Even if you don’t specialize in eating disorders, chances are you work with clients who struggle with eating and weight concerns. In our culture, a diet mindset and the pursuit of weight loss are often viewed as positive self-care. Yet this focus sets people up to get stuck in the diet-binge cycle, which frequently results in higher weights, worse health outcomes and, most insidious of all, deep feelings of shame when the pounds almost always return.

Here is an overview of some important considerations to keep in mind to help clients truly make peace with food:

  • The deprivation of dieting is a major factor that leads to out of control eating. Ask your clients to review their diet history. Do they end up bingeing on the very foods they previously eliminated? If so, let them know that this is a natural reaction to food restrictions. Also keep in mind that anytime your client manipulates food for the purpose of weight loss, it’s subject to the same physiological and psychological pitfalls, even it’s called a “wellness” plan.

  • Attuned eating, also known as intuitive eating, is the antidote to chronic dieting. Attuned eating helps clients break the diet-binge cycle as they reconnect with their natural signals for hunger and fullness. A key feature of attuned/intuitive eating is letting go of the judgements around food as “good” or “bad.” Instead, ask your clients to notice the difference when they eat foods that provide a feeling of satisfaction, keeping in mind that “all foods fit.” While this may seem scary at first, as clients pay attention to the feedback of their bodies, they’re likely to find that they enjoy a wide variety of foods. (Attuned eating is flexible, and clients can adjust their food choices due to specific health conditions such as diabetes, usually with the help of a non-diet dietitian.)

  • Many clients use food to soothe themselves in times of distress. While it’s important to explore emotions and develop additional strategies to regulate feelings, if your client is in a diet mindset, they will continue to find themselves eating to discomfort as they break through their food restrictions. Therefore, ending the diet mindset is a prerequisite to healing the reliance on food for affect regulation. As your client addresses emotional eating, help them to cultivate self-compassion toward their need to turn to food at times, rather than resolving to go on yet another diet.

  • Bodies come in all shapes and sizes and each of us has a set point, which is our natural weight range. Research shows that the more people diet, the higher their weight and set point will be over time; the vast majority of dieters regain the lost pounds after dieting and one-third to two-thirds end up higher than their pre-diet weights. While just about every diet works in the short run, given the lack of efficacy for any diet over the long-term, my suggestion is that even as you support your clients, make sure that you don’t view their success in their work with you as contingent on weight loss.

  • The Health At Every Size (HAES) framework offers an approach to help clients take care of their physical and mental wellbeing without a focus on weight loss. Instead, you can encourage your clients to engage in positive, sustainable behaviors that can improve health regardless of whether any weight is lost e.g., physical activity, good sleep patterns, honoring signals for hunger and fullness, mindfulness practices, etc. Studies show that yo-yo dieting is a factor in increased risk for health issues such as cardiovascular disease, and that behaviors such as exercise mitigate health risks for people at higher weights.

  • The Health At Every Size framework also looks at social justice issues related to body size and weight stigma. Research shows that exposure to weight stigma, in and of itself, contributes to poorer health. I encourage you to reflect on your own attitudes toward “thin” and “fat,” and to become aware of your own implicit weight bias. You can do that by taking the Harvard Implicit Bias Test.

I hope that this shift in thinking about eating and weight concerns will spark your curiosity if these ideas are new to you. We’ve all grown up in diet culture and the process of unlearning the diet mindset can be both challenging and exciting!

Judith Matz, LCSW
Judith Matz, LCSW