Monday, June 17, 2024
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5: Judith Matz: Binge Eating Disorder

Judith Matz, MSW, LCSW, took some time with us to discuss Binge Eating Disorder, and focuses on how recovery is not about weight loss. According to statistics, more people suffer from binge eating disorder than any other eating disorder, and this episode sheds some light on recovering from binge eating disorder.

Judith’s books –

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[asa book]1402205449[/asa]

[asa book]0692377816[/asa]

For more information about Judith, please visit her website

Full transcript –

Kathy Cortese: Hello and welcome to ED Matters. This is Kathy Cortese, your host, and today my guest is Judith Matz, Masters in Social Work, Licensed Clinical Social Worker. Judith Matz is an expert in eating and weight issues, co-author of The Diet Survivor’s Handbook and Beyond a Shadow of a Diet and author of the new children’s book, Amanda’s Big Dream. Judith is a popular speaker for organizations and at national conferences and descriptions of her work have appeared in the media including the LA Times, Fitness, Good Housekeeping, Self, Shape, Today’s Dietitian, Diabetes Self-Management, Psychotherapy Networker, NBC News Chicago with Nesita Kwan, Huffington Post Live and she appears in the documentary America the Beautiful 2. She has a private practice in Skokie, Illinois. Welcome, Judith.

Judith Matz: Thank you. Good to be here.

Kathy: Our topic today is going to be binge eating disorder, recovery is not about weight loss and I’d love for us to get started with some of the myths about binge eating disorder and weight.

Judith: Okay. The way I think about it is that most people who come to my practice come and they’re distressed about their overeating but it manifest themselves in being distressed about their weight. So people walk in wanting to lose weight and it’s understandable given that we live in a culture where there’s so much pressure and so much promise that if you lose weight, you’re going to be sexy, healthy and successful and so people are very distressed about that but the thing is, is that when people try to lose weight and diets are the way people do that, it actually triggers and sustains binge eating. So my goal once someone comes in is to empathize with their distress around their weight but also to help them focus more on how to heal their relationship with food, to take the focus off the weight and try to normalize their eating.

Kathy: It’s such a valuable concept to normalize and have a healthy relationship with food. I’m curious if you could just talk a little bit about that so our listeners can if they’re not familiar with that concept.

Judith: Yeah. So when I talk about a healthy relationship with food, I’m not talking about just eating healthy foods and a lot of times, people say I’m not dieting, I’m just eating healthy but anytime people start to categorize foods as good and bad, they end up feeling some of that deprivation. So like when I give workshops, I’ll say, “Imagine that starting tomorrow, you can never have ice cream again. What are you going to do tonight?” So Kathy, what are you going to do tonight?

Kathy: I’m going to have chocolate chip and coffee and chocolate chip mint, yes.

Judith: So you’re going to have that ice cream, you’re going to have it whether you’re hungry for it or not and you’re going to eat more of it than your body needs. So one of the goals in having a healthy relationship with food is to end the deprivation that comes when you ban certain foods. And so how do you do that when you spent months, years, maybe even decades saying I can’t eat this? Well, what we want you to start to do is reconnect with your signals for hunger and fullness. So that’s what I mean about having a healthy relationship with food, learning to eat when you’re hungry, learning to eat what you’re hungry for, what your body needs, what will really nourish you and stop when you’re satisfied.

Kathy: There’s so much material here. I’m not sure which way to go but here’s what I’m going to say. What are some of the quagmires that individuals with binge eating disorder may likely experience if they solely view recovery as weight loss?

Judith: The problem is you stay stuck in the diet mentality. So you might say okay, I’m hungry for a cookie but that cookie is fattening so I’m going to have a piece of fruit. Well, there’s nothing wrong with eating fruit. If you’re hungry for fruit, by all means you want to eat fruit but you’re just as off eating fruit when you want a cookie as you are eating a cookie when you want fruit and so the goal really is to start to listen to what your body tells you it needs so you can end that deprivation. So that’s the biggest quagmire for people is how do I get out of that diet mentality and it’s entrenched. It takes time to keep catching that diet mentality thinking.

Kathy: And hunger and fullness cues, where are they when someone’s been invested in a diet mentality?

Judith: So a lot of times, what we find is that people are eating for all kinds of reasons that have nothing to do with physical hunger. It might be because something looks good. It might be because I’m somebody when I sit down in front of the TV, I eat. It might be something emotional is going on. I’m feeling sad and or angry and I’m using food to soothe myself or I’m happy, people use food to celebrate. And a lot of times, people really aren’t even in touch with what does it mean to be physically hungry. So when I do workshops, I’ll say how do you know when you’re hungry and I’ll get things like I get headache, I feel lightheaded, I get crabby and those are all signs of physical hunger but they mean that you’ve waited too long that you’re too hungry and when that happens, you’re really at risk of overeating. When we’re that hungry, we feel desperate and we’ll eat whatever is there and we’ll eat way more of it than what we need. So what I really teach people is how to reconnect and look for what I would say is like more of a gnawing or an empty feeling in their stomach and beginning to use that as the signal that it’s time to eat and in our book The Diet Survivor’s Handbook, we actually have like a hunger scale so you can start to put words to it; I’m somewhat hungry, I’m hungry and that’s when you want to respond to yourself.

Kathy: So you were actually asking people to tune in to a physical sensation something likened to a gnawing. You were talking about the various times in people’s lives that may involve emotions, that may involve activities when they’re going to eat so to differentiate that for them from the emotional hunger and that physical hunger, what are some suggestions that you offer?

Judith: Paying attention. I mean that’s the biggest thing is to start to tune in and I want to be really clear about something. This approach is about getting to where you feel in charge of your eating, not control. It’s not about willpower. It’s actually, I talked the other day and they really focused on using willpower and I have to disagree with that because that’s what dieting is about, control. So when somebody is reaching for… I mean I encourage people who are learning this to just begin every 15 minutes or so check in and ask the question, “Am I hungry?” and if you find yourself reaching for food, am I hungry, yes terrific, I get to eat and enjoy it without guilt. If you find that you’re not hungry, you can certainly ask, “Can I wait?” and if it the answer is yes, fine but the nature of compulsory binge eating is that sometimes you’re going to need to turn to food when something’s bothering you. I think it’s so important for people to understand that that’s not really a bad thing. It feels bad and the goal is to work your way out of it but if you think about it from the time we come into this world, we’re soothed. When a baby is crying, they’re soothed with food and so it makes sense that in times of distress that you might to try to help yourself through a difficult moment by reaching for food and so I really encourage people to be very compassionate with themselves and just start to notice. I’m reaching for food and I’m not hungry, something must be bothering me and over time and we described this process in Beyond a Shadow of a Diet, people learn how to ask “What would I think about a feel if I didn’t eat right now?” and so over time, people learn how to sit through the feelings but in the beginning, you’re not going to be able to and the goal is to stop yelling at yourself.

Kathy: Let us talk about guilt and the role of guilt in binge eating and how damaging that kind of guilt because you said to eat to enjoy without guilt.

Judith: Right. Well, guilt comes up in so many ways. I ate a brownie, I shouldn’t eat that. What I love about this work and what I love about this approach is it really helps people get rid of the guilt because now you have it, you build this internal structure. If I’m hungry for a piece of chocolate, I get that chocolate and I feel satisfied and over time, I pay attention to my fullness and I can stop, there’s nothing to feel guilty about. I haven’t eaten past fullness, I feel good, and I took care of what I need. So often, the guilt is what feels over eating and here’s how that works. I’m not supposed to eat cookies but I’ve broken through my restraint and I’m eating cookies. Well, I might as well eat the whole box because starting tomorrow, I can’t have them again. Imagine instead if you said “Oh I ate more cookies than I wanted, I’m full. The sooner I stop, the sooner I’ll get hungry again.” It’s a really different mind-set. So letting go of the guilt and just tuning in to your hunger with great compassion that it’s going to take some time to really honor those signals helps people be able to eat all kinds of foods that nourish their bodies but we all like and I always say this one when I am doing trainings, I’ve never met anybody who only likes or only wants cake, cookies, candies, ice cream, pizza, and chips but I also never met anybody who only wants apples, carrots, and salads. We like variety and so as people learn that internal structure, it’s very calming and liberating.

Kathy: One thing I know we can’t overlook is the society of challenges of weight stigma and we just talked about guilt, now we’re going to bring in weight stigma. How do you address that with your clients when how ongoing is that dilemma?

Judith: Thank you for asking that question and I have to say my thinking about that has evolved over time. I came to the work. I subscribed to the Health At Every Size framework and when I first started working with people who are overeating, binging, it was through a liquid fast program way back in the ‘80s and I thought it was better for people to lose weight just like we all were raised to believe and what I saw was that people talked about willpower. I mean these people were going in this liquid fast program. We’re going with that food. We’re drinking these terrible tasting shakes for three months and then slowly reintroduce to food and yet the weight gained back and even people who do less extreme kinds of diets that we know statistically people any diet will work in the short run but sooner or later for the vast majority, the weight comes back and actually two-thirds end up higher than their pre-diet weight. So I started doing a lot of work with people about if they quit dieting, working on body image and feeling better about their bodies but I don’t think you can sit with people and do this work and not realize that we need to change our culture that there is like you said so much stigma out there and so with the Health At Every Size approach, it really helps people to focus on positive sustainable behaviors instead of the pursuit of weight loss. So often, people are concerned about health and there’s all kinds of ways people can take care of their bodies without dieting to lose weight.

Kathy: And the sustainable… what was the term you used?

Judith: I called them positive sustainable behaviors.

Kathy: These positive sustainable behaviors, my sense is is that it’s not a sort of a template that the same template does not apply to everybody that there can be positive sustainable behaviors that apply to person A and person B.

Judith: Yeah, I mean each person has to decide given their bodies, given their abilities, and given all kinds of circumstances what they have access to but as a therapist working with people who are coming to me often those behavior, I mean we’ve been talking about what I call attuned eating, it’s also intuitive eating honoring hunger and signals of fullness, a lot of times let’s just take the idea of exercise. We know that physical activity is good for people. It helps cholesterol, it helps blood sugar, it helps depression, and it helps all kinds of things and those things are helped whether a person loses weight or not but unfortunately so often, exercise is tied to weight loss and so you have a person who exercises a few weeks, misses a time. It’s a like a diet. Oh I miss, I feel guilty and then I quit or I exercise, I didn’t lose weight so why bother. So that’s an example of helping people figure out a way that they like to move their body if that’s something important to them and doing it because it makes them feel good whether it’s in a moment or finding joyful movement or they feel good afterwards or they feel like they’re taking care of themselves. That’s what’s sustainable.

Kathy: So we might say positive sustainable behaviors pretty much never becomes self-defeating.

Judith: Sure.

Kathy: They are always self-sustaining.

Judith: Yeah.

Kathy: Can you please share some of the fascinating cognitive and behavioral changes that would take place with recovery in binge eating disorder when the pressure to lose weight is not the focus? Big area, I know.

Judith: No, it’s a great question. So many ways to answer that and I’m thinking about a particular client so I’m just thinking about one woman I worked with who came in. She had a job where she had her summers off and every summer, she went on a diet, lose the weight, work resumed in the fall, gain the weight back and over the course of a couple of years, her binging ended and she was able… people who do these are able to focus their energy on other things like relationships and hobbies. She became pregnant. I want to relate this back to the stigma. One of the things that was so important is that when she went to her first gynecologist, there was pressure about how much weight she could gain and she knew right away again that weight stigma entering the room and she had done a lot of work in understanding that her body wasn’t meant to be thinner and she was using a group I was doing to get a lot of support around that really working and ending the shame around her body and was able to determine that that gynecologist was not going to be able to meet her needs and found through some networking a doctor who would support her at a higher weight. She had a perfectly healthy pregnancy and gave birth to a beautiful baby. So recovery might look different for different people but there’s a sense of I’m in charge. I mean that’s the most important thing for a binge eater; I’m in charge of my eating. Does that mean that you eat perfectly? There’s no such thing. Normal eaters over eat sometimes but there is a sense that I’m in charge of my eating. If I have a binge, I can… I always tell my clients that doing this doesn’t mean you’re never going to binge again especially at the beginning but the time it takes to get out of the binge is quicker the time between binges is quicker so somebody like this client I was talking about might have a binge maybe every few months and instead of it being as distressing as it was, it was a cue for her to say I wonder what’s up and she could use it as an opportunity to learn something about herself.

Kathy: And perhaps key issues that were right for her to take the time to explore in a different way.

Judith: Exactly.

Kathy: Yeah. So recovery from binge eating looks a lot of different things for a lot of different people. When you are first introduced, challenge, an individual binge eating disorder what can help them come into a room like yours to say I need help?

Judith: I think the most important thing at the moment is that binge eating disorder became an actual diagnosis in 2013 and it gave validity that I’m not just a weak or lazy person, this isn’t just a matter of willpower. So often, my clients are being told by their family, well just stop eating so much as if they could do it. So I think that’s the first thing is to acknowledge that this is real, this is serious and you deserve treatments and so there’s a podcast like this, there’s so many more articles out there that let you know you are not alone and sometimes, there’s books to read and they’re helpful but often people need help both with the mechanics of this of how do I really start to listen to my body and figure out what I’m hungry for because there’s just obstacles along the way after a diet history and then often, there’s the emotional aspect. I’m using food to manage certain feelings and so a therapist can be really important helping you make those connections learn other ways to deal with your feelings to get through those emotions. Often people with binge eating disorder may have some anxiety or some depression or even some trauma and so finding a therapist who really understands binge eating disorder who uses a Health At Every Size framework to help you work on how you’re going to view your body, the stigma that you’ve internalized because you’re part of this culture too and so that’s going to be a piece of your work. You can expect to work at so many different levels and you can expect to find a freedom that you may never have believed was possible that you can be in a roomful of food and it doesn’t occur to you to eat unless you’re physically hungry and that’s amazing and as a therapist when I watch my clients attain that, it brings tears to my eyes sometimes to see somebody reach that point.

Kathy: Right. You used the word freedom and that’s what I imagine. I’m curious how empowering it is when someone does realize I have integrated this weight stigma and now I am choosing to eliminate it.

Judith: It is both empowering and challenging and I always will tell you ending the binge eating is for the most people the easier part of the work. The stigma out there is so tough and so I love I had one client say to me once I realize it’s a choice, I can continue to feel this way about my body or I can decide that I’m okay but that doesn’t mean she felt okay all the time. She still have to gather her resources and so I encouraged you as you’re doing this work, find those resources. There’s all kinds of groups online. There’s some wonderful blogs. Certainly, the books out there and there’s a Health At Every Size Facebook group and I have newsletter we put out there so all kinds of things because you’re going to need that support but it’s so worth it. It’s worth letting go. It takes so much energy to feel bad about yourself and like you said when you can let that go, it’s so empowering.

Kathy: I know that our listeners can hear some of the different things that have come through in this conversation, your compassion, your kindness, your validation, your appreciation of the series nature of this and also your – let’s call it – motivation and hope that people could basically raise themselves and feel very good about who they are. Other closing words from you because I appreciate that sentiment that you’ve conveyed here.

Judith: I guess the biggest thing and I know I said this before but I just want to remind people other there you are not alone and the shame you’re feeling, you may think that’s unique to you but we live in a culture that’s very shaming around weight and fat and find people to talk with, find somebody safe whether it’s a friend, a therapist or an online group. Move forward, you’re not alone.

Kathy: Thank you so much. Our guest today has been Judith Matz and we appreciate your time.

Judith: Thank you. It’s been a pleasure to be here.

Kathy: Thank you.


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