Recently, I was talking to a client in eating disorder recovery (of note, all of this is being shared with her permission) who reported feeling really frustrated that so many non-diet dietitians are sharing messages on Instagram about trusting your body and having bodily autonomy while also being recommended by her treatment team (myself included) to eat more consistently. “Y’all need to make up your minds” she said (half) jokingly.
And to be fair, I get where she’s coming from. I am one of the many Health at Every Size dietitians talking about body trust, body autonomy, and body liberation on social media. So many of us are practically shouting it from the rooftops - because we steadfastly believe in it for everyone, full stop. We believe that everyone gets to make choices about their body, their health care, their food, their movement.
This conversation came up as I was challenging this client who has been struggling with hunger cues to eat more of a fear food we were eating during a meal exposure. I got her point loud and clear: why should I have to eat this if I don’t want to? I’m the boss of my own body! Don’t I get to decide?
The answer is yes…and no and neither and all of the above because the answer is complicated and nuanced. I have a strong suspicion that other people might be wondering about the same thing so I’d like to offer some thoughts:
I, like many other HAES providers, wholeheartedly believe in bodily autonomy for everyone. I believe that everyone is born trusting their body. I believe we can be disconnected from this by various things (eating disorder behaviors, diet culture, life!) but truly believe that we can all get back to a place where we can consistently rely on our body to send us appropriate cues. As I told my client, I’m not just putting it out there for the sake of social media.
There are some times in eating disorder recovery (or after a period of disordered eating, chronic dieting, etc) that our bodies *don’t* send reliable hunger/fullness cues and it can take a long time before these things normalize. At this point, relying on your body’s hunger/fullness cues is simply contraindicated because doing that would likely result in undernourishing your body.
One of my jobs as a provider is to help guide the folks I work with back towards an intake that’s appropriate for them. It’s also to help people differentiate between which cues are coming from their eating disorder, which are coming from their body, and which might be missing altogether.
That all being said…if I notice your eating disorder is running the show, I’m likely going to name that. And I might encourage you to do some things that feel scary or anxiety-provoking to help guide your body back to a place 1) of appropriate nourishment and 2) where you can trust your body’s hunger and fullness cues. Because while you can trust your body, you absolutely cannot trust your eating disorder. Your eating disorder’s goal is to make you sicker. I trust you but I don’t trust your eating disorder.
At the end of the day, it is YOUR body. You get to call 100% of the shots, 100% of the time.
Your eating disorder dietitian cannot make you eat more. We cannot force you to challenge your fear foods. We cannot make you do anything. What we can do (and, I would argue, should do in our role as your ED dietitian) is ask you to explore where your thoughts/beliefs are coming from. We can help you to challenge your eating disorder voice or note where it sounds like it’s calling the shots. We can use our clinical judgement to encourage you to make changes/choices that we think might help you get to where you want to be (with your consent). Sometimes that looks like giving words of encouragement or education, sometimes it looks like tough love, sometimes it’s just listening and hearing you (side note: it should never look your healthcare provider bossing you around or setting mandates).
Holding all these things in one hand can be very confusing. I want you to be able to trust your own body; I also want you to trust your treatment team’s judgement (and if you don’t, that’s another problem altogether). The bottom line is I want you to trust yourself enough to make the right choice for you - whether that’s listening to your body or maybe recognizing that you can’t trust your body right now and turning to a treatment provider, friend, or other support person who can trust. Either way, you get to decide.
Cover photo by Sarah Swinton