National Eating Disorders Awareness Week Author Interview: Judith Matz

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What’s an example of a healthy attitude toward food and eating?
Eating is meant to be a source of nourishment and enjoyment. Attuned eating—eating when you’re physically hungry, eating what satisfies you (choosing from a wide variety of foods) and stopping when full—gives you a sense of truly being in charge of your relationship with food. Unfortunately, many people find themselves preoccupied with what and how much they’re eating, feelings of guilt, and shame about their relationship with food. The good news is that people can learn to reconnect with their natural cues for hunger and fullness as they move toward becoming attuned eaters.

As something that’s fairly culturally ubiquitous, how can dieting be dangerous?
The truth is that diets don’t work in the long run. While just about any program or plan will result in short-term weight loss, research shows that the great majority of people will regain the pounds, and about two-thirds will end up higher than their pre-diet weight. So, the best way to gain weight is to go on a diet!

There is a mountain of research showing that yo-yo dieting is responsible for health problems. For example, the Harvard Alumni study of 17,000 men found that those who yo-yo dieted had an 80 percent higher rate of heart disease and 123 percent higher rate of type 2 diabetes than those who maintained fairly stable body weights. In the Framingham Heart Study, a 32-year analysis of weight fluctuations found that those with high weight variability were 25 – 100% more likely to be victims of heart disease and premature death, regardless of whether they were initially thin or fat and held true regardless of physical activity, smoking, and other health risks.

At a psychological level, people who diet end up feeling like a failure when the weight returns, even though this is the likely outcome for the vast majority. That’s why our tag line is: You haven’t failed your diet, your diet has failed you. People who diet may experience shame, poor self- esteem, depression, and are at a higher risk of eating disorders.

What is the ‘Health at Any Size’ framework and why is it important?
The Health At Every Size (HAES)® paradigm offers a shift from the traditional focus on weight management to a focus on the promotion of health and well-being. By focusing on sustainable behaviors rather than the number on a scale, this framework eliminates the harmful consequences that come from the pursuit of weight loss while offering support for sustainable, healthful behaviors to people of all sizes. Since dieting is known to trigger and sustain Binge Eating Disorder, the HAES approach is key in helping people end bingeing and to develop positive self-care practices.

The HAES paradigm is weight neutral, and therefore it is not "against" weight loss per se. However, it is incompatible with the pursuit of weight loss. In other words, one aspect of the HAES paradigm is to support people of all sizes in practicing sustainable behaviors that promote their physical, emotional, social, and spiritual health, regardless of whether weight is lost. If weight loss occurs, it’s viewed as a side effect of these behaviors, not the main event.

What are some of the warning signs that someone is developing an unhealthy relationship with food or an eating disorder?
An unhealthy relationship with food may be characterized as being caught in the diet/binge cycle, skipping meals, feeling guilty after eating, chronically under eating or overeating. When behaviors of disordered eating become more extreme, people develop eating disorders: Anorexia nervosa is associated with restrictive behavior; Bulimia is associated with bingeing and purging behaviors, and Binge Eating Disorder is associated with feeling out of control with – and consuming large amounts of – food. With both disordered eating and eating disorders, people become separated from their bodies’ normal signals for hunger and fullness, and from the function of food to provide nourishment, energy, and satisfaction.

What are some of the challenges facing someone working with a person who has an eating disorder, or who shows warning signs?
There is so much pressure in this culture for people to be thin, with its promises of happiness, sexiness, and success. In fact, it’s not uncommon for someone in the throes of an eating disorder (and who has lost weight because of extreme restrictive behaviors) to actually get compliments about their appearance. This reinforces the notion that thinness trumps health and well-being.

For the higher weight client struggling with Binge Eating Disorder, the weight stigma that abounds in our culture makes it particularly difficult to give up the pursuit of weight loss. Yet the restrictions of any food plan actually supports binge eating behavior; the diet-binge cycle means that, as people experience the deprivation that comes from restrictive eating, they break out of these restraints and typically binge on the very foods they’ve been avoiding.

Therefore, it’s essential for anyone who works with people who have eating problems to learn how to help them let go of the diet mentality and to develop a healthy body image. For the health/mental health professional it also means exploring one’s own attitudes and biases about weight.

What’s a key fact about Binge Eating Disorder or Compulsive Overeating that someone already familiar with eating disorders might not already know?The majority of people seeking help for Binge Eating Disorder or Compulsive Overeating are concerned about losing weight; in fact, about 30 percent of people who seek weight-loss interventions, including surgery, meet the criteria for BED. It is essential for both professionals and clients to move away from using weight loss as a measure of successful recovery. Instead, honoring cues for hunger and fullness, eating a wide variety of foods, stopping when full, physical activity that’s comfortable, good sleep patterns, and mindfulness practices are all behaviors that support the notion of recovery, regardless of whether weight is lost as a side effect of these behaviors.


1 Gaesser, G. (2002). Big fat lies: the truth about your weight and your health. Carlsbad, CA: Gurze Books, p. 144.
2 Lissner, L., et al. (1991). Variability of body weight and health outcomes in the Framingham population. New England Journal of Medicine, 324, 1839-1844.

By Judith Matz

  • Beyond a Shadow of a Diet

    The Comprehensive Guide to Treating Binge Eating Disorder, Compulsive Eating, and Emotional Overeating, 2nd Edition

    By Judith Matz, Ellen Frankel

     Beyond a Shadow of a Diet is the most comprehensive book available for professionals working with clients who struggle with Binge Eating Disorder, Compulsive Eating or Emotional Overeating. The authors present research revealing that food restrictions in the pursuit of weight loss actually…

    Paperback – 2014-04-04
    Routledge

About the Author

Judith Matz, LCSW, is a Clinical Social Worker specializing in eating and weight issues since 1986. She is Director of The Chicago Center for Overcoming Overeating, Inc. and has a private practice. Judith is a frequent presenter at local and national conferences. 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, and NBC News Chicago with Nesita Kwan, and she appears in the documentary America The Beautiful 2: The Thin Commandments.