Maria Sorbarra Mora and Joe Kelly joined us for an interview on their book Incorporating Science, Body, and Yoga In Nutrition-Based Eating Disorder Treatment and Recovery: the Integrated Eating Approach. What follows are our questions in italics, and their thoughtful responses.
In Incorporating Science, Body, and Yoga In Nutrition-Based Eating Disorder Treatment and Recovery: the Integrated Eating Approach, you define a nutrition treatment modality. What are the components of this approach?
Maria Sorbara Mora: Integrated Eating’s goal is healing. It weaves resilient and vibrant threads of science, dietetics and yoga therapy. Integrated Eating supports
people with eating disorders to practice structured eating; develop mindful eating skills; develop eating-body intuition; and ultimately experience mastery in life.
Joe Kelly: People sometimes ask “Perfectionism is the problem with eating disorders. Isn’t mastery just another word for perfection? ” No. In the book, we talk about “masters” in sports or the arts–like Serena Williams. For many years, Williams dominated professional tennis with her skill, intuition, strategy; in other words, her mastery. At NO point was Williams perfect at tennis. She lost points, games–even matches. At NO point did she stop practicing tennis. Practice is a process that facilitates mastery, which is itself a practice–not a state of perfection.
MSM: Successful healing (and, ultimately, mastery) means weaving and reweaving life with relationships, embodiment, and ongoing growth.
Structured Eating is a first step. Please explain the significance of this phase for recovery.
MSM: No matter what form they take, disordered eating results in a disordered relationship to food and a nutrient-distressed body.
JK: The basic structures of eating go out the window with an eating disorder. So, the first order of business is to feed the body what it needs.
MSM: Structured Eating helps patients relearn how to eat. We share the science of macronutrients and how they respond to the body’s needs, even while those needs change throughout the day. We describe meals, mini meals and snacks as “eating events” to help lessen the disordered connection to eating. They layer skills into their recovery: understanding the amount of macronutrients to consume at each eating event to meet clinical needs, how to obtain and/or prepare food for different eating events and their personal schedule, etc. Structured Eating takes frequent nutritional support and sustained, repetitive practice of elementary skills–like eating prescribed foods during every eating event.
JK: Structured Eating trains (or retrains) the body to effectively communicate its nutrition needs to the brain so that the body and brain work together in the eating process. Treatment requires brain-body communication and connection.
The experience of an eating disorder is generally accompanied by the experience of shame. Why do you encourage clinicians to explore this shame as patients are making behavioral changes?
JK: An eating disorder’s distorted, injured relationship with food and the body is likely to feature shame. Shame and guilt are also associated with trauma. For healing and recovery, clinicians and patients must address these issues. After all, skilled clinicians know that eating disorders are (simultaneously and paradoxically) “not about the food” and “about more than just the food”.
MSM: Many times, shame is linked to early memories of adults telling a child not to eat something and criticizing or praising aspects of the child’s appearance. In my experience, Nutritionists can support the work of other clinicians, as they help a patient let go of a core belief, thought or feeling that has manifested as guilt or shame. Clinicians working with food must understand the function and consequences of shame.
After Structured Eating, you suggest the next process is mindfulness and mindful eating. What makes mindfulness challenging?
JK: For years, eating disorders keep people “safe” by denying, distracting, detaching and dissociating their body, thoughts, emotions, memories, trauma, etc. Mindfulness practice is often jarring for people in treatment and recovery, because mindfulness increases awareness of what lies within the body they are feeding.
MSM: Mindfulness is taking the next step of inhabiting one’s body. It begins the journey of acceptance of what we notice. Of course, this includes noticing painful feelings, trauma, discomfort. Once Structured Eating skills are mastered, we add the layer of Mindful noticing-without-judgement. Patients learn how to use their senses and sensations to collect information about their eating and food experiences. This is difficult for brains and bodies ingrained with eating disorders’ judgement-first, sense-distorted patterns. Mindful Eating practice deepens and clarifies a patient’s connection to eating and body.
Bringing in yoga, clients get to “notice.” Please connect the dots as to how this type of noticing aids eating disorder recovery.
MSM: Yoga gives us information through sensation and awareness. Yoga also provides language. For instance, we describe discomfort, fear and other unpleasantness we notice as the body’s “edges.” Like most things in treatment and recovery, Mindfulness is edgy. To recover, our patients must explore and expand their edges (or windows of tolerance).
JK: When clinicians shine light of awareness on eating events, patients begin noticing how compromised their bodies are. Yoga helps them practice ways to tolerate what they find and move toward acceptance of what the eating disorder has done–and is still doing now.
MSM: In yoga therapy, I ask my patients, “What do you notice and how do you notice it? When they give basic sensory information like, “I have a pain in my back” I dig deeper and ask, “tell me more about how you know it’s pain; describe the sensation of pain in this moment.” We gather more data with curiosity and inquiry.
JK: Maria uses the same tactic in meal support. When someone says they are hungry or full Integrated Eating clinicians invite more information. “What sensations do you have right now? How about thoughts and feelings? What information is your body giving you? How does that information support the sense that you are hungry or full?
MSM: Yoga practice stimulates neuroplasticity, which creates and/or deepens new and/or healthier neural pathways. Yoga also reduces the tendency to revisit and reinforce the existing, problematic neural pathways.
Are your readers surprised by the amount of detail you provide with your various Food Tables?
MSM: This question makes me happy! Our readers are clinicians, people in treatment and recovery, and their loved ones. We pushed hard to show specific examples of nutrition strategies we Integrated Eating clinicians use to help people in our care through the phases of healing.
JK: We think the details illustrate how much PRACTICE recovery and mastery require. The eating-event tables and food logs are concrete examples of “imperfectly perfect practice.”
Flowing into Intuitive Eating and then Food Mastery brings amazing fulfillment. Please give us a glimpse of Food Mastery.
MSM: During Intuitive Eating, patients use the information they gather through mindfulness to practice discerning, choosing, and taking action. Wisdom exists, inherently layered in the person’s being. For instance, a healthy body will crave fish before the brain consciously discerns the body’s need for omega fatty acids. During Intuitive Eating, patients practice unblocking and trusting their inner wisdom’s speed-of-light discerning, choosing, and acting processes (aka intuition). Intuitive Eating is sustained conscious practice to create neural pathways and somatic memory that clear away eating disorder debris obstructing communication with inner wisdom.
JK: I think of Mastered Eating as recovering people integrating their skills and practices in the service of continual learning, responsibility, compassion, trust, gratitude and service to self and others. Mastered Eating is not perfect eating. They cherish the many ways that imperfection provides connection and grace. They know that our souls rely on fresh air coming through the doors and windows of our imperfections.
MSM: I like to tell an Unremarkable story about a former patient who recovered from the depths of eating disorders: It’s morning. She wakes up “in the mood” for eggs. She makes toast while scrambling two eggs. She smashes some avocado on her toast and pours a glass of juice. She mutters: “that was delicious” as she puts her plate into the sink. She grabs another slice of avocado before jumping into the shower.
JK: Sooooo, Maria. Is this UNremarkable story a simple story?
MSM: Actually, it’s not simple. Look under the nutritional hood, and we see complexity, process, flow, and liberation at work:
- She wakes up in the morning and instinctively knows she’s hungry.
- She doesn’t need to consult a clock or meal plan because her circadian rhythm and internal signals are synced with mealtimes.
- Her body communicates its needs via an “I’m in the mood” message. She responds by organizing, making and eating two eggs, toast, avocado and juice.
- She doesn’t wonder if or how she will get a chance to eat.
- The idea of skipping the meal never enters her mind (she’s been eating breakfast every day for a very long time).
- She eats varied combinations of balanced breakfasts, seamlessly using her body’s nutritional imprints to sate her specific needs.
- She’s a bit hungry when done and trusts her body will figure it out.
- She is present for and responds to the meal’s flavors.
- This breakfast was exactly–and simply–what she wanted and what her body needed. Even amidst the hustle of the morning, she finds peace and gratitude in her body.
- She is now ready to move on with her day.
JK: In truth, this story is simple and complex. Eating mastery is unremarkable for this woman. She is just doing her thing.
MSM: Her actions are natural and carefree. She moves into, through and beyond the experience with ease, mastery, and joy. And that is remarkable!
About the authors:
Maria Sorbara Mora, MS, CDN , CEDRD-S, C-IAYT, is a Certified Eating Disorder Registered Dietitian and Yoga Therapist, with a Masters In Applied Physiology and Nutrition Education. She founded and practices at Integrated Eating Dietetics-Nutrition PLLC in New York City, Long Island and Brooklyn.
Joe Kelly also co-authored eating disorders books with Margo Maine and Carolyn Costin. His other books include Dads & Daughters. A former public radio journalist, he co-founded New Moon Girls magazine. Joe coaches family members affected by a loved one’s eating disorder.