Los Angeles
We live in an epidemic of addiction and eating disorders in the United States. Meanwhile, the American advertising industry bombards us with images that encourage dissatisfaction with what we have and how we look, perpetuating fantasies that we can purchase some better version of ourselves. Technology is subtly changing the human brain. This is not mere observation- I can feel it happening in my own life.
We also live in an era of hope and opportunities for recovery. There is no shortage of treatment options for addictions and eating disorders. Social media allows people to interact with other people seeking help worldwide in blogs, chat rooms, and online meetings. Technology now enables healthcare professionals to have virtual meetings with their clients and patients. There are organizations speaking up against stigmas and operating with high levels of professional integrity.

What’s New In Eating Disorder Treatment?

Traditional eating disorder treatment has generated certain approaches that have stood the test of time and are considered vital to recovery. These include:
-Addressing underlying psychological issues
-Helping clients make peace with food
-Helping clients make peace with their body
-Developing strong support networks
-Preparing for the inevitable obstacles ahead
-Re-channeling energy once used obsessing about food/body
-Reintegrating and becoming useful citizens
My job as a Registered Dietitian Nutritionist is primarily to help individuals understand how food interacts with their body. One thing I have learned is that there are many ways to accomplish this.
One common treatment approach to eating disorders promotes making peace with food by suggesting that “all foods fit” and “everything in moderation.” Certainly this is an important concept for many patients with eating disorders. However, not all foods fit for all people. The Food Industry promotes this concept, but it does not mean we should accept it in all cases. One problem with large-scale treatment is that nutrition counseling can become broad and generic instead of individualized. A patient with a food addiction and binge eating disorder should not receive the same nutritional treatment as the anorexic patient who has intense food fears and restrictive eating patterns.
Contemporary treatment of eating disorders should involve personalized and individualized nutrition therapy, wherever possible. This can be difficult when there is limited dietary access and resources in an inpatient setting. Too often treatment professionals believe their client’s journey toward peace should look a certain way. It may be time to shift the emphasis away from old scale-able nutrition paradigms to a new understanding of disordered eating, which incorporates the complexities of the human condition, as well as the changing face of the food supply.

There’s An Elephant In The Room That No One Wants To Talk About…

Recently, there has been considerable debate about whether or not food has addicting properties. Eating disorder professionals have argued for it being a process addiction, a substance-related addiction, or not an addiction at all. We argue about the role of exercise in eating disorder treatment. We talk about the rate of re-feeding protocols, whether or not to discuss calories with patients, the best time to introduce principles of intuitive eating, etc. We debate the obesity epidemic, the impact of dieting, the weight-loss industry, etc. etc. etc. But there is something very important that we are missing- the elephant in the room that no one wants to talk about…the Food Industry aka Big Food.
Eating disorder dietitians talk about food quantity, but not often enough discuss the food quality. It’s almost as if nutrition professionals are afraid to implicate Big Food in any way, as if it will challenge their long-held belief that “all foods fit” and everything should be consumed in “moderation.” Big Food endorses the idea of “moderation” because it provokes an invitation to indulge in the products they sell- particularly processed food items that have been proven to have addictive properties for some people. Big Food has tremendous influence, generates large profits, while the American public suffers. Eating disorder professionals argue about everything except the impact of highly processed food.

Questions to Consider

-Is it possible that commonly consumed food actually does have something to do with the addiction and eating disorder epidemic?
-Is it possible that foods high in sugar, salt, and fat impact the human brain in ways that challenge old paradigms of eating disorder treatment?
-Is it possible that a calorie is not a calorie?
-Is it possible that there are some people who have issues with highly processed food, and these are legitimate concerns and not “disordered thoughts”?
-Is it possible that how we think about food needs to change?

Concluding Thoughts

As a dietitian, my job is to study food and its impact on people. In a large percentage of people with eating disorders, it’s not about the food. However, in a growing percentage of cases, eating disorders have more to do with food than some wish to believe. Food matters. Supplements are not equivalent to food. Extensive food processing creates confusing signals to the human brain and body. Refined grains are not the same as whole grains. Apple Sauce is not the same as apples. Roasted salted nuts are not the same as raw unsalted nuts. They may have the same amount of calories but the difference in the way it impacts the gut, brain, and endocrine system is significant, even if it is not fully understood.
Although I am critical of the Food Industry, I do not have a solution to the problems we are facing with the food supply and an exploding population. What I do know from clinical experience is that some people with addictive disorders are more sensitive to food than the general population. For many people with eating disorders, traditional treatment modalities that take all emphasis away from the quality of the food may be appropriate. Nevertheless, there is large group of people who have tried traditional eating disorder with little or no success. They have been to multiple treatment centers. They are experts at calculating exchanges, understanding different calorie levels, and have attempted to eat every dessert and candy item in moderation. They have tried and tried and tried and have never been able to overcome their malady.
I believe that food does matter. Food is more than just fuel. We are not cars. We are spiritual beings. We require spiritual food. We can live a life of sane and happy usefulness. We can free up all of that energy and begin to channel back into the stream of life, becoming productive and effective. You can recover. We can do together what we could never do alone. Help is available! Eating disorder recovery in Los Angeles is real.

Dr. David Wiss became a Registered Dietitian Nutritionist (RDN) in 2013 and founded Nutrition in Recovery, a group practice of RDNs specializing in treating eating and substance use disorders. In 2017, David received the “Excellence in Practice” award at the National Food and Nutrition Conference and Expo. The California Academy of Nutrition and Dietetics awarded him the “Emerging Dietetic Leader Award” in 2020. He earned his Ph.D. from UCLA’s Fielding School of Public Health in the Community Health Sciences department (with a minor in Health Psychology) by investigating the links between adverse childhood experiences and various mental health outcomes among socially disadvantaged men. His treatment philosophy is based on a biopsychosocial model which incorporates an understanding of biological mechanisms, psychological underpinnings, and contextual factors that integrate the social determinants of health. Wise Mind Nutrition is an app-based interactive treatment program available for download now - https://wisemindnutrition.com/download.

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