[LISA LEWIS] The Am I Ok? Podcast is part of the Practice of the Practice network, a network of podcasts seeking to help you market and grow your business and yourself. To hear other podcasts like Faith Fringes, the Holistic Counseling Podcast, and Beta Male Revolution, go to the website, www.practiceofthepractice.com/network. Welcome to the Am I Ok? Podcast, where you will discover that being highly sensitive is something to embrace and it’s actually a gift you bring to the world. We will learn together how to take ownership of your high sensitivity, so you can make positive changes in your life, in the lives of others, and it’s totally okay to feel this way. I’m your host, Lisa Lewis. I’m so glad you’re here for the journey. I am Lisa Lewis, your host, and welcome to the Am I Ok? Podcast. Thank you so much for tuning in. I like to remind my listeners that I offer a free eight-week email course titled highly sensitive people. My email course provides weekly tools that help you feel more whole in a world that isn’t exactly made for us and I show you how your sensitivity can be seen as a unique gift and how many others are just like you. To find out more about my email course, please go to my website, amiokpodcast.com. Today, my guest is Robyn Goldberg. Robyn began her career at Cedar Medical Center in Los Angeles as the inpatient dietician in the department of cardiology. Over the last 24 years, she has developed her own private practice from Beverly Hills, California, where she specializes in medical conditions, disordered eating, eating disorders, health at every size, pre-pregnancy nutrition and people in recovery. Robyn is a certified eating disorders, registered dietician and supervisor from international association of eating disorders professionals. She also is the author of the new book, The Eating Disorder Trap: A Guide for Clinicians and Loved Ones and the host of the podcast, The Eating Disorder Podcast. Welcome to my podcast, Robyn. [ROBYN GOLDBERG] Thank you very much, Lisa, for inviting me. I really appreciate it. [LISA] Well, it’s so good to have you here and I’m so glad to be talking about this topic just as a clinician myself. I don’t specialize in eating disorders, but it’s always good to know the signs will it to look out for. I also supervise marriage and family therapists trainees that see children from pre-K all the way up through 12th grade. The question of eating disorders and the symptoms always pop in and out of our supervision topics. So I’d like to ask all my guests and I’d like to ask you, do you think of yourself as a highly sensitive person and if so, can you just share a little story about that? [ROBYN GOLDBERG] Well, as we were chatting about before, I think as I’ve gotten older, I’ve become more and more sensitive. One of the reasons is I suffer from migraines. So smells and lights tend to be what people would say I’m very sensitive to. I think as a kid there was the, I’m a cancer, it’s so emotional, but I think from just how it affects me in day to day life maneuvering with the migraines and having visual auras and such, I would view myself as a sensitive person. If I didn’t, I think my family would say, I wasn’t being truthful. So really it’s, for me, the joke is when a person comes to see me that they’ll say, oh yes, I put on this great perfume or this sense of lotion. I’ll say what? I’d rather, so you don’t mind me coming in sweaty after working. No, I’d rather see you that way, because I think just again, the visual aura on how it really is so debilitating. So that’s my story. It’s not a very exciting story, but it’s just a fact about me. [LISA] Well, thank you for sharing that story. That’s one of the things of highly sensitive persons is their sensitivity to subtleties and part of that is part of the five senses. So can you tell us about the work that you do? [ROBYN] Sure. So I see kids, teens tweens and adults in my practice, Lisa, starting at age six up to, my oldest client currently is 89. So I see all ages, all genders, all body shapes and sizes, some with medical issues, them with full on eating disorders, other with body image issues. There’s so many confusing messages that diet culture puts out there that it makes eating a more overwhelming and confusing way to maneuver through life. So I work from, it’s called a non-diet, weight, inclusive approach, and incorporate health at every size and really like to clarify misconceptions and the various stigmas that we hear through diet culture that certainly could influence the choices that a person will and will not make. And really, I like to help people make peace with food in their bodies and not be afraid of any food or food group and really working on that piece of self-compassion and having them learn how to be the best they can be for them without comparing themselves to someone else. I think that’s so difficult, especially when you’re a teenager or a millennial and you’re trying to figure out who you are in life and your friend group and your interests. There’s so much comparing between peers and siblings. [LISA] Yes. That’s definitely so true and I think maybe social media doesn’t help with that as well. What are some of the stigma and misconceptions there are about, I guess, eating? [ROBYN] When you’re saying the stigma center around eating you’re referring to, for example, a person will perceive, you can look at a person and determine if they are “healthy” or not based on their appearance. That’s a stigma. That’s false, like a person could live in a larger body and not have any medical issues, whereas a person could live in a smaller body and have a variety of medical issues. You can’t look at someone and determine if they’re “helpful” or not. You can’t look at a person and determine if they’re compulsively exercising or not. And oftentimes the eating disorder that is the most common that’s the most overlooked is actually binge eating disorder whereas people perceive when we talk about eating disorders, that eating disorders are those with anorexia nervosa or bulimia nervosa. But again, I think it’s so much of like what you were describing with what media and Hollywood has portrayed, what disorders look like, and a person can “look normal,” or be in a larger body and have what’s called atypical anorexia nervosa. So I think the problem is people, and I was just listening to my client’s mother and she doesn’t know that her daughter’s been very sick with an eating disorder for quite some time. She was like, oh, she looks great. She looks fine. Well, does she know that her daughter is starving herself? A growing baby eats more than she does and that she abuses laxatives and that she purges. Again, there’s so much to a story and it’s really for me to unpeel each layer of the onion, to be able to get down to all of the symptoms and medical pieces that contribute to where the person is at as of today. [LISA] When someone does have an eating disorder what are some of the, I don’t know if it’s the right word, causes that contribute to the eating disorder? How does it get to that point? [ROBYN] Good question. Well, sometimes Lisa, it could be some kind of trauma they’ve gone through and it’s been a source of survival for them. Maybe they were bullied, they were fat shamed, they were molested. I mean, there’s so many traumatic experiences that can cause that. There could be like, I was listening to this one client yesterday who moved to Los Angeles from another country. She said she always had an eating disorder, but she felt like, because they were moving to the United States from another country, there was this piece of moving so “I can be more deceiving. I’m starting a new school. I’m developing new relationships. I’m involved in all these activity.” I think people don’t always realize that there’s a problem going on. I hate to say it, oftentimes it could be they’re learning from family members, parents that haven’t resolved their own issues centered around food, or they’re imposing their beliefs around various foods and food groups. So let’s say if it was a younger person, they’re feeling guilt and shame when they’re eating a specific food in food group, because their parents are not consuming it. Or it could be they’re comparing themself to a sibling. I mean, there’s so many factors. I mean, that could be an episode with you and I just within itself. [LISA] What are, are some of the signs to look out for, whether, I mean, you’re a clinician or just the person yourself, or you have a friend that you’re concerned about a family member? [ROBYN] Well, I actually speak a lot about this in my book, The Eating Disorder Trap and one that people don’t always take seriously is when an individual is excluding various foods in food groups. So for example, like you might say, Robyn, I tend to eat everything then all of a sudden they’re excluding dairy now, they’re cutting out gluten, they’re excluding various complex carbohydrates. They’ve become vegan. And one says like, oh yes, that’s great that this person becoming vegan, they’re cutting X, Y, and Z out. But they’re taking “health to an unhealthy level” and not only are they excluding various foods and food groups, but they’re eating alone. It makes them anxious to be able to eat with friends, family. They won’t eat out at a restaurant because they don’t know what’s in the food or how it’s prepared or how much will be served to them. They’re dressing differently. Maybe they always wore bigger clothes, but now they’re literally hiding themselves in, in bigger clothes. They’re frequently canceling plans that they make with people because they “feel uncomfortable” in their bodies. They don’t have the right outfit to wear. They haven’t moved enough in the day. I mean, there are so many red flags, Lisa, and unfortunately it gets to a place of urgency when, especially this last year and a half with COVID when many calls have come through, because all of these warning signs weren’t recognized, and now it’s in a urgent, drastic place that they’re needing a higher level of care and requiring more support. [LISA] And what should a person do if they do think they have a loved one or family member, a friend, even yourself, if you think, gosh, this sounds a lot like me or somebody know and how would I even approach someone? [ROBYN] Well to approach them, I mean, I think the first thing is to be able to let them know you’re concerned. You see that they’ve been isolating quite a bit. They’re not wanting to join the family for meals. They don’t want to go on outings. To be able to just have like an honest, hard conversation, this is what I’m concerned about. The thing I would say is, and unfortunately we have a deficit of them in Los Angeles is eating disorder, trained physicians. So even if, let’s say the family member or the partner were to say I really would like for you to have a physical with the doctor, oftentimes it’s, I don’t want to say a waste of time, but this is why I wrote my book. Because doctors are not trained in eating disorders. So they don’t know the warning signs to look at and labs could be normal until they’re not normal and understanding the vitals and such. So I think it’s a starting point and hopefully whether it’s the internist or the pediatrician, they will have resources to be able to refer to that person that is struggling. Or the other thing is I would honestly go on the IADEP website, which is International Association of Eating Disorder Professionals. I mean, that’s a starting point too, because then they’re able to find a therapist or dietician that lives and breathes eating disorders. Because someone like me then could give you a recommendation of a provider to be able to have a full medical workup. Like I take someone’s vitals, but you know dieticians were not authorized to draw labs. So that would be another place I’d look. The other place too, is the IFEDD website, I-F-E-D-D, which is the International Federation of Eating Disorder Dieticians. So there’s dieticians like me all over now, we’re all over the world, that are eating disorder specialists. I think that’s a great place because any sort of dietician can refer you to an eating disorder, trained mental health care provider ,to a physician, to a whole team because oftentimes it’s not done on purpose. Person who’s struggling will go to a provider who’s not a specialist and that’s doing more harm than good, because they don’t know the proper screening questions and how to assess them. And oftentimes they have their own biases around various foods and food groups, and those could be disclosed too. So I think, I mean, to me, this would be like the ideal. [LISA] Great. Thank you for sharing that. Those websites will be in the show notes too, for anyone that’s listening and didn’t catch them. Can you say more about the your book? I’m curious about the title of the book, The Eating Disorder Trap. What is the trap? [ROBYN] So the cover of my book, Lisa is a vortex, like a black hole, and it shows like the metaphors that a person’s going down and oftentimes they’re going down very fast. The voice of ED is what we call the voice, which stands for eating disorder. The eating disorder does not want a person to succeed. ED wants the person to fail and there’s so many traps that a person falls into or their loved one falls into because they’re oftentimes colluding with the disease without realizing that they are. So that’s what the cover title actually means. The trap of the messages through diet culture. The trap here, here’s one, a trap of like, if a person’s going into treatment and they’re saying, oh, I’m really sensitive, well, you know what, sometimes a person could be sensitive, but also they feel so overwhelmed. It’s like, well, I’m sensitive. I can’t eat this food. Or I’m like, I always like to say when, if a person is sensitive using that as a strength towards your recovery, because it’s giving you an invitation to embrace your eating disorder has provided for you. [LISA] Okay. I don’t know if there’s been any studies done or maybe this is your professional opinion. Is there a link or correlation to be like highly sensitive and eating disorder? [ROBYN] No, not anything I’ve really seen in the literature. I mean, I think oftentimes individuals are more aware of their feelings. Other times they’re so disconnected from their feelings. So the more that they have rules and they’re restricting the eating disorder voice is louder and louder because the disorder voice does not like the person to have feelings. So to answer your question, there isn’t anything I’ve seen. Oh, yes, it’s definitely tied into the research, but sometimes clients will say, well, this is what I’m feeling and these are my needs. Sensitive people are oftentimes caretakers, they’re nurturers, but to be able to say, well, this is what I need and to be able to use my voice and you know what, this is what I would like to have for a meal. So people that have eating disorders aren’t usually able to say what their needs are or separate them from other people’s because they put other people above themselves. [LISA] Okay. So that right there seems like, okay, maybe that’s the the crux of the holy issue, being able to speak up and actually be heard and wanting, and your people that are with you, your family members, your partner, being able to listen to you and hearing your needs and how important they are. [ROBYN] Yes, definitely. [LISA] What does treatment usually look like for eating disorder or disordered eating? [ROBYN] Well, it depends what level of care that a person’s going into. I mean, there’s the lowest that requires the most support. There’s medical stabilization, that’s to be able to get a person’s organs to a baseline place that they’re medically stable to progress into residential. Then from residential there’s PHP, partial hospitalization program, and then there’s IOP, intensive outpatient program. But there’s so many factors that contribute to what level of care a person is appropriate for. [LISA] Okay. And just to go back to the culture and how, there’s so many, like even going out to, there are so many different options, whether it’s if you’re vegan or if you’re gluten free, dairy free, I mean, everything is just available to us. I would see that if you have an eating disorder going down that way, how it could just really play into that. [ROBYN] Well, oftentimes these rules and beliefs are established in the crux of their eating disorder. Sometimes they had these thoughts before, but it’s sort of like, well, what else can I change? What else can I cut out? What else can I control since I can’t control what’s happening with the pandemic? I can’t control who my teacher is. I can’t control who’s president. I can’t control my parents are separating. I mean, there’s so many things we can’t control, but it’s like, oh, I can control what I’m eating, what I’m not eating, how much I’m moving, how little I’m eating, because it’s all about control. [LISA] Oh, okay. So the person, you can tell me if this sounds right or not, the person doesn’t feel they’re in control of their life so this is the one thing that they can control [ROBYN] Oftentimes. Yes. [LISA] Okay. That’s sounds really heavy to me. [ROBYN] It is. You’re right. It’s very — [LISA] What are some of the ways that you work with clients when they come to see you? [ROBYN] So what do I do in the initial appointment or? [LISA] Yes, or like, maybe share some of the healthy coping skills, if we were to see a way out this, a treatment for it, something like an eating disorder? [ROBYN] Well, oftentimes Lisa, so my goal with anyone is to teach them how to relearn being an intuitive eater, which means like when we’re small children and babies. We were all intuitive eaters. We would eat when we are hungry and stop when we’re satisfied and slowly through the aging process, we become more and more disconnected to stop paying attention to our bodies, hunger and fullness cues, and even just our needs. If each person was naturally able to reconnect and dial into these, they wouldn’t need me. So I’ll begin more with what I like to call mechanical eating. What that means is helping them create a roadmap of not only meals and snacks that feel safe and comfortable, but to help them learn how to become better connected to their bodies because of a person let’s say is not getting adequate nutrition, they’re able to have a better understanding of their various hunger levels but they’re in a, I would say, a hazy place of what fullness feels like to them because their eating disorder voice will tell them that they are fuller than they actually are. So when you’re at a lower body weight, like when you’re at a weight that your body’s naturally not meant to be at, there’s confusing signals for you to be able to identify what fullness feels like to you because that eating disorder voice is so loud and angry that you’re putting food in. So many of my recommendations are behavioral and many are food based, but I really like to help clients connect their feelings centered around food and also clarify misconceptions that they have centered around carbohydrates, proteins and fats. So again, there’s so many avenues and ways that I go with it. I think it just depends on the person and what their circumstances and the level of care of where they’re at, like if they’re just coming out of treatment, if trying to avoid going into treatment. Again, there’s so much involved on that question. [LISA] Yes, I can see that and just by what you shared. And I’m wondering, as I was listening to you, for someone that thinks are full and they’re learning how to, I guess, eat again and listen to their body. So like that may change the way that they look. They may be gaining, I don’t want, I feel sensitive just to use a word like gaining weight. [ROBYN] Yes, their body could change as their intake increases. That’s true, especially when a person will say, I don’t go to the bathroom regularly or I’m not getting my period like I had been. Basically your body, if it was meant to be at the place that it’s at, you probably wouldn’t have to exclude various foods in food groups. It wouldn’t result in being constipated or not menstruating regularly, or your hair falling out or having a problem focusing in school. So yes, the reality is that a person’s body can and will change. However, when a person is able to be an intuitive eater where their choices are not contingent on who they’re seeing or what they ate today, or how much movement they engaged in, when you’re learning how to eat for the proper reasons, and I always say this to client, your body will be where it’s naturally going to be at for you. We never know what a person’s body will do. Their weight could go up, it could go down, it could remain the same. That’s frustrating for so many clients, Lisa, because they want guarantees. They want to know, well, if I eat X, Y, and Z, my weight won’t increase, or I’m not going to have to buy another pair of pants. And nothing’s a guarantee, but I always like to phrase it in regards to what it is that they’ve gone through and how they’ve approached things as they do and if it was really the place that their body was supposed to be at. There probably wouldn’t be in intrusive thoughts and they wouldn’t have a team and they wouldn’t be seeing me and such. [LISA] And how do you work with body image? I’m saying like, as this, as you go through, as a client goes through this process, their body may change and that body image that maybe they preferred before may change to something else. [ROBYN] Well, we work a lot on the body image piece and the language and how they communicate to themselves and where their idea of body image came from and when it changed. That’s a very important piece because even like, I was listening to someone the beginning of this week, and he had said to me, he never had a positive body image even when he was in a smaller body. He was always told that he didn’t look “as good as his brother.” So he was always bombarded with these negative messages too. It gets to a point where teaching someone how to, I always like to say, well, can you love your body? That’s like an extreme question and not everyone is at that place or able to, but even where they can tolerate their body, where they can like their body, where they can sit with the feelings that come up centered around it. [LISA] As a woman, I’ve heard throughout my life, that there’s always one body part that women don’t like about their own bodies, whether that’s their legs or stomach, their arms. So I just think it just feels like it just plays into this as well. It’s just the way that we, as women, look at our bodies and we can easily put down what we don’t like about it. [ROBYN] But it could also, it’s not just women. It could be in men, it can be in the LGBTQ plus in transgender community. I mean, it’s with all folks too. So I think that’s important to look at. I think for a long time it was spoken more about women, but as time prevails, we see that this is with all genders, body shapes, whatever a person identifies as gender wise and such. [LISA] Yes. Thank you for clarifying that. That’s a really good point. So I just have a couple more questions to ask, and I just want to ask you, what would you like listeners to take away from our conversation today? [ROBYN] Well, I would like them to know that it doesn’t matter how long you’ve struggled with a body image issue or an eating disorder that it’s never too late to seek out help. The one thing I would say is too, if you’re someone who’s observing a loved one struggle, I wouldn’t wait because early intervention is the key to long-term success. The longer you wait, the longer and timely and emotionally and financially expensive it will be. [LISA] Right. Thank you so much for that, those really good points. Where can listeners find you? [ROBYN] My website is askaboutfood.com. My Twitter is at Robynrdn. My Instagram is Robyn with a Y, Robyn Goldberg RDN and my podcast is The Eating Disorder Trap Podcast, which is on iTunes and Spotify or where you can find podcasts. [LISA] Great. Thank you for coming on the show today, Robyn. It’s been so wonderful to have you here and share all of your expertise and knowledge. [ROBYN] Thank you for inviting me, Lisa. I really appreciate it. [LISA] Thank you for listening today. Remember to subscribe, rate, and review wherever you get your podcast. To find out more about highly sensitive persons, please visit my website at amiokpodcast.com and subscribe to my free-eight week email course. This is Lisa Lewis reminding each and every one of you that you are okay. Until next time, take care. Thank you for listening today at Am I Ok? Podcast. If you are loving the show, please rate, review and subscribe to it on your favorite podcast platform. Also, if you’d like to learn how to manage situations as a highly sensitive person, discover your unique gift as a highly sensitive person, and learn how to be comfortable in your own skin, I offer a free eight-week email course called Highly Sensitive People. Just go to amiokpodcast.com to sign up. In addition, I love hearing from my listeners, drop me an email to let me know what is on your mind. You can reach me at lisa@amiokpodcast.com. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher, or the guests are rendering legal, accounting, clinical, or any other professional information. If you want to professional, you should find one.