eating disorder dietitian

Mindfulness and Eating Disorders: Latest Research on Binge Eating Disorder and Bulimia Nervosa

Lifestyle /

Mindfulness, a practice rooted in paying non-judgmental attention to the present moment, has emerged as a promising approach to treating various mental health conditions, including eating disorders such as Binge Eating Disorder (BED) and Bulimia Nervosa (BN).  New research is shedding light on how mindfulness-based interventions can help individuals improve their relationship with food as well as their emotional well-being. Let’s explore the latest findings on how mindfulness is being utilized to treat BED and BN.  What is Mindfulness? At its core, mindfulness involves the intentional, non-judgmental awareness of one’s thoughts, emotions, bodily sensations, and the surrounding environment. In the context of eating disorders, mindfulness helps individuals tune into their hunger cues, become more aware of emotional triggers, and ultimately cultivate a more compassionate relationship with food. Mindfulness-based interventions, such as Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR), have been increasingly used as part of integrated therapeutic approaches to treat disordered eating behaviors. Binge Eating Disorder and Mindfulness Binge Eating Disorder (BED) is characterized by recurrent episodes of consuming large quantities of food, typically accompanied by emotional distress and guilt. Unlike other eating disorders, such as anorexia or bulimia, BED is not associated with compensatory behaviors like purging or excessive exercise. As the most common eating disorder in the United States, BED has attracted significant attention from researchers studying its psychological origins and treatment options. Recent research suggests that mindfulness can be particularly effective in reducing binge episodes and improving emotional regulation for individuals with BED. Mindfulness-Based Interventions (MBIs) A 2021 meta-analysis of randomized controlled trials found that mindfulness-based interventions significantly reduced the severity of binge eating episodes in individuals with BED. The study indicated that MBIs, particularly Mindfulness-Based Cognitive Therapy (MBCT), resulted in a reduction of binge eating episodes by approximately 50%, with long-term benefits observed in follow-up assessments1. This finding highlights the potential of mindfulness not only for immediate symptom reduction but also for sustained recovery.   Improving Emotional Regulation Emotional regulation is a key challenge for individuals with BED, as many binge eating episodes are triggered by negative emotions such as anxiety, sadness, or stress. Mindfulness practices can help individuals become more aware of their emotional states and reduce emotional reactivity. One study showed that practicing mindfulness meditation decreased binge eating and emotional eating due to improved emotional regulation.2   Use of Dialectical Behavior Therapy (DBT) DBT is also being explored as a tool for reducing emotional dysregulation in individuals with BED.  Originally developed as a modality for improving emotional regulation in personality disorders, more research is showing mindfulness-based strategies of DBT are effective in treating BED.  In a meta-analysis of eleven studies, DBT demonstrated greater efficacy compared with the control group in improving emotion dysregulation.3 Bulimia Nervosa and Mindfulness Bulimia Nervosa (BN) is an eating disorder characterized by episodes of binge eating followed by compensatory behaviors such as purging (vomiting or using laxatives), excessive exercise, or fasting. The disorder is often accompanied by severe body image distortion and extreme anxiety about weight and shape. Treatment for BN requires a multifaceted approach, but mindfulness is gaining recognition as a promising tool to address the psychological and behavioral components of the disorder.  Recent studies suggest that mindfulness can help break the cycle of binge-purge behavior and improve body image, leading to better treatment outcomes. Reducing Binge-Purge Behaviors A 2021 study investigated the effectiveness of mindfulness-based cognitive therapy on reducing the cognitive load of words related to eating disorders could result in a decrease in purging behaviors. Mindfulness skills improved significantly which were accompanied by a decrease in depressive mood. The researchers concluded that mindfulness-based cognitive therapy could be an effective tool in reducing binge-purge behaviors.4   Improving Body Image and Self-Compassion Body dissatisfaction and low self-esteem are common in BN and are often central to the disorder’s maintenance. Mindfulness interventions focusing on body awareness and self-compassion have shown promise in reducing these issues.  This shift in perspective is crucial, as body image issues often drive the cycle of binge eating and purging in BN.5   Addressing Cognitive Rigidity Cognitive flexibility, the ability to hold multiple perspectives and tolerate ambiguity, is often impaired in individuals with BN, leading to rigid thinking patterns about food, body image, and self-worth. Mindfulness has been shown to enhance cognitive flexibility by promoting an open, non-judgmental awareness of thoughts and experiences.6 Mindfulness-based interventions are emerging as a promising tool in the treatment of both Binge Eating Disorder and Bulimia Nervosa. The latest research suggests that mindfulness can significantly reduce binge eating and purging behaviors, improve emotional regulation, and promote healthier body image and self-compassion. As the field of mindfulness research continues to grow, it is crucial that these interventions be further refined and integrated with other therapeutic approaches to provide comprehensive, effective treatment for individuals struggling with eating disorders.  At LCWNS, we help you integrate mindfulness as part of a holistic treatment plan.   References Grohmann D, Laws KR. Two decades of mindfulness-based interventions for binge eating: A systematic review and meta-analysis. J Psychosom Res. 2021 Oct;149:110592. doi: 10.1016/j.jpsychores.2021.110592. Epub 2021 Aug 1. PMID: 34399197. Katterman SN, Kleinman BM, Hood MM, Nackers LM, Corsica JA. Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review. Eat Behav. 2014 Apr;15(2):197-204. doi: 10.1016/j.eatbeh.2014.01.005. Epub 2014 Feb 1. PMID: 24854804.  Rozakou-Soumalia N, Dârvariu Ş, Sjögren JM. Dialectical Behaviour Therapy Improves Emotion Dysregulation Mainly in Binge Eating Disorder and Bulimia Nervosa: A Systematic Review and Meta-Analysis. J Pers Med. 2021 Sep 18;11(9):931. doi: 10.3390/jpm11090931. PMID: 34575707; PMCID: PMC8470932. Sala L, Gorwood P, Vindreau C, Duriez P. Mindfulness-based cognitive therapy added to usual care improves eating behaviors in patients with bulimia nervosa and binge eating disorder by decreasing the cognitive load of words related to body shape, weight, and food. Eur Psychiatry. 2021 Oct 28;64(1):e67. doi: 10.1192/j.eurpsy.2021.2242. PMID: 34706785; PMCID: PMC8668447. Jansen P, Zayed K, Kittsteiner J. Body image and the relation to mindfulness and self-compassion in physical education students: a cross-cultural study. Health Psychol Res. 2021 Jan 14;8(3):9172. doi:

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Practicing Intuitive Eating Across Diverse Client Populations

Lifestyle /

Intuitive eating (IE) has gained popularity as a sustainable approach to nutrition and body image. This philosophy encourages individuals to listen to their bodies’ cues and remove food morality, fostering a healthier relationship with food. However, its benefits extend beyond individual well-being; intuitive eating can be a transformative tool for various client populations, including those dealing with chronic illnesses and eating disorders.  In this blog post, we’ll explore how intuitive eating can be adapted and applied across different clients with specific disease states and eating patterns, highlighting its potential to empower individuals to reclaim their autonomy over food choices. By understanding the unique needs of each population, we can better appreciate the versatility of intuitive eating and its role in promoting holistic health.  We spoke with three registered dietitians who specialize in different client populations to see how they use intuitive eating in their practices and how it helps their clients improve their health.  How do you use intuitive with your clients? Shannon Herbert PhD, RD, CDN, registered dietitian at Laura Cipullo Whole Nutrition Services: I use IE in clients with polycystic ovary syndrome.  I enjoy using principles of IE to help clients reconnect with their bodies, reduce the guilt and shame they feel around food and eating, and re-establish a more positive, balanced view of themselves and their eating.  Rebecca Stetzer, RD, CD, registered dietitian at Erica Leon Nutrition & Associates: One type of client I use IE with is clients with binge eating.  I might talk about how we start with structure and making sure the client is eating adequately for their body, and as we go along in that process I will integrate conversations and practices that help the client re-establish attunement to their body cues. We will explore what kinds of disrupters they have in their lives such as distractions, thoughts, food rules, and beliefs and lack of self-care that interferes with their ability to hear and respond to the needs of their body. Faith Aronowitz, MS, RD, CDN: One specific type of client with whom I often use Intuitive Eating with are those struggling with IBS. Many of these clients come to me feeling frustrated and anxious about food after trying various (unnecessarily) restrictive diets without symptom improvement or relief.  We work on creating space to pause during meals, tuning into hunger and fullness cues, and noticing how they physically and emotionally feel before, during, and after meals. This helps clients tune into their body’s signals rather than relying solely on external food rules.   What do you see as the benefits? Shannon: So much of the focus of PCOS management has been on weight, despite PCOS affecting individuals across body sizes and the high prevalence of disordered eating in the PCOS population. Research has shown that there is no one dietary approach that is superior for managing PCOS and that health benefits can be had by making changes to diet even in the absence of changes in weight.  Thus, I find that IE can be one tool to help individuals with PCOS over time let go of restricting dieting and truly learn how to nourish their bodies in a way that is satisfying to their taste buds and helpful for the management of the condition.  Rebecca: The reason I think using intuitive eating is helpful in the population of clients with binge eating disorder is that so much of what drives binge eating is a chaotic and dysfunctional relationship with food. What drives binge eating is restrictive behaviors with food and strong beliefs about what a person should or should not be eating. Emotional eating also drives binge eating, of course. But part of intuitive eating is recognizing how the lack of self-care can interfere with a person’s ability to hear and respond to the needs of their body in a timely manner, and this includes healthy management of emotions. Faith: The benefits I see in this population are reduced stress around eating, less fear with respect to adverse symptoms, and a more positive relationship with food overall. Many clients report fewer IBS flare-ups as they learn to honor their body’s needs and identify personal dietary triggers without unnecessary restriction.   When do you introduce intuitive to this population?  Shannon: When to introduce IE and what principles to introduce depends on the client.  If clients have a long history of restricting in an effort to manage PCOS, we may first work to reject the diet mentality.  Many clients with PCOS are accustomed to relying on external cues to eating, that re-learning interoception and how their body is communicating with them can take time.  Therefore, we may first prioritize adequate nourishment with balanced nutrition.  Then, we can work towards reacquainting them with their hunger and fullness and re-establishing the bodily trust.  Rebecca: I tend to introduce intuitive eating from the very beginning. I talk about how everyone is born with the ability to self-regulate according to what their body’s needs are. We explore how external factors such as dieting, diet culture, rules and beliefs around food in their family, etc. has shaped their current food beliefs and food rules and eating behaviors. The key to introducing intuitive eating from the very beginning is helping the client to set realistic expectations for themselves. By that I mean they’re not going to be able to be fully intuitive eaters from the beginning, but that through practice and patience they will be able to develop those skills again. I think that it really provides hope for clients with binge eating that they can not only eat normally again but that they can find peace with food. Faith:  I typically introduce Intuitive Eating concepts after we’ve addressed any immediate nutritional concerns and/or comorbid diagnoses, and the client feels ready to explore a more flexible approach to eating. This may happen during our initial consultation for some, or several weeks into our work together, for others. The timing typically depends on how many layers of unnecessary restriction we need to

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Turkey Chili

Recipes /

  Now that fall is in full swing, hearty bowls of chili are just the thing to keep you warm and toasty. This turkey chili recipe is so satisfying that you'll most definitely not be craving a sweet treat before bed. You can eat this meal without a side or pair it with a cup of cooked pasta, rice, or a baked potato.

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Who Helps A Child With ARFID?

Parenting /

As the saying goes, “it takes a village”. If you are looking for more support to help yourself or your child treat ARFID, you likely already deeply resonate with this saying. Luckily, the research is growing and the awareness is improving and spreading in the eating disorder field to help diagnose ARFID with more ease and specific criteria. The next order of business is creating your “village”.  Curating a specialized multidisciplinary team is the most tried and true approach to eating disorder treatment. At the most basic level, a doctor (preferably a child and adolescent medicine specialist for the kiddos), a registered dietitian (heads up to ensure actual RD credentials, not just a nutritionist label) with a Certified Eating Disorder Specialist credential indicated by “CEDS”, and a therapist who specializes in eating or feeding disorders. For more complex individual cases, a speech language pathologist and feeding specialist are essential components. When the whole family and team work together to change meal time behaviors, success will follow.  What does an RD do to treat ARFID?  In one on one sessions or parent joined sessions, we will educate you on healthy eating and addressing food fears one step at a time, to empower you to face these fears and live a full life that YOU control, not ARFID. We will teach you and/or your kiddo to move up the ladder and include all food groups gradually, moving up the steps to eating, without meltdowns and shuts downs. Treatment includes developing pre and post mealtime coping strategies, meal time structures and psychoeducation, as well as hands-on regulation tools to help quiet the chaos and create opportunity for change. In addition, the dietitian’s role may look like exposure therapy sessions, creating family meal calendars, meal supports, family-based interventions, cooking sessions, CBT techniques amongst other modalities (i.e. SOS Approach to Feeding, DBT, RO-DBT), and play based sensory exposures and integration. Visit our previous blog on How to Use a Food Hierarchy in ARFID for a more in depth look on what some of your nutrition sessions may look like. For children and adolescents, doctors will monitor labs, growth charts, and vitals ensure your kiddo is hitting their targets and getting back on their growth trajectory and prevent nutrient deficiencies. Additionally, doctors may prescribe medications to increase appetite or treat underlying/cooccurring anxiety. The therapist on the team will also troubleshoot this frequented component in sessions. OCD, ADHD, and sensory processing disorders and sensitivities are often co-ccuring in individuals with ARFID, therefore a therapist and dietitian will often use Cognitive Based Therapy (CBT) skills to help foster the safe connection between mind and body, the thoughts, feelings and behaviors. Navigating ARFID treatment can be tough and overwhelming, but we are here for you. Reach out to the LCWN Team and we would be happy to discuss how we can support you and connect you with experts in the space.

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Four Types of ARFID

Lifestyle /

ARFID, also known as Avoidant/Restrictive Food Intake Disorder, is a newly recognized eating disorder characterized by individuals having an extreme aversion to certain foods or food groups, leading to limited or restrictive food intake1,2.  This disorder can pose significant challenges for those struggling with ARFID, as it can greatly impact their overall health3.  Some individuals may have strong aversions to certain foods due to sensory issues or past negative experiences; however, individuals with ARFID experience these aversions to such an extreme degree that it impairs their ability to maintain a balanced diet.  This can result in weight loss, nutrient deficiencies, malnutrition, and other health complications2,3,4.  In contrast to other eating disorders like anorexia nervosa or bulimia nervosa, ARFID does not involve body image concerns1,2, rather, a genuine fear or anxiety around certain foods, which can make mealtimes a source of stress and discomfort.  Researchers have identified different subtypes of ARFID, including sensory-based and fear-based restrictions, with some individuals experiencing a mix of both5.  Each subtype presents its own set of challenges and behavioral patterns and may require a different approach to diagnosis and treatment. Avoidant ARFID What sets eating apart from other activities is that it engages all eight senses: sight, smell, taste, touch, hearing, vestibular (sense of balance), proprioception (sense of body position), and interoception (internal awareness)6.  Individuals with the avoidant type of ARFID have a heightened sensitivity to such aspects and may find certain foods to be intolerable due to these sensory sensitivities5.  For example, a person with the avoidant type of ARFID may refuse to eat foods with a certain texture, like mushy or crunchy foods, because they find them unpleasant to eat.  Restrictive ARFID Have you ever become so engrossed in a task that you forgot to eat or even missed a meal?  This phenomenon is not uncommon among individuals who are highly focused on their work or activities; however, for those with the restrictive type of ARFID, the reasons behind missing meals may be quite different. Specifically, individuals with the restrictive type of ARFID may not eat due to poor interoception and/or lack of interest in eating5.  Interoception refers to the ability to perceive internal bodily sensations, such as hunger and fullness cues6.  Difficulty in recognizing these cues can lead to unintentionally skipping meals.  Aversive ARFID Negative experiences with certain foods can have a lasting impact on our perception and future willingness to consume them.  For example, if someone gets food poisoning from eating sushi at a restaurant, they may develop a fear or disgust towards sushi in general. This understandable reaction may serve as a defense mechanism to prevent future illness or discomfort and, for most people, does not significantly affect their overall diet.  They may simply avoid the food that caused them harm and continue to eat many other foods.  Similarly, with the aversive type of ARFID, food avoidance may be due to negative experiences or fear of choking, vomiting, food poisoning, or other adverse effects5; however, these individuals may avoid a variety of foods, not just those that have directly harmed them.  If left untreated, it can lead to nutritional deficiencies and other health problems2,3. Mixed ARFID Finally, mixed ARFID combines both sensory-based and fear-based restrictions: that is, individuals may avoid certain foods due to their texture, taste, or smell, as well as fear of choking or vomiting5.  Research suggests that individuals with ARFID may experience each subtype to varying degrees, meaning one may be predominant7.  This dual impact can make it even more difficult to meet nutritional needs and maintain a healthy weight.   Key Takeaways In conclusion, while classifying ARFID subtypes can be useful for diagnostic and treatment purposes, it is important to consider the unique needs and challenges of each ARFID patient.  In doing so, clinicians can provide more effective and compassionate treatment that addresses the root causes of the disorder and supports long-term recovery.     References National Eating Disorders Association. Avoidant Restrictive Food Intake Disorder. Nationaleatingdisorders.org. Published 2023. Accessed July 1, 2024. https://www.nationaleatingdisorders.org  Attia E, Walsh BT. Avoidant/Restrictive Food Intake Disorder (ARFID) – Avoidant/Restrictive Food Intake Disorder (ARFID). Merck Manual Professional Edition. Published July 2022. Accessed July 1, 2024. https://www.merckmanuals.com/professional/psychiatric-disorders/eating-disorders/avoidant-restrictive-food-intake-disorder-arfid?query=avoidant/restrictive%20food%20intake%20disorder  Nitsch A. ARFID (Avoidant Restrictive Food Intake Disorder) | Symptoms & Treatment. ACUTE. Published May 26, 2022. Accessed July 1, 2024. https://www.acute.org/blog/avoidant-restrictive-food-intake-disorder-arfid-signs-symptoms-treatment  ARFID Eating Disorder: Comprehensive ARFID Treatment. The Emily Program. Accessed July 1, 2024. https://emilyprogram.com/eating-disorders-we-treat/avoidant-restrictive-food-intake-disorder/ Douglas S. The Link between ARFID and Neurodiversity. dietwise.net.au. Published May 29, 2024. Accessed July 1, 2024. https://dietwise.net.au/2024/05/29/the-link-between-arfid-and-neurodiversity/#:~:text=Mixed%3A%20characterized%20by%20having%20two Saunders (Bulman) M. The Sensory Experience of Eating: Part 1. The Healthy Eating Clinic. Published February 8, 2023. Accessed July 1, 2024. https://healthyeatingclinic.com.au/the-sensory-experience-of-eating-part-1/  Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current Psychiatry Reports. 2017;19(8). doi:https://doi.org/10.1007/s11920-017-0795-5 

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Pickled Red Onions

Recipes /

  Have you ever bought a red onion for a recipe and realized you have a lot of extra left over? Or you want an Instagram-worthy presentation with a beautiful garnish. Whatever the reason, you're going to want to use this recipe for pickled red onions. Not only do pickled red onions add the perfect amount of acidity to any dish, they are easy to make. You only need 5 ingredients: apple cider vinegar, salt, sugar, red onions, and water.

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