This is an invitation to all of us who practice in the eating disorders field, including, but not limited to, dietitians, psychotherapists, health coaches, nurses, and physicians. Acknowledgement and invitation is also given to chiropractors, acupuncturists, massage therapists, and other providers who identify as nutritionists and offer nutrition support to their disordered eating clients.
I’m Diana Richards, a Level 3 certified IFS practitioner, nutrition therapist, and registered dietitian. I began my dietetic career in corporate wellness in Little Rock, Arkansas. Moving to Boston found me in a management position at a weight management clinic of a large academic medical institution. After more than eight years any eagerness to go to work disappeared. Offering only restrictive and depriving plans, including 500 and 800 calorie diets, low calorie meal plans plus prescriptive medication, and gastric bypass surgery for weight loss resulted in negative backlash when the diets failed. Managerial approaches to change bodies to smaller sizes began to feel dismissive, punitive, and harmful.
Private practice afforded me an opportunity to learn about bodies – and our beliefs about them – in a new way. Entering an IFS Level 1 training in 2011 led me down even more eye-opening paths. I leaned into and expanded my knowledge of anti-diet approaches through the IFS lens, focusing on the polarized protective Parts that prevail with food and body.
In collaboration with a colleague – who is now a friend, Molly Kellogg – passion ran high to integrate IFS into the mainstream of nutrition and general health concerns, especially with dietitians. Together we created a 3-hour online course and a full-day experiential workshop. We wanted to serve those interested in weaving IFS into their practices.
As I brought cases to consultation and peer groups, I was met with curiosity and assistance with the IFS language and identification of Parts, but not an understanding of eating disorder behavior. I deemed this to be because many of us have some understanding of the issues around food and body image from a cultural perspective. Yet, there can be an uncomfortableness to acknowledging this, as many respond from a personal perspective. What I didn’t find was deeper connection to clinicians truly in the trenches of eating disorder work.
All this led to this invitation to you to join with me, in collaboration and solidarity, so that together we can support each other in our work of supporting clients who consistently find themselves engaged in food and body behaviors that no longer serve them.
Background and Definitions
Background and Definitions
Another part of this invitation is to find the path of knowing. We all want to have or return to a relationship with our body and ourselves that is enjoyable, flexible, compassionate, and connected to ourselves and with clients. In my experience, food choices, eating, meal patterns and plans, and body image create so many feelings inside of us, often polarized from each other, that can dominate throughout our lives. I’ve culled together a few definitions to help underline the depth of need for our contributions and collaboration as we move toward clarity in our work.
Body Image is a person’s subjective picture or mental image of their own body. It includes:
- How you see yourself when you look in the mirror or when you picture yourself in your mind. This isn’t always a correct representation of what you actually look like—it’s a perception, not the objective truth, often from a manager Part that is critical and judgmental about our looks. Thus begins a narrative, often negative, about our height, weight, shape, attractiveness, etc., and all the ways we could move forward to make changes to improve ourselves.
- What you believe and think about your own appearance (including your memories, assumptions, and generalizations). This would include legacy burdens from our own lives and family and from the larger culture.
- How you feel about your body, including your height, shape, weight, height, skin tone, and aging. From these feelings, managerial Parts often shout, ”I have to do this right!” and begin controlling our intake and planning meals and workouts, all to offer motivation for change.
- How you sense and control your body as you move. How you physically experience or feel in your body. What you do in relation to your body image that includes much of the managerial aspects including body checking and obsessive weighing; plus, firefighter activity of numbing, soothing, comforting by restricting food intake, consequential or on-its-own binge eating, purging, and exercising excessively: “I don’t want to live in this body in this way!”
Many of us had internalized messages starting at a young age that created either a positive or negative body image. If negative, we learned to engage in behaviors that, while meaning to be useful to us, tended to harm in some way.
Eating disorders broadly defined are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological, and social function. Types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, other specified feeding and eating disorder, pica, and rumination disorder (as defined by the American Psychiatric Association). Eating disorder behaviors are always Parts driven. The more extreme the behavior, the more desperate the Part is to avoid what it fears will happen if it does not do it.
Disordered eating is a descriptive phrase, not a diagnosis, and may not align with the criteria defined by the American Psychiatric Association. It is eating for purposes other than nourishment or energy. Examples would be manager-driven preoccupation with food that leads to negative consequences and quality of life, yo-yo or chronic dieting, rigid rituals and routines around food, loss of control associated with eating and exercise, and subsequent guilt and shame. Some of these behaviors can be both manager and firefighter behavior.
Dysfunctional eating patterns are eating or not eating sometimes for reasons other than nourishment, such as to shape your body, seek comfort and pleasure, or relieve anxiety and stress, all notifiable actions of polarized Parts.
Dysregulated eating is similar to and an often-used phrase for eating disorders and covers a wide range of behaviors commonly associated with eating disorders such as anorexia, bulimia, binge eating, self-induced vomiting, purging and food restriction. All of these are our polarized Parts in more extreme roles.
Food Addiction is loosely defined as a pleasurable eating behavior of highly palatable foods, those typically known to be high in salt, fat, and sugar, and in quantities beyond what the body needs to function.
Whether food addiction is “real” can be found in two camps. Those in favor of food addiction being a reality often cite four similarities between food and other addictive substances.
- Food shares common drug pathways in the brain
- Food can activate reward neurons
- When consumed, dopamine receptors are altered
- Anticipation of eating activates brain regions seen in drug abuse
While the concept of food addiction is extremely compelling, it’s very close to the pseudoscience language that the dieting industry capitalizes on so successfully. There are several reasons to exercise caution in its application. According to Marci Evans, a nutrition therapist in Cambridge MA, there is no actual definition of an addictive food; there is very little research that supports the food addiction model; the food addiction theory fails to consider other viable explanations for neurobiological phenomena; it includes four limitations to the food addiction model to consider:
- Pavlovian conditioning
- Food is meant to be rewarding
- Restrained eating increases the hedonic value of the food
- Hunger increases neural activation
My clients say that because they binge eat, they must be addicted to food, with flour and sugar being the top two culprits. When reviewing their daily intake, what becomes clearer is the addiction, if any, may be due to the behavior of the firefighter activity because the results include feeling comforted and soothed, or the disappearance of feelings after bingeing, allowing more ease in their system. I also note that when eating is restrictive through the morning and midday, there may be larger portions eaten or after-dinner snacking. Clients tend to refer to those as binges. I offer a rephrase of “make-up eating” as the body needs a certain amount of calories to sustain the body’s weight and that’s what later-in-the-day eating usually tends to be about.
Healthism places the problem of health and disease on the individual instead of at a larger societal level, and often with medical treatment recommendations, thereby sanctioning diet plans in the guise of supporting health. We have manager Parts scrolling the Internet to validate their Parts’ beliefs and for answers to their health concerns. They derive information from books written by health zealots and social media offering hard-to-follow plans. These are desperate Parts who will do almost anything to be “healthy” when, in fact, Parts are driven to and usually land on just another extreme restrictive protocol.
Wellness is a cousin to healthism. It is practicing healthy habits daily to attain better physical and mental health outcomes, so that instead of just surviving, you’re thriving. Wellness has been linked to health via social connections, nutrition, movement, sleep, and mindfulness.
Why Collaboration Could be Beneficial
IFS has been proven to be effective in treating trauma, PTSD, rheumatoid arthritis and much more. In my experience, IFS is the most effective treatment for all disordered eating patterns. Our role as IFS clinicians is to guide clients to an increased awareness of who (which Part or Parts) is at their table:
- Who is making the choices to eat – or not eat. Are they both here? Does one dominate?
- Who decides what and when to eat?
- Which Part(s) of them needs to engage in compensatory exercise?
- Who is body checking? Weighing daily or multiple times a day?
- Who is chewing and spitting?
- Who needs support from the outside, i.e., diet programs, so they are safe to pursue ways to nourish themselves inside?
The list goes on. We align with, attune to, validate, and affirm these Parts for the purpose of introducing them to the Self-energy of the client so that they can feel into their own inner wisdom and knowing.
My role is to integrate both nutrition education and IFS in support of my clients and to confirm the pain and discomfort that the Part’s behavior has on the client, despite its good intentions to create care. We build trusting relationships between us and them, and in their own system in the presence of Self-energy. IFS leans away from weight-centric approaches, protocols that typically are rigid and destructive over time to the client’s wellbeing. Bodies do not need to be changed to be worthy and good enough.
Let’s embrace a counter-cultural message that promotes body diversity and non-diet approaches. Let’s offer guidance toward clients to understand, appreciate, and listen to their body.
The vision I had that generated this invitation is to gather with you in a group for individual support of our own Parts when they get activated around our client’s food and body concerns. Furthermore to mutually support each other concerning general nutrition support for disordered eating clients, debunking the external locus of control around dieting. And anything else that arises that could be supportive of each other. I look forward to working alongside you! Please contact me via my website in the author box.
Swim Session organiser information:
A registered, licensed dietitian since 1998, Diana Dugan Richards sees her identities as white, cisgender, lesbian, neurodiverse, who was raised as working class military moving 48 times in her lifetime. She has been a Level 3 certified IFS practitioner and nutrition therapist for 8 years. She co-facilitated a Self-led eating learning experience for the IFS Continuity Program, has presented at IFS Conferences, and leads on-going workshops introducing IFS to nutrition professionals. She runs IFS-informed continuing group workshops focusing on nutrition, body image, and cultural burdens. Diana is trained to advanced level in Intimacy from the Inside Out and regularly staffs Level 1 and 2 trainings and immersive IFS retreats. She consults with dietitians and therapists interested in integrating IFS into their practice. Diana offers safety and warmth to all. She lives in Pigsgusset, the lands of the Pequossette and Nonantum people, currently known as Watertown, MA.