Healing Dysregulated Eating & Body Shame — Why Self-Compassion Is Key
By Karen R. Koenig, LCSW, MEd
Social Work Today
Vol. 20 No. 1 P. 18

For clinicians seeing higher-weight clients, effective therapy involves encouraging them to have self-compassion and practicing it themselves.

Many dysregulated eaters are on a mission to hate themselves thinner. They don’t think of it as such, but that’s what food deprivation, obsessive weighing, excessive exercising, and body and scale talk are all about. Hating yourself thinner is founded on the belief that harsh words show that you mean business and if you’re hard enough on yourself, you’ll shape up (pun intended) and learn how to eat right and take better care of your body.

Working with clients, we need to avoid becoming like two ships passing in the night. To connect, we want to recognize that while we’re offering clients an antidote to self-loathing, they’re clinging to the myths that hating their fat selves, dieting, and weighing less will help them feel good about themselves. To serve them, we do better when we understand the purpose and tenacity of their self-destructive thinking before trying to teach them a new approach to loving themselves.

Their mission of hating themselves thinner is unsurprising, bombarded as we are every day with messages demonizing high weights from society, health care providers, family members, and the media: Get tough with your body, power past your wants and needs, and beat back the devils of food and fat.

Origins of Fat Stigma
Whether it’s comedian Bill Maher’s fat-shaming HBO rant, Donald Trump’s fat-bashing someone at a rally, your next-door neighbor dropping hints for you to go on a diet, or a snarky remark about your size by someone you met on social media, it has long been open season on people of high weight. Most of the uninvited commenters would say that they’re only “trying to help” high-weight people become healthier by pointing out the error of their ways. Paradoxically, what they’re implying is that hating your eating habits and your body are the way to eventually love yourself. No wonder it’s hard for clients to tell the high road from the low road.

Most health care providers are well intended and genuinely care about their patients’ health and well-being, but, according to the 2017 book Helping Patients Outsmart Overeating: Psychological Strategies for Doctors and Health Care Providers, “Studies show that many doctors, reflecting the society we live in and the perceived realities of the enhanced risks that excess fat creates for patient care, do hold a bias against large-size patients.” This bias also has been found in studies of nurses and is likely pervasive in the health care system in general.

Family members contribute to fat-shaming and stigma when they put young children on diets, send them to fat camp, hide food from them, harp on their food intake, habitually force them into unwanted activity, make them eat different foods than the rest of the family is eating, and allow bullying to happen. Though usually well meant, these dynamics don’t cause children to grow into adults who think how much their parents loved and wanted the best for them. Rather, they grow up believing that there is something wrong with their eating, their bodies, and, worse, their very being.

Our job as social workers is to help clients sort out their healthy and unhealthy motivations for taking better care of their bodies. There is a vast difference between clients wanting to be healthier, move with ease, feel more attractive, improve their relationship with food, and escape being the object of societal or personal ridicule vs. feeling that, as is, their heavier bodies are and will always be unacceptable. Feeling unlovable, chronically ashamed, and immutably defective is a different story than yearning for enhanced physical and mental health and well-being.

Origins of Dysregulated Eating
Clients come to us with shame that their secret eating or bingeing is due to lacking self-control and self-discipline. They hate themselves because what appears so easy for others—eating in sync with fuel needs and saying “yes” and “no” to food in comfortable balance—has been a lifelong struggle for them. They long for comfort but want to stop relying on food. They want to exercise more but may believe they are lazy and unmotivated. They want to eat better but become weary at the thought of food shopping or cooking. We must educate ourselves in order to educate them about the complexities of these problems.

They ask us, “Why can’t I stick to a diet like others do?” or “Why can’t I lose weight as I did before?” Exhausted, ashamed, helpless, and hopeless, they look to us for answers and we must be prepared to reference the impact that genetics and metabolism have on weight; the effect that sleep deprivation, chronic dieting, and imbalanced neurotransmitters have on eating; that depression and anxiety underlie most dysregulated eating; and how childhood adverse experiences dysregulate the nervous system that makes emotional eating more likely.

To show how unequal the playing field is, we can teach clients how parental overfocus on food and weight in childhood may lead to overeating and how parents who are demanding and controlling set up their children to rebel by making poor choices in the food arena and elsewhere. We can ease clients’ shame and low self-esteem by helping them learn the life skills they’re lacking, such as those for emotional regulation, and acquire the traits that will guide them toward better decision making.

If we are to teach dysregulated eaters how to develop self-compassion, to include body compassion, we must put to rest the myth that will power and self-control are the mainstays of “normal” or healthy eating. In Secrets From the Eating Lab: The Science of Weight Loss, the Myth of Willpower, and Why You Should Never Diet Again, Traci Mann, PhD, presents scientific evidence debunking the value of diets and writes about how they’ve made us fat. Her conclusion, according to the book, is that, “Humans were simply not made to willfully resist food. We evolved through famines, hunting and gathering, eating whatever we could get, when we could get it. We evolved to keep fat on our bones by eating the foods that we see, not resisting them.”

Her theory of how willpower fails us is a game-changer for dysregulated eaters. The issue is that denying the self something that it also wants, what we call “using will power,” does work in some cases—but not when biological imperatives such as eating and sex are hard-wired into us for survival of the species. Mann advises that fighting against the food-seeking imperative using only will power is a losing battle, and that there are better strategies to prevent us from downing another helping of Thanksgiving stuffing or having sexual relations with our neighbor’s significant other.

As another talking point, Mann explains that will power is finite, not infinite—a nonrenewable commodity that works until it runs out. We can say no five or seven or 19 times to driving through McDonalds for some fries, but the 20th time the idea of “fries” pops into our heads, we’re more than likely to surrender and head for the big golden arch.

Blame-Shame Paradigm
No discussion of self-compassion, eating disorders, and body shame is complete without mention of how dysregulated eaters organize their thoughts and feelings around blaming and shaming polarities. Seeing only two choices, they alternate between wanting to blame someone else (or many someones) for their unhappiness or wanting to blame themselves, which activates shame. Nothing good ever comes out of ping-ponging between these two affective states, both of which may trigger emotional eating.

Rationality lies beyond an either-or dynamic. A more viable response is self- and other compassion as a response to their unhappiness. When they shift away from blaming and shaming, they can experience feeling badly, but not bad in the moral sense, for their mistakes and also show mercy toward others. This strategy helps them accept that everyone is doing the best they can, though sometimes it’s not nearly good enough (or even barely good).

Self-Compassion Promotes Self-Caring
To many dysregulated eaters, the notion of being self- or body-compassionate is counterintuitive. They may believe that they need to be harder, not easier, on themselves; that they must desire thinness more strongly, not less. Many can’t fathom letting go of the idea that being hard on themselves works against reaching their health goals and that generating more will power is not the superpower they want it to be.

Dysregulated eaters have trouble wrapping their heads around using self- and body-compassion to move forward and heal their food and body problems. They view self-compassion as weak and soft, akin to surrendering to the enemy or jumping ship. Self-compassion, they are convinced, is a cop-out for losers who can do nothing but accept defeat.

It is no such thing, according to Kristin Neff, PhD, author of Self-Compassion: The Proven Power of Being Kind to Yourself. In a nutshell, it is meeting suffering, in this case, one’s own, with kindness, nonjudgment, and gentleness. It involves intentionally comforting ourselves when we need it rather than feeling undeserving of comfort or believing that self-soothing implies weakness. It means not judging ourselves as good or bad for our thoughts, feelings, and behaviors, accepting our myriad imperfections and ending self-criticism, as well as recognizing that being hard on ourselves hurts us in the short and long term.

Self-compassion acknowledges that we gain power to effectively manage our lives by accepting that we are fragile beings. To reduce our suffering requires that we be curious and nonjudgmental about our petty mistakes, embarrassing failures, and spectacular losses. Self-compassion lifts our spirits and, therefore, according to Neff’s research, increases motivation.

For example, clients may be beating themselves up for a binge they had over the weekend. They meet with you feeling grumpy, frustrated, and hopeless, telling you they’re “in a bad mood.” The bad mood weighs on their mind and wipes out motivation to do anything about binge eating. Instead, they may sulk, wallow in self-pity, despair that they’ll ever change, and eat to soothe the distress.

Alternately, if they’d offered themselves compassion after having binged, they’d be feeling kinder toward themselves, recognizing that they aren’t perfect, but will continue to try to heal from their food problems. They may feel lighter and more self-aware, proud that they’re able to comfort themselves effectively during stressful times, and more confident that they’ll be kind to themselves the next time they have a run-in with food.

Body Compassion Promotes Self-Caring
Teaching clients how to be kind to themselves when they’re suffering from mistakes or misjudgments is nothing compared with getting them to activate body compassion. Clients generally make progress in not beating themselves up for overeating, bingeing, or even purging because they start to enjoy suffering less and being kinder to themselves. Gradually, because they’re happier, they spend less time engaging in mindless eating and more time taking care of their bodies through improved feeding and other self-caring behaviors.

However, many clients draw the line at body compassion because they (understandably) misinterpret its meaning. Over the years, numerous words have been used to describe the positive feeling we want to have about our bodies and none seem to be the right fit. One is “loving” our bodies. Clients may believe that loving something they do not want feels inauthentic, like a lie. Another word is “accepting” our bodies. Clients may object to wanting to say “it’s okay” to something they fervently wish to change. Although we may explain that one can accept a body as-is and still want it to be different, “acceptance” is a hard sell.

Another word that pops up in the vocabulary of the body positive movement is to “appreciate” our bodies. Clients complain that they value what their bodies do for them, but that doesn’t stop them from being unhappy with their size. Likewise, for the term body “respect,” clients insist that it doesn’t feel right because if they don’t admire their bodies, how can they respect them?

The biggest hurdle for dysregulated eaters in becoming body compassionate is fearing that it means letting themselves off the hook for putting themselves in their current situation in the first place. They think, “How can it not be my fault? And since it’s my fault, I need to take responsibility to change or that won’t happen.”

Another misunderstanding is allowing dysregulated eating and body hatred to influence their feelings about themselves. For example, could they be disappointed about mindless eating before bedtime after a rough day at work, yet not feel disgusted with their entire person? Could they be unhappy about what they did and not at who they are because they are far more than one act of indulgence? Could they, though they ate a pint of ice cream in a sitting, recognize that they graciously filled in last minute for a sick coworker, patiently helped their kids with their homework, and found time to call their mother on her birthday? The goal is to separate behavior from identity.

It’s highly unlikely that clients who are hard on themselves about their eating and weight will find themselves on the path to self- and body-compassion without considerable direction and support. They depend on us to teach them that they cannot rid themselves of the pain from overeating or being larger than they wish to be by causing themselves more pain. They need our compassion for their plight and our nudging to move them toward comforting themselves with kindness and tenderness.

To succeed at this task, we must value and practice self-compassion ourselves, not only in response to our clinical work with clients, but regarding any eating problems we have. Can we feel compassion toward our bodies at whatever size they are? Can we feel it when we have a falling out with food? Working with clients who have eating and weight concerns is a wonderful reminder to be kind to and loving with ourselves.

We also must attend to noticing—with curiosity and without judgment—our feelings toward our higher-weight clients. Is it a struggle to feel compassion toward them because we don’t like what we see? How much of society’s disdainful branding of fat have we adopted and how is it playing out in treatment? As with all clinical issues, we and our clients grow together. Sometimes they’re a step ahead of us and sometimes we’re in the lead.

What’s important to recognize is that we’re all on a lifelong journey to bring more self-compassion into our lives and working with dysregulated eaters is just another way of doing so.

— Karen R. Koenig, LCSW, MEd, is a licensed psychotherapist, motivational speaker, and international author who has specialized in the field of compulsive, emotional, and restrictive eating for more than 30 years.