Sweatin’ for the Wedding: Say, “I don’t.”

Posted on February 25, 2019 by drmuhlheim

Sweating for the Wedding? Say: I Don’t. — Image by rawpixel on Pixabay

by Carolyn Hersh, LMFT

In November of 2018, my boyfriend proposed to me. It was one of the most exciting days of my life thus far. With a proposal comes the next exciting chapter: wedding planning. For many brides-to-be, this entails finding that perfect gown.

Sadly, although not surprising, once I got on bridal mailing lists, I learned I was also being targeted by gyms for “Bridal Boot Camps” and “Sweatin’ for the Wedding.” The weight loss industry found yet another way to weasel their way into a life event that should have nothing to do with changing one’s body.

Why is it that you could be with someone who you love for a certain amount of years, and suddenly the moment they place a ring on your finger you need to change your body? Why does looking beautiful equate to weighing less?

Unfortunately, it has become the norm in our culture to experience pressure to lose weight for special events. A friend once shared that when she was dress shopping her consultant actually wrote down smaller measurements because “all brides lose weight.” When my dress consultant mentioned letting her know if I lose weight, my initial thoughts were, “Are you telling me I need to lose weight? Am I supposed to lose weight? What if I like my body where it is? What if I want to gain weight?”

Granted, our bodies can change. But, hearing about weight loss, exercise programs, and diets specific for the big day can be detrimental to our physical and mental health. The diet industry has found another market and doesn’t care how it impacts the people getting married.. Wedding planning can be stressful enough with trying to create a special day without the added pressure to create a “perfect” body.

But, here is the thing. Your fiance asked to marry you not because of what you’ll look like on that one specific day, but because they are in love with you and everything about you. Getting married is about making a commitment of love to one another. Your wedding day should be a celebration of that.

As brides or grooms, we should dress up and present ourselves the way we want to on this day but, it should not be at the expense of our health and well being. Remember what this day is about. Your wedding is not about the celebration of the size of your body but about the love between you and your significant other and making a commitment to one another.

What to do Instead of “Sweatin it”

Here are some tips I have developed to use myself and also with my clients who were wedding dress shopping:

Buy a dress that fits you now. Don’t buy something a size smaller. Don’t use words like “my goal size” or “I’ll be pretty when I fit into this.” Fighting your body to go to a size it isn’t meant to be is only going to add more frustration, stress, and sadness. If the person selling you a dress keeps harping on “when you’ll lose weight” or “all brides lose weight” speak up and tell her that isn’t your plan. You do not have to be a victim of diet culture. Buy the dress that makes you feel pretty right now. Also, do not forget that many dresses you try on are just sample dresses. It’s okay if it doesn’t fit perfectly when you try the dress on. The one you get will be tailored to your already beautiful body,
With that, remind yourself of the things that not only make you look beautiful but what makes you feel beautiful. One of my bridal consultants asked me when picking out a dress, “Do you want to feel whimsical? Do you want to feel like a princess? Do you want to be sexy vixen?” Wedding dress shopping became ten times more fun when I could close my eyes and imagine what style of dress would make me feel the most beautiful.
Write down what you want to feel on your wedding day. Write down your hopes and excitements for this day. Think about what memories you want to hold onto. While the idea of “looking perfect” in your wedding photos may be a strong drive to engage in diet culture, think about what those photos are truly capturing. Most likely, you’ll want to remember this as a day of celebrating love and new beginnings with your partner.
It’s okay to exercise and it is okay to eat. It’s okay to follow your normal routine, As you plan for your wedding continue to follow your intuitive voice. For many people, weddings take months if not years to plan. Do not remove fun foods out of your diet for the sake of just one day. Listen to your body when it comes to exercise. Exercise because you want to give your body the gift of movement, but know it is okay to take days off too. Exercise should not be a punishment to your body.

In Conclusion

You do not need to lose weight for your wedding day. Ultimately, remember what this day means to you and your partner. Your wedding dress should be the accessory to the already amazing you. You know, the person that your partner wants to spend the rest of his or her life with. So, when it comes to “sweatin’ for the wedding,” say, “I don’t.”

To the Family Member Who Worries I Am Not Helping Your Loved One’s “Weight Problem”

Posted on June 8, 2018 by drmuhlheim

Dear Family Member,

I understand your fears. I get it. You want the best for your loved one. You want him or her to have the best and healthiest and fullest life possible. I do too.

You believe that helping your loved one to lose weight will help achieve these goals. Here, I disagree—I will explain below.

You believe that weight loss will lead to better health. You have heard the scary information about the dangers of obesity and know there is an all-out war on obesity. Or you have seen or heard your loved one ridiculed or judged negatively by peers because they didn’t conform to a certain size.

However, did you know that:

The war on obesity is driven by political and financial interests?
Weight loss from dieting is unsustainable for most people?
Calorie deprivation leads to decreased satiety hormones and increased hunger hormones?
Calorie restriction also leads to changes in thinking and attention that causes dieters to become preferentially focused on food?
Dieting contributes to eating disorders, weight cycling, and weight gain more often than it succeeds?
Many of the medical problems attributed to obesity are correlational at best, and might be better explained instead by weight stigma and the social pressures experienced by people in larger bodies?

I have been working in the field of eating disorders since my training at a bulimia research lab in 1991. When I first learned to treat binge-eating disorder, a course of cognitive behavioral therapy (CBT) for binge eating was expected to be followed by a course of behavioral weight loss. However, since that time we have learned that behavioral weight loss doesn’t work. And while CBT for binge-eating disorder can be successful, it rarely leads to significant weight loss, even among those considered to be in an “overweight” weight category. However, CBT does lead to cessation of binge eating and prevention of further weight gain, which are lofty goals in their own right.

I firmly believe that bodies are meant to come in a variety of shapes and sizes. We are not all meant to be Size 0 or 2 or 4.

Take shoe size: while the average woman today has an 8 shoe size, most do not—some will have size 5 and others will have size 10. Shoe size has a normal distribution within the population.

Just as with shoe size, so it is with body weight. Every body appears to have a set point, a weight at which it functions optimally. This set point is not destined to be at the 50^th percentile for every person—some will be heavier and some will lighter. Repeated attempts at dieting seem to increase a body’s setpoint, which is the opposite of what most dieters are trying to achieve.

I no longer support attempts at deliberate weight loss because I have come to believe it is not only fruitless but in fact harmful. Every day in my practice I witness the destruction left by the war on obesity and failed diet attempts. I see the carnage of past dieting, weight regain, shame and self-loathing in the form of disordered eating and intractable eating disorders. Against this backdrop, I believe that above all else, my duty to your family member is to not harm them.

There is no magic solution. Failing to fit the thin mold can be a burden. I wish I could wave a magic wand and have your loved one’s body transform into one that would not be stigmatized, would be celebrated, and would fit into all spaces. But I can’t change your loved one’s genetic body destiny, just as I can’t change any person’s ethnic background or skin color to conform to the privileged group. And I believe the solution is not to change your loved one’s body to conform—the solution is to fight to end weight stigma and the oppression of larger bodies.

Here’s what I can do:

I can help your loved one recover from an eating disorder, using evidence-based treatments backed by scientific research.
I can help your loved one work on accepting and appreciating their body and all its capabilities.
I can help your loved one unfetter themselves from self-imposed rules and restrictions and live a fuller life.
I can help your loved unburden themselves from shame and self-loathing.
I can help your loved one to advocate for themselves if he or she needs accommodations from a world that was not built to accommodate his or her body.
I can help your loved one learn to stand up to weight stigma and bullying.
I can help your loved one request and receive respectful health care.
I can help your loved one improve their relationship with food so that eating and social situations are enjoyable.
I can help your loved one achieve peace.

If you want these things for your loved one, please let me do what I was hired to do—guide your loved one to healthiest, best, and fullest life possible. Please examine the basis of your own hope that your loved one will conform to the thin standard. While I know this comes from a good place, it’s not pointing to the right destination. There are happier places to land. There is much work to be done. We all have weight stigma.

To learn more, I suggest reading the following articles:

Interested in Weight Loss? I CAN’T Help You. Here’s Why

Are We Setting Recovery Weights Too Low?

Is Weight Suppression Driving Your Binge Eating?

How Health at Every Size Can Help With Eating Disorder Recovery

On Living 100 years in Diet Culture

Posted on January 18, 2018 by drmuhlheim

I recently went to visit my 102-year-old grandmother. In 1921, at the age of six, Nana emigrated from Russia to Kansas City.

She entertains her living facility with her piano playing and loves to talk all day. She continues to leave sassy messages on my phone. She sends thoughtful gifts to her great grandkids. With such a full life, the following stands out to me.

Always concerned about her shape and weight, at 102 this is still a concern as evidenced by her bathroom in assisted living. Although Nana walks with a walker and now requires some assistance with getting dressed, she still steps on her bathroom scale every day. (How exactly she does this without falling, I don’t know!)

She declared to me, “I weigh x. If I could lose 10 pounds, I’d look younger.”

Two years ago, when she turned 100, I actually did a brief interview with her about dieting. After all, how many 100-year-olds are there who can offer a perspective on dieting in the 1930s and into their centenarian years?

Following is an excerpt from my interview with Nana:

How old were you when you first became concerned about your weight and shape?

At 9 years old people wanted me to start appearing on stage playing the piano. My teacher wanted to speak with my parents and told them he thought I was overweight and should lose some weight. He wanted to groom me for concert piano playing. I remembered how he spoke about my being a little heavy. It didn’t set in right with me. It didn’t bother me. I wasn’t obese, but I was heavy.

When was the first time that you dieted?

On January 2, 1935 (at age 19), I started a strict diet (for me) while at the University of Missouri in Columbia. In 3.5 months I lost 45 pounds. I worked very hard at that. Not only did I have a diet plan, but I also read a great deal. Just before that I also bought a powder that I put in tomato juice and it helped reduce hunger. When I came back to college after Christmas I was told by a friend who was a medical student to stop taking it. He said it was harmful. And then I continued on with the diet plans and that was in 1935. That’s when I really lost the weight. I became ever more popular and I noticed that the weight loss was really helpful.

Do you still worry about your weight?

I’m still concerned about my weight. I watch it very carefully. I get on the scale every single morning because I want to get in the clothes I have. I used to measure myself with a tape measure every day.

Why do you think it is important to be thin?

I think it’s important. I love my clothes and if I don’t hold my weight to the clothing that I’ve bought, I’d feel very sad so I watch my weight carefully and I am able to get into clothing that I’ve had for years. There are some skirts that I can’t fasten at the waist, but I don’t wear skirts anymore. But weight has always been a very important concern. I don’t think you have to be thin but you have to look good in your clothing and for me, I don’t want to have to buy new clothes.

Nana’s Legacy

It is sad to me that after all these years, the fear of returning to a bigger size still looms over her. When she eventually passes I doubt many will remember Nana for her shape.

Instead, I expect they will remember her for how friendly and caring she is, how she finds the positive in everything, her desire to make everyone around her happy, the sharp dresser she is, and what a great pianist she is (she makes you FEEL the music).

I know I will always hold dear in my heart her tremendous love for so many people, her years of serving the community as a social worker and volunteer for numerous charitable organizations, her delicious pound cake, her witty jokes (mostly from Readers Digest!), her long stories, her piano playing, and for how she knows (and is loved by) everyone in Kansas City.

Don’t Diet! 10 Alternative New Year’s Resolutions

Posted on December 30, 2017 by drmuhlheim

I am skeptical of New Years Resolutions in general because I think they promote all-or-nothing thinking (I also don’t like to categorize entire years as being bad or good for this reason). I don’t feel that one needs to wait for the year to reset to make changes in one’s life. I am anti-diet and dread the increased obsession with dieting and weight loss that arrives with each January 1^st.

So I thought that this year I would offer some alternatives to weight loss goals as potential resolutions for those who will be making some for 2019.

Don’t Diet in 2019: Alternative New Year’s Resolutions

Resolve to learn a new skill. Whether you’ve always wanted to learn to rock climb, play the piano, make dumplings, or cross-stitch, now is the time to do it.
Commit to improving one relationship. Whether it’s getting to know that coworker, spending more time with your spouse, or getting back in touch with that childhood friend, do it in 2018.
Pledge to reject self-denigrating body shaming comments. Those negative body comments, often made between friends, make everyone feel worse. Try to avoid saying things like, “My thighs look fat,” “Does this make me look fat?” “I need to lose weight.”
Commit to not dieting. Focus instead on eating intuitively according to your own taste and hunger and satiety cues. Your amazing body will regulate itself if you let it.
Listen to one body positive podcast. Improving your body image will make you feel better than dieting will. Here are a number of great suggestions.
Spend more time in nature. Research shows that spending time in nature is associated with improved mental health. Go on a monthly hike, plan to visit a national park, or just spend some time outside appreciating your surroundings.
Volunteer! So many organizations are in need of volunteers and there are so many important causes. You can devote your time to helping animals, saving the environment, or improving literacy. Volunteering provides health benefits and can boost self-esteem.
Create something. Paint, draw, needlepoint, collage, write a story or a song. Art is a great way to express your feelings and the act of creating something can boost mood and self-esteem.
Expand your cooking repertoire. Whatever your cooking ability, there is room to grow. Learn a new technique, master a new cuisine, and try some new recipes. Cooking is a great way to improve your appreciation for food and can help with mindful eating.
Make no New Year’s resolution at all. After all, the passage from 2017 to 2018 is just a social construct — it affects neither your self-worth nor any progress in your life.

Winter 2017 LACPA Eating Disorders SIG Events

Posted on December 4, 2016 by drmuhlheim

1. Date: Thursday, January 26 at 7:30 pm

Speaker: Glenys Oyston, RDN

Title: The Dangers of Dieting

Description: Dieting for weight loss is a cultural norm – everyone does it, has tried it, or has been told to do it at one time or another. But is dieting for weight loss truly beneficial, or is it causing more harm than good? Registered Dietitian Glenys Oyston, discusses how intentional weight loss efforts are actually harmful to the physical, social and psychological well-being of people who engage in them, and what to do about it.

Bio: Glenys Oyston is a registered dietitian, size acceptance activist, eating coach, and blogger who runs Dare To Not Diet, a coaching business for long-timer dieters and weight cyclers who want to break free of food restriction and body dissatisfaction. She coaches people online or by phone through one-on-one and group coaching programs. She is based on Los Angeles, CA. You can find her at www.daretonotdiet.com.

Glenys Oyston, RDN

Dare To Not Diet

Dietitians Unplugged Podcast

@glenysoRD on twitter

Facebook

Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

RSVP to: drmuhlheim@gmail.com

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

2. February 10 at 11 am – LACPA Office (in conjunction with Sport and Performance Psychology SIG)

The LACPA Sport & Performance and Eating Disorders SIGs are pleased to announce our jointly held meeting for February, 2017:

Date: Friday, February 10, 2017

Time: 11:00 AM – 12:30 PM

Location: the LACPA Office, Encino

6345 Balboa Blvd. Building 2, Suite 126

Topic: When an Athlete Gets an Eating Disorder

Speaker: Abby McCrea, LMFT

More about our topic and speaker:

Clinical eating disorders cause significant problems for more than 40% of athletes. Subsequently, the subtleties between “good athlete” and “eating disorder” mindsets can become particularly tricky to discern after the onset of an eating disorder. Knowing the risks, possible causes, and how to support athletes with eating problems is essential for developing and sustaining athletic wellbeing.

This talk is designed to help you:

Explain how and why athletes get eating problems
Recognize the subtle differences between a “good athlete” and an “eating disorder” mindset
Create ways to support athletes with eating problems

Abby McCrea is a Licensed Marriage and Family Therapist who has a private practice in Sierra Madre, CA. She graduated from Fuller Theological Seminary with a Master’s of Science degree and a clinical focus on the integration between psychology and spirituality.

With over 13 years of experience in a variety of mental health settings including inner city gang rehab community programs, college counseling centers, and eating disorder residential centers, she brings a depth of understanding, experience, respect, and compassion to her work. In her private practice she specializes and works to empower teens, adults, and families that recovery from an eating disorder is possible. Additionally, she is passionate about developing research and treatment for athletes with eating problems, and helps clients, families, and coaches in her practice to navigate and manage the delicate balance between life, sport, and recovery.

Abby speaks nationally on the topics of eating disorders and athletes, eating disorder education, deconstructing social ideals of body image, spirituality and the rituals of eating problems, and identity development among teenagers in life transitions.

Please RSVP and/or direct any questions to Sari Shepphird at drshepp@msn.com

LACPA SIG Meetings are a LACPA member benefit and are open to all LACPA Members. For more information about LACPA Membership, SIG’s and other events, visit the LACPA events calendar: www.lapsych.org

Parking Information:

The LACPA office address is THE ENCINO OFFICE PARK, 6345 Balboa Blvd, Building 2, Suite 126, Encino, CA 91316 – second building from Balboa Blvd., conveniently located near ample free daytime/weekday street parking on Balboa Blvd, south of Victory Blvd. Both sides of Balboa have all day free parking. There is also plenty of free parking at the Sepulveda Basin Sports Complex on the west side of Balboa, south of Victory, 6201 Balboa Blvd. (2nd driveway past the Busway). 2-3 minute walk to the office door. Wherever you park, please check the signs.

Parking at The Encino Office Park lot between the hours of 9 a.m. – 6:30 p.m. is restricted to building tenants only. Do not park in the lot at the building.

I’m not the villain! My side of the story… by Starch

Posted on November 13, 2015 by drmuhlheim

Starch in Eating Disorder Recovery — Winter Artwork Illustrations

By Katie Grubiak, RDN

Hey, I have something to say!

Don’t forget my importance!

Although maligned by Atkins and many others, I’m not really the bad guy.

This is why:

I contain the falsely feared primary energy source in the diet: carbohydrate. My carbohydrates along with those found in the fruit & milk groups should make up 50-65% of total calories consumed. I supply 4 calories per gram. If you are very physically active I encourage you to use my power and consume me to reach the higher percentage so you have plenty of energy to soar!
As a carbohydrate, I am the preferred source of energy or fuel for biologic work in humans:
I contribute to the mechanical work of muscle contraction
I provide chemical work that synthesizes cellular molecules
I help transport various substances in the intracellular & extracellular fluids
I provide fuel for the central nervous system.
I enable metabolism of dietary fat (the other macronutrient you likely fear).
I prevent protein (likely the only macronutrient you perceive as safe) from being used for energy thereby allowing protein to be used for what it’s intended –building & repairing body tissue & making antibodies, hormones, and enzymes.
I become glycogen (stored glucose) for readily-available energy to support physical activity.
I’m in your favorite meals and come around often frequently since so many foods include me. It’s hard to get rid of me!
Meals are not the same without me & you know it!
The foods that contain me provide vitamins/minerals/phytochemicals that you have been taking via a daily multi-vitamin pill. Actually, my nutrients are in food form and are therefore better absorbed & utilized such as: B Complex Vitamins, Vitamin A/E/C, Choline, Inositol, Calcium, Cooper, Iron, Magnesium, Phosphorus, Potassium, Selenium, Zinc.
Without me, you may experience strong urges to binge. I help to create satiation. Blood sugar regulation requires all three of us macronutrients: carbohydrates, protein, & fat in just the right combination. We help each other out to help you have the most optimal blood sugar & metabolism. We also together prevent the HANGRY feeling!
Believe it or not, some vegetables also include me even though many think they escape me. Thank goodness I still have a presence in people’s lives even if they don’t acknowledge me.

The average recommended number of daily servings of starch for adults ranges from 9-12 exchanges for a 2000 to 2500 calorie meal plan.

Check out these excellent starch foods.

Each serving or one “exchange” of a bread/grain/cereal/starchy vegetable listed equals 15 grams of carbohydrates:

1 regular slice of bread (white, pumpernickel, whole wheat, rye)
½ English muffin
½ hamburger bun
1/4 bagel or 1 ounce (can vary)
½ pita-6 inches across
1/3 cup cooked rice, brown or white
½ cup cooked pasta
½ cup cooked legumes (beans, peas, lentils)
½ cup cooked barley or couscous
½ cup cooked bulgur
3oz potato, sweet or white
½ cup mashed potato
½ cup sweet potatoes, plain
1 cup winter squash (acorn or butternut )
½ cup corn
4-6 crackers
1 tortilla -6 inches across
½ cup cooked cereal
¾ cup dry cereal
3 cups popcorn
¾ ounce pretzels
1 plain roll-1oz

Recipes Featuring Starch

Some easy & quick ways to make sure you get enough starch (notice that the other macronutrients -protein & fat- just come around naturally):

Microwavable French Toast

Ingredients:

¼ cup milk

1.5 TB syrup

1 tsp cinnamon

1 egg

pinch salt

1.5 slices any bread

1 TB butter

Directions:

Spread butter on bread and slice into cubes. Put cubes into mug and whisk together wet ingredients and then pour them over the bread and stir to cover bread cubes with liquid. Microwave on high for 2 minutes. Top with sliced bananas or berries and it’s a balanced breakfast.

Tuna Pesto English Muffin Open Faced Sandwich

Ingredients:

1 whole separated English Muffin

Tuna 3oz

Mayo to taste-I like Trader Joes Mayo with expeller pressed oils

Himalayan pink salt & lemon-pepper to taste

Pesto to taste

Heirloom tomato-sliced

Lettuce of choice-2 leaves

Directions:

Make tuna salad by adding mayo, salt, lemon pepper to taste in bowl.

Toast the separated English muffin to preferred goldenness.

Spread a layer of pesto on each half of toasted muffin.

Add the tuna salad to the English muffin with pesto.

Garnish with a lettuce leaf and sliced tomato.

Katie Grubiak, RD is a Registered Dietitian and Director of Nutrition Services at Eating Disorder Therapy LA. You can read more about her here.

Thank you to Winter Artwork Illustrations for use of the photo.

Interested in Weight Loss? We CAN’T Help You. Here’s Why

Posted on September 9, 2015 by drmuhlheim

Learn more about the non-diet approach at Eating Disorder Therapy LA - Health at Every Size (HAES) — Yale Rudd Center for Food Policy & Obesity

Learn More About Our Non-Diet Approach

At Eating Disorder Therapy LA, we treat eating disorders (including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Other Specified Feeding and Eating Disorder or OSFED) across the weight spectrum. We often get inquiries from clients interested in help for binge eating or emotional eating, with their primary goal being to lose weight.

We always tell them that while we believe we can help them with their disordered eating, if weight loss is their real goal, we cannot help them. By contrast, we are willing to help with, and in fact are rather insistent upon, weight gain for our patients who are below their body’s healthy weight.

Many prospective clients seeking help with weight loss have completed a diet regimen (or often, in their minds, “failed” one) and are suffering from binge eating. They want to eliminate the binge eating and concurrently lose weight. While we are expert at helping clients to stop binge eating and learn to regulate eating, we will not consent to “help someone” lose weight.

Here’s why:

We don’t think anyone really has the answer to help someone lose weight. The research shows that diets don’t work. We are not so grandiose as to believe that We are any different.
- Traci Mann’s 2007 review of 31 weight loss studies showed that on average, 41% of dieters regained even more weight than they lost on the diet. In an interview about the study, Dr. Mann said, “You can initially lose 5 to 10 percent of your weight on any number of diets, but then the weight comes back. We found that the majority of people regained all the weight, plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority. Diets do not lead to sustained weight loss or health benefits for the majority of people.”
- Harriet Brown, the author of Body Of Truth – a detailed analysis of the war on obesity and the diet industry – wrote in an article about the book, “In reality, 97 percent of dieters regain everything they lost and then some within three years. Obesity research fails to reflect this truth because it rarely follows people for more than 18 months. This makes most weight-loss studies disingenuous at best and downright deceptive at worst.”
Dieting and weight suppression may be the major drivers of binge eating and ironically, can cause weight gain.
- Research on “weight suppression,” which is the difference between someone’s current weight and their highest adult weight, shows it is linked to both anorexia and bulimia. Drexel University psychologist Dr. Michael Lowe, Ph.D. is one of the leading researchers on weight suppression. His research shows that the greater the weight suppression, the more severe and difficult to treat was the eating disorder. His research also shows that the more weight-suppressed a person is, the more likely they are to regain weight in the future. To me, this suggests that some bodies are naturally larger and will resist all attempts to reduce in size. Attempting to fight the body’s predestined weight may contribute to binge eating behaviors and even higher future weights.
- Evelyn Tribole, coauthor of Intuitive Eating in a review of dieting wrote: “Dieting increases your chances of gaining even more weight in the future, not to mention increase your risk of eating disorders, and body dissatisfaction. “
Weight cycling – the repeated cycle of losses from dieting followed by the usual weight gains after going off the diet – creates its own health issues, in particular, additional stress on the cardiovascular system.
Weight loss can trigger both anorexia and bulimia. Research from the Mayo clinic shows that 35% of the young people who visited the clinic with anorexia started out in the “obese” or “overweight” weight range.
Dieting is incompatible with Cognitive Behavioral Therapy (CBT), the treatment we provide for adult eating disorders.
While CBT is very effective for eliminating binge eating, it relies on a non-restrictive approach to eating. The goal of CBT is to disrupt the diet-binge cycle through a pattern of regular eating and relaxation of dietary rules. Patients are encouraged to end restrictive dieting and behaviorally challenge dietary rules through behavioral experiments and exposure to forbidden foods as part of treatment.
Counterintuitively, when overweight binge eaters successfully complete CBT treatment for binge eating, they do not lose appreciable amounts of weight.
Even adding a behavioral weight loss program following completion of CBT for binge eating does not lead to additional significant weight loss. However, it is possible that long-term abstinence from binge eating may prevent future weight gain especially as compared to untreated binge eaters.

Our first responsibility as practitioners is to do no harm. Even if weight loss is a client’s stated goal for treatment, and even if their doctor is advising it, we fear that “helping” someone to diet may increase their binge eating and disordered eating. This may in turn cause greater weight gain or weight cycling – a far worse alternative than remaining at the current weight.

Here is how EDTLA can still help in the absence of weight loss:

We provide CBT-E for bulimia, binge eating disorder and subclinical disordered eating. I trained with one of the original developers of cognitive behavioral therapy for eating disorders. Clinical trials show 65.5% of CBT-E participants meet criteria for remission from their eating disorder. Relief from cycles of binge eating usually leads to benefits such as freedom from obsessing about food, greater productivity, decreased anxiety about food decisions, and improved self-esteem. Commonly, patients experience decreased guilt and shame around eating and food. Relationships improve as clients become more able to fully participate in meals with loved ones and friends. It also commonly leads to the expansion of other enjoyable areas of one’s life outside of dieting and body image.
We work with clients on challenging weight stigma (both their own internalized and in the larger community). We also work on improving body image.
My associates and I follow a Health at Every Size® approach. At Eating Disorder Therapy LA, we recognize and celebrate that bodies come in all shapes and sizes. We focus on creating and maintaining healthy behaviors including flexible eating and enjoyable exercise.

Many clients arrive in therapy feeling that they cannot feel better unless they lose weight. However, the majority of those who go through a full course of treatment make significant improvements in their eating behaviors and are surprised at how much better they are able to feel even without weight loss.

Additional HAES articles

Various articles that are found on the ASDAH website:

“Attitudes Toward Disordered Eating and Weight: Important Considerations for Therapists and Health Professionals”, Matz, J & Frankel, E

“Obesity and Anorexia: How Can They Coexist?”, Bulik, C. and Perrin, E.

“Obesity, Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years Later?”, Neumark-Sztainer, Dianne, et. al

“Shared Risk and Protective Factors for Overweight and Disordered Eating in Adolescents”, Neumark-Sztainer, D., et al

“Multiple Disadvantaged Statuses and Health: The Role of Multiple Forms of Discrimination”, Grollman, E.A.

“The Problem with the Phrase Women and Minorities: Intersectionality–an Important Theoretical Framework for Public Health”, Bowleg, L.

Children/Teens

“Dieting and Unhealthy Weight Control Behaviors During Adolescence: Associations With 10-Year Changes in Body Mass Index”, Neumark-Sztainer, D., Wall, M., Story, M., Standish, A.

“Helping Without Harming – Kids, Eating, Weight and Health”, Robison, Jon; Cool, Carmen; Jackson, Elizabeth and Satter, Ellyn

“Overweight and Obese Children Eat Less Than Their Healthy Weight Peers”, Hoyle, Brian

“Weight Status as a Predictor of Being Bullied in Third Through Sixth Grades”, Lumeng, J.C., Forrest, P., Appugliese, D.P., Kaciroti, N., Corwyn, R.F., and Bradley, R.H.

Category: Dieting