Episode 102: Part 2: How Chronic Dieting Exacerbates Eating Disorders in People with Type 2 Diabetes with Ashley Roehrig

Hola amigos! Welcome back —–

This episode is Part 2 of episode 101 from the previous week, click here if you want to catch up. Ashley and David criticize the implicit bias affecting people in larger bodies with diabetes and what this provider does to advocate for her patient’s well-being. Plus, more science about how trauma relates to the digestive system!

First a little intro about our guest…

Ashley Roehrig is a registered dietitian who practices in Charlotte, North Carolina with Second Breakfast Nutrition. She is a certified eating disordered registered dietitian, a certified intuitive eating counselor, and a student of the Embodied Recovery Institute. Ashley treats eating disorders in adolescents and adults through a trauma informed Health at Every Size lens. Her treatment approach is rooted in the belief that her clients are the experts on their own bodies and she partners with them as they tap into how life experiences, beliefs, and nervous system responses have influenced their relationship with food and their bodies.

Highlights of this episode:

• The process of dieting
• Disorder eating vs. eating disorder
• Assumptions about anorexia nervosa
• Restriction with diabetes
• Benefits of regular feeding
• Harmful interventions
• Trauma affects the digestive system

Full Description

Diabetes is when the body cannot control blood sugar properly.  Blood sugar is naturally created in everyone from eating and digestion. Diabetes is when that normal body function is not working well, or not at all. Unfortunately, many people are not screened for pre-diabetes and diabetes regularly at annual healthcare visits.

When high blood sugar is chronic, our bodies can develop other conditions and diseases that involve the nervous system, kidneys, eyes, and the heart.

Currently, the majority of healthcare is focused on weight loss to combat diabetes symptoms. This is problematic and we get into why.

[4:50] What happens when people diet?

The mental trigger to diet is typically goes like this:

“I am not okay in my body”
“Food isn’t right”
“I have to get smaller”
“I have to be better, I have to achieve”
“I need to take control”

Then the person finds a diet and thinks:

“Now I know what I am supposed to do”
“Nutrition is a math problem”
“I have a plan; I have control; I can do what I am supposed to do”

Diets may work for a little while and even feel good.  However, another part of the brain is feeling deprived. The person is not getting enough calories, or maybe not enough of different foods, or foods that the person simply likes. During this time, the control is high and the deprivation is high. Then that eventually flips.

We are hungry on diets. Then the brain says:

“I’ll just have a cheat day and then I’ll get back on the wagon.”

That explodes into out of control eating behaviors. We are not supposed to be starving. But we blame ourselves for the failure of not being able to stay on the diet. This scenario can happen over a short or long period of time.

In reality, the diet failed the person. Then, each diet claims to be different and may lure the person back into another deprived state. Over time, hunger signals may get confused due to the cycle of diets.

[11:14] When disordered eating becomes an eating disorder

Eating disorders are diagnosed by standards of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) by psychiatrists and doctors of expertise.  Usually, the patient’s symptoms are severe enough to identify a label for the patient’s condition.

Ashley states as a dietitian, she does not care about the label. She cares about the person’s behaviors and the impact of those behaviors. What is the state of their nervous system? So sometimes I use the terms disordered eating and eating disorder interchangeably.

[12:30] Problematic assumptions about anorexia nervosa

If the person is not feeling hunger and chronically stressed about their weight, but has a higher BMI, they are not typically associated with anorexia nervosa. The DSM-5 can be racist towards the white thin ideal and miss diagnosis in black and LatinX communities.

Within the DSM-5, words to describe eating disorders as “typical” and “atypical” are misleading, because “atypical” implies it is not common. Unfortunately, “atypical” is common.  The majority of Ashley’s clients are starving and in larger bodies, not the stereotype of thin, white females. Larger bodies are typically diagnosed with binge eating disorders solely due to their weight. However, a complete assessment reveals they are not binging, they are starving. Doctors can reinforce the patient’s disorder for praises of lost weight. The mental health and suicide rate is higher than the mortality rate of anorexia nervosa, which is high itself.

[17:20] Restriction with diabetes

With Type 2 diabetes and larger bodies, doctors and people assume the condition is behavior driven. The person will likely get a carb restricted diet, which can lead to erratic eating behaviors. This confuses the pancreas and worsens the person’s condition.

[20:14] The body needs to be fed regularly

The body is an assembly line and assembly lines work best with regular input. Ashley encourages regular intake with people’s schedules. She encourages permission to eat and feel full. Permission is given to eat for nutrition and social reasons. Letting go of food rules and creating balance out of understanding what different foods can do for us. Ashley recognizes that this may be a privilege in a person’s life and it is not an easy process. Good habits can only come after time is devoted to figuring out how those good habits will become actions.

[25:35] The solution is doing more harm than good.

If weight loss is the goal, then the actions become cloudy. A common thought from my patients is, “I am fat, how can I be hungry?” Therefore, the mental bias of losing weight becomes deprivation behavior. Unfortunately, when patients take a weight neutral approach, they will also have to ignore the consistent diet culture. Ashley encourages her clients to simplify the rules so they are less overwhelmed. She works with them to lessen their fears over food choice.

[32:54] Trauma affects the digestive system

The nervous system and digestive system are on parallel tracks in the body. There are so many obscure GI disorders, like IBS. The gut has its own brain and digestive issues can be a signal that you are anxious. One of the main treatments for IBS is to reduce stress. Clients are not ready to eat when they have digestive issues and stress. David and Ashley like to see clients work with psychologists as well to create balanced care. A treatment team can be beneficial to reduce stress while eating. Unfortunately, eating cannot wait and treatment is usually resisted.

Closing Remarks:

This was such a great episode about the challenges of eating disorder diagnosis in a society with high numbers of people with diabetes. Despite the condition, positive relationships with our body and food is still possible! I can’t wait to have you listen in and let me know what you think.

If you like this episode, hit that subscribe button so you won’t miss an episode, wherever you listen to podcasts Apple, Spotify, Amazon, Castbox, Google, or Stitcher. While you’re there, let me know what nutrition or health topic you’d like me to cover or leave a review.

Links from This Episode: 

• DSM-5 Information
• Ashley Roehrig’s Group Clinic
• Weight Neutral Diabetes Education for Providers

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