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Nutrition411: The Podcast Ep. 11

Trauma-Informed Nutrition Counseling

Lisa Jones, RDN, LDN, FAND
11/23/2023

This podcast series aims to highlight the science, psychology, and strategies behind the practice of dietetics. Moderator, Lisa Jones, MA, RDN, LDN, FAND, interviews prominent dietitians and health professionals to help our community think differently about food and nutrition.

In this podcast, Lisa Jones, MA, RDN, LDN, FAND, interviews Julie Feldman, MPH, RDN, about the most common eating disorders, anorexia nervosa, bulimia nervosa, and common misconceptions about eating disorders.

Additional Resources:

Julie Feldman

Julie Feldman, MPH, RDN, is a registered dietitian nutritionist, nationally recognized nutrition expert, consultant, counselor, speaker spokesperson, author, and owner and founder of Thrive Nutrition and Wellness, LLC, specializing in trauma-informed nutrition counseling for teens and adults (West Bloomfield, MI).

Lisa Jones

Lisa Jones, MA, RDN, LDN, FAND, is a registered dietitian nutritionist, speaker, and author (Philadelphia, PA).

 

TRANSCRIPTION:

Moderator: Hello and welcome to Nutrition411: The Podcast, a special podcast series led by registered dietician and nutritionist, Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant360.

Lisa Jones: Hello and welcome to Nutrition411, the podcast where we communicate the information you need to know now about the science, psychology, and strategies behind the practice of dietetics. My guest is Julie Feldman. I'm so excited that Julie is with us. Julie is a registered dietitian nutritionist who owns her own private practice, Thrive Nutrition and Wellness, in West Bloomfield, Michigan. She is an author, speaker, consultant and counselor and works with clients providing trauma-informed nutrition counseling to teens and adults.

Welcome, Julie.

Julie Feldman: Hi.

Lisa Jones: So glad you're here with us. Thanks for joining us today.

Julie Feldman: I'm thrilled to be here. Thank you so much for having me.

Lisa Jones: Yes. Is there anything else additional you want to tell us about your background?

Julie Feldman: No, I've been doing private practice work. I know next week will be 18 years and I know that exactly because my middle daughter turns 18 next week. So I started my practice, as they say, out of necessity. I needed to be flexible in my work-life balance when I had my second child. And so she turns 18, and so too does my practice work. So I love talking about what I do. I'm passionate about what I do and I'm thrilled to be here.

Lisa Jones: Oh, congratulations on both accounts.

Julie Feldman: Oh, thanks.

Lisa Jones: They're both milestones, right? Your daughter's turning into an adult.

Julie Feldman: Yes, yes.

Lisa Jones: Congratulations. It's a long time to be in practice. Successful. Very good.

Julie Feldman: Yeah, it is a long time. It doesn't always feel like it's been that long, but it's my practice as I'm sure most people listening, their careers have taken on different angles and different responsibilities and different nuances every day. So while it is a long time to be doing something, I feel like every day is a little bit different and I appreciate that a lot.

Lisa Jones: Yes. And always learning and growing in our field.

Julie Feldman: Oh yeah.

Lisa Jones: That's the magic of that.

Well, I wanted dive in to talk about eating disorders. So what I wanted to know is, can you talk to us about the different types of eating disorders and then what is the most common question you receive from your clients about this particular area?

Julie Feldman: Sure. So that's a big question. So let's just start at the beginning with the different types of eating disorders, and I'll just sort of refer to what is specified in the DSM in terms of actual diagnosis and the criteria to meet those specific diagnostic criteria.

So we can start with probably the two that people know most, which are anorexia nervosa and bulimia nervosa. Anorexia presenting as a real restriction of food intake. And that restriction is leading to an unhealthfully low body weight based on that person's age and gender and general growth trajectory. In, let's say a teenager, for example, if that child was always at the 20th percentile, now we're seeing that dropdown sort of off their curve, their criteria for meeting that diagnostic level would be a little bit different than perhaps somebody who was in a different place to begin with. There is, associated, an intense fear of weight gain with anorexia, and even though they're weighing a very low number, typically at time of diagnosis, there is a really tremendous fear of even gaining any weight from that place. And as well, there's a lot of body disturbance. So body image disturbance, meaning they just don't see what everybody else is of telling them is happening.

So there's a lot of denial and there are a lot of pieces that go along with anorexia that make treatment and recovery more challenging. Just the body isn't functioning as well. So our GI tracts aren't functioning as well in periods of restriction. So even if a client is willing and able to start to eat a little bit more, sometimes their body kind of puts up a little bit of a fight with that. And there's a lot of just distortion in general in terms of how people are viewing food, how people are viewing what weight would be appropriate. And so there's a lot of conversations around what that eating disorder voice is telling the patient or client to do, versus what their team, their family, their parents are of telling them to do. So there are a lot of moving parts in the treatment of anorexia.

Bulimia nervosa is a pattern of recurring binge eating episodes, followed by some sort of compensatory mechanism, whether that is vomiting or laxative use or over-exercise, the use of diet pills. Some sort of compensatory behavior to offset what feels like a binge. And a binge by definition is eating a large amount of food over a two hour period of time with a bit in the actual description of the diagnosis. It's this feeling of being out of control in those moments, in those sort of binge periods. And in order to really meet the total diagnostic criteria of bulimia nervosa, this binge-purge cycle has to happen at least once a week for a period of three months in order to meet that criteria.

Lisa Jones: Wow. Once a week to me doesn't really seem like that much in the grand scheme of things.

Julie Feldman: Yeah.

Lisa Jones: That's interesting. And the other thing that when you were talking about the differences, it just seems like as a potential client, if somebody's walking in not knowing any of this stuff, all this information, cause you're a dietician, but as a client, putting myself in the client perspective, it can be so overwhelming. So I can't imagine you're trying to... A lot of your time is probably spent on the actual education of it.

Julie Feldman: Yeah. Oh, a hundred percent. And also first and foremost, when we're really treating eating disorders, we are not treating an individual. This is really very much a family affair. And everybody in that family is, I think of it, is sort of engaged in much of a synchronized swimming routine, where everybody's sort of moving in this pattern and just in a synchronized swim, we can't just expect one person to suddenly have this new routine. Everybody in the troop has to have new routines and it can't just be addressing this one person's behavior. We're really looking at everybody's behavior, because we're obviously influenced by the people who are around us. I mean, I can't tell you how many conversations I have with clients.

In fact, I had a really powerful conversation with a 14-year-old girl yesterday, and it was the first time that I actually got to talk to just her by herself. And during that time she really shared with me a lot of information, how about how her mom talks about her own body and how it's always been pressure that the mom is on Instagram and talks about what her pictures look like. And her mom is only making recipes from a certain website that only has "skinny" type recipes on there. And the dad is drinking SlimFast shakes and so on. So there's a really powerful example, as much as I'm going to work with this 14-year-old girl who's lovely and delightful and really does want to be okay, she really does. There are lots of other things to address here.

So it's not just education of the client, going back to what you're saying, it's really a lot of education of everybody that's involved.

Lisa Jones: Yeah, definitely. And the synchronized swimming analogy that you mentioned is fantastic. That's the first time I've heard that. But that's kind of best way to sum it up, because that's really what you need to do is work with the entire family.

Julie Feldman: Yeah, we all play a role. Everybody has their assignment and we oftentimes internalize those assignments really right from the get go. We sort casually talk about birth order and families and how each, if you're a middle child, an oldest, the youngest, whatnot, that you have certain personality or character traits. But those things can really run deep and in some people who are just genetically wired, can really lead to a lot of issues. So those are all things to notice and pay attention to for sure.

And I would just also back up and say as much as you know, asked me, obviously tell me about these eating disorders. I really only use labels for that if it feels helpful or powerful to the client or to the family. But it's not something where I'm constantly spewing this information, "You did this for this much time, so this makes you this."

Lisa Jones: Yes.

Julie Feldman: I really try to stay away from that unless for certain people it feels powerful or it entitles them to a certain level of care or whatnot.

Lisa Jones: Or they're asking for a particular diagnosis or "Tell me what's wrong with me" type thing.

Julie Feldman: Yes, yes.

Lisa Jones: Okay.

Julie Feldman: Absolutely. Okay.

Lisa Jones: What would you say is the... So then, there's probably a range of questions that you get, but what could you pinpoint just the most common question that you receive from your clients? Or is that's not something that's possible because there's such a diverse...

Julie Feldman: Well, it really depends, and I only just talked about those two diagnoses, but we also have binge eating disorder. There's ARFID, which is Avoidant Restrictive Food Intake Disorder, which really has nothing to do with body weight. That sort of food restriction is not linked at all to fears or concerns around weight gains. So that can be a whole other category.

And then I think what's commonly sort of overlooked are what's called OSFED, Other Specified Feeding and Eating Disorders. And that's probably the largest population of  people dealing with eating disorders...clients with eating disorders or patients that are dealing with eating disorders... because these are sort of atypical presentations. So this isn't sort of the image that we might have seen in an after-school special or something.

This isn't necessarily somebody walking into your office who looks sickly thin or you can tell that something's wrong. These are people who are having issues around nutrition but not necessarily meeting the criteria. So maybe, "sometimes I binge, but I don't do it enough to meet the criteria for binge eating disorder." Or, "sometimes I purge, but I'm not doing it with a frequency that meets that criteria." Or really, really common is, "I am really restricting my intake, but my weight is still what would be considered within normal limits."

And so in the medical field, a lot of clients who present with their weight in a normal range, that's the end of the nutrition conversation in a lot of those settings where somebody would normally be. Maybe that would be an opportunity for somebody to catch that there was a problem. If the patient goes there and gets on the scale and the doctor says, "Yeah, weight, looks good." And that's the end. There is no further conversation.

I had a client once who I actually had seen at 12 years old and she had come to me over her weight that she felt comfortable at. And so she came to me to help with weight management, weight loss, and we worked together for period of time. And then I saw her again several years later with pretty intense anorexia. Probably would... Officially would've fallen into that OSFED category. And she had been, let's say about 180-something pounds and had gotten down to about 128 pounds. And when she went to her pediatrician, she was, I think 16 or 17 at the time, the pediatrician just praised her and told her that she had done a great job of losing weight and that she could still lose a few more pounds to be like that 125 for her, five foot four, five foot five stature. And what that pediatrician did not ask is, "how did you lose this weight?" And meanwhile, this young woman had literally just been eating pickles for a series of several months and a few other things, but very, very little.

So I always think of that as just a powerful story and a reminder that unfortunately in medicine, there's just a lot of focus on just that baseline number and not really a lot of talk about how we're getting there.

Lisa Jones: And it's kind of like they're just checking off a box saying, "Oh, you're within the weight that you should be." And they don't ask the exploratory questions, that's a really great point.

Julie Feldman: Sure. And or your weight is high, so you better figure out how to lose weight. Not asking, "tell me about your relationship with food" kind of a thing. So somebody could have a weight that is higher than the doctor thinks is appropriate and really be engaged in a lot of disorder-type behaviors and a lot of disorder-type thinking around food. But that gets missed and almost worsened by a comment like that.

Lisa Jones: Yeah.

Julie Feldman: So going back to your question about what is a common question, I think when somebody presents to me that has been really restricting their intake, the main question is, "do I have to gain weight?" Like, "Could I possibly stay this weight but somehow be okay?"

Lisa Jones: Okay. Yeah, I can see that being... Yeah, that's a good one.

Julie Feldman: Yeah, I mean that's probably the biggest fear and the biggest concern.

Lisa Jones:

And then that segues nicely into the next question I had for you, which is really what are the some common misconceptions about eating disorders? Because just from listening to what you're saying so far, I can think of a few, but I want to hear...

Julie Feldman:

Yes. So I would say common misconceptions are that eating disorders only affect teenage girls. I have several clients who are and identify as male who have eating disorders and are dealing with and battling with an eating disorder. So that is a huge misconception.

Also just that if you're over the age of 20, that you probably don't have an eating disorder. I have several clients who are mothers, who are fathers, who are in their midlife and are still battling a lot of disordered behaviors and complications of decades of restrictive eating and disordered eating. So I would say that is a huge myth.

I would also say, and I know I just sort of alluded to the fact, but that in order to have an eating disorder, you have to be extremely thin. And that's actually something that really keeps people from seeking help and sticking with their help because there is of a sense of competition, unfortunately, that is worsened with social media, but where people think, "Well, I'm not dangerously thin. I see people on TikTok who are scary and I don't look like that, so I probably don't need help." Or, "I probably don't need to eat as much as you're telling me to." Or, "maybe this isn't such a big deal." So I think there's a real myth around needing to be really sick or for my eating disorder to be visible to justify me asking for help.

And I would just say lastly that I really see... I don't know if it's a myth or not, but that a lot of people who struggle with overweight or obesity have a lot of disordered beliefs and behaviors around food. And unfortunately I think those often just get overlooked and everybody's just trying to create weight loss for those people, doctors, family members, friends, spouses, et cetera. The focus becomes weight loss and not a real conversation about that person's relationship with food, what types of thoughts they're having and so on.

Lisa Jones: Yes, and that is a great point that you bring up because it kind of goes both ways, right? In terms of you have people that are just... They get on the scale, their BMI is... It puts them in the overweight or obese category, and they're kind of just put in... They're just treated like a number. Like, "Oh, another one that's over here." And then if you're in a healthy range, "Oh, another person. Oh, you're fine." Don't have a deeper conversation, but the other people that are overweight or obese, they just need to lose weight.

So you are not having a deeper conversation. Maybe they do have an eating disorder, but you don't know about it because you're just assuming that they don't because they're overweight or obese.

Julie Feldman: Correct.

Lisa Jones: So it's all about assumptions.

Julie Feldman: And weight bias, of course. But yes, lots of assumptions, lots and lots and lots of unfortunate assumptions made in our world. And I think the EMR worsens that because it's just a lot more box checking. Insurance certainly isn't helpful, unfortunately, because again, more box checking and meeting certain criteria for various levels of care. And I mean, there are a lot of very real roadblocks. And I think when somebody struggles with weight, especially if they've been struggling with it their whole life, family members and people close to that person just assume that they don't have any willpower or they don't have self-control or whatnot. But if that same person presented weighing 30 pounds below some sort of "ideal" body weight, everybody would be panicking.

Lisa Jones: And they're not. They're kind of brushing it off and not diving deeper into it. And it begs the question, what can we as a society do to help? So my question to you is, what have been some of your successes that could potentially help other colleagues working with this population?

Julie Feldman: So I kind of feel like the thing that has helped me in my practice the most is, doing a lot of continuing education and just officially and unofficially around the mental health pieces of this. I feel like I have a... As I'm sure many people listening feel like they have a really solid understanding of the nutrition parts of this, but knowledge doesn't change behavior. And we can know all of the things about nutrition, which I'm sure most of us know everything we need to know about the nutrition science piece of this. But connecting to people's values is what ultimately changes behavior. And in order to do that, we really have to create a safe space for our clients to be able to really unpack their stuff and understand their stories and realize, "How did we get here?"

So I do a lot of work, and I know you mentioned it briefly in my intro, that I consider trauma-informed care. I like to teach around trauma-informed care. I teach physicians, nurses, dieticians on how to provide trauma-informed care because trauma is a huge topic. I mean we could have a whole other... I would love to have a whole other podcast around just trauma.

But I find my sweet spot really becomes creating a safe space for people to tell their stories. And when they start to tell their stories, their shame and guilt that are associated with a lot of aspects of their life start to kind of dissipate. And when our shame and guilt starts to get less and less and less, we rely on our unhealthy behaviors less and less and less. And it's that combination for me that's able to create really meaningful and permanent change for a lot of people. I've had many, many clients over the years share with me things that I'm the very first person that they've ever told. And things about... Stories from growing up, stories from their teenage years, stories in adulthood, not pretty stories, not the things that you're talking about at the water cooler or at dinner with friends.

And when they start to tell those stories for the very first time or maybe for the first time in a safe space, it's really kind of unbelievable what can start to happen for people. I always find it powerful to remind ourselves that our behavior makes sense. So if somebody is doing something that really doesn't make sense... It doesn't really make sense, per se, to starve myself. But there's something happening for me in my life that makes it feel like this is a really important and mandatory decision.

And so as a clinician, I feel like it's our opportunity to help that person to figure out, why does this feel so important? What is this doing for you? How is this protecting you? And what are we protecting you from? And kind of working backwards. So I think that eating or not eating, using one of these behaviors is... I visualize it as the last domino to fall in a very long line of dominoes. And I think when I was trained and an undergrad in grad school to do this work, the focus was on that last domino. How we change somebody, what they're eating or if they're exercising and so on. And what I learned after doing this more intimate work, where I'm able to spend 30 minutes or 60 minutes with a client and not just 10 minutes at somebody's bedside in the hospital, what I started to learn was like, I can't just talk about this stuff. I have to start backing up on this long line of dominoes.

So really, one by one, I'm just sort of peeling back those layers. And I don't expect every dietician to feel comfortable doing that right out of the gate. But with practice, it is a skill that can be honed and it's well within our wheelhouse. And I think we have just this unbelievable opportunity as dieticians to be part of somebody's food conversation because there's nothing bigger than food. There literally is no topic that is more intense, that is more private, that is more personal than somebody's relationship with food. And doctors don't have the time to spend with clients. And for the most part, nurses aren't spending that time with clients. And really, I mean, we really have this very unique opportunity to be just so completely engaged with the client around their food story and to help them sort of unravel it. It's pretty powerful, and I'm grateful to be able to do that work and to be able to help people in that way.

In terms of a single story about a client, I mean, I can think of many, but I can talk about one in particular. Actually, this woman was referred to me by her gastroenterologist for fatty liver disease. When she came to me, she was about, I think she was in the high 200s, maybe 290-something pounds. So I mean, nobody in her medical background had ever suggested, "do you have an eating disorder?" Everybody was just always like, "you need to lose weight, you need to lose weight, you need to lose weight."

And so she came to me, she was young... She's still my client, I'm trying to think how old she was. She was probably 30, 31. And we started talking and talking and probably about two or three sessions or so in, she told me, and I was literally the very first person that she had ever told that she was a victim of sexual assault. When she was in undergrad, she was at a school, she had received a scholarship to go to a school for performing arts, and she was sort of regularly assaulted by her professor. This was a really high-achieving young woman. She ended up dropping out of school and just getting a job.

And meanwhile, nobody addressed what happened to this girl. Here's this girl who got really good grades, who was... I mean, it's not easy to get a scholarship in the fine arts at anywhere. And she had one, and she developed binge eating disorder after leaving school and not telling anybody and not telling her story and feeling a lot of shame and guilt around it, and a lot of shame and guilt, not just around the sexual pieces of this, but also around not telling anybody. And then she started binging and gaining weight. I mean, I think... I didn't know her at that time, but I think her weight had changed probably close to about 150 pounds over the subsequent next few years.

And she started talking to me. We actually did a lot of work. She wrote a letter to the university, mean she never even reported this to anybody. And to me, she's really quite a success story. She was actually still in somewhat of a... Not somewhat, she was in a verbally abusive relationship with a man for many years. And she is, since out of that relationship, she maintains a healthy body weight. She's established a lot of healthy patterns. She's moved up career-wise.

So I really think of her as just a powerful example of what happens when people start to tell their stories and unpack their stuff, because it just alleviates and removes so many roadblocks for somebody and allows them to then use the nutrition knowledge that we all have in their life in a way that it feels more accessible to them and they really feel more worthy of utilizing it. So much of this, in my experience, is this sort of division between somebody feeling worthy, versus somebody feeling unworthy and helping somebody of move from feeling unworthy to feeling worthy.

Lisa Jones: That's amazing, Julie, the work that you're doing, because really you just showed an example of how you're connecting their values, which is then changing their behavior. But also it's kind of peeling back that onion and then thinking of... Say you have a house and you're really focusing on that foundation piece versus trying to fix the broken window or something.

Julie Feldman: Yep.

Lisa Jones: So... Yeah, I'm definitely interested in hearing more about trauma-informed nutrition counseling.

Julie Feldman: Yes.

Lisa Jones: Interesting. So thank you for sharing that with us.

Julie Feldman: Yeah, of course.

Lisa Jones: And that kind of brings me to thinking about any new therapies or treatment that may be on the horizon for eating disorders.

Julie Feldman: So yeah, there... Yes and no. In terms of what the research says, there is some nice new information on something... Well, DBT is definitely used in eating disorder treatment. I also, I teach ACT, which is Acceptance and Commitment Therapy, and I utilize the principles of ACT in my daily practice. Really, honestly, I use ACT with all my clients. And for those of you that aren't familiar with ACT, I'm happy to share resources on that. Certainly not... I didn't come up with ACT, but I do teach it and use it quite regularly. And I find it really, really helpful.

And then there is what's called RODBT, which is Radically Open DBT, which can be helpful for people dealing with anorexia. I am not formally trained in using RODBT, but if this is a field of practice that you are more interested in, that would definitely be something that I would have somebody understand. And just in terms of the traumas work, if you're not familiar with trauma as a concept at all, I would start by looking into the ACE's study, and you can just Google it, A-C-E-'-S, the ACE's study out of Kaiser Permanente in California. And this is sort of the groundbreaking research first done that links trauma with negative health outcomes, including increased risk for substance abuse, depression, cardiovascular disease, all sorts of things. So it's sort that research that I found initially most compelling and fascinating. And that's sort of driven me to create some curriculum around treating other health professionals on how to provide this trauma-informed care.

Lisa Jones: That's excellent information. And definitely any resources that you have, we can put in the show notes for listeners. I think that will be really helpful. It does sound like as somebody that specializes in this area, it's just so vast, and there's a multitude of resources. So it sounds to me, just from an outsider, because I'm not my area of specialty, trying to master it, you probably never can. There's always more things you can learn.

Julie Feldman: You know what, honestly, yes, of course. And I hope we're all just continuing to learn, because to me, that's one of the cool things about being in this area of practice, not just specifically the eating disorder area, but just studying nutrition is, there's just such a huge, vast field. And there are literally new studies published every day, it seems like. I mean, you guys probably get your smart briefs and stuff like that. And I subscribe to newsletters on Medscape too. So I'm just seeing all kinds of research, but obviously it's a topic that has a lot of interest attached to it.

Lisa Jones: Yes. Well, if you don't require sleep, I guess you can read all the research, but most of us like to sleep, so.

Julie Feldman: Yes, I know. You can't read everything. I appreciate you saying that because it's like sometimes I think, "Oh, I should know that." And then I'm like, "I can't know everything." And you can't spend... Exactly, there does have to be a balance and we have to take care of ourselves, too. And this work is... You're dealing with people really and families, and there's a lot of vulnerability and a lot of stuff. And I don't think you can do this work if you're not taking care of yourself.

Oh, and the other thing that I was going to say is I learn a lot from my clients, and I encourage anyone listening to really be open to learning from who you talk to because everybody's stories are powerful. And I've learned so much over the years from the work that I've done with different people and what works for them and what doesn't work for them and what resonates with some people, it isn't necessarily going to be a tool that feels helpful to somebody else. So as a clinician, I feel like I always have to be building my toolbox because not everything's going to work with every person.

Lisa Jones: But it sounds like the methodology that you're using really is gratifying when you can see the results that you see from helping them and getting them to the... I don't want to say other side, but to a healthier place.

Julie Feldman: Oh yeah. I definitely believe in recovery. I mean, I have so many clients who I am still in touch with, who are very much living in their recovery. I have one very dear client of mine who I was her 10th dietician. She even made me a t-shirt that with the number 10 on it. And she had been in treatment multiple times before I ever met her. And I'm not saying she's better now because I'm so good at what I do, but she was ready to be well, I think, and we were a good match for each other. But she just got married, she's a nurse. I mean, there were times where she would storm out of my office and just go stand in the parking lot. So I very, very, very much believe in recovery. And I feel like if you don't, this would really be pretty much the most exhausting work to do.

Lisa Jones: Sure.

Julie Feldman: Yes.

Lisa Jones: So if you could say one bottom line takeaway for the audience, what should they do or be aware of?

Julie Feldman: One bottom line takeaway for the audience. I would say that would be that... Just remember that when your client is sitting in front of you, their behavior is functional for them, their behavior makes sense. And so rather than just specifically focus on changing that behavior, we really want to... Like we talked about, peel back the layers and understand what is this behavior doing for them? How is this behavior protecting them? And see if we can start to make inroads with allowing them to realize that there are other ways of taking care of themselves in those moments. That this isn't actually going to be the thing that is the safest.

So instead of treating the symptoms, and I think most people who practice as a dietician, we're sort of taught this medical nutrition therapy. Sort of treating what's wrong with you. Treating cholesterol, treating blood pressure, treating A1Cs, treating BMIs. We're asking different questions. We're starting to say, "What happened to you?" And not just focus on these sort of numeric outcomes. And really being open-minded in your approach to all of this. Shifting away from just this numbers game and trying to see things in these more broad brush strokes. It can really, really be so helpful.

Lisa Jones: Yeah. And one thing that you said that's really sticking with me listening to you talk is really understanding their story. We all have our story, what's theirs? It's not a cookie cutter approach.

Julie Feldman: Yep.

Lisa Jones: Yeah. That's fantastic.

Julie Feldman: Awesome.

Lisa Jones: Well, thank you for sharing all of your knowledge with us about eating disorders. I want to end with a couple just personal questions. They're fun questions. And since we're upon the holiday season, I would like to know what your favorite gift to give is?

Julie Feldman: Oh, that's such a good question. I am a big-picture person. You just ask my teenagers, they'll tell you. So I like doing personalized things with photos and stuff. So that's probably my favorite thing to do is really surprise somebody with something thoughtful, with a picture or something with a photo.

Lisa Jones: Very nice. Because then they're never going to think, "Is this re-gifted?" Because a photo yourself.

Julie Feldman: Exactly.

Lisa Jones:  Yeah, that's an excellent idea.

So what about your favorite place to travel over the holiday season?

Julie Feldman: Oh, my favorite place. So although... Well, I guess I'm sort of going there. My favorite place to travel has always been to go to Florida. And mostly just because it's very nostalgic for me. My grandparents always had a place in Florida since I was seven. And my grandmother actually passed away 18 years ago come this January. My and my grandfather passed away seven years ago. So it's been about six years, I think, since we don't have that place in Florida. But now my mom now has a place in Florida.

Lisa Jones: Aw.

Julie Feldman: Yeah, so now last year was the first year that we did that, and we're going to get to go back there again this season. So Florida's just sort of my happy place. A lot of my childhood memories I feel like happened there. And I think my kids would say the same. There's just something about being away and having that sort of uninterrupted time as a family that I value.

Lisa Jones: Yes. And then when you're there and you're eating, what's one of your favorite memorable holiday foods to eat?

Julie Feldman: Well, probably my favorite holiday foods are actually Thanksgiving foods, because my mom is an incredible, incredible cook and she makes this sweet potato thing in a carved out orange. There's still a little bit of pulp in there. And then she pipes this sweet potato thing into it. I think I'm honestly... I think she just makes them for me at this point. I don't even think my kids even have ever tried. I don't even know if they eat them, but it's fine because then there's just more for me and she makes really incredible homemade pumpkin pie and pecan pie. So I love that.

And then I celebrate Hanukkah, so shout out to Trader Joe's because they have the best potato latkes. And we do... For Hanukkah, we do potato latkes and we always do, I know it might sound like a dorky dietitian thing to do, but we do this huge, massive salad bar with a thousand different toppings and everybody loves it. And even my kids love it and we chop it all up. They might do it like a nice restaurant with tape together, pizza cutters and a wooden bowl, and it's like the most amazing salad you've ever had.

Lisa Jones: Oh, that sounds good. You're making me hungry. It's delicious.

Julie Feldman: Now I'm kind of craving that salad, too.

Lisa Jones: Well, I will say Happy Hanukkah to you in advance.

Julie Feldman: Oh, well thank you. Thank you. Happy holidays to you, too.

Lisa Jones:

Yeah. And thank you for being on the show and sharing your insights with us.

Julie Feldman:

Absolutely. Thank you so much for having me.

Lisa Jones: Yes. I will share all the resources and links we discussed. And to our audience, thanks for listening and please tune in again and share your comments and feedback on our site. Have a great day, and enjoy a healthier lifestyle with the 411 in mind.

Moderator: For more nutrition content, visit consultant360.com.