Dr. Millner has specialized training and experience working with eating disorders and body image issues. In this time in our culture, many men and women deal with concerns about food, weight, and body image. Dr. Millner understands the significant impact these issues can have on the individual’s life as well as on their family and friends.
Several weeks ago I had the honor of attending and speaking at the BEDA/NEDA conference in Brooklyn, NY. As a psychologist who has been working in the eating disorder field for over ten years, I have been to my share of eating disorder conferences. Anytime I attend a conference, I think about it not just through the lens of a provider and what providers at the conference might be learning, but I think about it through the lens of my clients and considering what they would be hearing and be exposed to if they attended the conference. If they attended, would they hear eating disorder clients talked about with respect and care, or would they hear them being judged and pathologized? Would they hear messages about body size that perpetuate weight stigma or would they hear the dismantling of weight bias and naming of size oppression? Would they hear discussions of social justice issues and the naming of the patriarchy and white supremacy as significant contributors to messages people get about their bodies or would they hear the same stereotypes about eating disorders being the problem of white women and individual control? If my clients were to walk through the conference at a time that a meal was being served, would they hear providers talking about their passions, their love for their work, what drives them and fulfills them; or would they overhear talk of diets and weight loss and complaints about the food being served and the exercise they need to do? Would they see providers in all different size bodies and skin colors or would they see primarily thin white women walking around? And, would my clients in larger bodies feel comfortable in the space- would they be able to move through the conference space without getting the message that they aren’t welcome? Even though most conferences I attend are professional conferences that are geared towards those working in the field, I think about the perspective of my clients because, ultimately, they are the measure of how well we are doing as a field. Are we helping and healing or are we harming?
The BEDA/NEDA conference made a conscious effort to center social justice issues and to talk about weight oppression. There was a widening of the lens to acknowledge that eating disorders don’t exist in a bubble and that making eating disorders individual problems leaves the “fixing” to the individual person. There were sessions that focused on eating disorders in marginalized groups and a keynote that discussed research that truly considered the needs of the people being studied and centered them in the designing and implementing of the research. It was refreshing to hear acknowledgment that research and science are not value free and that most of the research around weight and health is biased. There was discussion of how much we don’t know and an awareness that different people will need different things in their healing process. It seemed that the conference worked hard to find a balance between the discussion of social justice, activism, and provider responsibility to push back against diet culture and offered sessions that focused on specific treatments and interventions. There was a clear Health at Every Size (HAES) message incorporated throughout the conference. This should be the norm at all eating disorder conferences but, unfortunately, it is not. I was relieved to see that there were no talks equating body size with eating disorders or using pathologizing language about body size in the title. There were no talks that suggested weight loss should ever be recommended or that talked about weight loss in the treatment of BED, which I have seen done at other conferences. And yet, with all the positives at the BEDA/NEDA conferences, there were still things that felt problematic. The main conference space was not set up in a way that was comfortable for fat people. There were several talks that fell short of their intended goal and either lacked the expertise one would hope to find in a conference talk or did harm in their discussion around eating disorders among people of color by using articles that were further stigmatizing and stereotyping. While there was more size diversity than some other eating disorder conferences I have been to, the majority of attendees were still white and in smaller bodies. In the time I spent walking through the exhibitor area and overhearing discussions amongst providers, I heard several conversations about diets and body dissatisfaction as well as comments about the food being served.
I have been in the field long enough to not be too surprised to hear that some of the feedback or “criticism” about the BEDA/NEDA conference was that the HAES messaging was “too strong” and social justice issues were “too focused on.” There was also feedback that people were uncomfortable with the use of the word “fat” in talks and amongst attendees. My reaction and response to this kind of feedback is that it’s not that we’ve gone “too far” it’s that we haven’t gone far enough. Even at a conference that was consciously committed to centering social justice, centering marginalized voices, centering fat people, not equating body size with eating disorders, not pathologizing people, not viewing weight loss as something to ever recommend, there were still problems. There was still space that was not set up for fat people. There were still talks that did further harm to marginalized people. There was still discussion about weight loss and diets amongst providers. There were still people discussing using weight loss messaging to “attract” clients or claiming that in order to “meet people where they are at” we need to be vague about where we stand regarding the recommendation of weight loss and diets. There were still things that I would not want a client to be exposed to. In contrast to people who say we have gone “too far,” I would say that at this conference, and even more so as a field, we haven’t gone far enough. We need to keep working until social justice issues are centered at every conference. We need to recognize that we will make mistakes, but that we can take steps to try and prevent further harm from being done. We need to make not only conference spaces, but the field in general more welcoming to fat people. We need to come to an agreement as a field that we will no longer use stigmatizing language, that we will no longer equate body size with eating disorders or see body size as a marker of health, and we need to be clear that recommending weight loss is always harmful. We need to commit to doing our own work, dismantling our own internalized biases, and to recognize that discussions about diets and weight loss amongst eating disorder professionals is problematic and harmful. We can’t just shift to whispering conversations about our own diets, or conversations about recommending weight loss to clients. We need, as a field, to fully embrace weight-inclusive care and be clear that fat people will not be pathologized or asked to become thinner.
Overall, my experience at the BEDA/NEDA conference was a positive one. It was great to connect with both old and new friends and to see the efforts to focus on topics that the field has neglected for far too long. As always, I am grateful to BEDA for pushing the field in the direction it should have always been heading and for naming the biases that the eating disorder field has stood behind for far too long. I came away with the reminder that we are still evolving as a field and that we still have a ways to go before we can claim to be safe for people in larger bodies, and with a commitment to continue speaking up and being clear about where I stand. I also came away with the reminder that there are many strong, passionate, and dedicated people following in the footsteps of past visionaries and leading the way in the evolution of the field. I hope that those who left the BEDA/NEDA conference saying that the field has gone “too far” or who were uncomfortable with the HAES messaging will take time to reflect on where their discomfort is coming from. Change can be uncomfortable, but staying stuck where we are cannot be an option. We have work to do as a field, and the BEDA/NEDA conference was both a reflection of the incredible work that has already been done and a reminder of how much work is still left to do.
A blog by Dr. Maria Paredes, Licensed Professional Counselor & Certified Eating Disorders Specialist, but you might also call her a:
Lover of ALL Bodies Self-Compassion Coach
Voice Amplifier Space Maker
Companion to those in Pain Believer in Hope.
A blog from Laura Lyster-Mensh, an award-winning American writer, healthcare advocate, consultant, writer, and podcaster
I could write you a long essay on the recent BEDA/NEDA conference from the perspective of an eating disorder advocate. I have plenty to say about eating disorder science and practice and outreach.
But I’d like to say a few words from a perspective I don’t always make a part of my eating disorder advocacy but is more familiar and important in my life. I am a mixed-race 50-something raised by social activists. My family’s activism was around race and poverty and war. I grew up with a sign in my hand and a protest song in my ears.
Despite all the work of people like my parents, racism and war and economic inequality are still with us. But because of their efforts and those of many others, things are improved. Without their dogged attention to righting wrongs and helping others the world would be a worse place, and I would not be an eating disorder advocate. It was their example of showing up and speaking up that help me know when I need to do so as well. When I chose to be an eating disorder advocate I had already been an activist on other issues. I am a veteran of many campaigns and initiatives and times of change.
When I think of the BEDA conference in Brooklyn I think of my parents. I think of the lessons I learned from them and from those around me growing up. From them I absorbed that change is hard. Change is challenging and uncomfortable. Change sometimes feels intolerable, and yet, looking back, it was necessary distress.
Change is messy. It isn’t easy to understand, at times, what side of an issue to make our own, and there are times when we think we’re doing the right thing but learn that we were wrong. We learn we messed up or were blind and need to acknowledge that. We learn that people were angry at us, feared us, or misunderstood us and that it is our job – not theirs – to bridge those gaps.
The worst insult, in a community for whom caring and feelings are so important, is to be told we are insensitive. But what group would also have the skills – in fact be experts at TEACHING the skills – of listening? And behavior change.
For many, it was probably new and off-putting to hear language that was not only unfamiliar but not meant to comfort us. The vocabulary of change is rarely familar. Hearing the words privilege and intersectionality used over and over probably isn’t home ground for those whose focus and advocacy have been on eating disorders. Some have not been paying attention to growing discontent and frustration even within the field: and that’s okay. Pretty much everyone who uses those words now was once someone who found those ideas uncomfortable. But change does not usually come about in comfortable places. We know this. WE know this as well as any one.
As someone who has fairly often been seen as “angry” and “extreme” and “single-minded” I am very familiar with the feeling of making people uncomfortable just by showing up. Being in opposition to the mainstream, no matter how politely and patiently and reasonably, makes people uncomfortable. I am mixed-race: I have been making people confront their own discomfort from the cradle on. Occasionally, it genuinely makes me angry to be marginalized and misunderstood for my positions on issues and the long-delayed justice for issues that matter in this field. But show one bit of my frustration or create one conversation that starts with my position rather than apologizes for it and I can be dismissed. And that is familiar, too.
My heart was glad at the BEDA/NEDA conference. I didn’t agree with everything and I didn’t feel included or valued by everyone. But I felt at home in a way that I rarely do at eating disorder events not because everything that came off the podium agreed with me but because genuine discussion and argument and dissent were welcome. People took risks, and engaged. No one professed to be perfect and all that was asked of us was to be ourselves, not to hew to a view or ideology. Just to be ourselves and listen to others.
I felt at home at the BEDA/NEDA conference this year because I believe collaboration isn’t just kumbaya and holding hands but facing differences in the same room and making progress. We need change and improvement in our field. We need to not be rooms full of people who think, act, make our money, look, protect our egos, feel valued, and fear things the same way.
The aspirations and the humility of this BEDA/NEDA collaboration were, for me, like family. And, like family, we learn from and gain from the experience. Nobody gets to go off and sulk, or nurse injuries, or gloat for long in a healthy family. For the first time I have a lot of hope that we can be that family.
I applaud and celebrate what happened in Brooklyn. I look forward to the next opportunity!
Laura Collins Lyster-Mensh, M.S.
You may know Laura already. She’s been active in eating disorders advocacy for many years. She’s helped found three organizations in the field, written books on the topic, organized events, and been invited to speak to audiences around the world with her message of optimism for full recovery, family support around patients, and the importance of starting with the science when it comes to treatment.
Laura continues her mission with Circum Mensam LLC. She serves as a trusted advisor for clinics and treatment providers and offers her deep knowledge of the field from a parent perspective to educational and advocacy organizations. Starting in 2017 Laura is also providing services for parents as well: through private consultations and Starfish Packages.
Much has changed and improved in the past decade when it comes to eating disorders. Patients are being diagnosed earlier, getting into effective care more often, and recovering faster and more lastingly. But the rapid changes have not reached most families yet. Retraining and changing the way treatment is provided takes time and courage and the challenging of long-held myths. Laura truly believes that parents and treatment providers are doing the best they know how, but that we all can do better if we know how.
The Binge Eating Disorder Association (BEDA), in collaboration with the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED) and the Multi-Service Eating Disorders Association (MEDA), request your assistance to pass H.952, an act making discrimination on the basis of height and weight unlawful.
Representative Byron Rushing (D-Boston) has introduced a bill (H.952) in the Massachusetts Legislature that would make discrimination against individuals based on height and weight illegal. A tentative hearing date for the bill is scheduled for October 17, 2017 in front of the Joint Committee on the Judiciary.
Please CALL or EMAIL your state representative and senator as soon as possible with the following information. If you are not sure, you can identify your state representative and senator, and contact information for each, here.
When you contact your representative and senator, you should:
Leave your name and address.
Express your support for 952 (An Act making discrimination on the basis of height and weight unlawful) and tell the person with whom you’re speaking why it’s important:
It would protect Massachusetts residents from height and weight discrimination in employment, housing, and public accommodations.
Discrimination based on height and weight is common.
Discrimination based on weight is a significant risk factor for eating disorders.
Ask if your representative/senator can support the bill. (If they need additional information before they can support the bill, let them know you will have someone contact them to provide any needed information, then promptly notify Joslyn Smith at the email address below.)
If yes, please request that your representative/senator:
Contact the chairs of the Joint Committee on the Judiciary and express their support; and
Consider appearing at the Judiciary Committee hearing on October 17th to provide oral testimony in support of H.952.
Additional information about H.952 can be found here.
If you have any questions, please feel free to contact Joslyn Smith, BEDA’s Director of Policy & Government Affairs at email@example.com or (607) 280-6488.
Over 15 years ago I met a reporter writing an article on eating disorders for Time Magazine. We were both attending an event on Capitol Hill and she was looking for people to interview. We struck up a conversation and she asked me if I was there to support someone with an eating disorder. I shared that I struggled with Binge Eating Disorder (BED) and was attending the event to get involved in advocacy.
I could tell by the look on her fact that the reporter was confused. I knew she was thinking to herself, “How can this woman have an eating disorder – she is fat, not thin?” She asked me to tell her about Binge Eating Disorder and began writing a story about my journey.
I struggled with the same question about eating disorders and body size for years. I did not know anyone with the diagnosis of BED and my own impression was that people with eating disorders were either thin or very thin. Throughout my long history of eating disorders, I was sure that my relationship with food had to do with my lack of will-power. I thought my weight cycling and extreme obsession with dieting and losing weight was the expected outcome of someone who was morally defective when it came to food. Unfortunately, most of the places in which I sought help agreed with me. They could not give a fat person an eating disorder diagnosis despite meeting criteria for several through the years.
Since that time, I have met people in higher weight bodies with eating disorders – lots of them. I now understand that an eating disorder can manifest in any size body and that the stereotype of a thin, white, emaciated teen-ager is the minority in terms of who is affected by these dangerous disorders.
Why is it important to know that eating disorders do not discriminate based on body size? According to the National Eating Disorders Association (NEDA), 32 million people have an eating disorder at some time in their life. This, combined with the mortality rates that put eating disorders close to the top of the list of lives lost from mental health issues, it is critical that we recognize and treat ALL people who are in the throes of these illnesses.
Across the spectrum of eating disorders, every body type and size can be found. A person presenting with Anorexia may be in a body that is higher weight. Like-wise a person with BED may be in an underweight body and assummed to have Anorexia or Bulimia.
Most people interact with someone with an eating disorder on a regular basis and are not aware. Perhaps the person who checked you out at the grocery store has Bulimia or your doctor has BED. Maybe your friend’s son has Anorexia. In most cases, you will not be able to discern whether or not someone has an eating disorder by the size of their body.
Fortunately, I found a therapist many years ago who did not make assumptions about me or my relationship with food based on the size of my body. She listened carefully to my journey and recognized that many of my behaviors sounded like an eating disorder. She did not tell me that I needed to change anything about my shape and size. She recognized I was in pain and needed relief. She worked on the underlying issues that manifested the need for an eating disorder and helped me find acceptance around my higher weight body in a thin obsessed world. She helped me find the resilience to heal and become the advocate I am today.
It’s time for healthcare providers who are the first line to mental health disorders to be more aware of who is at risk and who may be struggling. This begins with the recognition of what someone with an eating disorder looks like: you and me.
I hope that the Time Magazine reporter that I met all those years ago would not have the same reaction if she were to meet someone in a higher weight body at an eating disorders function today. She would recognize that anyone in the room could be struggling or recovered. She would know, as she walks down the street, that she cannot discern who has an eating disorder and she would realize that she cannot make any assumptions based on body size.
By the way, that story that the reporter wrote was a very comprehensive report on eating disorders and talked at length about the many misconceptions including size. It never saw the light of day because Time Magazine’s editorial director, back in early 2000, thought it was more important to do a story on obesity since “eating disorders are a small problem in comparison.”
BEDA is pleased to welcome Joslyn P. Smith as Director of Policy & Government Affairs. In this role, Joslyn will be responsible for developing and managing BEDA’s federal agenda, coordinating and strategizing with other national eating disorders, mental health, and healthcare provider organizations, monitoring regulations and legislation, and serving as the primary liaison with Congress and the federal executive branch. She will also provide analysis of proposed legislative actions, determine the potential impact on the organization, and develop organizational positions.
Joslyn brings experience and expertise to her new position, having previously served as Senior Legislative Assistant for the American Psychological Association’s Public Interest Government Relations Office in Washington, DC, where she was charged with establishing APA’s legislative portfolio on eating disorders and obesity prevention, where she focused her efforts on informing federal policy from a Health At Every Size® perspective. Prior to her work with APA, Joslyn worked on health, mental health and appropriations issues with the staff of then-Senator Hillary Rodham Clinton.
After spending the past seven and a half years focusing her time and energy on beginning a family in Ithaca, New York, Joslyn is honored to join BEDA and have the opportunity to re-enter both the policy and eating disorders fields.
The Need for Well-Trained Clinicians
Binge eating disorder (BED) may seem new since it was just added to the official list of mental health diagnoses. But the truth is that using food to manage difficult internal experiences and emotions has been around a long time! While it’s official status is “young” in the eating disorder (ED) world, well-trained clinicians are desperately needed! The problem being that many clinicians haven’t been properly trained on how to treat BED, which is distinctly different than treating weight. Often, clinicians conflate the two and unintentionally create a whole host of problems!
While the ED field has a long way to go in developing substantive research to guide our treatment protocols for BED, we must borrow from related fields of research to guide our way.
The first area of research ED clinicians need to become familiar with is weight stigma. Similar to other oppressive forces in our culture, weight stigma infiltrates all of our lives in sneaky and insidious ways. And sadly, even ED clinicians are top offenders when it comes to bias and stigma relating to weight.
What is Weight Stigma?
Check out this succinct PDF on weight stigma developed by BEDA. In short, weight stigma is negative judgment, bias, assumptions, attitudes, and treatment based on a person’s size. Most importantly, when a person experiences weight stigma it makes them vulnerable for WORSE health outcomes. This means that when people are stigmatized they are less likely to get proper care and are less likely to improve in any health parameters. This is why a weight neutral approach to improving health of people suffering with BED.
Why A Weight Neutral Approach
A weight neutral approach makes no assumptions about a person’s health or habits based on appearance. And it deems every individual deserving of health enhancing interventions regardless of whether it produces a change on the scale. Two important philosophies, Health at Every Size (HAES) and Intuitive Eating (IE), provide the scaffolding and guidance for clinicians to generate interventions that will improve the health of clients without interjecting harmful weight stigma. Integrating these philosophies into the backbone of BED treatment is critical to helping without harming.
Seeking Additional Treatment
It is imperative that ED clinicians seek additional training in weight stigma, HAES, and IE. I have developed an online training for ED clinicians that is focused on how to provide nutrition specific counseling that is HAES informed, weight neutral, and grounded in research. I developed it because I am passionate about reducing weight stigma and improving treatment for people with EDs. There are relatively few resources for clinicians so I created a training that is affordable and accessible from your own home. If you are interested you can learn more about it on my website.
Additionally, here are some other resources I recommend:
Let’s elevate the field of ED treatment and provide our clients with BED with the best possible care.
Marci Evans, MS, CEDRD, cPT manages a group practice in Cambridge, Mass. that specializes in treating eating disorders and body image concerns. Connect with her via social media on her blog, Facebook and Twitter.
Protecting your recovery during the holiday season can be difficult. It is important to brush up on relapse prevention skills and be mindful of complicated situations that can occur around food, body image and exercise. In this discussion, we will identify ways to put your recovery first by planning ahead and being proactive. It will include ways to cope with overwhelming situations and how to manage your meal plan at holiday get togethers. There will be discussion on how to utilize your support system as well as reminders of internal resources. This will help to prioritize your recovery during a chaotic time and allow you to enjoy the fun of the holiday season!
Facebook LIVE Discussion: Maintaining Recovery During The Holidays - YouTube
By Wendy Mathes, MS, PHD, LPCA, NCC, DCC
The concept of “creating a new normal” is often discussed in therapy as individuals work towards recovery from an eating disorder. For those who struggle with binge eating, recovery may mean establishing a new relationship with food, finding new ways to communicate with family and friends, or a defining a new way to approach and cope with stressful situations. With the holiday season upon us, you may be faced with challenges on the path to your new normal. Holiday stressors, crowds, and traditions and events centered around food may make it difficult to depend on the skills you have established – and may threaten to take you off course in your journey toward recovery from binge eating. Acknowledging the past without judgment, being in the present as an observer of the current state of things, and thinking about what’s working and how to incorporate those things into your future can be beneficial in helping you reach and maintain recovery.
As you look back at the year, it can be helpful to identify circumstances that led to binge eating. We know that periods of vulnerability, such as feeling stressed, tired, and/or out of control, increase the probability of a binge episode. It’s important to identify your red flags and vulnerability factors so that when you’re faced with these conditions in the future, you can rely on coping strategies that will mitigate binge eating. Throughout this process it’s important to not condemn binge eating behavior. Instead, remember to practice self-compassion and acknowledge these episodes without judgement.
During the chaos of the holiday season, it can be difficult to set aside time for self-care. However, it is especially important during this time to practice mindfulness, stay in the present, and take the time to observe your physical and emotional state. Mindfulness helps to reduce stress, anxiety, depression, and other vulnerability factors that contribute to binge eating. At the same time, it can help you to find joy during this busy season.
Engaging in this practice of reflection and mindfulness will help you to identify skills that have helped you find success in your work towards recovery. This can also be a reminder that you have skills to draw upon in moments of vulnerability. Sometimes when life begins to feel out of control, the automatic drive towards binge eating takes over. With continued practice, the coping skills you have successfully used in the past can become your automatic response to stress, decreasing the probability that binge eating will prevail in the future.
In facing the New Year, my wish for you is that you look toward 2017 with hope for an even brighter year ahead. Each day is a step toward recovery and to reclaiming your life and your well-being. No matter where you are on your journey, whether you’ve just begun or you’ve been at this for a while, I hope this new year leads you to find your new normal, and that 2017 brings you new victories and increased confidence in your abilities to continue working toward recovery.
Wendy has 15 years of experience in research, education, and clinical mental health. Prior to joining Veritas, Wendy worked as a counselor at the University of North Carolina at Greensboro counseling center, where she provided group and individual therapy for individuals with eating disorders, among other mental health concerns. Wendy also worked as a research scientist studying the neurobiology of psychiatric disorders and was a member of the research team at the UNC Center of Excellence for Eating Disorders. As the Outreach Education Manager, Wendy aims to increase awareness of eating disorders and their treatment among medical and mental health providers, educators, and the community. She earned a Master’s degree in clinical mental health counseling with a specialization in sport psychology from the University of North Carolina at Greensboro. She also holds a MS and PhD in experimental psychology from Tufts University in Medford, Massachusetts.