“Normal” Teen Eating

Normal Teen Eating

Parents are often surprised by the high energy needs of teen girls. This is especially true for those faced with restoring a malnourished teen’s weight.

 

But even parents of healthy teens can become confused about what is “normal” in a culture where dieting is pervasive.

 

This is what normal teen eating looked for this 16 year-old teen on one day. She was out of the house, walked about 2 to 3 miles, and got to choose all of her food. This teen is healthy, has good energy, and enjoys food. She is not usually very active. Not every day of eating is the same.

 

  • Breakfast
    • 1 piece of French toast with butter and syrup, a few tablespoons of hash browns
    • 3/4 of a Belgian waffle with whipped cream and syrup
    • 2 pork sausage links
  • Lunch
    • 4 pieces of tuna on crispy rice (could not finish the 5th)
    • An order of salmon sushi
  • Snack
    • 2 scoops of ice cream
  • Dinner
    • 1 fried chicken taco in lettuce with cabbage
    • 1 steak taco in a corn tortilla
    • 1/2 serving of creamed corn
    • Horchata (beverage)
  • Snack
    • A half wedge of blue cheese with crackers

I share this because it may be difficult for parents when teens eat the foods diet culture tells us are bad. Instead, it may be a way of creating a healthy relationship with all food and getting their high energy needs met.

On Living 100 years in Diet Culture

Living 100 years in Diet Culture

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.Living 100 years in Diet Culture

 

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.

 

Winter 2017 LACPA Eating Disorders SIG Events

Glenys Oyston, RDN1.  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

 

abby22. 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:

  1. Explain how and why athletes get eating problems
  2. Recognize the subtle differences between a “good athlete” and an “eating  disorder” mindset
  3. 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. 

 

Book Recommendation: “Dietland” by Sarai Walker

Marti Noxon and Joy Nash at Dietland Luncheon in Los Angeles

Dietland

This summer (2016) I read the novel Dietland by Sarai Walker. It’s rare to find a novel that is both relevant and sensitive to the concerns of my patients, rarer still one that features a main character in a large body whose happiness is not predicated upon successfully losing weight. I found the book so empowering, I’ve been recommending it to patients.

The book tells the story of Plum Kettle, a young 300-pound woman who lives in New York and works as a ghost-writer answering angsty emails to the editor of a teen magazine. She has been on multiple diets and is planning to have weight loss surgery. While living in the crowded city, she tries hard to not be noticed. Rather than living in the present, she focuses on planning for her future life as a thin person. She orders clothing online that will fit her future thin body.

Walker vividly portrays the stigma and unjust treatment faced by people who inhabit larger bodies. Like many of my larger patients with histories of repeated dieting, Plum suffers from depression and oppression related to being in a larger body. Living in a larger body in a world consumed by diet culture means not physically conforming in certain situations (think restaurant booths, waiting room chairs, and airplanes) and leads to shame and fear of being persecuted in social situations due to one’s size. Not surprisingly, people in larger bodies often have histories of dieting to try to make their bodies conform to the thin cultural ideal. However, because dieting doesn’t work and weight suppression ultimately drives eating disorders and weight regain, people in larger bodies often experience weight regain binge eating, and anxiety and depression.

Out of fear of being teased about her weight, Plum avoids parties, clubs, bars, beaches, amusement parks, and airplanes and, painfully, spends most of her time alone, answering emails either from the café or at home in her apartment.

Through a series of unconventional events, over the course of the book, Plum gains the strength to resist the unrealistic cultural archetype. She turns her anger outward, confronts weight stigma, and stands up to the pressure of society. Ultimately Plum finds her voice and becomes empowered. She learns to accept a body that does not fit the thin ideal, stops putting her life on hold, and starts living her life as she is:

It felt good to be free. With unexpected power in my legs, I kept going, racing ahead with the wind and the sun on my face, taking a leap into the wide world, which now seemed too small to contain me.

While the treatment I offer to patients is more traditional than Plum’s journey in the novel, I hope my patients will undergo the same transformations. In my work with all patients of every size, I employ CBT for eating disorders, but I supplement this evidence-based treatment with a weight-neutral approach and education about the impact of diet culture and weight stigma. I help clients to cultivate a more accepting and compassionate relationship to their bodies and to turn their anger outward, holding up a new lens through which to see the world. I seek to empower them to advocate for their needs while challenging diet culture. This transformation is profound and exciting to witness.

My favorite passage in the book is a line of questions I want to ask my clients:

“I want you to consider something, hon. What if it’s not possible for you to ever become thin? What if there is no one day? What if this is your real life right now? What if you’re already living it?”

The book is both fun and inspiring.

Addendum: June 2018: And, it is being turned into a television show which premieres on AMC on Monday, June 4th and stars Joy Nash as Plum Kettle. Appropriately, the tagline is “Join the Revolution!” I hope you’ll join me and tune in. I was fortunate to attend an event with Marti Noxon, the producer to discuss some of the important issues that will be highlighted by the show, including weight stigma.

 

Lauren Muhlheim and Marti Noxon at Dietland Luncheon 

When is it ok to comment on another person’s body?

When is it ok to comment on another person’s body? Spoiler alert: Never!

By Elisha Carcieri, Ph.D.

As a relatively new mom of an 11-month-old, I’m on the tail end of almost two years of a complete metamorphosis. In nine months my body grew to accommodate another human, delivered that human into the world, and has since been slowly returning to its original, albeit changed, form.

Something bizarre happens when you’re pregnant. For some reason, people take this as an opportunity to comment on physical appearance, especially size and weight, perhaps more so than they do with non-pregnant women. Most don’t mean any harm, and most of the time no harm is done. But even so, I ask…why do it? And I beg…please stop! For the most part, commenting on another person’s body size is, at the very least, unproductive and unhelpful, and at worst a triggering assault on the already high-jacked consciousness of an eating disorder sufferer.

Oftentimes pregnant women will receive comments such as, “looks like you’re ready to pop!” or, “any day now, huh?” But what if that’s not the case? Saying this to a woman who has many months of pregnancy ahead of her has the potential to bring up all sorts of emotions and uncertainties. I recall a stranger stopping me on the street to give me her business card for prenatal water aerobics. She asked me how far along I was and promptly added that I was “showing early for being only 6 months along” and could therefore especially benefit from her services.

As a society, we’re generally obsessed with weight loss, wellness, thinness, and, with regard to pregnant women, “bouncing back.” I think there is an assumption that if you’re saying someone is small or thin, then its fine. But my caution against body comments rings true for comments about thinness or smallness just as much as it does for fatness, largeness, bigness, etc. It can be difficult to understand how comments about smallness might affect someone. We all want to be thin, right? But for a woman carrying a baby, being told you’re looking small can be scary and can bring up unwarranted uncertainties and fears. I can recall being told at the end of my pregnancy that I looked small. “What a tiny baby bump,” “you don’t even look like you’re about to have that baby.” (Mind you, this was the same body that elicited the above “big for 6 months” comment.) These comments came after my doctor told me that I was, in fact, measuring small during that particular week of pregnancy. It took some work to cope with and wrangle the anxious thoughts running through my head. I went on to deliver a 9lb baby…further illustrating the fruitlessness of sharing our flawed perceptions of another person’s size or shape.

The truth is that you just don’t know what another human is dealing with at any given moment. You’re also not likely to be telling them anything they don’t know already. So what’s the point?

Experiencing these comments on my body during and after pregnancy has had me thinking about how difficult it would be to tolerate for someone with an eating disorder, and how difficult comments on body shape and size must be for those with eating disorders even in the absence of pregnancy. I do want to clarify here that no eating disorder is caused by comments made by another person or even necessarily by the negative body image that can result from being on the receiving end of body-focused comments. We don’t know what causes eating disorders. Eating disorders are likely the result of a myriad of genetic/biological, social, and psychological factors. However, we do know that for many men and women suffering from an eating disorder, there is often a core overvaluation of weight and shape in the person’s overall self-concept that places them at risk for engaging in efforts to control their weight or shape. This dieting or extreme restricting food intake can result in binge eating and subsequent control behaviors such as vomiting/laxative use/over-exercise/further restriction of food intake, resulting in a vicious cycle.

For a person in the throes of an eating disorder, a positive or approving comment on weight loss can serve as fuel to the already burning fire that is the eating disorder mindset. Also, what is the message we are sending when we comment on another person’s appearance with approval only when there is an observed weight loss? Isn’t the underlying message that that person is not worthy of approval when their weight is higher? Why would you want to send that message to a loved one? Alternatively, for someone in any stage of recovery from an eating disorder, comments on weight gain can be difficult to manage. I’ll also say that even for those of us who are neither suffering from an eating disorder or in recovery, fielding, and processing these comments simply sucks.

So, the next time you feel compelled to comment on another person’s body shape or size, no matter the circumstances, just don’t! Ask them about themselves, share something about yourself, tell them how great it is to see them, or comment on the weather if there is nothing better to talk about. There is little to gain and much to lose from body-focused comments, no pun intended.

Los Angeles Eating Disorder Events for Professionals January 2016

We are so lucky to have two amazing dynamic internationally recognized speakers regarding eating disorders in January via the Los Angeles County Psychological Association (LACPA).  One is a FREE SIG event (members only) and the other is a CE event with a charge (open to all professionals).

1)  Eating Disorder SIG meeting featuring international speaker and fat acceptance activist, Ragen Chastain

Wednesday, January 20 at 7:15 pm 

Title:   Elimination is Oppression – The Ill-Advised Fight Against Obesity

Presenter:  Ragen Chastain

Description:  You can’t have a “War on Obesity” without creating a war on fat people. There is no non-stigmatizing way to say “The world will be better when no one who looks like you exists.” The shame, stigma, bullying, and oppression that have arisen from massively failed attempts to “eradicate” obesity have far-reaching negative health effects on people of all sizes, including those struggling with Eating Disorders.  The solution is not to double down and do more of the same. The research is clear that body size and health are not the same, and that a focus on body size in healthcare does a disservice to people all sizes.  We can, and we should, create complete, thriving public health programs without the use of eliminationist language, without creating a culture of appearance-based stigma and oppression, and without waging war on anyone.

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

Bio:  Ragen Chastain is an internationally recognized thought leader in the fields of self-esteem, body image, Health at Every Size, and corporate wellness.  She is a sought after speaker on the college, corporate, and conference circuits who has set the stage on fire everywhere from Google Headquarters to Cal Tech to the Models of Pride Conference.  She is the author of the blog DanceswithFat,  the book Fat: The Owner’s Manual, a columnist for Ms. Fit Magazine, and frequently appears as a topic expert on television and in print media. Ragen is a featured interviewee in the documentaries America the Beautiful 2 – The Thin Commandments, Ragen’s More Cabaret, and A Stage for Size.  She lives in Los Angeles with her partner and their adorable dogs and in her free time she is training for her second marathon and her first IRONMAN triathlon.

RSVP to Dr. Lauren Muhlheim at 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)  A CE event (tell your colleagues who are nonmembers; we provide CEUs for psychologists, nurses, drug counsellors, MFTs, LCSWs, and LPCC)

“Unraveling the Enigma of Male Eating Disorders” with Stuart Murray, Ph.D. on Saturday, January 30, 2016 

10:00 a.m. – 1:00 p.m. CE Credits 3.0 

Held at the NEW LACPA Office

6345 Balboa Blvd. Building 2, Suite 126

Encino, CA 91316

Click here to register online:

http://www.lapsych.org/events/event_details.asp?id=726923

This three hour workshop will provide a historical, theoretical, and clinical overview of eating disorder in males. Dr Murray will provide a historical overview of the development of our diagnostic framework, highlighting how this may be inaccurate in indexing male eating disorder concerns. Dr Murray will also provide an overview of the most recent empirical evidence pertaining to the transdiagnostic array of EDs in males. Finally, this workshop will include an in-depth discussion of the clinical quandaries faced in working with EDs in males.

Stuart Murray, Ph.D., is an Assistant Professor at UCSF, where he leads an international research group dedicated to advancing our understanding of male eating disorders. He also serves as the Director of the National Association for Males with Eating Disorders, and as the Co-Chair for the Academy of Eating Disorders Special Interest Group on Males & EDs. To date, Dr. Murray has published more than 70 scientific journal articles and book chapters, and has conducted workshops and seminars internationally on the topic of male eating disorders.

Winter LACPA Eating Disorder SIG meetings (2015-2016)

Thursday, November 12 at 7:15 pm.

Title: Medical-Legal Aspects of Eating Disorder Treatment with Emphasis on Denial of Care

Presenter: David Rudnick, M.D., Ph.D.

Learning Objectives:

1) Become familiar with the issues in the treatment of eating disorders that are most likely to trigger legal interventions on behalf of patients.

2)  Understand the meaning of parity and the California Mental Health Parity Act as it applies to the treatment of mental disorders generally and eating disorders specifically.

3)  Learn the current categories of level of care involved in the treatment of eating disorders, their relationship to predictors of treatment outcome and the potential impact of insurance denial of the appropriate level.

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

Bio:  Dr. Rudnick was born and raised In Los Angeles, California. He received A B.S. in Physics from Stanford University in 1962 and a Ph.D. in Physics from Harvard University in 1968. After 6 years on the UCLA Department of Physics faculty, he switched gears and attended the University Of Miami Medical School in the Ph.D. – M.D. Program. He graduated that program in 1976, and then completed an internship in Internal Medicine at the Wadsworth V.A. Medical Center and a residency in Psychiatry at the UCLA Neuropsychiatric Institute.

Following completion of his residence in 1980, he became Medical Director of the UCLA Neurobehavior Clinic and opened his private practice in Santa Monica. His interest in eating disorders began during his residency, when together with Joel Yager, M.D., he started the first adult outpatient eating disorders program at UCLA. Since completing his residency in 1980, he has supervised this program in its many inceptions. His interest in medical-legal issues began in the context of criminal offenders who were evaluated in the Neurobehavior Clinic for underlying neurological and neuropsychiatric disorders. It extended to the neuropsychiatric aspects of brain injury, leading to multiple assignments as an expert consultant and witness in brain injury cases. It was then a natural evolution to marry the interest in eating disorders to participation as a medical-legal expert in cases involving treatment issues.

Dr. Rudnick has evaluated and testified about many aspects of eating disorder treatment that have come under legal scrutiny, and will talk to us about those experiences with emphasis on the, currently, hotly contested issue of denial of care.

RSVP to Dr. Lauren Muhlheim at 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

Wednesday, December 2 at 7:15 pm – joint with Sport & Performance SIG

Title:   When Fit Becomes Foe: Excessive Workout Supplement Use as an Emerging Eating Disorder in Men

Achiro

Presenter:  Richard Achiro, Ph.D.

Description:  Dr. Achiro will discuss his recent study which provides preliminary evidence that excessive over-the-counter workout supplement use is a variant of disordered eating in gym-active men. This work—which has received international recognition from sources such as Reuters, WebMD, The Huffington Post, NPR, CBS News, and the BBC—is timely due to the drastic increase in workout supplement use in recent years. Although consuming protein powders, creatine, and caffeinated “boosts” have become standard lifestyle practice for a significant subset of the male population, misuse of these products has remained largely overlooked as a potential risky body change behavior. Dr. Achiro will highlight psychological factors found to be associated with misuse of workout supplements, with an emphasis on gender issues and implications for assessment and treatment.

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

Bio: Richard Achiro, Ph.D. is a psychotherapist and published researcher who received his doctorate in clinical psychology with an emphasis in health psychology from the California School of Professional Psychology, Los Angeles. He has maintained several leadership positions, including past service on the Los Angeles County Psychological Association (LACPA) Board of Directors. Dr. Achiro provides treatment to individuals and couples as a Registered Psychological Assistant supervised by Stephen Phillips, J.D., Psy.D. in Beverly Hills.

RSVP to Dr. Lauren Muhlheim at 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

Wednesday, January 20 at 7:15 pm

Title:   Elimination is Oppression – The Ill-Advised Fight Against Obesity

Presenter:  Ragen Chastain

Description: You can’t have a “War on Obesity” without creating a war on fat people. There is no non-stigmatizing way to say “The world will be better when no one who looks like you exists.” The shame, stigma, bullying, and oppression that have arisen from massively failed attempts to “eradicate” obesity have far-reaching negative health effects on people of all sizes, including those struggling with Eating Disorders.  The solution is not to double down and do more of the same. The research is clear that body size and health are not the same, and that a focus on body size in healthcare does a disservice to people all sizes.  We can, and we should, create complete, thriving public health programs without the use of eliminationist language, without creating a culture of appearance-based stigma and oppression, and without waging war on anyone.

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

Bio: Ragen Chastain is an internationally recognized thought leader in the fields of self-esteem, body image, Health at Every Size, and corporate wellness.  She is a sought after speaker on the college, corporate, and conference circuits who has set the stage on fire everywhere from Google Headquarters to Cal Tech to the Models of Pride Conference.  She is the author of the blog DanceswithFat,  the book Fat: The Owner’s Manual, a columnist for Ms. Fit Magazine, and frequently appears as a topic expert on television and in print media. Ragen is a featured interviewee in the documentaries America the Beautiful 2 – The Thin Commandments, Ragen’s More Cabaret, and A Stage for Size.  She lives in Los Angeles with her partner and their adorable dogs and in her free time she is training for her second marathon and her first IRONMAN triathlon.

RSVP to Dr. Lauren Muhlheim at 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

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

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:

  1. 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.”
  2. 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. “
  3. 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.

  4. 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.

  5. 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.

  6. 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.

Suggested Reading and Viewing:

Bacon, Linda, Health at Every Size

Brown, Harriet, Body of Truth

Mann, Traci, Secrets from the Eating Lab

Saguay, Abigail, What’s Wrong with Fat

The Problem with Poodle Science (video by the Association of Size Diversity and Health)

Why Dieting Doesn’t Usually Work (TED talk by Sandra Aamodt)

Warning Dieting Causes Weight GAIN (video by Evelyn Tribole MS RD)

Why do dieters regain weight?

Additional References:

Berner, L.A., Shaw, J.A., Witt, A.A. & Lowe, M.R. (2013). Weight suppression and body mass index in the prediction of symptomatology and treatment response in anorexia nervosa. Journal of Abnormal Psychology, 122, 694–708.

Mann, T., Tomiyama, A., Westling, E., Lew, A., Samuels, B., Chatman, J. (2007). Medicare’s search for effective obesity treatments: diets are not the answer. American Psychologist, 62(3):220-33.

Lebow, J., Sim., L., and Kransdorf, L. (2015). Prevalence of a History of Overweight and Obesity in Adolescents With Restrictive Eating Disorders. Journal of Adolescent Health 56, 19-24.

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.