How Does Trauma Impact Food and Body?
The biological embedding of adversity is a fascinating area of research! This presentation is from the Los Angeles District of California Academy of Nutrition and Dietetics annual conference.
David Wiss MS RDN discusses how early life adversity impacts human biology. This presentation describes how social factors can get “under the skin” and alter neurobiology. Mr. Wiss discusses potential consequences such as sexual abuse and known links to eating behavior.
Do you have questions about biological embedding? Are you curious to learn more about the link between sexual abuse and eating disorders? Don’t hesitate to reach out!Read more
Who doesn’t love a rich podcast interview about behavioral health nutrition? Below is a list of David Wiss podcast interviews from this year. They are all different but most touch on David’s passion for using nutrition in the treatment of substance use disorders. Some of the interviews are more focused on eating disorders and others are more focused on mental health in general. Check them all out!
Getting Better with Adam w/ Adam Silberstein, PsyD
In this podcast we discuss:
- Co-occurring eating and substance use disorder
- Food and body issues among men
- Discernment regarding different treatment approaches for eating disorder
Think Yourself Healthy w/ Heather Deranja, MA, RDN, LDN, CPT
In this podcast we discuss:
- Nutrition for substance use disorder: history and where it is headed
- Food addiction: controversies and implications for public health
- Sugar addiction: how it affects gut health and mental wellness
Cope Like a Pro w/ Ilona Varo, LMFT
In this podcast we discuss:
- The life course impact of adverse childhood experiences
- Behavioral health disorders related to nutrition
- Pathways related to the gut-brain axis
Dietitian Rehab w/ Doug Cook, MHSc, RDN
In this podcast we discuss:
- Broad concept of nutrition for mental health
- Nutrition education for substance use disorder
- The current climate of eating disorder treatment
More David Wiss podcast interviews coming soon!Read more
What are some of the gender-specific risk factors for men in developing eating disorders? What does the data say about differences between women and men with eating disorders? Do treatment needs vary? What about non-binary individuals? How does body image differ across the gender spectrum? What is muscle dysmorphia? Should men with eating disorders seek gender-specific treatment? Should we expect more men to seek eating disorder treatment in upcoming years? What are your thoughts on men and eating disorders?Read more
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”
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”
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”
More information on Wiss Speaking Schedule for Winter 2019-2020 coming soon!Read more
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.
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.Read more
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
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.
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.
Tabita Farrar is an eating disorder recovery coach with lived experience. She was a pleasure to chat with and has a fantastic podcast.Read more
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 HERERead more
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:
Men and Eating Disorders
View last month’s video on Alcohol and HbA1c