Reclaim You- Medical Care in Eating Disorder Recovery
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In this conversation, Sarah and her guest, Rachel Shiflet, discuss the importance of having eating disorder-informed medical providers and regular check-ins with medical professionals during recovery. They explore the concepts of weight stigma and anti-fatness, emphasizing the need for awareness and consciousness in medical settings.
This conversation explores strategies for advocating for oneself and navigating medical appointments in the context of eating disorder recovery. Rachel shares tips to navigate medical appointments, the importance of educating providers and bringing an advocate when it would feel supportive. They also share grounding techniques and self-care practices to reduce anxiety and create a sense of safety.
The conversation highlights the need to know one's limits and set boundaries, as well as the challenges of navigating scarcity and deprivation in healthcare. Sarah and Rachel emphasize the importance of working with a treatment team and practicing self-compassion and self-inquiry throughout eating disorder recovery. They also address the challenges of managing dietary restrictions while in recovery and provide guidance on dealing with providers who blame all medical concerns on eating disorders.
Takeaways
Having eating disorder-informed medical providers is crucial for comprehensive care during recovery.
Regular check-ins with medical professionals are important to address both physical and mental health concerns.
Weight stigma and anti-fatness are pervasive in society and can negatively impact individuals' experiences in medical settings.
Advocating for oneself in medical settings can be challenging but is essential for receiving appropriate care and support. Advocate for yourself and educate providers about your needs and concerns.
Bring an advocate to medical appointments for support and validation.
Use grounding techniques and self-care practices to reduce anxiety and create a sense of safety.
Know your limits, set boundaries, and prioritize your well-being.
Work with a treatment team and practice self-compassion and self-inquiry.
To learn about Rachel and working with her business partners Kristen and Emily, visit https://www.liberatedplate.co/
Be sure to follow Liberated Plate on Instagram at https://www.instagram.com/liberatedplatenutrition
For Don't Weigh Me cards, visit More-Love at https://more-love.org/resources/free-dont-weigh-me-cards/.
Thanks for listening to Reclaim You with Reclaim Therapy!
To learn more about Reclaim Therapy and how to work with a therapist on the team, head to www.reclaimtherapy.org.
Be sure to comment, like and subscribe here, or on YouTube and come follow along on Instagram!
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[00:01] Sarah: Hi there. Welcome to reclaim you, a podcast published by the Reclaim Therapy team. Join us as we share stories, tools and insights on how to reclaim you in the wake of trauma, disordered eating and body shame. Grab your coffee, tea or your favorite snack and get cozy because we're about to dive in. Hey everyone. I'm so excited to have a special guest on today's episode. Rachel Schiflett is joining us. She's an anti diet dietitian specializing in eating disorders and disordered eating. She has experience working with folks with eating disorders and higher levels of care and has recently started her own practice, liberated plate nutrition therapy, along with two other dietitians that seek to provide nutrition therapy from a liberatory framework. While Rachel was starting her career in eating disorder nutrition therapy, she also pursued a degree in nursing. She's currently a registered nurse who is finishing her master's in nursing. Specializing in family nursing practice and primary care. She's passionate about providing fat positive and weight inclusive nutrition and medical care. She hopes to provide primary care deeply rooted in principles of social justice, fat positivity, and health at every size. As a nurse practitioner after graduation, I know you're going to love this conversation, so let's dive in. Hey, everybody. Welcome back to reclaim you. I'm so psyched to have Rachel on the podcast today. We're talking all things eating disorders and medical care and lots of offshoots of that topic. So welcome, Rachel.
[01:31] Rachel: Thanks, Sarah. Thanks so much for having me. I'm so excited to be here and talk about all things eating disorder and medical and therapy, and we'll be them all together.
[01:40] Sarah: Love that. So to start, I'd love to just ask you, what does reclaim you mean to you?
[01:47] Rachel: Oh my gosh. I've heard you ask this to so many different people and it's so cool to be able to answer it for myself. It's such a good question. I feel like it's such a broad question, too.
[01:57] Sarah: I know, right?
[01:58] Rachel: I know. But when I think about the word reclaim, I immediately kind of think about if we often have the chance to claim anything for ourselves to begin with, right? So I feel like the pressures of society and diet, culture and family systems and hustle, culture and performance, culture and all the systems of oppression are influencing people at a younger and younger age. And it's like, do we ever truly have a chance to claim to begin with our own needs or wants or desires from the start, right? So I think almost reclaiming to me means like, engaging in a little bit of self inquiry and understanding and questioning beliefs and narratives or patterns that maybe you've been taught to just sort of go along with. But maybe somewhere deep down, they feel wrong or not aligned or dehumanizing or objectifying or upsetting in some way. And I think too, right, since we are going to be talking about all things medical today, I think reclaiming you in the sense of a medical setting or in the medical world is really just reclaiming your sense of humanness and your sense of worthiness outside of our medical system's really rigid definition of health and really rigid criteria for being healthy or having health. And I think it's recognizing that and having that deeper knowing that you are so much more than a set of lab values or test values or diagnostic codes. And we can never reduce a person down to a set of medical data. So that's what I would say.
[03:41] Sarah: I think that's such a wonderful answer. Yeah. You're the perfect person to talk to about this because of your background as a dietitian and being back in school to be a nurse practitioner and do some primary care stuff. So to have an eating disorder informed primary care provider is, like, so special, so hard to find. Yeah. So I'm so glad that you're here talking about this. Why is it important for a medical provider to be eating disorder informed?
[04:15] Rachel: Oh, my gosh, it's so important. I think that the first thing, too, that comes to mind is I really like to use the term eating disorder aware and eating disorder conscious in addition to eating disorder informed, because I think sometimes the term informed can be this way that providers can kind of almost, like, intellectualize information and sort of weaponize it almost. Right. Like, I have all this information, but I'm not actually acting in alignment with the information that I have. And I think we'll go into this today, but I think that speaks to our own internal biases. Right. Sometimes, and I talk about this a lot with clients, too, but it's almost like that head to heart disconnect that happens so often in eating disorders. We could also say, like, cognitive dissonance sometimes, but I really like to do it as, like, head to heart. Right. So it just does not kind of translate into what we're doing. But, yeah, I think that being eating disorder aware and conscious is actually, like, the way that we practice, not just the knowledge that we have. So I think it can be a little bit different. But I think that being eating disorder aware, conscious, or informed just means that you are actively acknowledging that eating disorders and disordered eating do not discriminate based on body size or age or race or ethnicity or gender or sexual orientation or socioeconomic status, and truly, deeply, deeply knowing that any person who walks through your door could be deeply struggling, no matter how put together they look or how they're appearing or what their body size is or, again, how they're presenting and just knowing that we can never make assumptions and we have to be curious and we have to be asking questions.
[06:12] Sarah: Yeah. That's so important. You know, and I know, and the folks probably listening know that going to medical providers that aren't coming from that place and aren't just curious and open and looking for different symptoms or concerns, distress, suffering, they miss so much. Right. And if your provider is missing something or diminishing something that has a really serious impact in your sense of self or your relationship with your eating disorder and what's real and what's not and who's sick enough and who's not, it's really important.
[06:45] Rachel: Oh, my gosh. Yes, totally. Yeah. I think that's such a good point. Right. And I also think it's important, too, to acknowledge that even if your primary care provider is eating disorder informed or aware or conscious or whatever word we want to use, they might still not be specialists in eating disorders. Right.
[07:05] Sarah: True.
[07:06] Rachel: A big difference between informed and then specializing in something as complicated as an eating disorder. And I think that having a medical provider who is aware in and of itself is like a huge privilege. Right. And also having a medical provider who is a specialist in eating disorders is such a privilege, and it's so inaccessible for so many different reasons. Right. But just noting that being aware does not mean that they know everything about eating disorders, and it does not mean that they have a really deep expertise in eating disorders. And I think just having that acknowledgment and humility, it doesn't make anything that they say that could land poorly or not align with what you're needing in that moment any better. And also, eating disorders are so complex. And even people who do specialize in eating disorders, they miss the mark sometimes because it's just so challenging.
[08:07] Sarah: Yeah. And I think, in my experience, it can be difficult to really support folks to go see their care team. Right. Their docs, their specialists, things like that. And at the same time, we know that in most eating disorders, that it's important to have some medical oversight and to make sure that the body is okay along with the mind. Right. So can you speak to a little bit of why it's important to have regular check ins with medical providers while you're navigating recovery, whether you're new in recovery or in recovery for a long time.
[08:40] Rachel: Yeah. Oh, my gosh. Totally. I'm so passionate about this. I think one thing that we kind of acknowledge, and some people probably know this statistic, other people might not, right. But eating disorders are the second most deadly mental illness after opioid use disorder. So there are a ton of mental health and medical complications that come with eating disorders. So it really is like a team approach. Right? Like, the more support, the better. And I think that the first thing that comes to mind with this is, like, if you can find a primary care provider, whether that's an NP, that's a nurse practitioner or a physician assistant or a medical doctor or a do whatever it might be, that's just another source of support. That's like another bubble in between yourself and the outside world that can be so activating and triggering for the eating disorder. So I almost like to. This is from my supervisors. I did not come up with this, but kind of thinking about ourselves in this bubble with you in the middle and then creating these bigger bubbles kind of around you. And the bubbles kind of represent different levels of accountability and support, whether that's accountability for attending appointments or following your meal plan or feeling your emotions or whatever. But the more that we can kind of almost protect ourself and kind of put ourself in that place of safety, I think the better. So I think it can just be another source of awesome support, and it can be a way to combat the eating disorders constant dialogue around not being sick enough until XYZ happens. Right? So an eating disorder specialized doctor can help provide you with some medical knowledge to be able to kind of combat, again why certain bodies and certain people show various physical outcomes of eating disorders and why others do not. And I think that that can help increase motivation for recovery when a skilled provider is able to say that the body and the mind is not just fine, quote unquote, right. As a result of the eating disorder, even if the person is still technically able to function each day and go to work or go to school or take care of others or engage with their day to day routine in some capacity. Right. So they can really help with that understanding of, like, your body is so resilient. These are the compensatory mechanisms that your body does in the face of starvation, malnutrition, restriction, any kind of purging behaviors. Right. So your body is kind of compensating for your compensation in some ways. Wow. How miraculous, how resilient. How incredible is that? So I think it can be helpful in that sense just to have somebody else in your corner that can speak to some of the medical rationale and the medical complications that can come up that can make it so challenging.
[11:49] Sarah: Yeah, definitely. And even stepping outside of lab results. Right. We know that someone can have normal, quote unquote normal labs and still be very sick because of their eating disorder or suffering a great deal because of their eating disorder. So it does feel so important to have someone who can speak to this connection and the toll that disordered eating behaviors or eating disorder behaviors are taking on the body and on the nervous system and how everything is so connected. And something happens over here, and so something happens over here. And when we're not super aware of that, it can be easy to just kind of go through the motions and say, like, oh, well, my labs are fine. I'm not sick enough. This is okay. Right. And a lot of times I think that's the message that gets taken home, is that when my labs are bad, then I'll be sick enough to get treatment, to get help to whatever, when really the suffering is real, even when things are, quote unquote normal.
[12:48] Rachel: Yes. Oh, my gosh, yes. I love that. I always tell my clients to, eating disorders are mental prisons, right. And I think that one thing that can come up a lot of the time, if a medical provider, unfortunately, is not eating disorder aware, conscious, and or does not have eating disorder specialization, expertise, is sometimes when we've been working so incredibly hard to do recovery and to really follow our meal plan, to do that metabolic repair and healing, to heal every single organ system that's impacted by an eating disorder, that doesn't make the eating disorder go away. And what we know from research is that usually in eating disorders, physical health, quote unquote, the physical complications of eating disorders typically heal faster than the mental, emotional, the nervous system components of the eating disorder. And so, unfortunately, I think what can happen sometimes is when medical providers are not aware of that, and then we say things or send the message of, oh, well, look at this. Your labs are so much better. Your heart rate is up, right, your blood pressure looks really good. It can kind of invalidate that suffering that I think can actually be like, the worst of both worlds sometimes, right? I'm now in a medically stable body, and I'm so deeply still in this mental cage, this mental prison trapped by the eating disorder, and that can feel so uncomfortable having a medical provider that can acknowledge that and hold both and acknowledge that there can be grief and loss with becoming medically stable again.
[14:38] Sarah: Yeah, absolutely. And as you were saying that, I was also thinking of how it's also so important for medical providers to collaborate with the treatment team. Right. Because there's so many people doing lots of different ways of supporting someone and without kind of reaching out and sharing and discussing, conceptualizing together, so much can be lost. Right. Where people just like, oh, you're better, you're recovered. Okay, cool. Next, move on. Keep it moving. When really the treatment team could be seeing something a lot deeper because of their relationship with the client.
[15:13] Rachel: Yes. And I think that, too. Another part of this whole conversation is being eating disorder. Informed as a medical provider means having the humility to be able to coordinate care with other disciplines.
[15:26] Sarah: That's for sure.
[15:28] Rachel: I do not know everything that there is to know about nutrition or the medical complications of eating disorders. Maybe there is something to learn from a dietitian who is specialized. Maybe there is something to learn from a therapist who is specialized. Right. And so I think that a good provider will be curious about what they don't know, not only in a sense of being able to coordinate care, because I do think the gold standard for eating disorder care really, truly is having a really solid therapist. Right. Having an eating disorder, specialized dietitian, having a psychiatrist, and then having a primary care doctor so much. And to really kind of hold that as a privilege to be able to coordinate care for people in such a nuanced and vulnerable way, eating disorders are so complex, and it's a really vulnerable time for people to be entering eating disorder treatment and for them to even be able to kind of accept that help or support. So I think it's so important for us just to, as medical providers, myself included, is check our biases and always have humility. And it's like, I don't know everything. I know nothing sometimes. Right. And there's always something to learn from every single other person of the treatment team. And the best eating disorder providers, even if they're not specialized or have expertise, are going to want all the information. They're going to be so open to it. They're going to be so committed to learning and really understanding, not only, like I was saying, from the providers, but also from the client, most importantly.
[17:11] Sarah: Yeah.
[17:12] Rachel: Just the client's lived experience is the most important thing. We can have all the certifications in the world, and if we're not actually addressing the client who's in front of us and telling their personalized story, it doesn't matter.
[17:26] Sarah: Totally. Yeah. And I'm thinking about the biases around biases and beliefs around binge eating disorder. This isn't something that we talked about talking about, but it just came to my mind about a lot of times, folks who are struggling with binge eating disorder, which is often also could be qualified as anorexia. Right. They don't seek help because they're not considered, quote unquote, at risk, maybe due to body size or because of the concerning, quote unquote concerning behavior is the binge and not the restriction. So it feels important to kind of name that because I think often the folks that I've worked with over the years with binge eating disorder are kind of like, I'm fine. They're just going to tell me to go on a diet or to lose weight or to do whatever it is so that I stop binging when that just propels people straight into the eating disorder.
[18:24] Rachel: Yeah. No. As I was preparing to record this podcast, I was thinking a lot about that, actually. I have so many clients, too, who have been misdiagnosed with binge eating disorder, and they're actually struggling with anorexia, or they're actually struggling with. I don't love this term and I don't use it in my practice, but, like, quote unquote atypical anorexia. And that's just, I mean, we can name it, right? Anorexia with a side of stigma.
[18:50] Sarah: Oh, totally, right.
[18:53] Rachel: Or they're struggling with bulimia. Right. And because of their body size, they're diagnosed as binge eating disorder without any other questions or curiosity or inquiry into what that's looking like for them. And just for the record, binge eating disorder can occur in any body shape or size. Right. Just like any other eating disorder. You do not need to be in a large body to have binge eating disorder. Some people are in smaller bodies who have binge eating disorder, and I think that's just really important to name. And I don't know. I've actually done a lot of reflection on this, too, of like, we know that the biggest driver for binge eating disorder is restriction, right? So it's like, where is that line? Usually? I think what happens in my brain is like, I would diagnose a lot of patients. I mean, I can't formally diagnose right now, but as having anorexia because the restrictive thoughts. Right. The mental restriction, trying to restrict types of food throughout the day and quantities of food throughout the day. And we have all those thought patterns and kind of mental dialogues that anybody we would see in anorexia would have, but then their body is just kind of overriding them at some point, whether that's each night or at the end of each week or at the end of each month or what have you saying that this is not sustainable for me anymore. So I don't know. I think that the diagnostic criteria, too, for binge eating disorder and anorexia, just sometimes does not make sense to me. Oh, yeah.
[20:26] Sarah: It's just not it. Right? It's just not it. There's some work to be done around that, for sure. I feel like that's a great place to talk a little bit more about weight stigma and why even some people haven't heard of weight stigma.
[20:42] Rachel: Right.
[20:42] Sarah: So it's a good opportunity to share why it's so important to name it, talk about what it is, how it impacts folks, really, literally everyone, but also in the medical field.
[20:55] Rachel: Yeah. And I think there is often so much terminology that's thrown around, right. We'll often hear fat phobia, we'll hear weight stigma, we'll hear internalized fat phobia, internalized weight stigma, anti fatness, antifat bias. And I think sometimes it's like there are so many different terms, and the actual message behind them, like, the actual definition, the actual understanding of what it really is, gets lost in how much jargon that this community just kind of throws at people. And it's so overwhelming. And then we're like, I don't even know what that means. It's too much. I don't even want to look at that. I thought maybe, is it okay if I define a little bit of what those mean?
[21:38] Sarah: Please do. Yes. Absolutely.
[21:42] Rachel: Amazing. So, yeah, this is like a hot take, and I kind of have a soapbox about this, but roll with me on it. So if you actually look up the definition of fat phobia in the dictionary, what it'll say is it's an irrational fear, aversion two, or discrimination against obesity or people with obesity. And I'm going to use quotes, because again, I do not believe that medical or body should be medically pathologized in any way. I do not use the o words in my practice. But again, for the sake of the definition, that's kind of what it boils down to. And if we were to take that word apart and separate that out as fat and phobia, it makes sense that it's a fear of fatness, right? And again, I think it's like a hot take, but I actually prefer to not use the term fat phobia. And instead, I prefer to use the terms antifat bias and antifatness, which then, if we look at the definition of that, it's so much different than the definition of fat phobia, which is really interesting to me. My definition of antifatness is terms that describe the attitudes, behaviors, and social systems that are designed to specifically exclude, underserve, and oppress fat bodies. And it's a term that can be used to describe individual biases as well as institutional and system biases. So we are really broadening the definition of that. Right. And I think where. Where this all comes from for me is, I don't know if people are familiar, but there's an author and a fat activist and a writer named Aubrey Gordon. Her pseudonym is your fat friend. And she amazing and amazing writer. And oh, my gosh, has done so much great work, know, really speaking to the harms that she has been through with weight stigma and an anti fat bias in her own life, but is doing such great work and advocating for other people as well. But she really kind of takes a stance of like a phobia. Kind of implies it's a mental health condition to fear something, and it's not a mental health condition to fear fatness in the way that we've been taught that it can be. Right? So anti fatness is like a systemic form of oppression, right? Weight stigma is systemic, a form of oppression. And I think that kind of calling it fat phobia and having it be akin to an anxiety disorder or a mental health condition is one way that kind of really reduce kind of the ways that fat phobia, or again, I like to say anti fatness, sort of ripples out into every single part of our lives.
[24:20] Sarah: All the systems that it shows up in.
[24:22] Rachel: All the systems. Yeah. Especially, like the medical system.
[24:26] Sarah: Yeah. So much in the medical system. And also, I'm, of course, not in school to be that medical provider, but I would imagine it's not discussed a lot you can share because you are in the process of becoming an mp, but it feels like, or at least it wasn't spoken about. Docs really don't really know what we're talking about when we're trying to provide education around health at every size and the importance of being fat positive. Right. Docs don't super get it. So there's a missing piece. There's a missing link, right?
[24:58] Rachel: Oh, my gosh, yes, totally. Dietetics was my first career, right. So my trajectory was I became a dietitian before, and then I did nursing school, and I'll say for both. And also in NP school, right? It's not discussed. I have actually seen some improvements. Like, I took pathophysiology this past semester, for example, a master's level course in that. And while there was a lot of problematic things that were brought up, I was actually surprised in that class. And I also took another physical assessment and clinical decision making class. But there were some mentions of eating disorders, and there were some mentions of weight stigma and anti fat bias. And I was like, whoa, this is progressive. Like, hey, I know, but I would say that traditionally, like, 95% of the time, people are not really truly taught what it means and how it can show up. But I think one of the big ways that it can show up is we have so many studies on this, and it's so incredible to me that despite all of this research and despite all of these studies, it's still not being translated into clinical practice. But studies show that doctors have been shown to have shorter appointments with patients in larger bodies. They often withhold warmth from patients in fat bodies. So by that, I mean their social signaling, right? Their social signal kind of sends a message that there's a threat or there's fear or there's disgust. And this can show up, like having closed off body language, sitting farther away from fat patients, not actually touching people in larger bodies. I mean, a big part. I remember one of the first assignments that I had to do in my advanced physical assessment class was. I'm forgetting the name. But the general idea was we had to watch a TED talk done by a physician talking about how powerful the act of physical assessment and actually touching a body can be, not only in being able to identify and assess for things that need medical intervention, but also to be able to truly connect with the patient and just talking about how healing that touch can be. So if we're not even doing that as medical providers, number one, I would say that that's medical negligence. But number two, think about relationally, what message that sends to our nervous system and, like, our place in this world, right? My provider doesn't even want to touch me. That hurts. And I think that it's so hard, too, because doctors and nurses are often not as willing to share health information with people in larger bodies as well, which is such a disservice. And that's a form of oppression, right? Like, oh, I'm less deserving to have all the information and to be actively able to consent in or consent out of certain interventions that you're providing me or certain recommendations that you're giving me. How am I supposed to do that if I don't actually have all the information which is really concerning. Right. And then, I mean, nurses. Nurses are really challenging, too. Yeah. Like, a little personal tidbit about me is that my mom was an ICU nurse. Sorry, mom, if you're listening to this, probably listen to it, but it's fine. But she worked as an ICU nurse for 40 years. Yeah, nursing runs in my family. That's like a whole other conversation that we could have. Right. But nurses and my mom has listened to me go on my rants and my rampages and has had some openness to my education on some of this. But again, like, 40 years of working in an ICU. Right. Again, we could talk about that for forever. But nurses definitely make assumptions about people in larger bodies, same way that doctors do.
[29:00] Sarah: I mean, even all the way back to the medical assistants that are often bringing people into the waiting room and doing the initial, I don't know, questionnaires or whatever they are. It can start there, right. Getting on the scale or requesting to get on the scale, and then the comments about if the number is higher or lower or what it means, and then comments about their own bodies. Right. It can get really yucky, really fast.
[29:25] Rachel: So fast, so fast. And it's just like, wait a minute.
[29:29] Sarah: How did we get here?
[29:31] Rachel: Yes. How did we get here? How did. All of a sudden, you have now commented on my body size. You've made assumptions about my eating behaviors. You've made assumptions about my exercise habits. You've made assumptions about all the things, my abilities, my life, my resources. And you've also made assumptions about what I want to hear from you.
[29:52] Sarah: Yes.
[29:53] Rachel: Right. And you're bringing in yourself to this situation. Right. Like, I did not ask you to bring in what your personal views are on nutrition or weight or health or body size in this moment. Right. What makes you feel like you're entitled to inundate me with that information without asking me first? Right. Can I talk to you about your weight, or can I talk to you about your nutrition, or can I talk to you about your movement patterns? Can we even have this conversation? We just steamroll way ahead of that. And we assume that again, because we live in diet culture. And I think it's what we're talking about so often throughout the day. It's almost like, right, neurons that fire together, wired together, we're conditioned to talk about it in every single moment of the day.
[30:47] Sarah: Yeah. And I'm just thinking of consent. Diet culture sinks in and seeps in without our consent. Right. These comments, these questions, these assumptions. There's no consent for this. So just thinking of reclaiming. Right. How can we support folks to reclaim their autonomy and saying, like, yes, this is okay for me, or, no, this is not okay for me. Actually, I didn't ask about your weight watchers attempt last year. I don't think it's called weight watchers anymore, but whatever it is, you know, ww. Whatever, it'll change tomorrow.
[31:18] Rachel: Like, it's fine. I'm like, oh, my God. Yeah. Especially as it relates to you in the context of you saying this, as it relates to my body in the strange. But, yeah, I heard on a podcast, like, years and years ago, this idea of, like. Yeah, I think it's twofold. Not only do we not consent into diet culture, but people with eating disorders don't consent to have eating disorders.
[31:47] Sarah: Yes.
[31:47] Rachel: Right.
[31:48] Sarah: It's not a choice.
[31:50] Rachel: Yeah. I'll tell my patients all the time, show me the document where you were informed of all of the mental, psychological, social, financial, relational, all of the consequences that you might face because of your eating disorder. Show me where you were told all of those things and where your signature was. Right. It doesn't exist.
[32:09] Sarah: Yeah, of course.
[32:12] Rachel: Oh, my gosh. Doctors do, and, like, all medical providers, I think, do a really poor job of actually practicing again. Right. It goes back to what we were talking about earlier. We can be informed of the process of informed consent, but what does it actually mean to be conscious? Am I actually providing the education? Am I actually providing the resources? Am I actually providing all of the options for this person to truly, truly consent and to have body autonomy and body sovereignty in this moment? Because if I'm not giving them all the information, if I am not cultivating as much openness and as much dialogue and as much conversation about this as I would want to have for my loved one, then it's not informed consent.
[33:01] Sarah: So how do you feel like folks who are living with an eating disorder, how do you feel like they could advocate for themselves differently or maybe for the first time in medical settings? What are some tips or strategies or tools?
[33:18] Rachel: Oh, my gosh. I could talk about this forever, too. I think, just to start. This isn't like a tip or strategy, but I think that we just have to acknowledge how really sad, really sad it is that this is the patient's responsibility.
[33:34] Sarah: Yes.
[33:36] Rachel: Right. The onus should not be on the client. The onus should not be on the patient. And I think that's really sad that 99% of the time, it is. And white coat syndrome is such a thing. And I think that when we see people with a lot of credentials behind their name, myself included, when we see people in white coats with stethoscopes, I think it does something to our nervous system. I think that white coat syndrome truly is like nervous system dysfunction because we just get so activated. Right. Go straight up into fight or flight around that. And I also think that it's a privilege to be able to advocate for yourself in a medical setting. So something that I've been thinking a lot about is, let's say that somebody's in, I don't know, like a rural area and does not have access to a variety of different treatment providers or treatment options, then advocating for yourself could actually be a threat to getting the medical care that you so desperately need. Because what if you were advocating for yourself? And then again, the physician, the doctor, the NP, the PA, did not like the way that you advocated for yourself and really carceral, paternalistic approach to care. And again, not all doctors approach care in this way. There are some who unfortunately, then what happens if you advocating for your needs and your values actually inhibits you from getting some of your basic medical needs met as well? And I think that that's a really tricky situation.
[35:15] Sarah: Yeah.
[35:16] Rachel: Right. And so I think that if we have the privilege of being able to advocate for ourself is, number one, acknowledging that not everybody will be reachable or teachable in that moment.
[35:31] Sarah: Or ready.
[35:32] Rachel: We're ready. We have to think about stages of change, right. When I'm about to go into a session with a client, I always think about what stage of change might they be in? Right. What were they in last time? What are the stages of change, right. What kinds of things do I need to remind myself about all the stages of change? And then I just reflect on when I've been asked to make big changes in my life, what were the barriers? What were the things that I wish I had been asked or the ways that I wish it had been approached that it wasn't. But yeah, some medical providers are not going to be in an action based stage of change in order to be receptive to the information that you're providing and they might shut it down. And that's really hard. And so in that situation, I would encourage you to bring the grief and the anxiety and the frustration and the fear and all of those really difficult emotions to your primary treatment team, therapists, dietitians, so you can really process those. But another thing I think is there are actually cards that you can download. I have tons of resources on this if we wanted to link to it in the show notes, definitely. But there are various cards that will kind of express what intuitive eating is, what health at every size or haze is, what a weight inclusive approach to care is. And then they have some specific ones. I think I have some from morelove.org. You're familiar with that organization that are don't weigh me cards. Please only weigh me if it's medically necessary. And this is what would meet the criteria for medical necessity. Am I getting a medication change and is the medication weight based? Do I need anesthesia? Do I have congestive heart failure? Where I'm going to be fluid? And we need to monitor that as that weight change is fluid based and will give me insight into the progression of my congestive heart failure. Right. And there are a number of other conditions that are chronic and we would need to be monitoring that. But I would say for the majority of the population, weight is not going to be a useful measure. It doesn't really tell us anything besides our relationship with gravity. So sometimes it can just feel calming and feel a little bit more safe to be able to have something tangible to give to every member of the office. So going up to the receptionist and saying, these are two cards. These are what they are. I would like for you to read them and I would like for you to deliver them to the nurse and the doctor who are about to engage with me during this medical encounter and then having some extra copies if somehow that got lost in translation to being like, hey, before we proceed with this medical encounter, could you please take a moment and read this card for me? Happy to answer any questions that you might have. You're kind of setting that boundary. I know that's so scary and I know that's so hard. And I think it can be super empowering. Course, too. You can have your treatment team call up your doctor's office and really advocate for you too as well, and try to provide some education, provider to provider, and that can be really helpful. I feel like the more tools and strategies we kind of stack on and the more that they're kind of hearing this and they associate certain modalities or certain ways of thinking with certain cases. Like, oh, multiple people are telling me that this client is not appropriate to be weighed at this visit. Maybe they'll be a little bit more receptive to that. Right. And I think, too, if a doctor. So a couple of different things. If a doctor or a medical professional, if a provider ever says that you are required to be weighed at a visit for them to get reimbursed or for it to be covered by insurance.
[39:32] Sarah: Right. Like billable. Yeah.
[39:34] Rachel: Yes, billable. That's inaccurate. You can tell them, refused weight today, and that is perfectly acceptable, and it still provides a billable medical encounter. And sometimes there's pushback about that. And I would need to reiterate, I am not being weighed today. If you would like to document my refusal, please do so.
[39:56] Sarah: It's so hard. I know often folks kind of freeze in those situations and just be the good patient. Right. Do what they're supposed to do. And sometimes I think about how if you know yourself, you know your nervous system, you know, that might be your response. How can you prepare yourself to maybe reduce some of the harm that's going to be done by the resistance that you're going to meet or even stepping onto the scale, getting the print out with the numbers on it. There are some ways that you can reduce that internal harm that happens because things just don't feel safe. And that is just a trigger for most people who are living with an eating disorder.
[40:36] Rachel: Right.
[40:36] Sarah: Like, things just don't feel safe.
[40:38] Rachel: Yes. Oh, my gosh. Yeah. I think that the nervous system work is so important before, during and after the visit. I mean, there are so many different strategies that we could talk through. I think that if at all possible, bring an advocate to the appointment with you. Even having a safe person be in the waiting room with you and be able to offer you that support and that validation and just that sense of calmness. And I'm not alone in this, can be so incredibly grounding. I think that other somatic practices can be so grounding, too. Whether it's some essential oils or doing some breath work in that moment or whether it's doing some progressive muscle relaxation that's maybe a little bit more subtle. One that I really like, too, which I think is pretty discreet sometimes. Right. But is putting our hands underneath our armpits and kind of just like rocking a little bit back and forth can be really helpful.
[41:41] Sarah: Things that help you maintain contact with yourself. Right. Contact with yourself. What's true for you, what you might be needing, even if it's not super present, but it helps you just stay a little bit more, giving yourself some semblance of safety in an environment, a setting, an interaction that maybe feels super unsafe for you.
[42:01] Rachel: Yeah. And knowing your limits, too. Right? I think it's so important to kind of know, okay, when have I entered into this place of dissociation? Or when have I really entered into this unsafe place? For me? When does this feel like too much? I know, again, it takes privilege to be able to schedule and reschedule appointments, too, but I think sometimes we can almost again, kind of like the good patient, try to force ourselves past our limits because it would disappoint. The medical provider or our dietitian said that we really needed to get that PCP appointment, or the therapist is concerned or in order to go back to my sport in college, I have to have this. And this was the only appointment that the doctor had. And it feels there's like this sense of scarcity or deprivation with doctors appointments because I think that there is. Right? I mean, you only have eight minutes for a typical appointment. Activating my nervous system already. It's so wild, right. And so it can feel like this scarcity type thinking can come in. Right? This is my only chance. I have to do this, and if I don't do this, and what am I going to lose out on? And then that can make us feel really fearful to advocate for ourself, because then not only is there this pressure if I have to make this appointment, so I then get X, Y and Z, but, oh, my gosh, I have to also stand up for myself at the same time. And I can't just be, like, this participant. That is really challenging. But again, like, knowing your limits. Right? So if you need to exit the suite for a little while and call a support person, if there is that time, doctors notoriously run behind. They sure do, like three to four minutes to do that and just have somebody kind of on call for you, like, hey, friend, I'm going to the doctors tomorrow. I have an appointment. Right. Smacked up in the middle of the day. I know that they're usually running really behind. If I call you between one and 02:00 p.m. Would you have the ability to just answer and talk with me for a couple of moments? Sometimes that's really all it takes to be able to get that validation, get that support, kind of bring our nervous system back into that window of tolerance so we can feel a little bit more grounded and just a little bit stronger going into that appointment.
[44:18] Sarah: And lots of stuff to work on with your treatment team. Right? Like, lots of ways to resource yourself through imagined things and through tapping into your body or anchor objects. Lots of ways to try to just stay with yourself a little bit more.
[44:35] Rachel: Yeah. And it doesn't have to be all or nothing. We don't have to fully present in that experience. Right.
[44:43] Sarah: But what feels right? Like, maybe none of it feels good. And that's okay. It's all just these really brilliant ways that our bodies protect us from more harm. But knowing what feels right for you and trusting, that just always feels so important.
[44:56] Rachel: Yeah, I know. Dr. Gaudiani, she's the author of Sick Enough. She talks about a lot in some of the podcasts that she does, a framework of just three simple questions. I posted about it on social media before. But just asking yourself, right, what do I need in this moment? How could I see this need through any shame or resistance that's coming up for me? And how could I meet this need? And even if we don't have answers to those or we don't have the best things or ways to meet those needs in the moment, that would be ideal. Sometimes, just like asking ourself, those questions can generate a little bit more self compassion and can kind of bring us back down if we're able to really sort of just again come back to the self, to the body, versus right into some of our thoughts and spiraling or whatever it might be.
[45:45] Sarah: Yeah. Whatever kind of vortex could be on the other side. Well, I don't want to take up too much more of your time, but we just have a couple questions from Instagram that I thought we could maybe cover, if that's okay.
[45:57] Rachel: Ready?
[45:58] Sarah: All right, so the first one is how to deal with necessary dietary restrictions while I'm in recovery. For example, celiac disease.
[46:07] Rachel: That's a hard one. I have so much compassion for anybody who asks this. I don't know if the person who asked this actually is going through celiac right now and maybe has been recently diagnosed, but I think it's so challenging, regardless of if that's you who's going through that, right? Trying to navigate eating disorder recovery with a co occurring medical condition that does require some medical nutrition therapy. And I think it can be equally as hard to help support somebody who's going through eating disorder recovery and also has medical nutrition therapy needs. I think the first thing that comes to mind is, like, talking about it. So I think that there can be a lot of shame associated with being in recovery. And also, maybe the recovery doesn't look like the recovery that we've seen on social media, right? Like maybe food freedom and some of the principles of intuitive eating and gentle nutrition. And the way that we are navigating with ourselves, our self talk, our needs, looks a little bit different than the highlight reels of recovery that we see again online. Right. So just really talking about know, I think that talking about it helps reduce shame. Right. We know that Brene Brown talks about how empathy is the antidote to shame. So I think if you're experiencing any kind of anxiety with like, talk to your treatment team about it, of course, I think that sometimes it can be helpful to reframe restriction as maybe like changes, maybe some changes to our nutrition that are going to be supportive for us versus restrictions. And I don't think that restrictions all the time are restrictive. I think that sometimes under some situations, engaging with it can be like a form of self care and can be a strategy to really develop more self understanding, really engage in gentle nutrition, really engage in a different type of self care than, again, I think is just a watered down version. Sometimes recovery can feel like a watered down version that we see on social media. So that's what I would say. And I would also say that a big part of this, and I can talk about some nutrition strategies in a moment, but grieving that recovery is maybe going to be a bit more complicated for you. I think that that makes so much sense. Eating disorder recovery, I think, is one of the hardest things that a human can do. Truly, like, one of the hardest things. And oh my gosh, it's already so hard. Now we have this other thing, this whole other component that is going to send our brain just in like, oh my God, it's like sparks. So much dysregulation can come with that. It can activate the eating disorder voice, right? It can activate all those emotions, shame and guilt and fear and anxiety. And when we already have fear and anxiety around food and eating, now we have this added layer of celiac disease. So I think that that's so hard. I think doing a lot of self compassion, doing some grief work around that too. Bringing that to your treatment team is going to be so healing and then practicing some radical acceptance. Right? So maybe we don't like the situation, maybe we wish a part of us wishes it would change, but really thinking about what can we do to radically accept that this is sort of where we are right now, and how can we meet our body's needs without shame or resistance? And then nutritionally, just thinking about this as how can I be as least restrictive as possible, right? So how can I really incorporate all of the gluten products that I would normally eat, but maybe swapping those out with some gluten free products that we can get at the store? I think it's so incredible how many gluten free products are actually available now on the market. Like, they're everywhere. And I think that's really awesome. And we have so many more options now that we did even ten years ago. I think just working with your treatment team or your dietitian on where do I find these products? How do I incorporate these in a really recovery minded way? How do I make meals for myself now using these products? And then I think there's a whole added layer that we could talk about forever, too, around. What does that mean for social eating? Right? What does that mean for eating out? And what is it going to mean for me with my eating disorder if I have to constantly check food labels or kind of be hyper vigilant in some ways about my food intake as a form of self protection and self care versus as a form of self abandonment or self sabotage. And I think holding that, like really doing that mental work around that is so hard and so complicated. And this is like a huge forced lifestyle change. And it makes so much sense that it takes some adjustment, some trial and error, some couple of steps forward, a couple of steps back. Right. So just giving yourself a lot of grace and compassion with that too, and just giving yourself some space to be able to have struggles and have challenges.
[51:42] Sarah: Yeah. So much nuance. That was such a lovely response to that question.
[51:46] Rachel: Thank you. Yeah.
[51:48] Sarah: And the last one that we have is just how to navigate providers blaming all of your medical concerns on your eating disorder. Another really nuanced question, which we could probably do a whole nother podcast episode on.
[52:02] Rachel: We totally could. Maybe one day we will, but I'll give you too long raid answer for this. That's just coming to my mind. This gives me full body chills when I think about this. I think that what we're really talking about here is medical gaslighting. And I know that there have been a ton of articles on this recently. I remember I've talked about this in various different settings before, but that is so hard. It is so hard. Gosh. And again, everything that we talked about today, I think makes it so difficult for us to be able to advocate for ourselves. I think one thing that really comes to mind is if a provider is blaming all of your medical concerns on your eating disorder, is asking, what's your differential diagnosis? Right? So if we could prove right now that if it was not my eating disorder, what else could be my symptoms? What else could my symptoms be attributed to? So what's the differential diagnosis? And then asking, how have you ruled those out? So tell me how you have come to this conclusion as a medical provider. That it must be my eating disorder and not another differential on your list. So asking what's the evidence for and against all these differentials? And that can be really powerful. It's just asking them to kind of speak to their clinical decision making, because I think so often there, unfortunately, is not a lot of clinical decision making that occurs when we see eating disorders and then all these complications. Right. It's just. Oh, that's the eating disorder? Yes. Okay. Make your doctor, make your provider use their brain a little bit. I know that's really scary, and I have so much compassion for that. And you could even role play in session with your therapist or a dietitian if that's coming up for you. You can have a note card with these questions.
[53:58] Sarah: Write a script.
[53:59] Rachel: Write a script. Yes, absolutely. And I think that that's also something, is you can make a plan for your visit, right? So you can make a list of everything that you want to talk about during that visit. You can make a list of the goals for the visit. You can write down questions. You can write down a symptom diary. You can do all these things to kind of provide evidence or at least provide a little bit of support that, no, it might not all be my eating disorder. You can bring somebody with you. Like, you're allowed to have an advocate in doctors appointments as long as there is consent there. And you're like, yes, I am fully consenting. I would like this person to be a part of this medical visit for me. Because, again, if you're in fight or flight, just to bring more light to the nervous system component to this, you're not going to be able to access your prefrontal cortex, the logic system of our brains. We cannot operate from that. If you are sitting there and you are like, oh, my gosh, I'm blaming everything on my eating disorder. I'm feeling my heart rate increase, I'm sweaty, my blood pressure is dropping, I'm feeling dizzy. How are you going to remember what a differential diagnosis is, let alone how to ask that? Bring somebody with you and maybe, like, tap their knee or something, having some sort of little code or little signal between the two of you. That can be a moment for them to be like, oh, I need to take over for this person right now. I think that that can be a powerful way to send safety to our nervous system, too. I think that you can also, if the provider is blaming all of your medical concerns on your eating disorder, ask for a detailed record of that visit. And so by that, I mean, unfortunately, oftentimes what actually happens in a medical visit is not dictated, is not charted in a way grounded in reality. You can ask for all of your medical records. I would ask for a detailed record of that visit if you felt medically gaslit and ask your doctor if they can record in the chart if your specific concerns weren't addressed and the reason why, again, making them kind of use their brain. Right. And really being able to say, I know this is so hard, but I know that this is not what we talked about during this visit. These concerns were not addressed in the way that you charted. I would like for you to change this documentation and they would have to go back and change it because that stays in your medical record and can inform then the way that future doctors are going to be approaching your care. Those are some of the initial thoughts that come to mind and then just looping it right back into what we were talking about in the beginning. Right. Do not blame yourself for this. Do not internalize all of that blame and do the same thing that the doctors are doing to you. Right. This is really real. And having an eating disorder specialized primary care physician or nurse practitioner in your corner, it will feel validating and it will not feel patronizing. So again, hold on. Hope that those people exist in your life, or you could find them, because my hope for everybody is that they will find a primary care doctor who is able to validate their eating disorder and not just blame all of their medical concerns on the eating disorder.
[57:32] Sarah: And I'm so looking forward to the time that you'll be one of those primary care providers in our community.
[57:38] Rachel: Just about. We'll say, like maybe a little more than a year after I bored. So hang on, wait one more year and then I'll practice. So stay tuned for that. But yeah, really excited to do some more of this work. But yeah, ask what your differentials are, ask how you roll them out, ask evidence for and against, and bring a support person and make a script before the visit.
[58:05] Sarah: Yeah. And I think too, just for your relationship with yourself to come back to this trust and hearing and acknowledging that there's a part of you that's saying like, wait a minute, this doesn't feel right. It doesn't feel like this is super connected. It doesn't feel like this is all that's going on. Feel like that kind of bid for a relationship with yourself can be super healing over time. Hard at first. Yes. And over time can really make a difference. So trusting yourself. We know that eating disorders are disconnecting and these little bids for connection with yourself. Really important.
[58:44] Rachel: Yes. Self validation rates. Use your own history to guide your self perception as well. Right. If this started way before the eating disorder, maybe it's a medical concern that's been exacerbated by the eating disorder. But it started before the eating disorder, right. Or it started before the eating disorder got more intense. Right. So again, just sort of like almost fact checking a little bit, right. Because it can be so disconnecting to have somebody kind of force you into a reality that you know is not yours. We have to be like, okay, what are my strategies to, again, like you're saying bring me back to the self, reground me and reroute me in my own experience in my body. You are the expert in your body. Doctors are not, dietitians are not, nurses are not, therapists are not. If you're noticing that you are feeling more disconnected to yourself, your values, your body, all the things after that appointment, check the facts, really rely on your wisdom and your own knowledge of your body in order to kind of be able to then make the next best step for yourself.
[59:53] Sarah: I feel like we could talk all day. Rachel.
[59:56] Rachel: No. Covered the tip of the iceberg.
[01:00:00] Sarah: I know. You'll have to come on again and we'll pick up where we stopped.
[01:00:05] Rachel: Good. I know I told you at the very beginning, you're going to have to cut me off.
[01:00:11] Sarah: I love it. There's so much to say, right? Such important information and just like education and knowledge for people to have because this stuff is so hard and eating disorders are hard enough. Facing medical systems that are oppressive and gross and harmful. I could say gross seven more times, but. Right. Yeah, it's so gross, so harmful.
[01:00:38] Rachel: And you're not alone. You're not alone in this. It sucks. Right? And I wish it weren't this way. Right. But you're definitely not alone in this world with that. It's unfortunately a common experience and there is support out there.
[01:00:52] Sarah: Well, to finish up, why don't you tell everyone where they can find you on the Internet, a couple of different places.
[01:00:59] Rachel: Yeah, totally. Yes. So I have a private practice, so you can find me at www. Dot Liberatedplate co. I'm not accepting any new clients right now, but my fabulous business partners are and they would be so happy to work with you. And just if that's not an option or something that you're interested in, point you in directions to get support or have more resources or what have you. So that's one way that you can find us and engage with us. We're also on social media at liberated plate nutrition on Instagram, and we put out content, we try to almost six days a week. So that can be a nice eating disorder resource for you as well. And I think those are the two best places that you can find me.
[01:01:45] Sarah: Well, thank you so much. It was such a privilege to have you on to talk about this when folks were asking for more information on medical stuff and eating disorders and the team we were talking about, who can we have on? I was like, well, Rachel would be perfect. So we're so happy that you came on to chat, to share your wisdom and your expertise and all of the things. Thank you again and everybody, we will be back next week for another episode, so we will talk to you then.
[01:02:08] Rachel: Bye.
[01:02:10] Sarah: Thank you so much for joining us on this episode of reclaim you. Be sure to, like comment and subscribe and check us out on YouTube at reclaim you. If you're looking to start therapy for trauma, disordered eating or body image concerns, head over to our website at ww reclaimtherapy.org to learn more about us and our work will be back next week with another episode. Until then, take good care of yourself.
Reclaim therapy provides therapy for eating disorders in Horsham, Pennsylvania, EMDR for eating disorders and trauma, complex PTSD treatment and grief counseling in Pennsylvania.
We also provide PTSD treatment, binge eating disorder therapy, and therapy for body image in Horsham, PA.
We’re passionate about helping people reclaim their lives in the wake of of trauma, diet culture and body shame.
We would love to support you as you Reclaim YOU and the life that you undeniably deserve.