Conversation 27 - Hiding in Plain Sight: Diet Culture, Shame & Disordered Eating

Dr. Jillian Lampert (she/her), a distinguished expert with over 30 years dedicated to understanding and treating eating disorders, joins us to shed light on her inspiring journey and profound insights. This episode explores the intricate landscape of eating disorders, focusing on the pervasive effects of diet culture, the impact of social media on body image, and the need for increased awareness among counselors. The conversation highlights the importance of recognizing disordered eating behaviors across diverse demographics and urges professionals to ask the right questions to uncover these hidden struggles.

• Understanding the pervasive influence of diet culture  
• The impact of social media on body image perceptions  
• Recognizing emotional and psychological consequences of eating disorders  
• Overlooked demographics affected by eating issues  
• Importance of counseling in destigmatizing eating disorders  
• Resources for individuals and families facing eating disorders  
• The role of counselors in challenging harmful narratives surrounding food  
• Encouragement for open conversations about eating disorders and recovery

Mentioned Resources:

Jillian Lampert: https://emilyprogram.com/about-us/leadership-team/jillian-lampert/

National Alliance for Eating Disorders: https://www.allianceforeatingdisorders.com/groups/

FEAST: https://feast-ed.org/

Peace Meal Podcast: https://emilyprogram.com/peace-meal-podcast/

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Created by the OCA's Media, Public Relations, and Membership (MPRM) Committee & its Podcast Subcommittee

·Hosted by Marisa Cargill

·Pre-Production & Coordination by Marisa Cargill,  Kendra Thornton, and Victoria Frazier

·Editing by Leah Wood

·Original music selections by Elijah Satoru Wood

·Closing song: Accretion Discotheque by Who AD

Transcript

Marisa 0:04

Welcome back to Ohio Counseling Conversations, the official podcast of the Ohio Counseling Association, bringing you updates and conversations from around the state. On today's episode, we're joined by Dr Jillian Lampert, a trailblazer in the field of eating disorders, with over 30 years of experience as a clinician researcher, advocate and leader. 30 years of experience as a clinician researcher, advocate and leader. As the vice president of communications and brand for the parent company of the EMILY program and Gather Behavioral Health. Dr Lampert has dedicated her career to improving treatment standards, access to care and advancing collaborative research. In addition to her impressive academic and professional credentials, dr Lampert serves as a co-founder and president of the Residential Eating Disorders Consortium and is a passionate educator and advocate. Stay tuned as we dive into her vast expertise and insights on diet culture and ways counselors can support individuals navigating eating disorders.

Marisa 1:01

I'm your host today, dr Marissa Cargill, a counselor, educator and counselor in Northeast Ohio. Let's dig in. Welcome back to Ohio Council and Conversations. I am your host, marissa Cargill, and I am joined today here by Jillian Lampert from the EMILY program. We are so excited to have you with us today. Thank you for joining us, jillian.

Jillian 1:24

Thanks for having me.

Marisa 1:26

Yeah, we're so excited to talk to you, and I think this is such a relevant conversation and one conversation that we really haven't had on the podcast yet. So before we kind of dig into that, please tell us a little bit about yourself and what brought you into this line of work.

Jillian 1:40

Oh, I was in the right place at the right time. I think that's how I found myself here. But so I have worked in eating disorders for about 30 years, which seems wild that it's been that long. But I really got into eating disorders because I trained at. I'm a dietician by training, have a PhD in nutrition and epidemiology and I've done a lot of eating disorders related research.

Jillian 2:01

But I found myself here because I trained at a at a hospital for my dietetic internship that had an eating disorder program and it was one of the few eating disorder programs in the country at the time and I don't think I realized that there, you know, were only a couple eating disorder treatment programs across the country.

Jillian 2:18

But I trained in this program and all of my other fellow interns were really nervous about the eating disorder rotation.

Jillian 2:23

All of my other fellow interns were really nervous about the eating disorder rotation specifically and the mental health rotations generally, and I was sort of curious about why they were so nervous about it. My rotation was a little bit later in the year and I got up to the floor where it was part of the part of the floors with multiple mental health units in this part of the hospital and there was a separate unit for folks with eating disorders and I just felt at home. When I stepped on the unit, I started talking to clients and I just felt like, oh well, this is sort of where I, where I belong unsurprisingly because I had an eating disorder as well. But when I had an eating disorder, nobody really knew what to do and how to treat it and it it was sort of a it was very difficult experience, but I found myself so at home among eating disorders and I didn't even really realize that I could have a job in that area.

Jillian 3:13

I really didn't set out to do that, but I found myself there and loved it and felt really comfortable. And then, from then on, each time I've had something sort of unique happen, whether in my education path or my employment path, where somebody has said like, oh, does anybody know anything about eating disorders? And I'm like, well, I do. And so I've gotten to do a lot of different leadership and clinical areas of expertise and study and work for the last three decades, because I've I don't know. I think I've just been in the right place at the right time and found myself excited to do it.

Marisa 3:46

I always joke with guests because I, um, I teach career counseling and I have worked in a college setting where I've done a lot of career counseling and EAP work, where there's some career stuff there too, and I'm always interested in how people um kind of come to the line of work. But that is sometimes like it's just like right place, right time, so like weaving into the area where you work diet culture, like it's a hot topic. It's really ingrained in our society and something that I feel like or have witnessed being talked about a little bit more but maybe not fully understood. Can you tell us more about it and how there's like this constant pressure to conform to certain standards that might make it hard for people to recognize actual disordered eating or eating disorders?

Jillian 4:37

Absolutely. When I talk to people and say I work with people with eating disorders, oftentimes people say something like doesn't everybody have an eating disorder because of this world we live in? And not everybody does, of course. But it's so true to your point that diet culture is just the bedrock of our society in a lot of ways that it's how we encapsulate food judgment and body judgment and how we think about whether we're okay as human beings or not, based on what we're eating and how we look and do we measure up. And of course all that is connected to whether or not we feel like we belong and we are accepted, and that's. There are a few more powerful forces right Than whether we as human beings feel like we belong in a group.

Jillian 5:18

And so diet culture really weaves its way through people's lives with subtle and overt ways that whether there's a pressure on an individual certainly a societal pressure to be a certain way, to look a certain way, there's a lot of societal pressure on how we eat, what we eat, how much we eat, who sees us eat, how we feel about what we've eaten, whether we're following certain trends, fads, that it really just becomes I don't know the water we swim in and we sort of get to see it and then with somebody who's really struggling with with more sort of the extremes of that.

Jillian 5:55

I teach at the University of Minnesota and I tell my students all the time like diet, you know, diet culture is this spectrum. Eating disorders are just the ends of the spectrum. Like nobody with an eating disorder has invented a new thing that human beings haven't done in the name of diet culture or some food-related ritual, eating disorders are just more the extremes of that spectrum, because there's so much disordered eating across that spectrum that people engage in all the time in the name of health or weight loss or following a trend or a food fad. So it really is so ubiquitous that sometimes it's hard to recognize.

Social Media and Eating Disorders Study

Marisa 6:34

Yeah, yeah, because you get so used to hearing certain things. I identify as an elder millennial and I laugh at a lot of the social media content that shares, like old commercials that I used to see growing up about, like Special K, for example, not to pick on them, but that like it was like, oh, eating this, to like slim down for spring break or stuff like that, where it was just so commonplace it's like literally in our advertisements and hard to avoid then as well. Yeah, speaking to that point, what role do you feel like social media, online platforms, media in general, play in shaping the body image and diet culture that contribute to development of disorders?

Jillian 7:27

Yeah, I think it's incredible the role that media plays and certainly not to put it all sort of all causal implications on the media there's. You know, when we think about eating disorders, there are multiple complexities to the to like who gets an eating disorder, and a lot of it is genetic and biological and certainly some of it is life experience and how somebody's temperament experiences that life experience.

Jillian 7:53

And then there's this big bucket of social influence and so many of us are spending so much of our time on social media or have so much of our social capital connected to social media that it's you know, we're way past those days where we might remember seeing advertisements or stories on magazine covers, when you're waiting in line at the checkout store, when you see something in a movie, and it was so much more intermittent 10, 20, 30 years ago and now it's so constant, and I think that's part of the issue, is that it's the social media barrage we get is so constant and it's so tailored to us, right, it's so specific.

Jillian 8:33

And so, if we think about eating disorder development, we know that the onset of eating disorders typically is in the adolescent years, but that anybody of any age can have an eating disorder, and we see this sort of spike in diagnosis in later adulthood as well.

Jillian 8:49

And so we have this young adolescent period in this later adulthood, and you think about the things that happen in those time periods, right, you get puberty which who wants to do that again? And the pressures that go along with puberty, and particularly amplified on social media now, with all of these images of what you could look like. And of course, we all know somewhere, or most of us know somewhere in our you know our reasonable lines, that most people don't look like that, but it sure feels like everybody does and it sure feels like everybody looks better than us or different than us or is achieving things we're not. And then social media advertising comes in and tells us that, right, like all of our needs are so personalized to us to really help us feel like if we just did these things then we could be okay too.

Jillian 9:29

And the same thing happens throughout the lifespan, that we're seeing more and more eating disorder diagnoses among menopausal women, and when you look at the perimenopause and menopausal space, there's incredible social pressure on social media and advertisements to magically avoid aging and all the changes in the body that happen around perimenopause and menopause, that I think social media just feeds us the information to perseverate on constantly and then helps us to perseverate and then, if it does its job, it helps us to buy products that deliver us the best, products that don't work, and then we have to go back and get more.

Marisa 10:07

So it's a really dangerous you put that on all the time mentality, compared to maybe past generations who could close the magazine or turn off the TV, where, like, yeah, intentionally, you can like put the phone down, but that one is a lot harder, more challenging and way more accessible. Yeah, okay, you mentioned some physical elements with, like menopausal, perimenopausal women, and I know that eating disorders go beyond the physical. Right, we hear a lot about the physical because that seems to be some of the first things that people maybe can witness like they actually see. But what about beyond the physical? Can you tell us more about those other consequences, emotional, social, psychological consequences of the conditions?

Expanding Understanding of Eating Disorders

Jillian 10:59

Absolutely. It's a great point, because I think what most people don't realize is that only about 6% of people with an eating disorder quote unquote look like they have an eating disorder. Like if you looked at them you might think, oh, that person is significant and that tends to be what we think about as defining an eating disorder. But 94% of people don't quote unquote look like they have an eating disorder. Their bodies might appear to be a weight that we wouldn't qualify in our minds somehow as matching what we think about as somebody with an eating disorder. They might be a quote unquote normal weight or quote unquote overweight, and so we can't really tell. And so, to your point, you can only see some of the physical signs for a very small percentage of people, and the other pieces that we don't see are people's inner experience, where they're struggling with trying to decide what to eat, how to eat it, who's going to see them, how they're going to feel when that happens, navigating schedules or how to eat in front of people or how to get an exercise before, after or during interactions. See the sort of hamster wheel that people's brains run on constantly around food and weight and judgment and appearance, and what their emotional experience is that if I could just get more of this I might feel better. If I had less of this I might feel better.

Jillian 12:16

That it's a constant barrage of stimulation that people feel like and describe as sort of noise in their brain that they're just like have this low level or high level depending on the time and place and what's happening, sort of interruptive noise that they just hear all the time about. What about their bodies? What about this, what about that? What about who sees them eat? What about the judgment they have about themselves? That's constant and makes it really difficult to get anything else done. That's, ironically, part of what eating disorder behaviors do, by inducing this sort of restrictive kind of semi-starvation or, in the case of binge eating or overeating, sort of numbing. And either way, people find that constant barrage of noise quieter. And so the sort of behaviors are in this sort of you know, sort of evil circle of of helping to quiet that noise while at the same time putting somebody's life at such risk.

Marisa 13:13

Yeah, yeah, like that compulsion, almost it keeps it like at bay. Yeah, also makes the client, the patient, unsafe, exactly, and I appreciate you mentioning like the statistic about like only 6% of people maybe like visibly look like they might have an eating disorder. And I think that that's really important for counselors to be aware of, even if not treating eating disorders but like in an initial intake, understanding like well, they maybe shared something that was like of concern, but like who doesn't like think that and it's like, yeah, but that might be part of the problem and why it goes kind of under the radar for a lot longer Exactly.

Jillian 13:59

Well, and particularly since we know that the things that counselors do see more frequently go hand in hand with eating disorders, right? So anxiety, for example, there's. You know the statistics vary, but anywhere from 60 to 90% of people with an eating disorder will struggle with anxiety. Well, how many of us see folks for anxiety? Right, there's so much seeking of care that's really more rooted in anxiety, and if you don't ask the questions about eating, you won't. People generally won't offer, unless they're asked about it, right, that they may be more willing or more able to talk about anxiety and the difficulty they have in their lives with managing their experience of anxiety or depression.

Jillian 14:36

We know that depression additionally shows up in a significant amount of people. More than half of people with eating disorders will experience depression. Sometimes you can't even really tell if it's diagnosable depression or if it's malnourishment that leads somebody to look like they're struggling with depression because of the ways that malnourishment is expressed in the body and in the mood. And so if you're seeing anybody for anxiety or for depression or for substance use disorder, those are very likely co-occurring conditions with eating disorders. And if you don't ask, people probably aren't going to be offering that information as readily, and we also know other things like OCD or ADHD. If you're working with somebody on the autism who is a diagnosed with autism, eating disorders are much more likely in those populations.

Marisa 15:21

So, probably people are seeing folks with eating disorders even though they might be aware that they're seeing them for some reason, yeah, and that the client may say I'm presenting with this thing. But what I've witnessed in my own work too is that there's a lot of self-hatred, self-loathing that might come up as like image issues or, you know, like depressive symptoms, ocd, even, like but that, and I've seen like actually that you know Venn diagram with ADHD as well, but that if you're not kind of digging into those more, you may not unpack that. Oh, there's more here, exactly, okay, beyond, like just the consequences and the ways like we know it may affect people. I think there's a lot of assumptions around who, like eating disorders, affect that. It's like primarily young, white, like adolescent females. Can you talk to us about how eating issues or disordered eating manifests across a much broader spectrum age, gender, race, ethnicity, socioeconomic status? Yeah, absolutely.

Jillian 16:42

I think we definitely tend to think of eating disorders as just impacting a slice of the population, and that's really because that's the slice of the population that has been written about, studied, shows up in popular media or popular culture, also is a part of the population that tends to have more secure access to treatment and more secure access to treatment coverage through insurance. But what we know is that there are other populations that are at really high risk of developing or having an eating disorder that we tend not to even think about and that when we do think about them we realize that they go underdiagnosed and undertreated. So when you take a couple examples of that, we look at a population of folks who are BIPOC, who identify as BIPOC, that folks are twice as likely in some situations to be struggling with an eating disorder and half is likely to be accessing care, and so you have an issue that's more likely but you are not going to get care for it because mostly because nobody will ask, or that access to care isn't offered because nobody has asked and nobody has thought about you as somebody who might be struggling with this illness. So we see a significant lack of access to care for folks in the BIPOC population. Similarly, we see folks in the LGBTQ plus IA population who are, some of the statistics will indicate, about four times as likely, particularly transgender kids, youth, who are much higher risk of disordered eating but are not asked about it or are overlooked by their healthcare access, and so they're struggling with an eating disorder but nobody's asking and they're not getting any treatment for it. And it's getting worse.

Jillian 18:21

And we know that that's true in whatever the population is that if you don't ask, people are less likely to offer, and if they don't get treatment, people are less likely to recover. And they're because of the truth. We know about eating disorders that they have the second highest mortality rate of any mental health diagnosis. Folks who are undiagnosed and untreated are more likely to die from their illness, and so we tend to, for some reason, remain sort of attached to these myths about who gets eating disorders.

Jillian 18:52

And then, with the age and the gender, when we look at the population data and we don't have really good as a field, the magical, we as a field gender diversity in our data, but when you look at the data that have been collected over the past 10, 15, 20 years, when you compare a male and female population. You see about 60% of people with eating, 60 to 65% of people with eating disorders are female and the remainder are male. In that sort of binary gender perspective setting, you don't see 35% of the people in a treatment center being male and 65% being female. You see a much closer to sort of 90-10 split. And so we know that far more males get eating disorders than show up in any treatment situation, whether it's individual treatment or a group-based treatment in a treatment center.

Jillian 19:45

And so we have this gender gap where people because probably of the myths that surround eating disorders and probably the larger conversation we have as a society around women's experience of being judged for our bodies and our appearance and being objectified for that that we tend to think about eating disorders more as something that impacts women. But actually it's much more impactful for males than we realize, particularly young boys and young men who are really striving for muscle and for strength and for bulking up. I think that's a completely overlooked piece. And then the piece that we mentioned earlier in perimenopausal and menopausal females we see a lot of those eating disorder behaviors either come roaring back or showing up for the first time, and we tend not to think about those folks, because we're we're just sort of again sort of stuck in that myth of who we think we should be asking about eating disorder behaviors.

Marisa 20:39

Yeah, and when you said that about men and like the bulking up, I couldn't help but think of like the influence of both on like men and women, but like sports or athletics, like certain expectations maybe of of certain athletes that that can be challenging, like wrestling right, making weight, like that's the first one. I thought of that like yeah, that could kind of set some really bad patterns up for someone.

Jillian 21:14

Right, right, and it's true that a lot of athletes.

Jillian 21:16

A lot of athletic performance requires a really intense time during season or competition of you know, moving your body in a certain way and eating a certain way, training a certain way. For most athletes they sort of go off season and maybe go back to more normal eating and more normal activity. I think the issue is, as increasingly as seasons have gotten year round, particularly in younger and younger ages, that there's you know club this and school this and intramural that, and so you can do your sport year round, versus having a season where you then you went back to doing whatever you were doing, that we're seeing more intensity around performance related eating and moving focus, and so that kids and young adults are never getting a break from the intensity of training. There's a really great. It just came out recently, in early December, a short movie called Generation Flex no-transcript.

Marisa 22:48

Yeah, exactly, what are some like signs that people maybe miss because they're subtle or they're unexpected signs when we are trying to assess for an eating disorder, and how can we better educate ourselves to like be more aware of these things?

Jillian 23:06

Yeah, I think it's a good question because I think we ask some screening questions and, again, if we're in a relationship with a client where they're not fully ready to disclose yet or they're not certain yet of the trust and the support in that relationship, they might not be fully accurate in their depiction of what's happening.

Eating Disorder Red Flags & Resources

Jillian 23:29

I find that one of the questions to get the conversation started is to ask somebody like tell me about your relationship with food. Because if you don't have any, if you don't have any distress in your relationship with food, or if you don't have any quirks about food or worries about food or your body, you probably will get kind of a blank stare, Like what do you mean? My relationship with food? And that's probably somebody who's got just a fine relationship with food and they're eating when they're hungry and they're stopping when they're satisfied and they just don't have much of a disruption. I find when you ask people like, tell me about your relationship with food, they're like, oh, they sort of lean in and tell you. Or if somebody is not engaging in disclosure about that relationship, you tend to get a response that makes you want to ask more, Like, okay, Most of the time when people say it's fine. We want to know more.

Marisa 24:24

I'm like visualizing responses I've gotten that are like hesitant or just like um, I mean like it's okay, like yeah yeah, for sure.

Jillian 24:35

I think that's a great you know entry into. Like well, tell me more about it and you know what's your relationship with your body Like? How does that feel Like? Just those more general questions that help you to get not only at people with with eating disorders or might have an eating disorder diagnosis to be a little bit more comfortable disclosing, but also gives you, I think, andre, into the realm of disordered eating and body image, dissatisfaction and distress that people feel so frequently and gives them a place and an arena to talk about it.

Marisa 25:07

Yeah, helps those subtleties come out in conversation. Yeah, are there any red flags that we should be really mindful of when we are assessing and meeting with new clients? To say that should like get my spidey senses going like off.

Jillian 25:24

Yeah.

Jillian 25:24

I think if you're when you're, you know you're doing your your and you notice that somebody is saying things about their activity routine that make you really question like well, that sounds really intense, I should ask more questions about. That. Seems like a lot of time at the gym that this person doesn't seem to be presenting as a lot of time at the gym. Or if somebody is presenting as having their day-to-day experience, with their routine being very rigid. And when you try to push a little bit about like oh well, you know, tell me, but are you eating mostly at home or at work or at school or whatever? The situation is that when you pick up that somebody doesn't really want to talk about their eating, it is just has that flavor. It's not like they don't want to talk about it because that's not the main issue that they came to see you for. It's more that they don't want to. They don't want you to ask questions about it, which is a different feeling, right? So I think if you pick up on the, on the feeling that somebody doesn't want to answer any questions about food and eating and their experience, their body, and that's where I think presenting them as just you know, we all have bodies. We all have experience in the society. I wonder what your experience is in the society that tells us so much about what we should look like and how we should be and achieve, because it's so tied into our mental health. So I think it's a natural thing to ask people about, like you know, tell me about your eating patterns, tell me about your relationship with your body, tell me about your relationship with food, tell me about your relationship with movement. How does it feel to live in your body?

Jillian 26:52

When people start to talk about that, you can so easily pick up on those red flags of that. They're very they they're feel very isolated in in how they're eating and moving. Behaviors are keeping them isolated from peers and from family. They may feel very defensive about their, about their behaviors. They may feel very reluctant to talk about them. They may feel very obsessive in their descriptions of those behaviors and they you often can pick up on that sense of like. Maybe you're not getting the whole story and we tend to know that feeling of like. Okay, there's more there and when you feel like that about somebody's eating or moving, that can be a pretty big red flag.

Marisa 27:34

Okay, what kinds of resources beyond, like the Emily program itself, do you think, like counselors, would benefit from being aware of and engaging with to support anyone who maybe is dealing with disorder eating or an actual disorder?

Jillian 27:54

There's some really great online virtual free support groups that are run through the National Alliance for Eating Disorders. We love our friends over at the National Alliance. They do support groups seven days a week. They have some particular focus areas for support groups. I think they have a BIPOC focus support group. They have an LGBTQ plus support group. They have a family, friends, supporters support group. So it's a place for people to get information and support.

Jillian 28:24

And I always tell people like have your clients go, check it out, it's easy, it's free, just go to the allianceforeatingdisorderscom. I think is their website. You can click on the support groups, you can get the Zoom link and you don't even have to say anything. Like people can join the support group and not even say anything and they can just sit in the group and listen. And I think that the piece that's so beautiful about that is that people find out that they're not alone. That's so often people with eating disorders feel like nobody's going to understand this thing that they do. Nobody's will even sort of believe that it's possible that that happens or they'll. They feel like I must be the only person that struggles this much with my relationship with food and with eating. And why is this happening to me, and they get into these groups and they're like, oh, there are people that struggle with the same thing. So I love the National Alliance for the support groups they offer.

Jillian 29:15

There's also a lot of great education and information on their website. The National Eating Disorders Association has a lot of great information on their website as well. There's some great resources for families, a lot of information there. There's another great group for families called Feast. That's all about families empowering and supporting their loved ones with eating disorders and Feast has all these great educational videos and different support opportunities for families or for families and the person struggling with eating disorder. But I find for folks that are working with adolescents, families generally don't know what to do to support their adolescent because they, you know, we don't, how would you know? And so I think finding those resources for families can be really, really helpful.

Jillian 30:02

And then I think there's the last thing I'd say is there's a lot more. You know, when I started in this field a long time ago, there were very few stories that people like first person memoir kinds of stories that people were sharing, and now there's all kinds of ways to access stories about people in recovery, like people who had an eating disorder and recovered. We do a podcast in the family program called Peace Meal that has recovery stories. There are lots of recovery story books that you can get on Amazon. You can just Google, you know eating disorder memoir and get hundreds of books. At this point there are different social media channels that talk about recovery and I think it's a little tricky when you go on social media to find eating disorder information because so quickly you can find diet culture-fueled information. But eating disorder recovery stories are so much more readily available now and people can hear from other people who are recovered and are better and are doing well that it's possible.

Jillian 31:01

Having an eating disorder is of all the people that I've talked to in my career who've had an eating disorder, and I can attest to this personally too. It's a really difficult illness to have. These are tenacious, horrible illnesses to experience and most people feel like, oh my gosh, I'm never going to be able to get better and they hear somebody talking about their recovery story like, yeah, that's great, but what about me? I don't know that I can do that. So I really encourage people to just hear from other people. It is possible, recovery is totally possible and it's way better than having an eating disorder. That, I think that's you know. We know so much about the neurobiology of eating disorders now that the brain gets so sort of set into these neural pathways of of dieting and restricting and overeating and whatever the person's doing that it feels so hard to change that behavior.

Marisa 31:48

Yeah.

Jillian 31:49

And it feels so much better once that behavior is changed and new behaviors are established. It just takes a while. It takes way longer than than it would be great if it didn't take that long, but it does.

Marisa 32:00

Yeah Well, if it's something that's been ongoing for so long to kind of hiding in secret, it's also going to take some time to to shift, and so there's a lot of stigma. When it comes to that, there's a lot of shame. When you were talking about the groups, I was thinking like, yeah, because there's less shame when you realize you're not the only one or you're, you don't. Oh, you too. Like that, shame dies and sometimes those support spaces. But how do you feel like stigma related to eating disorders has changed depending on population, whether it's, you know, race, gender, age, Can you talk about?

Jillian 32:43

that I think awareness is much broader. Right, we know more about eating disorders now than we did even a few years ago. I think about all of the journalistic attention eating disorders got during the pandemic and I think it was because people were, you know, experiencing relationship with food and body in different ways and we're feeling isolation and lots of anxiety. You know, if you were going to, if you were going to invent an eating disorder in a blender, you put in a big dose of anxiety, a big dose of isolation and a huge dose of social pressure to look and eat a certain way and out of that you create an eating disorder. So a lot of people during the pandemic either developed an eating disorder for the first time or experienced a relapse in their eating disorder. But I think that the piece that the reason I bring that up is that reading about it in a newspaper article or a magazine article or hearing a piece on somewhere or seeing it on social media really, to your point, sort of helps, you know, make that shame go away or dissipate, because, oh, other people have this, it's not just this thing that nobody understands. So I think the increase in awareness is really great. I think that the tricky part about it is that we have such you know it's sort of where we started this conversation Diet culture is so strong and there is this expectation that if we all just try hard enough, we're going to be able to eat right and look a certain way, and it totally forgets the genetic diversity in size and shape that we have.

Jillian 34:08

The pressure on our society to weigh a certain thing or to lose weight if we're deemed overweight is so strong that I think that some of some of the shame and stigma from from having an eating disorder comes from like okay, uh, in a in a total sort of you know eating disorder perspective thought like okay, actually you did it wrong, you're supposed to thread that needle.

Jillian 34:33

To like lose the right amount of weight or eat the right way or look a certain amount of way. Look at the certain you know particular kind of way. Oh, but now you have an eating disorder Like it's. So it's just so societally cruel, I think, to say where did you go wrong? And particularly if you have an eating disorder that's not the kind of societally imagined eating disorder Like oh, you're struggling with overeating, you lose control around food or you're making yourself throw up or whatever it is that you're doing, that are behaviors that are not the ones that are going to get you the high five or the thumbs up Right. And so I think there's so much shame in that like, oh, I just can't get it right, and yet there's no right. Like right, we're all different bodies and sizes and shapes.

Marisa 35:18

There shouldn't just be one right, but it it kind of preys on that like desire to get it right yeah, yeah, it's um, dare I say like that capitalist, like, because they're, we keep selling a new, um, you know, a new goal, if you will like, oh, this, this year curvy bodies are in and this year, um, it's. No, it's model chic, like supermodel chic, like slender, and at to your point, the diversity of bodies allow for, like, all of these types of bodies to exist and be a-okay, but, like if you're trying to change the goals, it's like moves the needle and affects, like the, the psyche, psyche.

Jillian 35:59

Right, yeah, it's. The goal is always changing yeah.

Understanding Control in Eating Disorders

Marisa 36:03

Yeah, yeah. Um, this question I think is is a general, but I think it's really important because it maybe is hard for some folks to digest and understand is like what role does control play in eating disorders?

Jillian 36:17

I like to explain control as like a side effect of an eating disorder, because sometimes people think like, oh, somebody with an eating disorder gets an eating disorder to feel in control, and it doesn't generally work that way. It generally is a side effect. But if somebody is feeling in this world where we're supposed to look a certain way and do a certain thing with our food and do certain stuff with our activity, and somebody does that, and it starts to feel at the same time like, oh, I'm doing the thing that I'm supposed to do, yay, I feel good about accomplishing that thing. And then, wow, I feel like I can't stop doing the thing and now I feel kind of out of control. So I feel like, yeah, I'm meeting the standard, and now it's taken over my life and somewhere in that early stage of the slippery slope of the eating disorder, people feel like, oh, I kind of got this, like I'm deciding what to eat and deciding what to do to move my body, and I feel like this focus is really helpful. And I feel like, wow, things are going well and people are giving me tons of praise because I'm doing all the things, and so I feel more in quote, unquote in control. And so I feel like, oh wow, this kind of behavior results in me feeling a little more in control. Well, if, if that feels good which it does to many people who are sort of genetically wired to feel like feeling in control feels better, if that feels good which it does to many people who are sort of genetically wired to feel like feeling in control feels better, then why wouldn't I keep doing it?

Jillian 37:45

So people continue the behavior because it's societally reinforced. They feel a little bit more, a little more soothed, a little more ordered in their mind, a little calmer. Their anxiety often decreases, and so things feel pretty good. So why would you stop that behavior? It makes sense. And then well-meaning people come along and they're like oh no, I'm worried about you, you're doing this, that and the other thing with food, and they're like A, it's what you told me to do. And B, I feel better this way. And now I'm afraid that if I don't do these things, something bad will happen. And so I think that's where that control is really more of a side effect, and it's something that we end up working on in treatments with folks to say, like you can have that sense of, of mastery with yourself in your life, without having it to be about how many. This isn't that you put in your mouth different ways to feel that.

Marisa 38:39

Yeah, I'm curious because, like, the majority of the people who listen to this podcast are counselors, but I know that sometimes we get some just other folks listening. But counselors are human too. Like, what advice do you have for like, unlearning, diet, culture?

Curating Social Media and Eating Disorders

Jillian 38:56

Yeah, I think it's a great question and I think you're right because, you know, no matter what population of people you see as a counselor, you're going to see people with eating disorders, whether you know it or not, and you also probably going to see or have the experience, more likely, of working with a client and feeling something in your body that's that starts to make you feel a little uncomfortable about your appearance, about your appearance, and that, I think, is a really key thing to listen to. Like why is it that that person makes you, or you know your, your session with that person results in you feeling like uncomfortable in your body, or uncomfortable in your clothes, or overweight or not looking like you want to. It has really nothing to do with that person, it's really how you're experiencing it, right, and so I think the degree to which we, as as clinicians, like experience our own stuff is really important to know and to really be able to identify and be able to say like, oh, ok, yeah, I live in this diet culture, you know, dominated world, manage that. Like, how do I say to myself, yeah, ignore that ad. Or how do I scroll through my feed and not buy that supplement or that you know, cream or that, whatever. How do I support myself?

Jillian 40:08

And I think there's a, there's a way to cultivate. You know, I, from a social media perspective, I always encourage people to, you know, utilize the algorithms that feed us the damaging stuff to feed you. Pot yourself positive stuff. That that my, my, my instagram feed is full of pictures of baby animals, because I've cultivated a lovely feed of baby animals. That's great. It's so happy and uplifting and I'm like look at how cute and it doesn't make me feel bad about my body and I feel good about the world by looking at these adorable little pictures of baby animals. There's also some good research that shows that baby animals are like the happiest things our brain can see. So I'm like bring it on, and I cultivated that using the algorithms that fed that, you know, typically feed us all the dieting stuff, and so I feel like it's really like a cone upon ourselves to take a look at.

Jillian 40:55

Like, what are we fueling ourselves with? Like, how am I experiencing the world? Because it's so easy to get all the diet culture messages, but it's actually possible to get other messages that have nothing to do with diet culture, whether it's, you know, baby animals or travel or whatever it is. And then the to to what you said earlier is so difficult, but putting your phone down, said earlier, is so difficult, but putting your phone down like it's so it's so powerful, the pull of having having that information in our hands and the data are so clear that if we can put that down and then if we can ideally put that down and go outside, that's great Right. And so I think we have to really push ourselves. Just like we're going to work with clients, like how many times have we talked to clients about their social media diet? Like we have to do that too.

Marisa 41:47

It's so important.

Marisa 41:49

Yes, I appreciate all of what you shared there.

Marisa 41:52

I think curating social media is so important, and especially if you're seeing things that are contributing negatively to your well-being, and it's not to just look away when bad things happen.

Marisa 42:05

That's not maybe like the encouragement, but also if there's stuff that's just like hey, that's there and that is making me feel badly about myself, like that's something I need to check in as a human who is serving other people but also can encourage my clients to model the same, the same behavior. And I think I part of the reason I asked that question is because I I recognize, maybe from social media and things like that, where, if it, if an eating disorder goes unnoticed, or things like that where there might be someone who's talking about behaviors that are disordered, that are almost encouraged by like professionals, where there might be someone who's talking about behaviors that are disordered, that are almost encouraged by like professionals in there not just counselors, sometimes physicians and things like that of like, oh yeah, that sounds like a good like eating plan when you're cutting out foods, for example, and so I guess, like I just want to make sure that, like, as counselors, we're trying to unlearn some of those encouraging behaviors that may not be very helpful yeah, I think you're absolutely right.

Jillian 43:10

I think that the most common ones I hear that somebody will say like, oh well, I'm not eating any sugar, or I'm not eating any carbs, or I'm not having any treats, or I'm not like something that has judgment in it, like somehow those things are bad and I and everybody makes their own individual decisions and everybody's body is their own to figure out how it feels better or less better. And typically cutting out big chunks of a of of the diet is not such a great idea. A because most of the time we end up eating them anyway and then we end up eating more of them than we would have eaten before. So that tends to backfire on people. But I think the ideas of like, oh, I shouldn't eat these foods because those are bad, and if I don't eat them I'm going to be healthy, that really food is just food. It's really just carbohydrate and proteins and fats, like recombined in a bunch of different ways to get all the different foods.

Jillian 44:00

And when you hear people talking about like I'm cutting out this or that, I always get really curious. Like, oh, tell me more about that. Like what are you hoping will happen? Or what do you, you know, is that set of foods or that food difficult for you to have? Or what happens when you eat it? And that's a good way to get into like, oh well, I eat it and then this happens and that happens, or or I think this will happen, and you can really have an interesting conversation, I think, around, like what people's beliefs are, or what their, what their hopes are, and to see if that changing the way they're eating in that particular way is actually going to be helpful or, unfortunately, far less helpful than they think it'll be. And so I think that's a really great way to start that conversation of like, oh, tell me more about that. And and when we ourselves are doing it or find ourselves saying it to loved ones or friends or something to you know, ask ourselves like, what are we hoping for? What are we? What are we hoping will happen? And you can practice on on your friends and family and loved ones, because people say stuff all the time, so you can just, you know, like, oh, what are you hoping will happen? They sure do. Yeah, yeah, particularly during the holiday season, around all the holiday foods and then the New Year's resolutions, it's a great time, a lot of grist for the mill.

Jillian 45:15

But I find just asking the questions like we're just so connected to the magic of the promise of weight loss or of eating in a certain way and what's it all for? What's it going to get us and is it at all practical, is it at all realistic, is it at all for us? And, like you said, if everything worked, why would we need a new fad, like if that new diet worked? Why would we need a new fad, like if that new you know diet worked, why would we need another one next week? It's just to keep us focused on something that's all consuming. And what if we were, you know, didn't have to focus on that? We could probably solve a lot of other problems in the world.

Marisa 45:54

Well, right, yeah, I mean, if we're not focused on, like how we look all the time, mean, if we're not focused on like how we look all the time, like, then what other thing can be sold to us? Right, like you kind of are armored a little bit more if that doesn't penetrate as much. But I'll wrap it up with our final question, and we ask this question on every episode specific to the name of our podcast, which is Ohio Counseling Conversations. What important conversations do you think counseling professionals should be having with each other or their clients in our state or in general? I know you're not in Ohio.

Jillian 46:32

Yeah, I think through the Emily Program locations we have in Ohio, that here we hear from counselors and other folks a a lot are around. We need to. We need to talk about disordered eating. We need to talk about eating disorders, that we know that so many of our clients who we're seeing for other things, are struggling with eating disorders. And if somebody doesn't ask about eating disorder behaviors, like I was saying earlier, most people won't offer.

Jillian 46:58

And so I think that's super important to ask first about us. It starts with us like well, how do I think about my body? How do I think about food, what, what, like how might I hear clients through my lens of how I think about food and body? Right, I think that's number one critical and we teach all of our staff in in in Ohio and every other state we're in to think about that. Like, how are you hearing your clients through your own filter? And then, how are we asking questions? So, how are we hearing it? Then, how are we asking? Because, again, if we don't ask the questions, people won't typically offer the information. That doesn't mean that every counselor in Ohio has to be an eating disorder expert.

Marisa 47:35

Like you know, family programming help you and other eating disorders yeah, there can be referrals, but to understand and be aware so that, like there was the, that gap can be closed, so that the services can be offered.

Jillian 47:48

Yeah, and just to ask, because again, the second highest mortality rate of any mental health diagnosis. We all need to be asking more questions about eating disorders. And exactly like refers to somebody else. That's not your specialty, but but it's really important that we ask people. So I think, first asking ourselves and then, second, asking our clients.

Marisa 48:08

Awesome, awesome. Well, thank you so much, jillian. Is there anything else you'd like to add before we wrap?

Jillian 48:13

I'm just excited to have the conversation and appreciate your adding it to the to the you know list of so many things that I know that counselors have to think about, so I really appreciate it.

Marisa 48:23

Awesome. Thank you so much, and thank you for listening to Ohio Counseling Conversations. We'll see you next time.

Leah 48:36

Ohio Counseling Conversations is on a mission to make this podcast meaningful to you. Ohio Counseling Conversations is on a mission to make this podcast meaningful to you and we can't do that without your help. A feedback form is linked in the show notes for this episode and is also available on the OCA link tree. If you have any recommendations for topics or guests or any other general feedback, you can let us know by using the form. We welcome your thoughts so that we can continue to develop the podcast and grow as creators. The form we welcome your thoughts so that we can continue to develop the podcast and grow as creators. If you are interested in joining the team or being a guest, you can also reach us by emailing ohiocounselingconversations at gmailcom. We value your insight. Thank you so much for listening.

Marisa 49:17

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Leah 49:27

This podcast is brought to you by the Ohio Counseling Association's Media, public Relations and Membership Committee and its podcast subcommittee. This podcast features original music selections by Elijah Sotorowood and our closing song, accretion Discotheque by who AD. Views, beliefs or references mentioned in this episode do not constitute an endorsement or recommendation by the Ohio Counseling Association. The views expressed by guests are their own and their appearance on the podcast does not imply an endorsement of them or any entity they represent, and their appearance on the podcast does not imply an endorsement of them or any entity they represent. Views and opinions expressed by guests do not necessarily reflect the view of the Ohio Counseling Association or any of its officials. Thank you.