Food addiction: does it exist or not? Is it helpful or harmful? Does science support it or disprove it? These questions have become so polarizing, especially in the eating disorder and substance abuse communities, where people often take a hard yes or no stance.

In this podcast, we look at it differently.

The fact that there are such strong, diverging opinions on this topic is the best indication that both experiences are real. There are people who are helped by the food addiction model and people who are harmed by it. Otherwise, why would so many be so emotionally invested in defending one position or the other?

In our last episode, we talked about the importance of acknowledging food addiction so that we can hold space for those who experience it. In this episode, we explore the pitfalls of adopting a food addiction framework for people whose loss of control around food is actually rooted in restriction.

Our guest, Libby Supan, shares why she joined and why she left Overeaters Anonymous. She talks about the hope and sense of community she initially found in OA, a space where she could speak openly about her food struggles. And also discusses how the abstinence-based model, which positions certain foods as addictive substances, ultimately perpetuated the food struggles she was trying to recover from.

Libby talks about the shame she felt as an “unsuccessful addict in recovery,” the growing dependence on her sponsor that left her unsure of her own judgment and unable to trust in herself.

Libby is a licensed marriage and family therapist and a certified intuitive eating counselor. As someone who has personally recovered from a 20-year struggle with an eating disorder, she has a deep understanding of what it's like to live with, and heal from, an unshakeable eating disorder.

Libby runs a therapy and coaching practice, specializing in supporting individuals who are exhausted from obsessing over food and body image. Most of her clients are caught in the binge/restrict cycle and are seeking to break free from it. She is dedicated to guiding as many people as possible toward intuitive eating and a life of true food freedom.

Connect with Libby

Email: libby@libbysupan.com

Website: libbysupan.com (https://libbysupan.com)

Tik Tok: foodfreedomwithlibby (https://www.tiktok.com/@foodfreedoomwithlibby)

IG: foodfreedomwithlibby (https://www.instagram.com/foodfreedomwithlibby)

FB: foodfreedomwithlibby (https://www.facebook.com/FoodFreedomwithLibby)

Binge eating recovery with Elka https://elkacubacub.com/

Does food addiction exist?

This question is the topic of heated debate within the eating disorder recovery community.

We know that binge eating and compulsive overeating can share some characteristics with substance use disorders, such as loss of control, repeated unsuccessful attempts to quit, and continued use despite negative consequences.

However, the question is whether this loss of control around food is the body’s response to food restriction, as is often the case with chronic dieting and binge eating disorder, or the result of disinhibition, similar to patterns seen in substance use disorders.

In this episode, David Wiss explains what ultra-processed food use disorder is, how it differs from deprivation driven binge eating, and why it's important to recognize clients who present with it and feel misunderstood by the eating disorder narrative.

He touches on his own substance abuse history but also emphasizes his value for acting on a sense of purpose and engaging with clients and the larger systems that impact them in a way that extends beyond his own story.

David is a mental health scientist and registered dietitian nutritionist. He has a PhD in public health with a minor in Health Psychology. He founded Nutrition in Recovery, a group practice based in Los Angeles, CA, that integrates nutritional care into substance use disorder treatment. David also founded the Wise Mind Nutrition mobile app, which bridges the gap between nutrition and mental health. As a clinician and researcher, he has over a decade of experience working one-on-one with patients. He has authored more than 20 peer-reviewed journal articles on topics related to disordered eating and ultra-processed food addiction. David is dedicated to disrupting the status quo and contributing innovative solutions to the mental health crisis.

Nova food classification https://ecuphysicians.ecu.edu/wp-content/pv-uploads/sites/78/2021/07/NOVA-Classification-Reference-Sheet.pdf

Review of the research on ultra processed food addiction https://www.mdpi.com/2072-6643/16/12/1955

More on David https://drdavidwiss.com/

Wise Mind Nutrition App https://wisemindnutrition.com/features

Binge eating recovery with Elka https://elkacubacub.com/

In the West, medical treatment tends to be highly specialized. In eating disorder recovery, dietitians are typically responsible for specifying and monitoring clients' food intake. Therapists are responsible for helping clients build coping skills and navigate their internal worlds. Psychiatrists or nurse practitioners are responsible for prescribing psychiatric medication and monitoring medical risk. And so on...

However, human beings are not easily compartmentalized. It is near impossible to change physical health behaviors without navigating a person's emotional reality, and vice versa.

In this episode, Tracy Brown talks about meeting what's in the room with clients as a registered dietitian who is also trained in Internal Family Systems and Somatic Experiencing, both therapy modalities often associated with trauma recovery. Tracy talks about the personal and professional experiences that led her to seek out these trainings, and how she uses them in her practice as a dietitian working with food-related challenges. She also discusses when and how she collaborates with therapists around deeper issues that come up in her sessions.

Tracy is a somatic nutrition therapist, registered and licensed dietitian, and attuned eating coach in private practice. For almost 2 decades, she has provided in-person, phone, and online counseling to individuals seeking support with eating disorders and eating-related challenges. She specializes in working with both adults and children, addressing concerns such as disordered eating, overextension of the body, adrenal fatigue, hormonal imbalances, PCOS, and gut health.

In addition to her clinical work, Tracy regularly teaches intuitive eating workshops and gives talks on disordered eating throughout Florida. She has presented at institutions including the University of Florida and Santa Fe College in Gainesville, Flagler College in St. Augustine, and Florida Gulf Coast University in Fort Myers. She also serves as the guest Nutrition Therapist for Feast, an online intuitive eating program, and has been featured on many podcasts discussing topics such as intuitive eating, trauma healing, body image, and recovery.

Her approach is grounded in the belief that healing food and weight concerns is ultimately about choosing to live fully—embracing the richness of being human in the diverse and amazing bodies we inhabit. She encourages clients to feel deeply, live courageously, and commit to the fullest expression of who they are.

To connect with Tracy and her team, visit https://www.tracybrownrd.com/

For binge eating recovery with Elka, visit https://elkacubacub.com/

GLP-1s, such as Ozempic, Wegovy, and Mounjaro, are a class of medications originally developed to treat type 2 diabetes. More recently, they've become a hot topic in the mainstream for their weight loss effects.

A quick Google search brought up the following headlines:

“Weight loss is finally easy with a prescription to GLP-1 medication”

“Join 100,000+ patients and transform your health, body, and life”.

“A natural approach to medicine”

Media and marketing promote these medications as the key to finally feeling at home in your body.

Eating disorder recovery professionals, however, tend to be much more skeptical. Many have lived through countless fad diets and “miracle” weight loss drugs, none of which delivered on their promises, some of which did more harm than good.

In this episode, Winter Groechl talks about how her perspective on GLP-1s has evolved. She shares her initial hesitation and how her stance became more nuanced and flexible as she observed both positive and negative client experiences.

We also touch on the broader question of how we, as professionals, approach intentional weight loss—acknowledging the painful reality of weight discrimination while making space for clients who hold this as a goal.

This conversation is about stepping away from dogmatic thinking and approaching clients with openness, a willingness to learn, and deep respect for the diversity of the human experience

Winter Groeschl (she/her/they/them) is a Licensed Professional Counselor in Arizona, dedicated to providing competent, compassionate care for individuals healing from substance use disorders, eating disorders, disordered, body image issues, depression, anxiety, trauma, and more. They have experience across all levels of care in Arizona’s mental health system and draw from ACT, mindfulness, DBT/CBT, polyvagal theory, Compassion Focused Therapy, and Client-Centered approaches.

Winter practices from a social justice, weight-neutral, and inclusive lens. As a member and advocate of the LGBTQIA+ community, they are committed to creating an affirming, safe space for people from all backgrounds.

Their vision is to help each client explore their true self and connect with their capacity for growth, a restored sense of self, and lasting empowerment.

Book Recommendation:Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs by Johann Hari

Eating disorder recovery with Winter: https://eatingdisorderrevealed.com/

Binge eating recovery with Elka: https://elkacubacub.com/

The most fundamental question in treating eating disorders is “What works?” Eating disorders are so painful and can be so fatal; we want to use the treatment that has the best chance of giving our clients their lives back.

We live in a time when empirical observation can be used to answer this question as more and more research studies examine the effectiveness of various interventions.

Family-Based Treatment (FBT), sometimes referenced as the gold standard for treating eating disorders, is a manualized treatment that gives parents the responsibility for restoring their child's weight and managing eating behaviors. Critics of FBT are concerned that in cases where a parent is abusive, neglectful, or psychologically unstable, this type of parental involvement may increase family dysfunction and in some cases enable a child’s abuser. Others are concerned that FBT addresses only the eating disorder behaviors without understanding the underlying psychosocial dynamics.

In this episode, Abby Sarrett-Cooper discusses her experience combining Dialectical Behavior Therapy (DBT) with FBT to help clients achieve tangible improvement, while also navigating theirs and their families’ emotional realities.

Abby shares her history of struggling with an eating disorder while in an unstable family environment during a time before targeted, evidence-based treatment was available. She speaks about how now she navigates complicated family dynamics and uses FBT and DBT to help parents support loved ones.

Abby challenges the assumption that evidence-based treatment is rigid and distant, and talks about how individualized, client-centered care is a key component of evidence based intervention.

Abby is a Licensed Professional Counselor in New Jersey and Pennsylvania and a Certified Eating Disorder Specialist. She has been in private practice for 20 years, focusing on evidence-based, Health at Every Size (HAES)-informed approaches to treating eating disorders. Her postgraduate training includes certification in FBT and intensive training in standard DBT, DBT for adolescents (DBT-A), DBT for families, and DBT for eating disorders. Abby is an early adopter of FBT in community private practice, and of integrating DBT with FBT to empower families and manage the dysregulation common in treatment.

Outside her practice, Abby served on the psychology faculty at Caldwell University in New Jersey for 10 years, teaching Child Development, Adolescent Development, and Psychopathology, and designing the university’s first Positive Psychology course. Throughout her career, she has been a vocal advocate for evidence-based treatment that is nonjudgmental, stigma-reducing, and myth-challenging. Abby is a member of the International Association of Eating Disorder Professionals and has been active in the Academy for Eating Disorders for 15 years, currently serving as co-chair of its Special Interest Group Oversight Committee.

This is our second time recording this episode so to begin, we briefly reflect on our first time recording and what we'd like to shift this time around.

One of the challenges in the current digitized climate, is that the things we say become so solid and permanent, while as humans we are constantly evolving. I cringe inside when I look at so much of what I’ve written or produced in the past. And I hope that we approach this episode, and all the others, with flexibility and forgiveness, recognizing that each of us is perpetually reflecting, growing, and changing.

To work with Abby, visit https://partnersincounseling.net/meet-the-partners/

For Elka's binge eating recovery program, visit https://elkacubacub.com/

What happens when someone with a high acuity eating disorder needs more support than can be provided in outpatient settings, but refuses a higher level of care?

Considering the high mortality rate of eating disorders, this question can quite literally be a matter of life and death.

In a previous episode on harm reduction, we discussed the value of meeting clients where they’re at and how high-risk behaviors can, and sometimes must, be mitigated in outpatient settings, especially for those with treatment trauma.

In this episode, we explore the flip side: the importance of acknowledging when a client’s needs exceed our limitations and, at times, challenging a client to seek higher levels of care, despite their apprehension, in the interest of preserving their safety.

Psychotherapist, Amber Cardemil reflects on how she supports and, when necessary, challenges clients with treatment ambivalence. We discuss the benefits and limitations of treatment contracts which clarify the minimum requirements for maintaining safety in outpatient settings and outline the conditions under which more intensive treatment becomes necessary. Amber also shares the nuanced, individualized nature of decisions as to whether to refer out or continue a therapeutic relationship based on the quality of rapport and individual client’s needs. Beyond the sticky, complicated ethical questions, Amber speaks to what it is to be a human being supporting someone who struggles deeply—what it's like to celebrate their growth, grieve their setbacks, and let go when it's time to move on.

Amber is a Licensed Clinical Social Worker with extensive experience treating eating disorders, food-related concerns, and co-occurring conditions. She is trained across all levels of care—inpatient, residential, PHP, and IOP—and has worked in admissions, assessment, individual, family, and group therapy. She is a certified Health at Every Size® provider and has advanced training in Family-Based Treatment for adolescents with Anorexia Nervosa.

She uses evidence-based treatments tailored to each client, with attention to individual and family dynamics. She empowers families to support recovery and collaborates closely with other providers to ensure effective, multidisciplinary care. In addition to eating disorders, she treats anxiety, depression, and life transitions.

Amber also provides psychoeducation to schools and universities on early detection and prevention of eating disorders, and serves as a Body Project facilitator through NEDA. She is a member of Project HEAL and is committed to equitable treatment access.

Treatment with Amber https://www.collectivehealingtherapy.com/about

Binge eating recovery with Elka https://elkacubacub.com/

What is an eating disorder? We know it can involve symptoms such as food restriction, binge eating, or purging behaviors. But what underlies these behaviors? What causes an eating disorder, and how do we treat it? These are questions that do not have a universal, clear-cut answer.

Is an eating disorder a coping strategy developed in response to trauma, an attempt for control, a cry for help, a response to societal pressures, or a biological susceptibility triggered by food restriction. Is an eating disorder about food and body image or some deeper biopsychosocial dynamic?

How we answer these questions determines the type of treatment we provide.

In this episode, Rachel Lewis-Marlow discusses her work in eating disorder recovery using a comprehensive approach that includes trauma-informed, attachment-based, and somatically integrated methods. We break down what each of these mean and how they relate to eating disorder etiology and treatment. Rachel shares how attachment in her personal relationships impacted her ability—or inability—to eat at various periods in her life. She also discusses powerful moments of connection and co-regulation she’s seen as a clinician. From Rachel's perspective, an eating disorder is a form of communication to listen to rather than a pathology to erase. Recovery, then, is an additive process focused on building a client’s resources and support, rather than an eliminative process aimed at removing behaviors.

Rachel is the co-founder and director of the Embodied Recovery Institute. She is a somatically integrative psychotherapist, dually licensed in counseling and therapeutic massage and bodywork. She is a Certified Advanced Practitioner in Sensorimotor Psychotherapy and has advanced training and 25 + years of experience in diverse somatic therapies including Craniosacral Therapy, Energetic Osteopathy, Oncology massage and Aromatherapy.

Rachel began her work with eating disorders in Residential, PHP and IOP treatment programs. There she developed the Embodying Recovery group therapy protocol which forms the basis for the Embodied Recovery for Eating Disorders (ERED) treatment model. She provided program development, training and supervision for the implementation of this model to enhance the effectiveness of current best practices, such as DBT, Interpersonal Process, ACT groups. She also developed the Body Wisdom group protocol, an alternative to the traditional body-image group, which focuses on enhancing the mind-body relationship through mindful experience of and through the body.

She has extensive experience as a teacher and presenter, focusing on accessing the body’s unique capacity to give voice to the subconscious and to lay the foundation for healing and maintaining psychological and physical health. In her private practice in Chapel Hill, NC, Rachel specializes in working with people exploring recovery from trauma, eating disorders, and dissociative disorders.

Rachel and the Embodied Recovery Institute https://embodiedrecovery.org/

Elka’s binge eating recovery program: https://elkacubacub.com/

If you’ve had a client who has been through multiple treatments, tried countless medications, received diagnosis after diagnosis—bipolar disorder, borderline personality disorder, depression, eating disorder—leaving their treatment team confused and unable to find a path that sticks, it might be dissociative identity disorder (DID). Many people with DID go years, even decades, cycling through the mental health system without a clear understanding of what’s really happening.

In a previous episode with Annie Goldsmith, we discussed how DID is far more common—and less dramatic—than how it's often portrayed. In this episode, Monica Ostroff takes us deeper into this topic, sharing her own experience of being diagnosed with DID—then known as Multiple Personality Disorder—in the early 1990s. This was a time when the False Memory Syndrome Foundation had just been established and was questioning the validity of repressed memories of severe abuse uncovered in therapy. Monica also reflects on the harmful effects of media portrayals that depict people with DID as either fantastical or violent—representations that are dehumanizing, disempowering, and most importantly out of touch with the lived experience of real people with this condition.

As an accomplished professional, Monica began sharing her story publicly in an effort to break these misconceptions and show what it actually means to live with DID. Through conversations like this, we move closer to a world where people with DID are met with respect—not just for their suffering, but for their strength, creativity, and humanity.

Monika is the Executive Director of the Multi-Service Eating Disorders Association, Inc (MEDA). Prior to leading MEDA, she directed several residential, partial hospital and intensive outpatient eating disorder programs in addition to having owned a thriving private practice. Monika is the co-author of Anorexia Nervosa: A Guide to Recovery and a contributing author to Self-Harm Behavior and Eating Disorders. With more than 25 years of experience in the field of eating disorders, Monika has presented at many national conferences, taught at the university level, and appeared on many media broadcasts, publications & podcasts. Practicing from a trauma informed, social justice and staunchly HAES® aligned lens, Monika is a dedicated ally and strong advocate working to ensure access to equitable, compassionate, and affirming care for all. Her passion for treating eating disorders and mentoring other professionals was borne out of her own struggle with severe and enduring anorexia nervosa and life experiences.

Additional resources

Understanding DID:

Healing my Parts substack and podcast https://healingmyparts.substack.com/

The CTAD Clinic https://www.youtube.com/@thectadclinic/videos

An Infinite Mind https://www.aninfinitemind.org/

Katie Keech https://www.katiekeech.com/

Assessing dissociation:

https://www.mid-assessment.com/mid/

Research on Dissociation:

Dr. Bethany Brand https://bethanybrand.com/

More from Monica https://www.medainc.org/

Elka’s binge eating recovery program: https://elkacubacub.com/