EDeology: The People Behind Today's Eating Disorder Treatment Landscape

Moralistic judgment is the root of so much division in our field and in our society. The perception of ideologically opposing groups as uninformed, evil, or inherently harmful is the surest way to eliminate any possibility of dialogue. Moralistic judgment can be a way of naming oppressive systems that have been enabled or whitewashed; but when directed at individual people, it becomes a painful an...

Many of the hot topics in eating disorder recovery—health at every size, food neutrality, whether some foods are manufactured with addictive qualities—extend beyond eating disorders and to the messages we hold and teach our children about food and bodies. In this episode I am joined by Katie Gilder and we talk about how we address these issues with young kids. We discuss whether there's “healt...

Is an eating disorder the result of past trauma? When we see someone stuck in self-destructive and potentially life-threatening behaviors, it’s natural to ask what terrible event created this? Clinicians often debate the importance of addressing past trauma in eating disorder treatment, versus targeting present symptoms. Psychodynamic and embodied approaches typically emphasize past history and co...

Periodically, I hear someone describe a past therapist, a particular therapy modality, or a treatment center as “just in it for the money.” On the flip side, I’ve had many conversations with therapists and other mental health providers about how hard it is to hold fees, guilt for raising fees, strain strain related to enforcing cancellation policies, weak boundaries, and frustration with insurance...

In this episode, I discuss why this podcast has no content rules and how I address information that might be triggering to the listener. I also do a deep dive into the question, can words cause harm? More on Elka: https://cubacubcounseling.com/   Elka’s book, Binge Eating Demystified https://www.amazon.com/dp/B0FD493WZ3

How do we know what is real? There is a growing number of treatment modalities, each with its own acronyms and catchphrases. There is also a large diversity of opinions around issues related to food, health, and eating disorder recovery. How do we know what treatment approach to follow?  In this dialogue, I have two guests who are both highly skilled and experienced in their respective, and very d...

When we argue with other clinicians about treatment-related issues, it’s natural to focus almost exclusively on content. And when it doesn’t go well, we often attribute that to the wrongness of the other person’s position. We might accuse them of perpetuating harm, or being small-minded or out of touch with reality or science. I would argue that process is equally, if not more, important, particul...

It can be taken for granted that there are many non-disordered ways of eating. In addition to food preferences and aversions, allergies, food-sensitivities, and body composition, our food choices can be also shaped by spiritual, cultural, and ethical values. In eating disorder treatment, this simple truth becomes much more complicated for two reasons: Firstly, because of the acuity and potential l...

The therapeutic relationship is, in some ways, a bizarre one. On one hand, it’s a meeting between two people, a space where you share so much of yourself, your deeper emotions, and experiences. And at the same time, there are very clear and firm ethical and professional boundaries. Human nature alongside the depth and vulnerability of the therapeutic space can create the conditions for attraction,...

Is it a therapist’s responsibility to advocate for social justice, to take a stance on political issues that impact the lives of their clients and/or minoritized groups? Or are therapists supposed to be apolitical, to enter the therapy space without an ideological agenda so they can hold space for whatever belief systems the client brings in? When we remove the “shoulds” the “supposed tos”, the mo...

Bariatric surgery is a medical procedure that modifies a person’s stomach and sometimes intestines to help them lose weight. In the eating disorder recovery world, this topic isn’t discussed often because so many professionals take an active stand against fat phobia and, by extension, intentional weight loss. Our guest today brings together two worlds that don’t typically converge. She entered the...

In healthcare, we know that the same set of symptoms can reflect different underlying causes. The more we understand the range of causality and underlying dynamics in eating disorders, the more we can offer truly individualized and effective care. In previous episodes, we’ve discussed the role that trauma, complex trauma, dissociation, and genetics can play in the development of an eating disorder...

In this episode, Dr. Marcia Nickow talks about anti-racism, DEI, and white privilege. Marcia shares how her upbringing as the child of Holocaust survivors influenced her interest in these topics. She discusses how she approaches racially charged issues in therapeutic contexts, including group therapy and clinician DEI groups. She also talks about what it is to be a white-presenting clinician in DE...

So much of Western medicine has been tied up with body weight. Weight is often disproportionately and inaccurately associated with health. Weight loss is a common recommendation for many health conditions.  Although eating disorder treatment typically emphasizes body acceptance and weight neutrality, weight remains central to so many aspects of the treatment process. Body mass index (a measure of...

In eating disorder treatment, do we focus on managing symptoms or addressing root causes? There are so many issues tied into this question, at both a theoretical and very practical level. Treatment focused on symptom management often rests on the premise that the issues encountered in eating disorder recovery are the result, not the cause, of food restriction. From this perspective, when a person...

How do you know? So many challenges to any particular position boil down to this question.  How do you know that what you're saying is accurate? How do you know that the modality you're using is effective?  In the medical and academic communities, we're often taught that the only acceptable answer to this question is scientific study, preferably double blinded and/or within a randomize...

In this episode, Elka Cubacub provides a framework for understanding the "what, why, and how" of dialogue in this podcast. To participate in dialogue, please complete the following interest form https://docs.google.com/forms/d/e/1FAIpQLScgWTg0mo532TUlfRBAawQ9uh9pmPr1O9IsKlFgBmO7NOji_g/viewform?usp=sharing&ouid=107239699529464533283 Connect with Elka https://elkacubacub.com/   Elka’s...

This is our first dialogue episode on the podcast. In it, we have Libby Supan, a therapist and certified intuitive eating counselor and David Wiss, a registered dietitian with a PhD in public Health. We're coming together to talk about food addiction. I hesitated a lot before publishing this episode.  This was a difficult conversation in ways that both guests had predicted and hoped to avoid. At m...

When I studied psychology, I learned about psychoanalysis as the id, ego, and superego, the mind depicted as an iceberg, with the subconscious submerged beneath the surface. We covered psychosexual development and the Oedipus complex. Some of it seemed relevant, and other parts seemed overly speculative. Mostly, though, it was presented as part of the history of psychotherapy—a relic of the past t...

Perhaps the single most charged issue in eating disorder recovery is intentional weight loss. In the general population, we know based on research that the long-term success rates of intentional weight loss diets are abysmally low. In the world of eating disorder recovery, not only are the success rates low, but so many people have been deeply harmed by diet culture. For so many in this field, the...

Many traditional approaches to eating disorder treatment focus primarily on behaviors such as meal plan compliance, and strategies that aim to support and reinforce these behaviors.  In higher levels of care, and some outpatient settings, the goal is to make eating disorder behaviors non-negotiable. This may be accomplished through contingency management, where access to certain privileges depends...

Food addiction: does it exist or not? Is it helpful or harmful? Does science support it or disprove it? These questions have become so polarizing, especially in the eating disorder and substance abuse communities, where people often take a hard yes or no stance. In this podcast, we look at it differently. The fact that there are such strong, diverging opinions on this topic is the best indication...

Does food addiction exist? This question is the topic of heated debate within the eating disorder recovery community. We know that binge eating and compulsive overeating can share some characteristics with substance use disorders, such as loss of control, repeated unsuccessful attempts to quit, and continued use despite negative consequences. However, the question is whether this loss of control a...

In the West, medical treatment tends to be highly specialized. In eating disorder recovery, dietitians are typically responsible for specifying and monitoring clients' food intake. Therapists are responsible for helping clients build coping skills and navigate their internal worlds. Psychiatrists or nurse practitioners are responsible for prescribing psychiatric medication and monitoring medical r...

GLP-1s, such as Ozempic, Wegovy, and Mounjaro, are a class of medications originally developed to treat type 2 diabetes. More recently, they've become a hot topic in the mainstream for their weight loss effects.  A quick Google search brought up the following headlines: “Weight loss is finally easy with a prescription to GLP-1 medication”  “Join 100,000+ patients and transform your health, bod...