Rehab Kids

Using Food to Survive

Early Trauma
Binge Eating as Self-Harm
Behavior
Amy Pershing, LMSW, ACSW

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Using Food to Survive
Early Trauma
Binge Eating as Self-Harm
Behavior
Amy Pershing, LMSW, ACSW

Rehab Kids

ZNM059573
10/23
Copyright © 2023

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 MATERIALS PROVIDED BY

Amy Pershing, LMSW, ACSW, is the Founder of Bodywise, the

first binge eating disorder (BED)-specific treatment program
in the United States, founded in 1995. She is the Director of
Pershing Consulting, which offers training to clinicians treating
BED around the world. Amy is also the creator of “Hungerwise™,”
a 9-week program for ending chronic dieting and weight
cycling using the Attuned Eating and Movement approach,
offered nationally online. Based on over 30 years of clinical
experience, Amy has pioneered a treatment approach for BED
that is strengths-based, incorporating Internal Family Systems,
somatic trauma techniques, Attuned Eating and Movement, and
a Health at Every Size philosophy. Amy lectures internationally
and writes extensively on the treatment of BED and her own
recovery journey for both professional and lay communities. She
has been featured on radio, podcast, and television speaking
about BED treatment and recovery, relapse prevention, weight
stigma, and attuned eating and movement. She is a founding
member and Past Chair of the Binge Eating Disorder Association
(BEDA) and is the winner of BEDA’s Pioneer in Clinical Advocacy
award. She is the author of the book Binge Eating Disorder: The
Journey to Recovery and Beyond as well as many articles and
chapters about BED treatment and advocacy.

For speaker disclosures, please see the faculty biography in activity advertising.

Materials that are included in this course may include interventions and modalities that are beyond the
authorized practice of certain professionals. As a licensed professional, you are responsible for reviewing
the scope of practice, including activities that are defined in law as beyond the boundaries of practice in
accordance with and in compliance with your profession’s standards.
 Binge Eating as Self-Harm Behavior:
Using Food to Survive Early Trauma

Amy Pershing, LMSW, ACSW, CCTP-II

Founder, Bodywise LLC
President, The Center for Eating Disorders
Author, Binge Eating Disorder: The Journey to Recovery and Beyond (2018)
Co-Author: Emotional Eating, Chronic Dieting, Bingeing And Body Image: A Trauma-Informed Workbook (2024)

Statement of Accuracy and Utility/Scope of Practice: Materials that are

included in this course may include interventions and modalities that are
beyond the authorized scope of practice for your profession. As a licensed
professional, you are responsible for reviewing the scope of practice,
including activities that are defined in law as beyond the boundaries of
practice in accordance with and in compliance with your profession’s
standards.

Conflicts of Interest: As required by several accrediting boards, speaker and
activity planning committee conflicts of interest (including financial
relationships with ineligible organizations) were disclosed prior to the start of
this activity. To view disclosure information, please see activity advertising.

1
 Today

a. Define binge eating/BED

b. Understand how bingeing (and restriction) offer protections in the face of
overwhelming early experiences
c. Re-defining Recovery
d. The Critical Components of the Change Process; Best Models of
Practice/Attuned Eating and Movement
e. Clinical Assessment
f. Questions

All quotes are from my

clients

All quotes are used with
permission

My immense gratitude and
respect for the risk takers

2
 What is binge eating disorder?

A response to deprivation

A response to fear and shame

A response to oppression

A response to weight stigma and the thin ideal

A way to survive

Lived Experience

“For me, binge eating was the one
thing that was completely mine.
When I first entered treatment, I
felt two very different things. Part
of me was ready to change. The
other part was very clearly saying
no way am I doing what I’m
supposed to do. I nearly died doing
that my whole childhood.”

“I do know there are times I eat
when I’m angry. Or when I feel
self-loathing. Knowing I’m not
healthy, that I’m struggling with
pre-diabetes, with autoimmune
issues, with food allergies, with
high cholesterol. And I binge
anyway. In spite of it. To spite it.
To spite myself. To spite life. To
spite God. To make it worse.
Because I feel so, so, so bad. And
sometimes feeling worse kind of
helps me express the anger.”

3
 Clinical Definition of Binge Eating Disorder (BED)

BED: The Statistics

BED affects approximately 9%
of the general population (27
millions people)

Most common eating disorder
by 5x

Affects the biggest number of
men of any ED

Most underdiagnosed ED
(“obesity” as focus; diet as
“treatment”)

70% of people seeking WLS
have BED/ED.

60% of people seeking BED tx
have one or more diagnosable
mental health issue (including
anxiety, depression, PTSD)

4
 Etiology/Co-Occurring

Highest rates of trauma of any of the EDs (SA, PA, neglect, early
loss, greater situational trauma (e.g. poverty))

High rates of developmental/attachment trauma in FOO

High rates of substance use disorders in FOO

Significant rates of co-occurring mood disorders

Families often have significant difficulty with affect tolerance;
vulnerability may be seen as weakness

Significant social anxiety

Significant histories of dieting/restriction

High rates of weight related bullying/weight stigma experiences

High rates of ADHD and meeting “HSP” criteria

Common Comorbidities
• Type 2 diabetes • Anxiety
• High blood pressure • Sleep apnea/sleep
disturbances
• High blood cholesterol
• PCOS (polycystic ovary
• Gallbladder disease syndrome)
• Heart disease • Cushing’s Syndrome
• Certain cancers (overproduction of cortisol)
• Osteoarthritis • Asthma
• Joint and muscle pain • Stress related illnesses
• Gastrointestinal problems • Nutritional Deficiencies
• Depression • Side effects associated with
starvation (possible at any
• Metabolic changes weight)
• ADHD (30%)

10

5
 Is BED an “addiction”?

The dopamine theory (food increases dopamine levels as do
SUDs)

We are dopamine seeking creatures inherently. It is not
pathological, but hard-wired.

We experience dopamine surges in many ways, including
listening to music/reading a good book.

Food naturally triggers dopamine release.

Thus, sugar is not intrinsically a substance, using addiction
parlance, any more than a hug from a friend would be.

For most people with BED, there are other issues (anxiety,
depression, trauma histories, unmet needs of many kinds)
that drive them to seek ways to feel better.

This is not physiological addiction; it is a survival response to
control anxiety and shame.

11

Is BED an “addiction”?

The abstinence model is much like a diet model; diets increase the reward value of food
thus creating false perception of being “out of control” when abstinence is “broken”

The effects of deprivation due to dieting are by far and away the biggest contributor to
increasing the reward value of food. Neither our bodies nor our minds make a distinction
between diet and famine.

In any food plan that requires making certain foods forbidden or demands sustained
hunger, we will be far more likely to think about those forbidden foods, to seek them out,
and to overeat them given the opportunity. This is not addiction.

Implications for treatment (abstinence vs. permission; “powerless” vs. powerful)

12

6
 Why Binge Eating “Works” physiologically: Some
Possibilities

Some studies suggest that cravings for foods high in sugar and fat may be connected
to higher levels of cortisol production associated with ongoing stress. These foods
seem to lower the production of cortisol short-term

Dopamine surges associated with” highly palatable foods” (may be driven by impact
of forbidden nature of these foods) lessens experience of trauma activation

The hormone ghrelin (the “hunger hormone”) may play a role. Increased ghrelin is
produced during stress. Additionally, researchers found that increased levels of
ghrelin make the brain more vulnerable to traumatic events, suggesting that it may
predispose people to posttraumatic stress symptoms, and thus a further desire to go
to food to soothe.

The enteric nervous system may play a role. Part of the limbic system, the ENS is a
complex of nerves that regulate the activity of the stomach (sick to your
stomach/”butterflies”). Overeating may somehow impact our experience of ENS
activation in times of stress

Biological impact of overeating: both the PFC and limbic system are temporarily less
active when people overeat significantly as the body is focused on digestion. Thus
the “numbing” effect of overeating on emotional and cognitive awareness.

13

Lived Experience

“It’s like standing on the edge of a cliff. The

last thing you should do is jump. You know
that. You have jumped before and deeply
regretted it. And yet you feel absolutely
compelled to do just that.”

“When I finally do decide to binge, it feels like
the fight is over. That fight is exhausting, and
for a moment, I’m actually relieved.”

“When I get too close, I am terrified. Binge
eating keeps everything at bay.”

14

7
 Complex Trauma
Complex (or Developmental) trauma is a neuropsychological injury that
results from protracted exposure to prolonged social and/or
interpersonal danger in the context of dependence, captivity or
entrapment (a situation lacking a viable escape route for the victim),
which results in the lack or loss of control, helplessness, deformations
of identity and sense of self (and/or body), and both somatic and
affective accommodations as a result of adaptations to the damage. It
is a lessening of our ability to be in the world, and to see its complexity
and nuance. We are looking through the lens of the damaging
experiences, and behaving somatically, emotionally and cognitively as
though the tiger remains.”
From BED: The Journey to Recovery and Beyond (Routledge, 2018)

15

“The moment I decide to binge, I’m free.

I can feel my body relax and then kind of
disappear. Then I see the evening ahead
of me. Just me, the TV, and the food,
then sleep. A kind of sleep you can’t get
without bingeing. There won’t be room
for anything, or anyone, else. I won’t
think about all the things I’m going to
screw up tomorrow, or who doesn’t like
me, or who is going to leave. Nobody can
get to me here.”

16

8
 “74% of 293 women attending residential treatment (with binge behavior) indicated
that they had experienced a significant trauma, and 52% reported symptoms
consistent with a diagnosis of current CPTSD based on their responses on a CPTSD
symptom scale. These symptoms are far less correlated with restriction behaviors
without binge eating (about 15%).” -Timothy Brewerton, 2008.
“A total of 83% of BED patients reported some form of childhood maltreatment. A
total of 59% of BED patients reported emotional abuse, 36% reported physical abuse,
30% reported sexual abuse, 69% reported emotional neglect, and 49% reported
physical neglect. -Carlos M. Grilo and Robin M. Masheb, 2001.
“Emotional neglect was the most frequent event experienced (77.8% of females vs.
63.5% of males) in cases where binge eating was present.” -Didier Quilliot, MD, PhD,
et al, 2019.
“Participants with three or more ACEs had nearly nine times higher odds of
developing BED at two-year follow-up. Of the different types of ACEs, household
mental illness, household violence, and having a criminal household member were
most strongly associated with BED.” -Jonathan Chu, et al, 2022.

17

The Body on Trauma: Somatic symptoms

of CPTSD

Extreme fatigue

Chronic pain

Muscle tension/freeze or flight sensations

Disconnection from basic somatic cues
(hunger, fullness, pain, arousal)

Insomnia/sleep problems

Immune system problems

Gastrointestinal problems

Anger/outbursts/ agitation

Numbness/dissociative symptoms

Blunted or extreme affect

Sense of confusion/inability to focus
attention

Hyperfocused attention

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9
 How the Damage Happens:

Lack of adequate soothing

touch/voice/nourishment (co-
regulation)

Lack of/inaccurate mirroring/lack
of attunement

Contempt, impatience, shaming
(especially body shaming)

Lack of holding emotional
container; narcissism in caregiver

“Legacy trauma”: caregivers
consistently assessing for threat,
often caregivers have weight/body
image issues or eating disorders

Crossing physical boundaries/lack of
body ownership

19

A lack of foundational safety

results in deeply entrenched
stories of a lack of worthiness
of being protected. (The
child’s PFC creates narratives
to explain implicit memories)

Self exploration and self
development are hindered
(parts cannot develop
properly)

Psychological safety requires
preserving illusion of
connection with caregivers.
Requires significant self-
abdication, i.e., the forfeiture
of self- esteem, self-
confidence, self-care, self-
interest, self-protection,
physical self-awareness
(somatic cues), body trust

Shame narratives are
ultimately adopted by the
child as their own voice.

20

10

Eventually, inclination
toward authentic self-
expression activates shame
narratives

Survivors may live in
varying degrees of this
“flashback” much of the
time

This “critic” (or “manager
part” in IFS) assess the
person’s every action,
reaction, and body in an
attempt to protect from
further harm. Shame
becomes a tool of survival.

21

Resulting Underlying Beliefs Explain

Implicit Memory

I caused everything
that is wrong with
me

I am not lovable

I am defective

I deserved this (and whatever

I am stupid
shame that comes my way)

I will be alone

Others are better/more deserving

My body is than me
wrong/bad/shamef

I will be hurt
ul (weight stigma
narratives)
I cannot survive pain/I am weak

22

11

“My parents assigned chores, but no instruction or support was
ever provided to ensure successful completion. I tried, and from
my 7-year-old perspective, thought I did what was asked. Until I
was yanked out of my sleep and bed at 1 a.m. to look at the
‘half-assed job’ I did putting away the silverware. Did I put it in
the wrong drawer? I was sure I hadn’t. I looked at my Dad,
confused, which seemed to infuriate him further. ‘Look!’ he said.
I looked, still unsure what the problem was. Then, he pointed it
out. I had placed the spoons in their slot in the silverware
drawer, but I had not put them in so they were nesting against
each other. They were willy-nilly backwards and forwards, and
not spooning against each other the way my Dad thought they
should be. I heard all the time ‘How could you not know that?
How can you be this stupid?’ I can't remember ever feeling like I
was capable of doing a good job of anything."

23

Complex Trauma: Community and Culture

Poverty

Basic physical safety

Lack of access to basic resources
(housing, medical care, high-quality
food choices)

Lack of support system/community
support

Racism, anti-Semitism, homophobia,
transphobia, misogyny, gender bias,
rape culture and objectification,
ableism, classism)

Unemployment/underemployment

24

12
 Complex Trauma: Weight Stigma

Weight stigma is the discrimination toward
people based on their body weight and
size. It promotes the assumption that all
bodies are “thin” naturally, and being fat is
an inherent state of pathology (typically due
to overeating/lack of exercise/poor
willpower).

Clients in larger bodies are often fat
shamed, bullied and discriminated against in
many settings (including healthcare,
education, hiring practices)

Body shame is easily internalized for trauma
survivors, with an entire culture to back it
up.

There is rarely a questioning of body shame
as normative; in our culture, it is normal to
hate one’s body, even without trauma, and
at any size.

Internalized WS drives binge eating and
normalizes body shame

“I don’t live in my body; I monitor it.”

25

“I was five when my

stepfather sexually abused
me. I needed him in my life so
badly, and my mom did too.
We couldn’t afford the rent
without him. I remember
clinging to him, begging him
not to leave, despite what he
did to me. I felt like a loser
my whole life because I
begged him to stay. What kind
of freak wants their abuser to
stay? What I didn’t realize is
that I was still shaming myself
for what he did to me. He is
still off the hook, and I’m
always in the wrong. Now I
know I had no other choice but
to blame myself and my body.
And a fat body is easy to
blame.” -Allison

26

13
 Binge Eating and Associated Restriction
through A Self Harm Lens: Why food?
a. Food is predictable, more
available, and already
intrinsically comforting
(dopamine), especially for
children
b. Less psychological dissonance
than other forms of self-harm
(cutting/burning, suicidal
ideation)

27

Psychological Uses of Bingeing

a) To “punish” a “bad”, “dirty”,

“unworthy”, “evil” body
(protects the perpetrator)
b) A bigger body feels like a
shield, substantive (especially
if the abuse happened at a
smaller body size)
c) To feel less sexual (given
weight stigma)
d) To express feeling out of
control, pent up, contained,
confined
e) To punish a body for being
“fat”, for betraying
vulnerability to shame

28

14
 Psychological Uses of Bingeing

a) To take up space
b) To rebel against
restriction, dieting, being
“good”
c) To feel “disembodied”, to
dissociate
d) To express abuse, pain,
rage
e) To induce coma-like sleep
f) As an "excuse" to check
out, get away from
others/out of events

29

Psychological Uses of Restriction/Dieting

a. To diminish affect and somatic awareness

b. To feel “better”, more “virtuous”, “envied”, to
quiet the critic
c. To not “need”, and thus diminish vulnerability
d. To punish the body for its desires (especially SA
survivors)
e. To “fit”
f. To distract with weight obsession/body shame
g. To feel powerful, in control of something, capable

30

15
 Do people heal? YES!

We are “hope merchants”

Honor the adaptations

Offer compassion, curiosity and
space to struggle

Binge eating is not a moral
shortcoming or failure; it may be
a reasonable choice for some
time

Recovery is imperfect,
incremental and incomplete

31

“Recovery from BED in terms of behavior means an

increasingly peaceful, Self-directed relationship
with food and movement, based on physical desire,
nutrition, health and well being. It may or may not
mean a complete cessation of behaviors. It is about
appreciating our unique journey with food and
weight, challenging any body messages, from inside
or outside, that trigger shame and disconnection. Redefining Recovery
Psychologically, it is about being able to look with
growing compassion and lessened trauma activation
at our inner world and our outer world, our past
and present. It is about know what happened, and
knowing now is different. It is coming to de-
pathologize the experience of being “activated”
or “triggered”, and tolerate the affective
experience to heal the exiled pain.
And perhaps most critically, it is about allowing
ourselves, right now, to be seen and loved by safe
others. It is coming to learn that healthy
connection, finally, is both possible and abundant.
From 30,000 feet, it is also about dismantling the
social justice issues that maintain the disorder
through advocacy for structural change and space
for all bodies.
This journey is the art and science of our work.”
from BED: The Journey to Recovery and Beyond
(Routledge, 2018)

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 Best Practices Always:

Help clients to bring compassion and
curiosity to their relationship with
food, and offer interventions that
promote empowerment, safety and
connection

Assume “client as expert”, therapist
as holding the container, companion
and mirror (build Self
access/availability)

Eliminate “recovery perfection” or a
“finish line”; treatment may be
lengthy/episodic

33

The Critical Components of the Change Process

i. Models that suggest bingeing is about being

“powerless” should be avoided (abstinence models
such as Overeaters Anonymous)
ii.The “choice” to binge must belong to the client; no
behavior contracts
iii.Bingeing must be seen as a part of the journey of
healing, not a “relapse”
iv.The client’s relationship with food is theirs; it may
remain in the toolbox (harm reduction model)

34

17
 The Critical Components of the Change Process

a. Weight stigma, body objectification (internalized self-

objectification and cultural objectification) must be
addressed
b. Non-diet/intuitive eating model builds trust in the body
and allows clients to be the expert and owner of their
body and experience
c. “Fixing” the body (i.e. weight loss or shape change)
should not be a treatment goal; body autonomy should
be the goal of best practice
d. Psychoeducation about weight and health (and the
common myths) is essential

35

Trauma-Informed Somatic Models

Interventions that help clients learn to de-pathologize the experience of
being “activated” or “triggered” and process the experience effectively:

IFS

Feminist psychodynamic

Help clients build skills to get out of a fight/flight/freeze/fawn state (and the
impulse to binge when triggered):

Somatic Experiencing

Mindfulness

EMDR/body-based interventions

Interventions for clients with ADHD to enhance affect identification and tolerance;
depathologize ADHD thoughts/behaviors and build coping skills

36

18
 The Critical Components of the Change Process

Components of Treatment

Individual psychotherapy (trauma informed)

Family/couples counseling

Intuitive eating support with nutrition professional and/or group

Eating coach

Recovery community

Higher Levels of Care (i.e. residential, IOP)

When more support is needed for change, especially for intensive trauma work

When medical monitoring is necessary

37

Healing the Relationship with Food: Best

Practices

The goal of recovery is healing from
pain, not weight loss or diet
adherence

Non-diet (eating patterns must come
from the client, not an external
“expert”)

Weight neutral (no assumption about
what the client “should” weigh; the
body decides)

Body autonomous (the client knows
best about food and movement
choices)

No food or weight moralization; help
the client hard what is best for them

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19
 “Healthy” eating/exercise myths

We can correctly define “healthy
eating” (amount/proportion/types
of foods needed for optimal
health)

Healthy eating is the same for
everyone

Healthy eating results in thin
bodies for everyone

We know the mechanisms of
causality with regard to food,
exercise and weight on
health/disease

39

40

20
 The Real Deal
o Dieters may lose weight in the short term, but the chance of keeping if off for five years or
more is the same as the chance of surviving metastatic lung cancer: about 5 percent
(Brown, 2015).
o “Between one-third and two-thirds of dieters regain more than they lose. Three quarters to
90 percent regain at least the amount originally lost within two years.” Mann, Traci et al.,
‘Medicare’s Search for Effective Obesity Treatment: Diets are Not the Answer,’ American
Psychologist, April 2007.
o “Paradoxically, adolescent girls with elevated scores on dieting scales are at increased risk
for future onset of obesity...indicating that dieting predicts weight gain in adulthood.” Stice,
E., et al., ‘Psychological and Behavioral Risk Factors for Obesity Onset in Adolescent Girls: A
Prospective Study,’ Journal of Consulting and Clinical Psychology, Vol. 73, No. 2 195-202
(2005).
o “Adolescents using weight control practices at Time 1 increased their BMI by about one more
unit than adolescents not using any weight control behaviors and were at approximately
three times greater risk for being overweight at Time 2.” Neumark-Sztainer, D., ‘Obesity,
Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do
Dieters Fare Five Years Later?’ Journal of the American Dietetic Association, Apr;106(4):559-
66 (2006).

41

Dieting simply doesn’t make biological sense

Fundamentally, our bodies don’t know the difference between a diet

and a famine. When we go on a weight loss plan that involves either
significant caloric reduction, or tolerating hunger for a sustained
period, we experience key survival-based biological changes that
drive us to seek food, including:

First, brain chemistry changes with prolonged hunger to make us feel
overly interested in food, and making foods appear more tempting than
normal. Our brain thus fuels obsessive thinking about getting high-calorie,
ultra desirable foods to sustain us.

Second, when you lose body fat quickly, the amount of certain hormones
in your body changes. Most relevant to dieters, the levels of hormones
that help you feel full decrease. At the same time, hormones that make
you feel hungry increase. Thus you become more likely to feel hungry, and
less likely to feel full, given the same amount of food.

Finally, our metabolic rate slows, and our bodies use calories with
increasing efficiency. Our bodies adapt over time to needing fewer and
fewer calories to operate, and those we do consume are increasingly
stored as fat. (the “weight loss plateau”). When you inevitably go off your
diet, and “cheat”, your body is likely to be in this slowed storage mode,
and weight comes back on even more rapidly.

42

21
 But what about health?

43

“Healthy” weight is…

individual and somewhat variable

impacted by many factors, both individual and environmental (including
access to nutrient-rich foods, disease, genetics, environment, age,
composition of gut bacteria, exposure to hormone-disrupting chemicals,
metabolism, stress levels, and trauma)

not necessarily indicative of health status

largely predetermined by genetics

highly resistant to long term change

44

22
 “Healthy weight is not…

a single unchanging number on a

scale

a Body Mass Index (BMI) category

a specific shape or specific size of
clothing

readily controllable

a measure of willpower

easily known/calculated

45

● “Studies suggest that the genetic

contribution to BMI may be about
70%. …studies yield remarkably
consistent results.” (NIH Clinical
The Role of
Guidelines on the Identification,
Evaluation, and Treatment of
Genetics
Overweight and Obesity in Adults)
● “Genetic studies have shown that
the particular set of weight-
regulating genes a person has is
by far the most important factor
in determining how much that
person will weigh. .. It's even
greater than that for many
conditions that people accept as
having a genetic basis, including
heart disease, breast cancer, and
schizophrenia. 2004).

● 43% of females have the

‘heritable’ propensity to
“achieve” thinness (Suisman, et
al, 2012)

46

23
  2005 – Greggs, et. al. found
decreased cardiovascular disease
risk factors in all weight
categories.

 2013 – Phillips defined

“Metabolically healthy obesity”
and “Metabolically unhealthy
normal weight.”

 2015 – Brown and Kuk found that

not only did weight loss not
necessarily resolve all medical
issues, it could actually be
detrimental in some people.

 Bottom line: we cannot connect

higher weight to
disease/pathology/reduced QOL
indices in any given person.

47

Thinner = healthier, right??

The prevalence of obesity treatments would suggest the connections
between weight, nutrition and health have been established through
scientific and medical research.

Indeed the opposite is the case. We simply do not know at this time
what makes for a healthy diet.

Nor do we know if everyone should eat the same things in the same
proportions, or get the same amount of exercise for optimal health.

In addition, much of the research is predicated on faith that when
fat people lose weight, they become healthy in the same way a
thinner healthy person is healthy.

The evidence says otherwise. In fact, it suggests that even if you lose
weight, you will always need fewer calories and need to exercise
more or the weight will very likely return. Our bodies seem
determined to return and remain at the higher weight. Thus, obesity
treatments offer a solution to something that may not be a problem,
and a solution that does not even work as promised (Bacon, 2010).

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 Correlation vs. Causation

Disease is often related to specific dietary choices. For instance, eating fast
food once a week has been linked to high blood pressure in teens (Pereira, et
al., 2005). And eating fruits and vegetables every day is associated with lower
risk of heart disease. But science has yet to establish causality

Higher BMIs have been linked to a higher risk of developing Type 2 diabetes,
heart disease, and certain cancers, especially esophageal, pancreatic, and
breast cancers. But weight loss is not necessarily linked to lower levels of
these diseases. A 2004 study suggested patients with Type 2 diabetes
who maintained their weight had the best prognosis (Field, 2004). This study
has been repeated and similar results shown.

The only study to follow subjects for more than five years, the 2013 Look
AHEAD study, found no significant difference between people with Type 2
diabetes who lost weight and those who didn’t for heart attacks, strokes, and
death (The Look AHEAD Research Group, 2013).

Study after study has turned up what has come to be known as the “obesity
paradox”: “obese” patients with heart disease, heart failure, diabetes, kidney
disease, pneumonia, and many other chronic diseases fare better and live
longer than those of "normal" weight (Pi-Sunyer, 2022).

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25
 Who benefits from stigma?

The total U.S. weight loss market is $159.76 billion. The
total market is forecast to grow 2.6% annually through 2026.

228,000 bariatric surgeries in 2017 (up from 128,000 in 2011,
despite significant increase in complications reported).

In 2022, 14.9 million surgical and 18.8 million non-surgical procedures
performed worldwide. The report shows a continuing rise in aesthetic
surgery with a 41.3% increase over the last four years.

In the US. :

Breast augmentation (365,000 procedures, up 4 percent from 2021)

Liposuction (400,000 procedures, up 5 percent from 2021)

Tummy tuck (140,000 procedures, about the same as 2021)

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Attuned Eating and Movement (AEM): Essential to

BED Recovery
Attuned eating and movement is a health
philosophy based on the premise that
becoming attuned, on all levels, to the
body’s needs for food and movement
allows for maintenance of a healthy
weight (as defined by the body), a
decrease in food and weight obsession, a
decrease in overeating/binge eating, and
a more peaceful relationship with one’s
physical body.

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 AEM Invitations

shift from external rules for eating/movement to reliance on internal cues

making choices from a combination of the immediate “felt sense,” past body
experience

"big picture" nutrition

acceptance of your body "as is”

a focus on "curiosity and course correction"

a focus on providing the best possible care for one’s current body

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AEM Tenets

Unconditional permission to
eat, rest, move

Reject the diet mentality

Learn to connect safely with
the felt sense of body needs
(hunger/fullness and
movement)

Leave morality out of food

Discover the critical nature
of satiety

Build body wisdom over time
and honor your health needs

Allow your body to
determine your weight

Beware of the “AEM Diet”

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55

Assessment Questions About Eating Behaviors and

Self Harm

Do you use food to change how you feel emotionally or physically?

Do you ever eat or overeat to deal with stress or anxiety? What about if you’re angry? Sad?

Do you ever feel out of control when you eat, unable to stop?

Do you think about food a lot in your life? Do you notice how you feel about yourself is
connected strongly to what you eat?

Do you have difficulty trusting your body about what to eat unless you’re on a program or
diet?

Do you feel a lot of guilt or shame if you eat things you think you “shouldn’t”, or after a
binge episode?

Do you limit the foods you allow yourself to eat, but then end up overeating those very foods
instead?

Do you have a history of dieting or restricting food? How about family members?

When have you felt best about your body in your life? What circumstances created that
feeling?

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 Assessment Questions About Eating Behaviors and Self Harm cont.

Tell me a little bit about what you hope to change about food in your life?
(don't assume what they want to change)

Are there any times in your daily life that you don't think about food or
weight? When? How does that happen, do you think? (assessing for Self
awareness here)

What is a "perfect" eating day for you? What is a typical eating day?

Do you notice any patterns to your binge eating? Any idea why?

Can you think of any ways your relationship with food might be helpful to you?
Or: Why do you think these patterns have developed for you?

Do you remember a time when food was just a normal thing in your life? Has
there been a charge around it for a long time for you?

What are some things you have tried to change your relationship with food or
exercise? What happened in those attempts?

Be sure to share the following:

binge eating always makes sense; it is never about willpower or personal
weakness

binge eating is actually made worse by dieting

therapy will help you find out why binge eating happens for you (and how it
may actually have been helpful in psychological ways), and how you might
meet those needs in other ways. Bottom line: create hope.

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You deserve
to do your
own healing…

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 Summary
1. Honor the adaptation of binge
eating (and restriction)
2. Work to heal trauma
3. Learn the body’s language
and develop trust
4. Expose the impact of weight
stigma and body shaming
5. Food may remain in the
toolbox
6. Challenge roadblocks to body
autonomy

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Thank you!

www.thebodywiseprogram.com

www.center4ed.org

amypershing@gmail.com

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NOTES
NOTES