As we are beginning a new year, we thought it was the perfect occasion to re-introducing ourselves, our practice and how we work with our clients. Our approach is at the core of what we do so we wanted to share it with you
The Balanced Practice is an interdisciplinary team of health care providers specialized in eating disorder recovery, disordered eating, intuitive eating, body image and overall health.
Our relationship with food and our bodies affects us in so many ways, often in ways, we don’t even realize. When we don’t have an accepting and positive relationship with food and our bodies, it affects the way we perceive ourselves; our value as whole human beings. Because of this, it affects our relationship with others, our relationship with our hobbies, our relationship with our job etc. It basically impacts EVERYTHING.
This struggle to find peace and safety with food and our bodies is something many individuals struggle with. Through our work with our clients and our lived experience, we know how this constant fight can take away so much from their valuable lives.
That’s why The Balanced Practice was created; to fill the gap between physical health and psychological well-being. We thoroughly believe that we cannot speak about food without addressing our mindset. We are a team of professionals who work together to help individuals learn to appreciate food and their bodies. We’ve decided to focus our area of expertise on supporting people with eating disorders and disordered eating because balancing food, body and mind is the key to full recovery and sustainable change.
We believe that balance is personal. Everyone has their own version of what balance is. And in every stage of life, that balance can look different. Within our practice, we believe in the balance of food, body and mind.
Our philosophy is based on these 3 pillars:
These three pillars in the balance paradigm are constantly interacting with each other. Research shows us that they are in fact, dependent on each other, meaning one cannot exist without the other (Tribole, E. & Reisch, E., 2020).
That’s why our approach focuses on all three pillars because to achieve true balance and peace with food, we must interact with our body and mind’s needs.
As we know, eating disorders are not just about food. It is a mental health disorder that suffers severe physiological consequences. Therefore, the food, body and mind paradigm addresses all of the complex facets involved in the development, and the treatment of eating disorders.
Research shows that recovery is about more than the absence of eating disorder symptoms (ex: bingeing, restriction, purging, over exercising etc.), but also includes the presence of adaptive body and eating-related attitudes (Koller K, et al., 2019). So, not only should we be focusing on what and how the person is eating, but also noticing changes to how the person thinks and feels about food and their bodies.
Our work is evidenced based, meaning that our decision making and our problem solving are based on the best, current research in a given area of expertise. Our approach to helping our clients recover from an eating disorder, and heal their relationship with food and their body, is based on an anti-diet, weight inclusive and trauma informed framework.
What does this mean?
Being anti-diet refers to being against diet culture, an oppressive system of beliefs that idolize the thin ideal and demonizes food (to learn more about diet culture: read the articleWhat is Diet Culture?). This means that we approach food and nutrition from an “all foods fit” and body trust perspective. We do not promote dieting or any form of restriction. We empower clients to trust and learn how to nourish their bodies.
What does the research say?
Dieting refers to any form of intentional psychological, physiological or biological restriction with the purpose of weight loss or “wellness”. This does not account for individuals with certain medical conditions or allergies who need to omit/monitor certain foods to remain medically stable.
Over many years, diets continue to take on different forms, food trends come and go, and we find ourselves with headlines screaming a new superfood every week. However, for years, the research continued to show that diets do not work.
We know from the literature that diets only provide short-term outcomes to many people’s desired “weight loss goal”. However, there is a lack of research indicating the long-term benefits of dieting and food restriction. In fact, most research alludes to the unsustainable nature of diets. A meta-analysis published by Tomiyama and colleagues reviewed the long-term effects of dieting on health outcomes. They concluded that there was no significant improvement in any health indicators including hypertension, blood cholesterol, blood sugar etc. (Tomiyama A, et al., 2013). In fact, research has shown us that the long-term effects of dieting and restriction are more harmful in the long run and individuals who work from an anti-diet framework actually have improved health outcomes and a better quality of life (Bacon, L & Aphramor L., 2014).
We believe in balancing food, body and mind, and dieting is not the answer. The diet culture industry hyper focuses on individual responsibility and willpower without taking a look at the bigger picture. We believe that working from a diet focused approach is unethical (not just individuals with eating disorders) as it is not supported by sufficient evidence.
If you want to learn more about why diets don’t work, you can check out my blog post “What happens to your body when you diet” to learn more!
What does this mean?
Practicing from a weight inclusive approach means that treatment plans, success outcomes and health goals are not based on an individual’s weight. We do not discriminate against anyone’s body weight shape or size. Individuals of all shapes and sizes will receive the same treatment approach.
Why did we choose this approach?
We know that eating disorders are under-diagnosed amongst people in larger bodies. The high rates of weight stigma and weight-based discrimination amongst higher weight individuals result in an increase in body-related shame, thus an increase in health care stress and healthcare avoidance among this population (Mensigner, J., 2018). We want to make sure everyone feels heard and supported because just like prescribing diets, weight-based discrimination is unethical.
Many studies have shown that weight-based oppression, discrimination and stigma lead to poor health outcomes and increased distress. In a study by O’Hara et al., they reviewed the impact of health promoting principles informed by a health at every size approach, in female university students. The results showed sustained improvements in overall wellbeing and health promoting activities (such as joyful movement, stress management, sleep patterns etc.), without using a weight centric approach. Another study by Bégin C. et al, from 2019, evaluated the effects of health at every size intervention on eating-related and psychological outcomes, in women with varying BMIs. With an emphasis on self-acceptance and intuitive eating behaviours, the results revealed that a weight inclusive framework was effective in improving eating and psychological related variables among women who struggle with body image and eating. (Bégin C. et al., 2019).
There is an ample amount of research to justify the benefits of using a weight inclusive approach in improving eating behaviours and psychological wellbeing.
Furthermore, we believe that health is not reserved for thinner bodies. We believe in the approach of Health At Every Size which supports the idea that health behaviours are more important than the number on the scale to predict health outcomes. You can learn more about health at every size here.
What does this mean?
Being trauma informed means that we acknowledge the impact of trauma on the individual’s life and how it impacts their current physical and mental health. By being aware, we are able to truly connect and meet clients where they are at. We also are mindful of not causing any further damage or trauma to client.
Why is this important?
Research has shown that post traumatic stress disorder (PTSD) symptoms are prevalent amongst patients with eating disorders (Rienecke R. et al., 2021). Most particularly, PTSD symptoms have been reported in high rates in Bulimia Nervosa and Binge Eating Disorder, as compared to individuals without eating disorders (Dansky et al., 1997). PTSD and eating disorders share common risk factors, why may explain why they are so commonly co-presenting. According to Brewerton et al., “Other psychiatric disorders, personality traits and temperaments have also been reported to be associated with both EDs and PTSD, including obsessive-compulsive and avoidant personality disorders, perfectionism, high harm avoidance, neuroticism, novelty seeking, negative emotionality, and behavioural inhibition.” (Brewerton T. et al., 2019). Given the complex reasons for the development of eating disorders, a trauma informed approach supports the multifaceted needs of an individual with an eating disorder.
Furthermore, we know that many folks who develop eating disorder or disordered eating have had traumatic experience which has led to the development of the disorders. Our approach ensures that we provide our clients with the support they need to address these issues and work towards full recovery in safe place.
Eating disorders have the highest mortality rate amongst all mental health diagnoses (NEDIC, 2015). In fact, throughout the pandemic, there has been a significant increase in eating disorder development (Monteleone, A., 2021).
The approach to eating disorder treatment requires an interdisciplinary approach of medical, nutrition and psychological specialists!
Our area expertise is the treatment of eating disorders and disordered eating. As a team of dietitians and psychotherapists, we are well equipped to support our client’s recovery from an eating disorder by addressing the food, body and mind paradigm.
The Balanced Practice is a place where you can be seen for who you are and supported without judgment.
Eating Disorder Recovery Program
Recovering from an eating disorder is not easy, however it IS possible. With the high demand for eating disorder services, and limited access to acute care, we have developed a virtual, outpatient eating disorder program to increase accessibility to recovery from the comfort of your own home.
This program includes:
- Individualized session with a dietitian or psychotherapist (weekly)
- Group sessions (weekly)
- Meal support (weekly)
- Parent, Caregiver, Partner support group (weekly)
- Care coordination
Want to learn more about? Register for our free information night on January 19th 2022 at 7pm EST: http://www.thebalancedpractice.com/infosession
The Balanced Practice is a team of health care providers specialized in eating disorder outpatient treatment, disordered eating and intuitive eating. Our mission is to help folks heal their relationship with food and their bodies so they can live happily outside of diet culture!
We strive to provide evidence based counselling to support you, or your loved one, in achieving full recovery. Schedule a connection call now.
Marie-Pier Pitre-D’Iorio, RD, B.Sc.Psychology
Lead Registered Dietitian and Founder of The Balanced Practice
Bacon, L. & Aphramor, L. (2014). Body Respect: What conventional health books get wrong, leave out and just plain fail to understand about weight (First edition). Texas: BenBella Books.
Bégin, C., Carbonneau, E., Gagnon-Girouard, M.P., Mongeau, L., Paquette, M.C., et al. (2019). Eating-related and psychological outcomes of health at every size intervention in health and social services centers across the province of Québec. American Journal of Health Promotion, 3(2), 248-258. DOI: 10.1177/0890117118786326
Brewerton, T. (2019). An Overview of Trauma-Informed Care and Practice for Eating Disorders. Journal of Aggression, Maltreatment and Trauma, 28(4), 445-462. DOI: 10.1080/10926771.2018.1532940
Dansky, B. S., Brewerton, T. D., O’Neil, P. M., & Kilpatrick, D. G. (1997). The National Women’s Study: Relationship of victimization and posttraumatic stress disorder to bulimia nervosa. International Journal of Eating Disorders, 21, 213–228.
Kelly, J. (2015). Eating Disorders among girls and women in Canada report: Where are we now? National Eating Disorder Information Center Bulletin, 30(5). Retrieved from: https://nedic.ca/general-information/
Koller, K., Thompson, K., Miller, A., Walsh, E., Bardone-Cone, A. (2019). Body appreciation and intuitive eating in eating disorder recovery. International journal of eating disorders, 2020 (53), 1261-1269. DOI: 10.1002/eat.23238
Mensigner, J., Tylka, T., Calamari M. (2018). Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress. Body Image, 25, 139-147. DOI: 10.1016/j.bodyim.2018.03.001
O’Hara, L., Ahmed, H., Elashie, S. (2021). Evaluating the impact of a brief Health at Every Size informed health promotion activity on body positivity and internalized weight-based oppression. Body Image, 4, 225-237. DOI:10.1016/j.bodyim.2021.02.006
Rienecke, R., Blalock, D., Duffy, A., Manwarning, J., Le Grange, D., et al. (2021). Posttraumatic stress disorder symptoms and trauma-informed care in higher levels of care for eating disorders. International Journal of Eating Disorders, 54 (4), 627-632. DOI: 10.1002/eat.23455
Tomiyama, A., Ahlstrom, B., Mann, T. (2013). Long-term effects of dieting: Is weight loss related to health? Social and Personality Psychology Compass, 7(12), 861-877.
Tribole, E. & Resche, E. (2020). Intuitive Eating: A Revolutionary Anti-Diet Approach (Fourth Edition). New York: St. Martin’s Publishing Group.
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