to do well in the first place. Neat trick, right?

"Thinking about what you're afraid of can help us open the door to what is driving your perfectionism." - Rachelle Heinemann

"The perfectionism target is always moving, which means that you will never be able to attain it, and that's kind of frustrating." - Rachelle Heinemann

"The idea of striving for perfection in some ways is trying to avoid imperfection, and that any sort of mistakes or flaws are just unacceptable." - Rachelle Heinemann

"One of the most important parts to understand about perfectionism is the illusion of control." - Rachelle Heinemann

"We are too busy focusing on how our body ends up looking... that we don't focus on what it is like to actually get there." - Rachelle Heinemann

"Vulnerability is not only about sharing deep, dark secrets." - Rachelle Heinemann

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Forget everything you think you know about eating disorders—this episode goes way beyond the old myths about "willpower" and "control." Today, we're digging into the real, science-backed roots of eating disorders with Dr. Erin Knopf: pediatrician, psychiatrist, Certified Eating Disorder Specialist, and co-founder and chief medical officer of Very, a virtual outpatient treatment center delivering high-level care straight to your laptop.

Dr. Erin Knopf is a board-certified pediatrician, adult psychiatrist, and child/adolescent psychiatrist as well as an IAEDP Certified Eating Disorder Specialist. Dr. Knopf completed residency training at the University of Kentucky in a combined residency program, the Triple Board program. She previously worked at The Eating Recovery Center and ACUTE Center for Eating Disorders. She is co-founder and Chief Medical Officer of VERY | Virtual Eating Recovery for You, an outpatient virtual treatment option dedicated to individualized care and grounded in weight-inclusive, trauma-informed, and gender-affirming principles.

"Binge eating is not just about being undisciplined or impulse control issues. It is actually based in restriction." - Dr. Erin Knopf

"You have to be intentional and really look for ways to create balance." - Dr. Erin Knopf

"It's[SSRIs] not necessarily causing any damage or harm, but it's certainly not going to give them the benefit that they are waiting for." - Dr. Erin Knopf

"There is no medication I can give to make the "nutritional restoration process", weight gain happen with just a pill. There's no such thing." - Dr. Erin Knopf

"Health biometrics are so much better looked at from a vitals perspective, lab perspective, functionality perspective, quality of life too." - Dr. Erin Knopf

" There's so many questions when it comes to medications and eating disorders, especially because there isn't a clear cut answer. It's just not that simple." - Rachelle Heinemann

Connect with Dr. Erin Knopf here!

Connect with Dr. Erin Knopf on Instagram!

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In this episode, I'm diving into the messy and complicated cycle of restriction and bingeing—not just with food, but with all the things we tell ourselves we shouldn't need. Why do we do this? How does it backfire every time? And more importantly, how do we break free?

"You can't just ignore your needs and wants forever. That's when this moment of lapse of judgment, the binge, whether it's money, food, sex, anything under the sun, comes in." - Rachelle Heinemann

"Food is inherently soothing." - Rachelle Heinemann

"How did it come to be that the only way that you know how to deal with your emotional pain is with food?" - Rachelle Heinemann

"There's something about acknowledging, "yeah, I actually do need this", which is the hardest part of it, but also the thing that allows us to actually have it and feel good about it eventually." - Rachelle Heinemann

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In this episode, I sit down with therapist and author Ilene Fishman to explore what it really takes to achieve lasting recovery. We dive into the complex, sometimes uncomfortable truths about healing from an eating disorder, the importance of self-compassion, and why true freedom goes beyond simply "eating normally."

Ilene V. Fishman, LCSW, ACSW, FAED, has maintained a general psychotherapy practice specializing in the treatment of eating disorders for more than 40 years in both Montclair, NJ and New York City. Ilene helped found NEDA, serving on its Board of Directors for over a decade. She then served on the board of ProjectHEAL. Ilene speaks widely as an expert on the subject of eating disorders and is the author of the book, THE DEEPER FIX.

Note: The podcast is off for the next two weeks! We will be back on April 22nd, with a new episode!

"I don't wanna keep people comfortable. People will talk about, 'Oh that therapist was so nice, she was such a nice person.' But did you get better?" - Ilene Fishman

"If we avoid our pain. If we don't suffer constructively, productively, then we're blocking ourselves." - Ilene Fishman

"Tell your therapist everything. Try to find a therapist where you can say, 'I'm afraid to start therapy with you, and these are the reasons I'm afraid.' Let's talk about it." - Ilene Fishman

"It's about taking the risk and being afraid and not really knowing what's gonna be on the other side and doing it with somebody who's gonna, who's gonna hopefully catch you, but that you need to do it scared." - Rachelle Heinemann

"Good therapy should be growthful and empowering." - Ilene Fishman

"Recovery is so worth it." - Ilene Fishman

Connect with Ilene Fishman Here!

Find Ilene Fishman on Instagram

Check out Ilene's book: The Deeper Fix: For Your Growth and Empowerment

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When it comes to exercise and movement, we believe it is this wonderfully balanced, healthy thing, right? But for a lot of us, it's… complicated. Maybe you feel like you have to move or else your anxiety will skyrocket. Maybe you mentally calculate every bite of food and match it with a "required" workout. Or maybe you find yourself hitting the gym even when you're sick, exhausted, or, oh—I don't know—literally injured. Sound familiar?

"It wasn't about enjoying movement—it was about earning my food, controlling my body, and never feeling like I was doing enough." - Rachelle Heinemann

"At some point, I had to ask myself—am I moving because I love it, or because I'm afraid of what happens if I don't?" - Rachelle Heinemann

"The truth is, over-exercising isn't healthy. It's just another way to punish yourself under the disguise of 'discipline.'" - Rachelle Heinemann

"Recovery meant redefining movement—not as a requirement, but as something I get to do, not something I have to do." - Rachelle Heinemann

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