Important Insights into Overeating and Dieting: Interview with Marc David and Amy Pershing

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Published:May 23, 2019|Last Updated May 23, 2019

Interview with Marc David and Mary O’Malley

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I started my first diet when I was ten years old, and over time it for me grew into an eating disorder, which we now call binge eating disorder.

To some degree it’s about severity.

The problem is the diet. Not the going off the diet.

I started my first diet when I was ten years old, and over time it for me grew into an eating disorder, which we now call binge eating disorder.

But we didn’t really have a name for it when it was happening for me, and so over time, and I decided to go into this field because doing the therapy and a variety of different things helped me find a very different relationship with food and with my body.

But it was a very difficult journey to find those resources, and many of them I really had to kind of find my own way and figure out as I went along. I really wanted to make a difference so that others wouldn’t have to go through that same very complicated journey. The first diagnosis that I got was a failed bulimic. Basically what that meant was that I didn’t purge. So it doesn’t feel very good to fail at your eating disorder. So that’s really what I had to come up against was that this wasn’t seen as an eating disorder. Indeed, it was more a failure to stick to a diet.

Now we understand it is something very, very different from that. But that was a lot of my own mentality around it. So I didn’t want other people to go through that same journey that’s fraught with shame and really blaming the victim for a way of coping.

Marc: As you’ve been sort of scanning the terrain of eating and eating disorders over these bunch of decades, why do you believe, why do you see that this overeating and dieting cycle is so common? It doesn’t seem to go away.

Amy: I phrase it a little differently. What I think about is that actually dieting is very common and overeating is a response to that. So if we think about dieting really as––and this isn’t just for folks who are struggling with an eating disorder, but for all of us. When we go on some kind of program where the decision making about how to feed our bodies well is for the most part removed from us, and is put in the hands of some company that makes decisions, that’s problem the first because it can’t really respond to our body, which is always the wisest decision maker. So that’s one issue.

The other issue is that as soon as we begin to restrict, in a manner that we’re eating less than our body truly needs, or we’re not eating foods that truly satisfy us. Our body is designed to think about food and to look for food, particularly highly palatable foods. So those overeating cycles tend to be highly palatable “forbidden” foods.

So then the person who’s been restricting on the diet, their body, not knowing the difference between a diet and famine, essentially begins to be very efficient and to store food very, very effectively. Can’t do it for one more hour, day, minute. Finds

themselves in front of the ice cream, the pizza, the potato chips, whatever the food may be, and is eating far beyond satiety. Actually, our body is wired to do that because it believes finally it has an opportunity to eat.

But what happens is you’re overeating at a time when your body is the most efficient at storing. Diets have a 95% failure rate over three years. Of those folks who failed, failed at the diet, 75% will gain back more than they lost. So what we know is the very best way to be “overweight” is to go on a diet. That’s the best way to do it.

The bottom line is that people will gain more than they originally tried to lose on the diet, and that reinforces this whole buying in of the cultural message of shame. They feel bad about their bodies. They feel like they’ve failed on the diet, they were derailed, and they try again and we’re off to the races.

Marc: It feels like such a powerful, emotional dead end and a metabolic dead end, because what you’re describing, “Okay, oh my goodness, I’m not losing weight. I’ve got to diet better. I’ve got to work harder at this because clearly there’s something wrong with me,” wow, have we gotten buried now. It seems like almost a nowin situation because people get pulled in more.

Amy: Absolutely. We have not only the diet overeating cycle that’s physiologically based, but we have fundamentally damage at a psychological level as well because most people go into dieting from a space of shame about their body. It’s something that needs to be fixed or altered or in some way made to look different. When we’re doing something, when we’re trying to implement change from a space of shame, that does not stick, and indeed is damaging and for some goes on to become a full blown eating disorder.

Marc: To me one of the important questions is, where is that line? How do we determine when somebody is just dieting all the time, and they have an eating disorder? I meet so many people, and even before I knew anything about this, it seemed like every person I knew, just about, or every woman I knew, every young woman I knew, was on a diet and going through this cycle endlessly.

How do you start to determine and assess, okay, here’s an eating disorder, as opposed to somebody dieting a lot?

Amy: It’s a good point to make too that dieting a lot is not a good idea if you have an eating disorder, or if you don’t. That said, not everyone who diets a lot obviously has an eating disorder. So there for sure are some distinct differences.

To some degree it’s about severity.

For example, the diet and weight loss and body size and shape become the most important things in that person’s world. One thing that’s a little tough to discern is when people are on a diet who don’t have an eating disorder, they tend to be food obsessed because they’re hungry. So it’s not always an easy line to discern for sure.

But it is a question much more of shame, much more about selfworth. It’s much more tied in to the way the person sees themselves, and sees their worth and value and their lovability in the world. So it’s how they’re doing on their diet. How they feel about their body is a metaphor in many ways for how they feel about themselves. It goes much deeper than I want to lose a little weight for summer vacation. It’s much bigger in that way.

We also typically see long histories of that connection to body shape and size and shame. So it’s been around a long time in the person’s life. Also food, that relationship to maybe an overeating or a binge time, isn’t just about going off of a diet, but it’s about trying to take care of themselves or trying to soothe or trying to check out or trying to deal with underlying anxiety or depression or conccurring trauma. There’s a lot of trauma survivors in the population of people with binge eating disorder. We see a much more powerful draw to binging or to overeating that’s not only a result of not having had adequate food. Those are just some of the differences.

Marc: When you mentioned that there’s a lot of history of trauma in a binge eating disorder population, can you define trauma a bit more? What might that look like?

Amy: Absolutely. There are a couple of major categories that we can think about with regard to trauma. One is something that’s referred to just as “Big T” trauma or sometimes it’s called single incident trauma. Those are specific losses. It might be the loss of a person close to us. It might be we lose our home, we lose a very important job.

Something significant happens to us. That’s a single incident. Our home may burn down or be destroyed by a storm or something like that. Those are significant traumas.

But typically with an eating disorder it’s something we refer to more as “small t” trauma, or complex trauma. Those are significant experiences, negative experiences, that impact relationships and attachments early in the person’s life.

There are a lot of different kinds of trauma. But some of them are based on family relationships that have not gone well, incidents of abuse or alcoholism in the family, or depression or other mood disorders in family members, such that their environment was not a safe place for them to be. So they really had to learn not to thrive, but to survive. That takes a very profound toll on people because a lot of their world becomes about soothing and about trying to keep themselves safe, instead of going out into the world and thriving.

So that’s a lot of what drives the relationship with food from a very young age because food is accessible for children often. It’s one of the few things that they have that they can have as their own and rely on.

Marc: I like to think of that as a very smart strategy in a way. To the young mind it makes perfect sense. Feel bad, eat food, feel good.

Amy: You bet it does. It’s one of the reasons I find it very important to treat binge eating disorder from what I call a strengths perspective. Meaning we have to look at how that relationship with food serves the person. How does it take the very best care of them? It’s not pathology. It’s about survival.

Marc: Amy, as you’ve been observing this terrain over the years, I’m wondering for a moment if you can offer some of your big picture views of where do you see us having come in the last 20, 30 years? Do you see more incidents of binge eating disorder and people having challenging relationships with food? Does it stay the same, less? Is there even any way for you to determine that when you just eyeball it? What do you notice?

Amy: In a way it is a little bit tough to tell because we haven’t had the diagnosis of binge eating disorder, except for the past year. It’s really a new diagnosis in the diagnostic manual. So we’re just now beginning to get some sense of the numbers of folks struggling with binge eating disorder.

What we do know is that it’s about five times the number of people who struggle with any other eating disorder combined. So it’s a significant number of people. Again, if you think about that relationship with food, it’s a very primitive one. It’s a very basic one. It’s one of the very first ways we’re cared for and soothed. So it makes sense that a lot of people in pain might choose that as a way to take care of themselves. At least to the degree that that’s the reason that someone might go to food, there’s a lot of folks out there for whom that’s one of their primary coping skills.

What’s also true is this is the first––I would say the last year or so is the very first we’re beginning to have people call our center and say, “I have binge eating disorder.” To label it, to talk about it and to know that indeed there is treatment, and treatment does help. So that’s the good news.

The bad news in one sense is that since I’ve started doing this, I certainly haven’t seen any decrease in the rates of eating disorders. Again, part of that is better diagnostics and better awareness. But I think a part of it too is that we still have a long way to go in terms of prevention and in terms of dealing with things like weight stigma, and the cultural milieu that allows eating disorders to flourish. So there’s still a lot of work to do.

Marc: Yeah, for sure. There’s also this interesting feature of when we talk about eating disorders, and in this case binge eating disorder, of women and men. It seems as though the women of the population have staked their claim here a little bit more. Is that what you observe? Might it be different? What do you think is going on when it comes to looking at this through the male/female lens?

Amy: We know that binge eating disorder is by far and away the most common eating disorder among men. I think the really good news in identifying binge eating disorder is that we’re also beginning to shine a light on men struggling, not only with binge eating disorder, but with eating disorders in general.

So I think we’re doing a better job. I’m seeing more and more books and talks at conferences that either are by men who have histories of eating disorders, or are certainly more inclusive of men when they’re speaking. That I think is getting better. Again, we’ve got a long way to go, but it is getting better.

What I’m seeing that’s saddening to me, actually, especially among the college students with whom I work, some of whom are men, that there’s as much pressure on

young men to look a certain way, to have the sixpack and to be defined in certain kinds of ways and to look a certain shape. The pressure is there increasingly looking like the pressure on women, and that’s not the good news. So I think, again, we’re getting better. The problem is in identifying it, and the problem’s getting at least not any better, if not worse. So it’s getting there.

Marc: Sometimes for me it seems like this conundrum that’s been laid out here of, okay, I’m trying to lose weight, I’m on a diet, which ends up feeling to my body like it’s starving itself. Then I’m binge eating, and I’m really not losing weight in this process. I might even be gaining it. To the logical mind it seems like I should be dieting because, oh my God, if you put me on eating food isn’t that the enemy? I’m eating more food. How do you context for people dieting, and that this might not be the way, and what gets put on the table in its place?

Amy: I think that’s a wonderful question, because the setup I think for many people when they’re dieting––again, with an eating disorder or not––when they’re dieting is I’m on the diet and I’m following the rules and I’m losing weight, so all is going well. But then I hit a wall and I start overeating and I gain weight. So ergo, I blew it is the message. So surely I can’t be trusted, I think is ultimately the conclusion, that I’m only doing well when I’m doing what the diet says to do. So that’s what I need to do is figure out how to stick to that diet because clearly that’s the right answer.

It makes sense on the surface. It does. It does make sense. But it’s exactly wrong, because indeed, what’s happening is our body is driving us against staying on a restrictive diet and it’s driving us toward eating more food in a given sitting that we would normally need. We’re essentially making up for lost calories.

So I think what happens is our body is actually responding exactly as it’s designed, but because we’re going into it with the setup of I’m supposed to be losing weight at a certain rate and that happens when I diet, then that’s what I should be doing. We say, and look at what happens when I’m not on the diet. I go crazy and I eat a gallon of ice cream and a pizza, whatever the thing is that the person goes for. Ergo, I can’t be trusted. Indeed I think the opposite is true, which is your body is behaving exactly, as I said, as it’s designed. Ergo, you can trust it.

The problem is the diet. Not the going off the diet.

I think one of the things that is very difficult for people typically, many of the people that I see as clients, but also colleagues and peers and friends and other folks that I know, is that they’re either on a diet or off a diet, but not really with much of a sense of how do I feed my body when I’m either––if I’m not going to diet, or eat like crazy until I’m on the next diet, what do I do?

So that’s what Hunger wise really is about, the program that I developed, was to help people get back in touch with how they knew to eat before they even started dieting. Children know how to eat. I think one of the things that we know is that our body knows what to do. Our job is to relearn how to listen to it because we’ve been taught not to trust it. I think that’s extraordinarily unfortunate.

Marc: Amy, as you were mentioning how so many people that you know they’re either on the diet or off the diet. I remember when I was about eight or nine years old, just kind of watching what adults do because they’re pretty cool and I want to be like that also. I used to notice how whenever I was with any adult and we’re getting a soft drink, we’re getting a soda, it’s I want coke and the adult wants a diet coke. I want a Pepsi and they want a diet Pepsi. I realized at some point that the conundrum gets set up from a young age where you’re either regular or you’re diet. Wow, is that a heavily advertised concept.

Amy: Absolutely.

Marc: Hard to escape.

Amy: It also puts food in this binary kind of good food, bad food. It may be a bad example in this way, but diet coke is good. It’s okay. It’s virtuous. Coke is bad. Broccoli is good.

Whatever, fettuccini Alfredo, is bad. So we have these setups that tell us, again, from the outside, what our body, what we ought to eat and what we ought not to eat, with very little consideration to how any of those foods actually make us feel.

How do I feel if I eat a lot of fettuccini Alfredo, versus if I have a smoothie, versus if I have some ice cream, whatever it might be. How do I actually feel when I eat those foods is almost never something we’re invited to consider. That’s, I think, how we from a very early age lose those cues.

Marc: You mentioned the term a number of times, trust. It seems like that’s such a place where the rubber meets the road in terms of people not trusting their body. Which then leads me to think, oh my goodness, I’ve got no control, I can’t trust this, you can’t tell me I’m supposed to eat more food or not diet, I’ll go crazy. To me it’s kind of sad when I hear that because there’s such a fundamental bond between me and my body. If I don’t trust it, wow, then I’m walking around my day not trusting.

Amy: Absolutely. Absolutely. In one sense we think about our body much more as a billboard than we think about it as our home. In this culture we’re invited to constantly be aware of how it appears, not how it feels. So we lose a tremendous amount of touch with those cues. Our body does not ask us to overeat. Our body does not ask us to undereat. Those are responses to things that we are psychologically deciding.

The very idea that your body will just go crazy and you’ll just eat and eat and eat if you’re not on a diet, actually doesn’t make any sense truly. What I see over and over and over again is indeed when people let go of the model of restriction as the goal, their overeating stops. That doesn’t mean that they don’t sometimes choose to eat more than their body might want, a special occasion or they’re really enjoying it or whatever. But it’s conscious. It’s a conscious decision.

Our body will not ask us to do damage. So it’s interesting that that’s I think then the setup in a way is that we starve. We eat because we’re starving. Then somehow that means our body has failed us.

Marc: This lack of trust of the body, I also see oftentimes what goes along with that is this intense sense of perfectionism. Of I have to look exactly like this or I have to eat exactly like this, and if I’m not doing it exactly or looking exactly then the computer printout is something is wrong with me. It feels like we’re living in a time when this perfectionism thing has really gripped us.

Amy: I think that is absolutely spoton. We have very specific, very narrow ideas about beauty for one thing. We also imply that being beautiful is the most important thing you can be, or handsome or whatever kind of term we want to use. They’re typically very male and female terms around that. But it’s the most important thing you can be, is to look as close to the ideal as possible.

So we don’t celebrate diversity. We don’t see beauty around us in the incredible array of people. We look for it in these very narrow kinds of ways, and imagine they’re constructions of beauty that very few of us can attain. So we have this setup already going in that you’re never going to be good enough. We’re always chasing after being good enough. Making our billboard look the best that it can be, and in the process getting further and further away from it as our home.

I don’t think there’s anything wrong with playing with being beautiful and enjoying that and looking a certain––playing with makeup or clothes or enjoying that at all. But I think when we begin to say there’s something wrong with me if I don’t look like XYZ then I have to start to think, says who? Who says that? Is that really in the best interest of us all? I don’t think it is. It is very much in the best interest of the people who make money off of that system. It is a multibillion dollar industry. So there’s a lot to be made in there for us going around feeling like our billboard is unacceptable.

Marc: It seems like we get in such tricky territory once we start to say, oh wow, I should accept my body as it is. But then I have this little part of me that wants to change it. Yeah, I’ve done all this effort with dieting and that doesn’t work. A lot of times it feels like so many people don’t want to give up the dream because it’s such a dream, and it’s been a dream for so many people for so long.

Amy: Absolutely, Marc. I think that’s one of the points that really can get missed in this process in many ways is that it really is a loss. To come to accept our bodies, to see the beauty in them, to think about our eating and our movement as actions of selfcare. Not as actions of reparation for some unacceptable thing. We’re letting go of something, something that I was chasing from the time I was ten years old. How was my body not acceptable at ten? It wasn’t even done yet. But I already knew somehow, it wasn’t what it should be.

Since I was ten, and I’m now close to 50, that’s a very long time. I’ve been doing it for awhile. But for many years I was chasing after being something else. So to suddenly decide to let that go was a grieving process, and I think it really is for many of us.

If we’re really thinking about moving out of this thing that holds us in shame and in selfdoubt, letting it go is not an easy process because it means letting go of this thing that we have been promised will make it all better, will make us beautiful and lovable

and acceptable and valuable. That is a tough thing to let go. But the good news is we find that’s all true anyway.

Marc: You’re reminding me. Just days ago I was working with a woman who is approaching 60, and she’s been dieting since––she thinks she could remember her first time was around 11 or 12 years old. So this is just about 50 years worth of thinking about food, talking about food, wondering about food, worrying about it, dieting on and off.

Anyway, I posed a question to her. I said, who would you be if this was off the table. If for some reason you weren’t doing this anymore, what would you do with all that energy? I asked it with this big smile on my face because I’m sitting thinking, wow, this is this amazing opportunity.

The look on her face was priceless. This is a woman who’s a Ph.D. who’s a brilliant woman. She said, I have no idea who I would be. It was a beautifully honest statement, and I was just struck by, oh my goodness, how easy it is in a strange way in this world to lose ourselves in that.

Amy: Absolutely true. I have heard that statement from many, many clients many times.

What happens if your relationship with food is peaceful? What happens if your body is okay as is? That your job is to take the very best care of it. Not to fix it. What changes? What do you think about? What do you dream about? What do you hope for?

For many of my clients initially their answer is exactly that. I have no idea. That’s not always an easy precipice to look over and see what might be there, but it’s well worth it. We’re reclaiming our voice and our space. We’re getting rid of the voices that tell us we’re supposed to somehow be different. We’re moving them away so that we can listen to what else we might hear if we weren’t listening to that. It is daunting and it is always worth it.

Marc: Amy, on that note, it also seems like for a lot of people who struggle with this, they often think that the best that can happen is that I will be able to somehow maintain this tense balance of I’ll finally lose the weight, but boy am I going to have to control my appetite and I’m going to have to really exercise. I’m going to really have to watch myself. I’m not going to be really super happy, but at least I’ll have the look that I want. It’s almost as if they’re setting up that they can’t be happy because they can’t imagine anything bigger than just having my hands tied.

Amy: I absolutely agree. I think that’s very, very true. If you think about––the messages come so young. For many women, and increasing numbers of men, but for many women, those messages come even at a time when they’re just developing a sense of self and who they are in the world. For many women with long histories of dieting, they really have to go back and do some of that work of really getting to know who they truly authentically are.

A client of mine gave me a wonderful bumper sticker as a gift. It said “Remember who you wanted to be”. I loved that. I loved that, because it went right back to before this was the world. Before I was thinking about how to fix this thing that’s wrong with me and I was just listening to it, and listening to me, what was there? For most people they remember that actually as a pretty wonderful experience. That’s what’s being taken away. So I absolutely agree with you.

Marc: It also seems, Amy, that one of the challenges that people face, that we face, is that it’s easy it seems to find the culture called, hey, how’s your diet going and what’s going on? It’s easy to find people to commiserate around I should lose weight. It’s harder to find this kind of conversation that’s happening where we’re not being assessed and judged and measured for what we look like and how much we weigh. It seems like for a lot of people they don’t even know that this conversation exists.

Amy: I think that’s absolutely true. The good news is it’s getting out more. There’s more challenge to it. We’re seeing more things like campaigns for ads that don’t use Photoshop. There’s a little bit more of it out there to sort of say, wait a minute, let’s at least stop and have a conversation about this, as opposed to it being given.

But I think you’re absolutely right. In one sense doing this at this point still requires someone to really be a renegade. To make decisions about what conversations to participate in and what conversations not to participate in, in order to protect themselves. You may be the one person in your office who’s not in the Biggest Loser challenge from the beginning of the year. You may be the one who says no thank you. So it is not easy, in one sense, to decide to take that power back because there will be lots of people around you who are not in that place.

But what I often say to people is if what’s on the table is you being able to lose more time to shame, lose more time to trying to make your body something that it may not

ever truly want to be, it’s worth being a renegade. It’s worth people maybe saying, I just don’t understand her. I think that’s okay. It’s not easy, but it’s okay. You’re worth it.

Marc: What’s some of the most rewarding pieces for you of the work that you do?

Amy: I think by far and away my favorite part is watching––this sounds like an odd thing––but is watching the change in how women move over the course of doing recovery work. They come in uncertain in their bodies and stiff and afraid, and not really inhabiting themselves. Over the course of the work that we do in recovery, I’m talking about doing eating disorder work, their movement is smoother and safer and they’re at home.

That transition is beautiful to me to see. Everyone’s beauty truly comes out in a very different kind of way when they’re at home in their physical self, regardless of their physical shape. It’s not relevant.

Marc: When you kind of look into your crystal ball, what would you like to see? Let me say that. When it comes to the world and its relationship with food and the culture and its relationship to dieting and eating, what could it look like?

Amy: If I got to dial up how it would look as of tomorrow, and what would I change, there’s a number of things I hope for. I hope will happen. One is that we’re able to celebrate a diversity of shapes and sizes and ages and colors. All of the differences among us that we don’t pathologize or we don’t say this is the ideal and we have to change to fit this ideal. That would probably be the single biggest thing, actually.

There’s a wonderful video that Deb Burgard and some colleagues put together. It’s on YouTube. It’s called Poodle Science. The idea behind it, which I think is really wonderful, is if we used dogs as a metaphor for people, and we think about the diverse shapes and sizes of dogs. Then we have this idea that somehow we should all look like poodles. Our job in one way, so we think, is to make dachshunds and bulldogs and German shepherds and schipperkes all look like poodles.

The idea behind it is, indeed, if we all tried to eat the way and move the way a poodle moves, what we’re going to have are starved bulldogs. In other words, their paradigm in the world is not going to fit with the bulldog and the German shepherd and the

schipperke, who have different bodies that are designed to do different things. So in the ideal world according to the diet mythology, we would all be poodles.

What I would like to see is the notion that our work is to take the very best care of our home. To eat with joy, to eat with an eye to good nutrition, to honor our body’s cues and desires for movement, and wherever it goes it goes. In other words, our body knows best if it’s a poodle or a schipperke. It knows where to go. I would love to see teaching our children from the getgo how to trust and how to listen, as opposed to how to control.

Marc: It feels like that fresh start at the beginning when we’re young is so important. My goodness, we’re such impressionable human beings. How often do we see that we’re working with smart, intelligent, brilliant adults who are almost trying to untie and unknot the mess that can happen early on when we pop into a world that’s giving us some very bizarre messages.

Amy: Yes. It isn’t really any different than any other kind of brainwashing. So we really are having to undo tremendous, tremendous repetition of messages that really go against what our bodies intuitively want to do. What I find is there’s a critical point for clients where they really begin to get hold of and gather steam and really come to understand, wow, I was really imprisoned by that. In other words, when they move past it and look back at living in the paradigm of body shame it becomes an, oh my gosh, I can’t believe I bought that.

That’s also really a wonderful place to see is again people coming from not a space of shame about their body, but from a space of listening. Then being able to look back at that and say, what was I doing there?

Marc: It’s a revelation really, and it’s kind of a rebirth. Or it might just be the first time that we’re being born into who we really are.

Amy: Yes. Yes. I think that’s well said. Well said.

Marc: Amy, I’m thrilled about the work that you’re doing and how you have such a clear and really compassionate way of approaching this. Resultsoriented for sure, but also embracing humans for who we really are, which I think is what helps us heal and grow and transform. Anyway, I would love for you to share with viewers and listeners how

we can stay in touch with you and your world and what we should know about what you’re up to.

Amy: Sure. There are a number of ways. Please come to visit our website. It’s thebodywiseprogram.com. We try to have different quizzes and bits of information and videos and different things that relate to both treating binge eating disorder, but also to letting go of the diet paradigm and learning more about that. That’s really where most of the information that we have is. Then we do provide referrals. So if folks aren’t in the Ann Arbor area, we do provide referrals across the country. But that’s the best place to get information about what we’re doing.

Marc: Yay. Amy, thank you so much for the amazing work that you’ve been doing, and for just being a champion for helping people return home to a good way of being in the body. I so appreciate what you’re up to and what you’ve been doing for a long time now. So thank you.

Amy: Great. Thank you, Marc. I appreciate talking with you again.

Marc: Thanks, everybody, for tuning in. I’m Marc David