Part 1: How Chronic Dieting Exacerbates Eating Disorders in People with Type 2 Diabetes with Ashley Roehrig


Hola amigos! Welcome back —–Ashley Roehrig and David Orozco discuss how a weight-centric healthcare system creates an unhelpful and stressful nervous system response in patients. Doctors have good intentions, but looking at the full picture reveals shocking outcomes.

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 topics we discussed on today’s show

  • Weight Neutral Diabetes care
  • How bias leads to misdiagnosis
  • How eating disorders may develop
  • Stigma is trauma, trauma is stress
  • Hyperarousal with food
  • The thin ideal is making us sick

Full description:

[5:20] Ashley had a friend from graduate school who asked her to help in an eating disorder clinic temporarily. This experience led to Ashley’s best match professionally. She loves to combine clinical scientific methods and building client relationships.

David invited Ashley to be on the show after he heard her presentation during a weight neutral diabetes symposium. You can listen to the symposium here, https://wn4dc-symposium-2019.teachable.com/. This symposium discussed how food restriction and weight loss can be harmful to patients with diabetes.

There are many biases leading to diagnosis in patients with eating disorders, that includes missed or incorrect diagnosis. Over the years, Ashley saw many patients in larger bodies with diabetes prescribed restrictions or specific diets. She decided to hone in on this common place situation in healthcare.

Why a weight-centric approach to diabetes is harmful

[12:30 min] Ashley describes the “fertile ground of which eating disorders grow.” One example is a family experience or early experience where a person in a larger body as a child is placed on a diet or food restricted. If there is a family history of diabetes, the fear of diabetes is fostered through constant conservation around food and weight.

We cannot assume that healthy bodies look a certain way or diagnose eating disorders based on appearance. People’s bodies may appear in different sizes because of their individual, or natural, metabolic response.

The harm in a weight-centric approach is described. A person in a larger body, who is already starving, lives in a weight-stigma world, goes to the doctor to lose weight. The doctor says, “of course,” and the person goes on to diet and without realizing it, makes their health situation worse. We know that the restriction of carbohydrates in diabetes can make symptoms worse.

[16:25] Stigma is a type of trauma, including weight stigma. It can come from parents, peers at school, or a healthcare provider. Body size is seen as the main medical issue, but this is a bias. Stigma gets in the way of medical care because the patient failed the diet, when really the diet failed the patient. Chronically dieting can lead to nutritional deficiencies, depression, and anxiety. We feel like we cannot take care of ourselves.

When a person is told to lose weight, the nervous system can respond in a flight or fight response. Too often, patients give up and avoid healthcare because of that triggering situation. Then, other aspects of self-care fall away. It is hard to care for ourselves in a stressful state. Increasing and constant stress can raise blood sugars, which can lead to diabetes or diabetes complications.

Food Triggers Threat

[24:50] David says that many of his clients claim to “look at food and gain weight.” He asks them to look into this. Is weight the issue? Why is food a threat? Often there is a hyperarousal, a threat, that is triggering a stress response.

Ashley recommends the book, Why Zebras Don’t Get Ulcers, a metaphor of that playful animals and humans approach stress differently.

[27:00] The way the nervous system responds, is not a voluntary choice, its automatic. In the chaos of flight or flight, eating behaviors will be used as tool for calming or by restricting food, this control is calming. The way food feels in the body can be a trigger within itself, an example of interoceptive awareness.

[31:18] David explains that satisfaction work or satisfaction gauge is disrupted when in stress mode. Ashley shares that one of her clients feels stressed after feeling fullness due to her weight, but finds herself looking in the pantry for more food. She explains, there is a fullness in the stomach, but true satiety was not delivered, maybe a mental satisfaction or the body needed different nutrients than what the meal provided.

Diets Don’t Work

[35:25] slows metabolism and activates mental and emotional crisis in the brain. Eventually, the body and the brain say, “I need food.” Diets may work in the short term; however, most studies do not look at the long-term effects. Weight can come back 1-5 years in most people. This yo-yo effect can be harmful.

[38:15] Ashley’s grandparents were from rural South Carolina. They were working class and her grandmother was influenced by diet culture. She went through the egg diet, the grapefruit diet, and had a machine on her porch with a vibrating belt that claimed to shed fat. Even without an abundance of tv and newspaper ads, she still got the message to be thinner. Thinness ideals are ubiquitous, although our bodies are designed to gain weight.

Don’t miss next week for Part 2, with a continuing conversation with Ashley Roehrig.

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