Eating Disorders

NUTRITION IN RECOVERY CURRICULUM

Nutrition in Recovery Group Curriculum is now Available! 

Nutrition in Recovery Curriculum

In 2012, I ran my first weekly nutrition group at a residential drug and alcohol treatment center in Los Angeles where I taught people about the link between nutrition and behavioral health.  We did not have a TV, so I put together various handouts as reading material for group discussions, based on information that I learned through my own treatment in 2005 & 2006. I’ll never forget the excitement of my first year running Nutrition in Recovery groups and building out the curriculum, and becoming a specialist working with this unique population. The experience was magical – I’ve enjoyed being contacted over the years and people sharing memories of that first nutrition group; someone recently told me that my trip with them to the grocery store while they were in treatment changed their life, and they are now sober working as a chef. This is in part due to the Nutrition in Recovery curriculum.

Nutrition in Recovery took off quickly and by 2013, I was running groups at several different treatment centers, conducting individual counseling and occasionally leading hands-on nutrition workshops. I took on dietetic interns and built out a legendary team of dietitians. We have run groups both locally in Southern California as well as internationally and have hosted various forms of staff training. To date we have contracted with over 30 treatment centers, including facilities that treat eating disorders as well as general mental health. During these years, I have refined the Nutrition in Recovery curriculum based on feedback from attendees as well as the facilitators, and of course the rapidly changing nutrition landscape. 

I have always tried to be available, but have never shared any curriculum, until now. The legendary Nutrition in Recovery curriculum is available to you. The content is designed to be delivered by a registered dietitian but can be done by someone who has a proficient background in nutrition and is attuned to recovery culture. Many of the slides have notes under them to help guide you through it all. If you or anyone you know is interested in conducting research using the curriculum, let’s talk.

The Nutrition in Recovery curriculum consists of 24 weeks of educational presentations, handouts, videos, games, activities, and discussion topics, all of which build upon the previous weeks, but can also be used in any order. Some groups include homework, recipes to keep, and are all designed to stimulate excellent discussion. There is no nutritional agenda embedded into the curriculum, it is flexible to a wide range of approaches. It is also eating disorder informed and friendly, and the best part about it is that you will get the actual PowerPoint and Word docs whenever available, so you can customize the curriculum as you see fit! 

  • Week 1: The Basics
  • Week 2: The Nutrition in Recovery Method 
  • Week 3: Fiber the Missing Nutrient
  • Week 4: Incorporating More Fiber
  • Week 5: Budgeting Food During Recovery
  • Week 6: Smoothie Workshop 
  • Week 7: Sugar, Salt, Fat
  • Week 8: Let’s Talk Breakfast
  • Week 9: Substance Substitution 
  • Week 10: Oats Workshop 
  • Week 11: Conversations About Sugar
  • Week 12: Emotional Eating 
  • Week 13: Exercise in Recovery 
  • Week 14: Whole Grains and the Mediterranean Diet 
  • Week 15: Artificial Sweeteners 
  • Week 16: Salad Dressing Workshop 
  • Week 17: Fads and Myths 
  • Week 18: Guess that Plant 
  • Week 19: Binge Eating Solutions 
  • Week 20: Body Image and Disordered Eating 
  • Week 21: Chocolate Bites Workshop 
  • Week 22: So Many Different Approaches 
  • Week 23: Mindful Eating 
  • Week 24: Food Safety 

The cost of the curriculum is $695 and as a limited-time bonus includes a 30-minute consulting session with David Wiss MS RDN within 3 months of purchase. David will also send you his range of academic publications related to nutrition, substance use disorders, and eating disorders. You can use the 30-minute session either to seek clarification on the curriculum, to dive deeper into the research and learn more about the link between nutrition and mental health, or to pick David’s brain about anything. Lastly, those who purchase the curriculum will be added to a special mailing list where we will eventually form a group of nutritionists who work in addiction treatment centers sharing ideas, challenges, and victories. The goal is to one day have a recognized certification, and those who get in now will likely end up as the original leaders. Let’s join forces! 

Questions? Email davidawiss@nutritioninrecovery.com

Ready to make a payment? Use credit card HERE. 

Please make sure to include the proper email address for correspondence. You will be asked to sign a non-disclosure before receiving the Nutrition in Recovery curriculum. 

 

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David Wiss Speaking Schedule 2019

Mr. Wiss has three big conferences coming up, and hopes that you will be able to join him at one of them!

We are excited to announce his speaking schedule over the next several months. Please let us know if you will be attending so we can plan a meet up! Cape Cod, London, and Philadelphia here we come!

Cape Cod Symposium on Addictive Disorders (CCSAD) 

September 5-8, 2019, Hyannis MA

Saturday September 7, 10:45am-12:15pm

“Nutrition for Addiction Recovery: Exploring Links Between the Gut and Brain”

Register HERE

International Society of Nutritional Psychiatry Research (ISNPR)

October 20-22, 2019, London UK

Tues October 22, 11:00am-12:30pm

“Moving Toward Nutrition Standards in Substance and Alcohol Use Disorder Treatment”

Register HERE

Food and Nutrition Conference and Expo (FNCE) 

October 26-29, 2019, Philadelphia, PA

Pre-FNCE workshop hosted by Dietitians in Integrative and Functional Medicine (DIFM) 

Saturday October 26, 8:15am-9:30am 

“More than Meets the Eye: How Unseen Factors Impact Nutrition and Health” 

Register HERE 

More information on Wiss Speaking Schedule for Winter 2019-2020 coming soon!

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Nutrition During Childhood

David Wiss MS RDN walks you through some of the controversies around nutrition, eating behavior, and food addiction during childhood and adolescence. Key take-away points:

  • Nutrition and weight loss interventions on children and adolescents appear mostly ineffective
  • Addiction-like eating may be the explanatory mechanism 
    • Not an individual problem as much a societal problem
  • The use of food to regulate mood starts early
  • Loss of control eating is common during adolescence
  • First 1,000 days appears critical for shaping one’s relationship to food
  • It probably starts sooner! In utero & parental genes 
  • Food environment and other social factors are of course critical
  • We need nutrition-related public health policy 
6:53

Nutrition in Recovery is a group practice of Registered Dietitian Nutritionists and other health professionals who specialize in the treatment of addictions, eating disorders, body image, mental health, as well as general wellness.

We send out a monthly Newsletter summarizing the latest research linking nutrition and mental health. Each newsletter will include a short video with some helpful hints and actions you can implement to improve mental, spiritual, and physical wellbeing for yourself and for your clients. You will be among the first to hear the findings and insights from cutting-edge data, and we are providing references so you can do your own research if interested.

Within the next year you can look forward to the following topics being covered:

Circadian Rhythms

Men and Eating Disorders

View last month’s video on Bariatric Surgery

Read more

Food Addiction and Disordered Eating

Sorting Through Dialectical Truths

In this webinar, David Wiss MS RDN helps you sort through dialectical truths that plague the nutrition profession. People seem to pick a “campsite” and then wage war at the other camps. In other words, there are false dichotomies in the nutrition field. For example, someone once said that one cannot believe in food addiction and treat eating disorders at the same time. Such an interesting comment, particularly with the use of the word “believe.” In this presentation, David discusses how these topics converge and how they diverge. Mr. Wiss uses concepts of statistics to set the stage for a presentation of dialectical truths. Useful terms are defined and the broad category of nutrition for mental health is explored. This presentation is particularly useful for those who are interested in theory, and philosophical debates. Tips for assessing food addiction are offered.

40:23

Read more of David’s thoughts on food philosophies.

David is currently doing virtual sessions with people all over the world who have co-occurring eating and substance use disorders. Feel free to reach out and find out more about working with him.

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Thoughts On Food Philosophies

What is your food philosophy?

I have caught myself feeling frustrated with this question. Recently I have had several stimulating conversations with esteemed colleagues and have gathered my thoughts enough to finally share. Please send me your comments and feedback, and please share this with anyone who is firmly committed to having a “food philosophy” especially healthcare professionals. This one is for my fellow treatment providers…

“Let’s chat so I can learn more about your food philosophy”

Throughout my career as a dietitian, I have received this inquiry far more than any other. The question rarely comes from prospective clients but rather from other professionals. It’s a common question asked by eating disorder (ED) treatment providers. It’s basically code to assess if someone has been trained to work with EDs. By far the most socially acceptable answers are “all foods fit” or “non-diet” or “intuitive eating.” These answers imply promotion of flexible, non-punitive approaches that do not impose unnecessary rigid rules into eating. I am a big fan of these approaches for many of the chronic dieters that end up in my office. These food philosophies inform solutions for many individuals with disordered eating patterns. No one can knock these approaches because they are designed to be protective against the development and progression of EDs, which can be deadly. “All foods fit” is thus a very safe thing to say, as well as a safe thing to teach people in recovery. The client might not always appreciate it and may even disagree, but there is low risk of doing any direct harm with it. 

The other safe claim is “Health at Every Size” which basically lets people know that weight loss will not be supported as a primary health goal, but instead other forms of health will be emphasized (e.g. quality of life). This phrase is trademarked, so by using it one is claiming somewhat of an allegiance to the “brand” which is quite explicit in its social justice mission: reduce weight bias and weight stigma. It is such an important mission and a message that I carry to clients when appropriate (the timing of this message can be quite important). Because it has become somewhat of a professional “identity” I am selective about using the term although I am in alignment with most of the tenets. It just makes so much sense. 

So, what is your food philosophy? 

I have answered this question in various ways over the years, and I have even answered it differently to cater to different audiences (how’s that for vulnerability?). This question has always made me somewhat uncomfortable, and only recently have I started to fully understand why. To begin, I know a lot about food politics. I am keenly aware of the agenda and tactics employed by the food industry. I am aware of the extent to which they have invested in influencing the mindset of the registered dietitian nutritionist (RDN). “Big Food” seems to love the idea of dietitians teaching “there are no bad foods” and emphasizing a “total diet approach” because it exonerates these corporations from public health concerns thereby supporting their bottom line. Industry funded research agendas typically have predictable conclusions: “nothing wrong here, everything is safe.” Me personally I have a problem with the feeling that I was trained to promote the financial agenda of multinational food companies. It doesn’t sit right with my recovered spirit. Information about conflicts of interest and bias in nutrition research has only recently become mainstream, but my antenna has detected it since I was in graduate school. I am grateful for the courage to speak up on these issues (even when people thought I was maniacal). I actually believe that deceitful practices by the food industry are an upstream driver of EDs. Meanwhile, “all foods fit” is still an important and useful message for many individuals in recovery, and although I rarely use the term, I do carry the message when it’s appropriate. It’s the message that many restrictive eaters need to hear (over and over and over again). 

What is your food philosophy?

A few years ago, I attempted to create a condensed summary version of a food philosophy which I concluded several big presentations with: “All foods fit, but not all foods fit for all people. And just because the food industry manufactures and sells it, does not mean we have to include it.” This worked well for a few years because it balanced my role as an ED dietitian (focusing on individual health) as well as my role as an advocate for transparency in conflict of interest in nutrition research (focusing on population health). This statement summarizing my philosophy let people know that I can “toe the party line,” but that I was also brave enough to take a stand against corporate greed. It really worked for me for a while. I recently outgrew it.  

Is having a “food philosophy” important?

The concept of a “food philosophy” is actually quite important for treatment settings. It is the only way to scale treatment to a group of individuals (i.e. treat 10 people at once). While many facilities claim to individualize care, group nutrition education cannot be, and personalized nutrition can create additional burden on the food service staff. Differential messaging and menus have the potential to create chaos on the unit. Furthermore, if an individual with an ED is in residential treatment, they need to get a consistent message from their dietitian, therapist, psychiatrist, supporting staff, etc. Can you imagine how jarring it would be for that person if they were receiving conflicting information about food during treatment? Can you imagine the challenges that would ensue if that client stepped down to an outpatient level of care and ended up being exposed to a different food philosophy? It would not go well. A food philosophy is thus very important for continuity of care in ED treatment. An ED treatment center is thus dependent on having a defined food philosophy. If a job applicant does not align with the food philosophy of the center, they will not get the job. A treatment center needs to be explicit about their food philosophy, and for very important reasons. In summary, food philosophies are important in inpatient treatment settings, but should become way more flexible and individualized post-treatment. Trust me, this is my full-time job.  

Eating disorders are heterogenous

One of my key points is that EDs are far more heterogenous than most people think. Lumping them all into one category of “eating disorders” is a big mistake. Even using the blanket term “eating disorders” can be problematic. Most people still think of the restrictive patient with anorexia or bulimia nervosa when they hear the term. Some professionals would argue that all EDs are just symptoms of deeper underlying issues and that “it’s not about the food” however that doesn’t sit right with me- it’s too general of a statement. The food absolutely matters for some people. It has to. Everyone has different brain chemistry, and food has a profound effect on neurobiology. Any ED model that overlooks biology is coming up short.

Eating disorders present in a multitude of ways. The 22-year old female with anorexia nervosa and obsessive-compulsive disorder who has never touched a drink or drug is quite different than the 35-year old female with bulimia nervosa who has an extensive trauma history and is purging rice cakes and almond butter to self-soothe during opioid treatment. The 32-year old male patient who learned how to vomit to make weight for his high school wrestling team and has been doing it to control weight ever since is quite different than the 57-year old female who started bingeing recently when her husband left, who has never tried to compensate or engage in any dieting behaviors. The 28-year old female volleyball athlete who has become “orthorexic” in an effort to support her performance in sports is quite different than the 40-year old male who has been to 15 treatment centers for methamphetamine addiction who reports using the drug to stay lean and engages in high risk sexual behaviors, currently bingeing and night eating at his sober living. You got the point. These people cannot be lumped into one category. That would be like lumping all personality disorders into one and trying to treat them with the same message of recovery. It would not work. Granted, many of the same nutritional strategies can be employed (e.g. balance, variety) but the long-term strategy needs to be conceptualized on an individual basis. 

So, what is your food philosophy? 

My food philosophy is that I don’t have one. I have many tools. I am a private practice dietitian. I work with a very wide range of challenging cases. Having a single “food philosophy” that gets extended to all people regardless of their biology, psychology, or social conditions feels anti-scientific to me. It can be an important service to someone who is a perfect fit for a particular philosophy, but it can be a disservice to the population. Too often providers will try to get the client to bend to their personal philosophy, rather than referring them to someone who is a better fit. Having a defined and fixed “food philosophy” in an outpatient setting is more beneficial to the provider than it is for the client. It makes the clinicians job easier because they can say the same things and use the same handouts with all of their patients. Be careful with this! You don’t want to end up as a one-trick-pony or get trapped in a cycle of bias you are not aware of. In all fairness, it’s actually quite difficult to have multiple food philosophies, or to hold seemingly opposing ideas true at the same time. It requires more thought, effort, and attentiveness in each moment. It can be emotionally straining. It is the essence of dialectics. 

Psychotherapy is individualized, and nutrition should be too. If an oncologist had one preferred cancer treatment and everyone who came in got the same treatment, it would be considered malpractice. Why can a nutritionist get away with it? RDNs can get attached to a “food philosophy” that matches their own eating style, so there is an emotional attachment to it, and an inherent bias. When faced with an alternative food philosophy it creates dissonance, and many will seek to resolve this dissonance by criticizing the alternative philosophy, to strengthen and “confirm” their own approach. This is particularly true in the ED space, where someone who does not proclaim “all foods fit” can be viewed as disordered or orthorexic. 

Just say it, you believe in food addiction, don’t you?

Indeed, I do. I have been publishing about in peer-reviewed literature for years. I believe it exists and I believe it to be a public health concern. I have successfully treated many people who have addiction-like relationships to certain foods, and to the ritual of eating. It has been very meaningful work for me because it is mostly an inside job. It can be addressed without rigid rules, very similarly to EDs, just with a slightly different lens and perhaps some different language. But just because I believe it exists, it doesn’t mean it’s my “food philosophy” it just means I believe it to be a legitimate construct supported by the current evidence. And I don’t extrapolate what I know about food addiction to patients with EDs who do not have any addictive disorders. I am able to see where different constructs converge and diverge and am able to assess each case on an individual basis. I have treated people who believe they have a food addiction, but they really just have restrictive eating patterns. I have also treated people who were diagnosed with an ED but benefitted tremendously from learning about the neurochemical reward mechanisms associated with food intake. Again, EDs are heterogenous. A comprehensive intake and assessment are critical to a successful outcome. There are many pathways to recovery. Just because you have a singular food philosophy don’t assume that I do. My approach is plural. #NonBinary 

False dichotomies 

One of the main goals of ED treatment is to reduce black-and-white thinking. But I have noticed that many ED treatment professionals have black-and-white thinking about treatment philosophy. For example, if it’s not “Health at Every Size” and “non-diet” then it is deemed “fat-shaming” and “diet culture.” That is the same kind of dichotomized thinking that we would try to talk our clients out of. Many ED professionals will unfortunately extrapolate what they have learned about EDs to the entire population, for example viewing all expensive health food stores as orthorexic. Many are failing to see how heterogenous eating pathology is, and rather rely on what they have learned in the past rather than adjusting to the current climate. I have heard some insist that “food addiction doesn’t exist” most likely because it doesn’t match their personal food philosophy, or perhaps because they mainly treat people with anorexia. Their food philosophy thus becomes the lens by which they see the world. This can be quite problematic and in my opinion one of the reasons that ED treatment fails more often than it should. What if attachment to food philosophies were contributing to poor outcomes? 

So… do you have a food philosophy? 

Fine, yes. I do. I am multimodal. That means I believe in multiple modalities. I am a non-diet dietitian generally against weighing, measuring, or counting anything. But there are of course exceptions to every rule. Meanwhile, if all you have is a hammer, everything looks like a nail. My food philosophy is an entire toolkit. It is flexible like the approach to eating I teach to most of my clients. It is evolving with new and emerging scientific findings, such as the role of the gut microbiome in mental health and the role of food sensitivities on whole body inflammation. It evolves with our understanding of dopaminergic reward pathways in the brain, and how these are influenced by stress, trauma, and adversity. It expands with our evolving sociocultural approach to size diversity. My food philosophy is fluid and patient-centered. It is different for every client who walks into my office. I am a healthcare professional, not someone trying to convert others to my way of seeing the world. My practice is very successful because of this open-mindedness.

If you detach yourself from your “food philosophy” you may be surprised at how effective you can become. Be open to new science. Help clients to develop their own food philosophy that they can use after the work together is done. Recovery comes first. In my experience, recovery is about empowerment and freedom. Recovery is individual and personal. That is my philosophy in a nutshell. You are more than welcome to take my philosophy and build upon it. Let’s share and grow. Together we can accomplish what we could never accomplish alone. 

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Eating Disorders and Substance Use Podcast 1

Eating Disorders and Substance Use Podcast

Eating Disorders and Substance Use Podcast – Interview with Tabitha Farrar

In this excellent conversation Tabitha and David Wiss discuss the co-occurrence of eating disorders and substance use disorders, and the challenges faced by treatment providers. David discusses how many people with EDs can “hide out” in addiction treatment.

Eating Disorders and Substance Use
LINK HERE

Tabita Farrar is an eating disorder recovery coach with lived experience. She was a pleasure to chat with and has a fantastic podcast.

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Nutrition for Mental Health Webinar

Nutrition for Mental Health Webinar

Hot Topic: Nutrition for Mental Health

David Wiss MS RDN presents to students at California State University Northridge about the connection between nutrition and mental health. This presentation covers the microbiome, substance use disorders, disordered eating, depression, recovery, and more. It’s just over 50 minutes long, but worth every second! Why? Because nutrition for mental health is the future! Read more about this topic and check out some recent references HERE

Nutrition for Mental Health 53:34 #GutBrainAxis
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Los Angeles Conference April 6, 2019

“Dialectics in Dietetics: Multiple Truths in Nutrition Science” Conference April 6, 2019

History of the Conference

At the Los Angeles District of the California Academy of Nutrition and Dietetics annual transition meeting in the summer of 2016, we had a big idea. What if we could throw our own conference?

In 2017 we actually did it and it was epic! Our first conference was called “Public Health and Private Profits: A Dialogue about Critical Topics Shaping the Future of the Dietetic Profession”

Our 2018 conference was called “One Size Does Not Fit All: Promoting Diverse Perspectives in Dietetics” and was also SOLD OUT.

Our April, 6 2019 conference should be the best one yet! “Dialectics in Dietetics: Multiple Truths in Nutrition Science.” We are so thrilled to have such a star-studded line-up this year! The conference is held at Children’s Hospital Los Angeles and is not to be missed!

April 6, 2019
http://www.ladannualconference.org

We have special pricing for students, RDNs, and LAD members!

Register for the conference HERE

April 6 will be here before we know it!

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Changes After Bariatric Surgery? Video

How does taste change after bariatric surgery?

David Wiss MS RDN walks you through some of the latest research related to changes in taste following bariatric surgery. How is that possible? Evidence suggests alterations in gut microbiota following certain procedures may be responsible for changes in food preferences for some people. It appears that the gut-brain axis can explain so many of the questions we still have about nutrition and health.

Nutrition in Recovery is a group practice of Registered Dietitian Nutritionists and other health professionals who specialize in the treatment of addictions, eating disorders, body image, mental health, as well as general wellness.

We send out a monthly Newsletter summarizing the latest research linking nutrition and mental health. Each newsletter will include a short video with some helpful hints and actions you can implement to improve mental, spiritual, and physical wellbeing for yourself and for your clients. You will be among the first to hear the findings and insights from cutting-edge data, and we are providing references so you can do your own research if interested.

Within the next year you can look forward to the following topics being covered:

Child Nutrition

Circadian Rhythms

Men and Eating Disorders

View last month’s video on Alcohol and HbA1c

Does Alcohol Affect HbA1c?
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Nutrition Interventions Amidst an Opioid Crisis

Nutrition Interventions Amidst an Opioid Crisis

“Nutrition Interventions Amidst and Opioid Crisis: The Emerging Role of the RDN” by David Wiss MS RDN

The opioid crisis has reached epidemic proportions. The time to include nutrition into the treatment paradigm has arrived. David Wiss is not afraid to take the lead, and is doing research on this topic at the University of California, Los Angeles. 

This presentation was given at the Food and Nutrition Conference and Expo (FNCE) on Sunday October 21, 2018 in Chicago which was an invited presentation in response to the opioid crisis. Here David Wiss describes the impact of opioids on nutritional status and gastrointestinal health, identifies common disordered and dysfunctional eating patterns common to opioid-addicted populations, and describes nutrition therapy protocols for specific substances including opioids and for poly-substance abuse.

The presentation is 1:29:01 and was moderated by my dear friend and colleague Tammy Beasley, RDN. If you want to skip the video, and go straight to the slides, you can do so HERE. 

In summary, nutrition interventions have not yet been standardized or widely implemented as a treatment modality for substance use disorder (SUDs). Emphasis should be placed on gastrointestinal health, and reintroduction of foods high in fiber and antioxidants such as fruits, vegetables, whole grains, beans, nuts, and seeds. Adequate intake of protein and omega-3 essential fatty acids should be consumed daily. Regular meal patterns can help to stabilize blood sugar. Water should replace sweetened beverages. Caffeine and nicotine intake should be monitored. Dietary supplements can be very helpful in the recovery process, but should not supplant whole foods. Once nutrition behavior has improved, use of dietary supplements should be reevaluated. Lab tests and stool samples assessing gut function should provide valuable insights in upcoming years. In addition to expertise with the interaction between specific substances and nutritional status, RDNs working in treatment settings should specialize in gastrointestinal health, eating disorders, and should be current with food addiction research. There is a timely need for specialized nutrition expertise in SUD treatment settings, including outpatient clinics and “sober living” environments. Public health campaigns and specialized training programs targeting primary care physicians, mental health professionals, and other SUD treatment professionals are warranted. 

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