Further word from BED pioneer

I recently came aware of therapist Amy Pershing via a blog post on psychcentral.com in which she was interviewed. I found a lot to agree with in what she said — that binge eating isn’t diet failure but is an eating disorder deserving of treatment, not societal scorn, for example.

But one passage bothered me enough to track her down for a few more questions. Here’s the passage, which came in response to interviewer Margarita Tartakovsky’s question: “What are common challenges that make it tougher to overcome BED or problems with overeating?”

”From a cultural perspective, we begin to teach people to distrust and dishonor their bodies from childhood. We do not, as a society, value size or shape diversity; in fact weigh bias and stigma fundamentally underlies any eating disorder. “Thin” has to be presumed more valued for the symptoms to coalesce. We are taught to distrust our food preferences and our appetites, especially as girls, from early in life. We are taught to “exercise,” but not to play. Children learn their bodies are to be controlled, not honored. So the ability to hear cues, to really feel the positive impact of playing and eating well, typically must be relearned.”

Additionally, weight and being “fat” is so completely vilified now that the idea of body wisdom is more remote than it has even been. We have a “war on obesity.” Literally now people are encouraged to be at odds with their bodies. Then, we are sold a profound “bill of goods” by the diet industry (with a 95% failure rate over 6 months), further removing us from simply listening to our needs. The current system makes recovery a veritable act of defiance. You have to be a renegade just to be in your body.

Though certainly I agree with her outlook on the diet industry, I couldn’t relate with the notion that my problem was that I wasn’t “listening to [my] own needs.”

Amy Pershing, executive director of Pershing Turner CentersWhat I’ve found is that my body can’t hear — or is some combination of unable or unwilling to heed — the signals to stop eating. When I got out of food rehab in 1991, I harbored the hope that I could follow the portion practices they suggested for a while, until my eye would readjust and I could eat like others — without measuring cups and the food scale. But every time I’d try to proceed unaided, my portions sizes would start to creep — and never toward smaller.

Pershing, a therapist and executive director of the Pershing Turner Centers of Ann Arbor, Mich., and Annapolis, Md., clearly sees the situation differently, and reminded me that “it’s different for different people. What may work for you may send me off the rails.”

Pershing’s perspectives come both from experience — her top weight was 270 — and from academic and clinical training. She said, “In the beginning [of her recovery], the structure was really important for me. Over time, it became more important not to have that structure,“ she said. “I can’t hear my own cue as soon as there’s another one from the outside.”

Another assertion that caught me short was that, as a society, we don’t value size or shape diversity. Anyone would concede that she’s right, but I question valuing very large body sizes, since obesity often indicates ill health, or incipient ill health, and not only physical health, either.

”I think our goal is the same, to have kids in the healthiest body they can have. We’re not talking about valuing diversity no holds barred,” she said, which I was glad to hear. But she also expressed concern over practices such as reporting kids’ body mass index, a widely used measure for physical fitness, on their report cards. “Shame never creates change,” she said. “Shame creates fear.”

She added, “We do a disservice to kids by not allowing their bodies to grow and develop at their own pace. We have to be careful about calling a body that’s still growing and changing ‘obese.’”

Even though it had a second part the next day, Tartakovsky’s brief post did not, of course, purport to present Pershing’s complete views on these issues. Even so, a facet I found missing was the lack of value most people place on nutrition, especially considering the tactics of processed-food industry.

“Those foods discourage paying attention” to what we eat, she said. “Proportions are enormous. Tastes are chemically designed to keep our taste buds firing after our stomachs are sated. There’s much less nutritive content than whole foods.”

One of my solutions, which wasn’t prescribed but has evolved, is to cut out processed food wherever possible; I find I am better off abstaining from these products than trying to manage them. But Pershing uses, and counsels, a different way: “I think if we set them up as forbidden, we run into some of the same problem. ... One of my favorite binge food was Doritos. But if I eat more than 10 or 15 or them now, I’m sick of them. It took some time to pay attention that I’m done, but then, there’s been a whole lot of push to get people not to pay attention, because then they sell more.”

In addition to her clinical practice, Pershing is the developer of the Bodywise outpatient binge-eating-disorder treatment program and a director of the Binge Eating Disorder Association. Her partner in the Pershing Turner Centers is Chevese Turner, BEDA’s founder and CEO.


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