November 20, 2025 • 25 mins
Most people picture anorexia as a body that looks frail. We pull back the curtain on a form that hides in plain sight: atypical anorexia—true restriction, real medical risk, and a brain consumed by food rules, occurring at any body size. With registered dietitian Isabelle from Bamboo Nutrition, we unpack how emotional eating can mean both eating to self-soothe and restricting to numb, why culture normalizes harmful patterns, and how those habits can quietly harden into an eating disorder or a relentless diet cycle.
We walk through the practical difference between emotional eating and a clinical disorder, then flip the script on “you can go days without eating” myths that put larger-bodied patients in danger. Physiology doesn’t care about size: restriction stresses the heart, hormones, and mind in everyone. You’ll hear clear signs to watch for—dizziness, cold intolerance, missed periods, hair changes, obsessive food thoughts—and why waiting for the “right” label can delay the care that prevents complications.
Ready to seek help but overwhelmed by options? Isabelle shares a simple, reliable path: contact an eating disorder treatment center and ask for their vetted outpatient providers. We outline how a team-based, weight-neutral approach works in practice—therapist plus dietitian, steady re-nourishment, skills for distress, and medical monitoring—to restore safety and rebuild trust with food. If you’re in Missouri, Bamboo Nutrition offers coordinated therapy and nutrition care; if not, use their strategy to find local specialists who truly understand atypical presentations.
If this conversation challenged your assumptions or gave you language for your experience, share it with someone who needs it, then subscribe and leave a review so more people can find evidence-based, compassionate help.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Lindsay Ogle, MD (00:00):
Welcome to the Modern Metabolic Health
Podcast with your host, Dr.
Lindsay Ogle, Board CertifiedFamily Medicine and Obesity
Medicine Physician.
Here we learn how we can treatand prevent modern metabolic
conditions such as diabetes,PCOS, fatty liver disease,
metabolic syndrome, sleep apnea,and more.
(00:21):
We focus on optimizinglifestyle while utilizing safe
and effective medicaltreatments.
Please remember that while I ama physician, I am not your
physician.
Everything discussed here isprovided as general medical
knowledge and not direct medicaladvice.
Please talk to your doctorabout what is best for you.
Welcome to Metabolic Healthwith Dr.
(00:47):
Lindsay Ogle.
Today we are going to talkabout an often overlooked
diagnosis, but an extremelyimportant diagnosis to review,
and it's called atypicalanorexia.
And I have an expert here totalk about atypical anorexia.
I have Isabelle, who is aregistered dietitian.
(01:08):
She is also the owner of BambooNutrition in Columbia,
Missouri, and Rochester,Minnesota.
She specializes in eatingdisorders and um her bamboo
nutrition clinic.
It started off with justdietitians, but they actually
expanded into aninterdisciplinary clinic and
(01:31):
included therapists.
And with their dietitians andtherapists, they approach
patient care through a non-dietweight neutral approach to help
improve behaviors and thinkingaround food and body image.
So I couldn't think of anyonebetter to have here today to
talk about atypical anorexiathan Isabel.
(01:52):
So thank you for being here.
Isabelle Bouchard, (01:54):
Absolutely.
Thanks for having me on yourchannel.
This is really fun and umsomething I'm very passionate to
talk about.
So looking forward to it.
Let's dig in.
Dr. Lindsay Ogle, M (02:04):
Absolutely.
Well, before we talk aboutatypical anorexia, let's talk
about um emotional eating, whichis extremely common.
And I think we all do emotionaleating at some point.
So can we define what emotionaleating is?
Isabelle Bouchard, RD (02:21):
So I'm going to use my own definition
because I know anybody can justGoogle this and find a
definition that they're lookingfor.
So when I'm in particularworking with clients, which I
mostly work with individualslike you alluded to with eating
disorders.
However, we do find individualswho come to our office and
clinic who are unsure, do I havean eating disorder?
(02:45):
Is this something I need to beworried about?
Um, people often have aconcrete image in their mind of
what an eating disorder lookslike.
So when they don't fit thatmold, they're confused.
But they can definitelyidentify with this concept of
emotional eating.
And for some people, emotionaleating might be when they're
feeling emotional, when theyfeel sad, when they're having a
(03:08):
rise in emotions that they can'tcontrol.
Um, and oftentimes this mightlook for somebody they're in
their car and they want to gothrough a drive-thru, or they
are at home and they raid thepantry.
Um, so it it can sometimes feellike as an emotional, I eat to
excess, I eat to the point ofoverfulness, it's uncomfortable.
(03:30):
Um, but what sometimes we don'tthink about is emotional eating
can also be different emotions.
It can be for numbness, it canbe depressive episodes where it
can be more related to um angeror or um just long-term episodes
of anxiety.
Uh, so it's not necessarily anextreme emotion, but it can also
(03:52):
be used for numbing.
It could be um, it could alsosometimes look like not eating.
So even though in the termemotional eating, you're
assuming you're doing the verbeating, but sometimes you're
not.
Sometimes you're emotional andyou're avoiding food.
Um, so that's that's how Iwould best describe the
definition of emotional eating,is it can look different for
(04:13):
everybody, but also to just kindof break with the concrete
ideas some people have in theirheads of what that looks like.
It's not always black andwhite.
Dr. Lindsay Ogle, MD (04:23):
Yeah, thank you for going over that.
And I love how you brought upit's not always those extreme
emotions, um, because I thinkthat that's like you said, most
commonly thought about are thoseextreme emotions.
Um, and I think it's reallyimportant to bring up the um
numbing aspect because I do seethat quite a bit in my practice
(04:46):
and just with talking withpeople about um emotional
eating.
I think that that's extremelycommon.
Um, and it can get into apoint, I'm sure you see this in
your practice as well, that itjust gets into a habit that we
don't even realize that we areare doing it, are using food for
numbing.
And I think that that's whyyour clinic is so wonderful
(05:07):
because not only do you have thedietitian perspective, but
you're working very closely withthe therapist to help, you
know, bring out those emotionsthat have been numb for so long
when somebody isn't even youknow realizing that they're
doing those behaviors.
Isabelle Bouchard, (05:24):
Absolutely.
I think most of the time you'reunaware of it, or it's
normalized in society of um,yeah, you're upset.
Of course you're gonna go get amilkshake, whatever, you know,
or of course you're gonna eat abag of chips.
Um uh or it's it's common tosee on commercials, you
especially commercials that areselling medication for um
(05:45):
depression, a lot of times yousee lots of food around, you see
garbage piling up.
And so it's just kind ofnormalized that if I have this
condition, this is what I do.
So you immediately go to treatthe condition, but you're not
thinking about the symptoms too,which is complicated because
food, I tell my clients, you dofood, you do food, you eat food,
(06:07):
you make choices about food upto six plus times a day on
average.
So if you're if you're going toignore the symptom of emotional
eating or how you're eatingyour food, the behaviors around
that, this is a problem thatit's gonna create negative
habits, in which even if you didtreat the depression or
whatever the condition is you'restruggling with, the emotional
(06:28):
piece, you could still havethese lingering negative
behaviors with food that couldeventually turn into an eating
disorder, or at least entrap youin this dieting spiral where
your confidence with food, yourconfidence with your body image,
your confidence eating aroundother people can be really poor.
Dr. Lindsay Ogle, MD (06:47):
Yeah, and that brings us to the next
question.
What is the difference betweensomebody who is emotionally
eating or maybe following like astrict diet versus a true like
definition of an eatingdisorder?
How do you go about umdeciphering between those?
Isabelle Bouchard, RD (07:08):
There are sometimes online quizzes.
I think as a provider, as atreatment, as a treatment
professional, I am probablygoing to treat you the exact
same, whether you come to mewith a diagnosis or without,
which side note, dietitianscannot diagnose.
So if you go see a dietitianhoping that they can tell you,
you know, specifically, do Ihave an eating disorder?
(07:30):
If so, what kind do I have?
What is my diagnosis?
Well, we can't even do thatfirst all, first off.
So we don't even try.
But does it change mytreatment?
Probably not, because even ifI'm not going to treat you like
somebody with anorexia nervosawho's maybe even needing a
higher level of care, maybeyou're not that extreme on an
(07:51):
eating disorder where I'm reallyworried about your medical
stability.
Um, I could still use a lot ofthe same tools that I use with
depending on what your behaviorsare.
There's binge eating disorder,there's anorexia, there's
bulimia, there's um some thingslike in between there where it
would fall under this diagnosisof other specified feeding and
eating disorders.
(08:12):
So there's all these treatmenttools in my toolbox that I could
use for you, no matter if it'sa real diagnosis or not.
The bigger thing is proving itto yourself, because we have
clients who I would say aredefinitely ambivalent to
treatment.
Um, and it could also bebecause they're in denial of the
problems that they themselvesare encountering.
(08:33):
So it's more proving it to youthan myself.
Dr. Lindsay Ogle, MD (08:37):
Yeah, well, that's wonderful.
And I I love that approachbecause, like you said, even if
you don't have a clear diagnosisor you haven't been able to
find the right um physician ornurse practitioner or you know,
PA or the, you know, somebodywho can make that diagnosis, you
as a dietitian and your, youknow, your other dietitians and
(08:58):
your therapists can stillprovide excellent care.
Um, and I think that that'sreally important, especially
because there are not a lot ofeating disorder specialists in
the, you know, on the medicalside to make those diagnoses.
And, you know, our hope is thatprimary care doctors and
obesity medicine doctors aretrained and qualified to make
(09:20):
those diagnoses, and most are,but not everybody has had that
specific training.
And I know, you know, during myresidency in failing medicine,
I um chose to do an elective umwith uh at an eating disorder uh
center, and so I had thatadditional training, but that
was something that I sought outmyself.
It wasn't really built in uminto our curriculum.
(09:45):
So um it's not something thateveryone is comfortable with.
So um, like you said, you mightnot, you know, present to the
dietitian um with thatdiagnosis, but that's wonderful
that you're still able to, youknow, help all those patients,
even if they don't have thatclear diagnosis when they come
to you.
Isabelle Bouchard, RD (10:02):
Yeah, and I I appreciate you saying how
eating disorder training isreally something that the
provider has to seek out.
And it doesn't make you abetter provider or a worse
provider if you have thatexperience.
It just helps maybe give you adifferent, different set of
tools in your toolbox that youcan help clients with.
Um that's how I would yeah,describe that.
(10:22):
But yeah, absolutely.
Dr. Lindsay Ogle, MD (10:24):
Yeah, and that brings us ultimately to
atypical anorexia, because thisis something that is often
overlooked.
Um, so let's just start withwhat is the definition of
atypical anorexia?
Isabelle Bouchard, RD (10:39):
So again, my definition would be if I
were to describe this tosomebody, it's someone who's in
a larger body.
So when you think of an eatingdisorder, I feel like most
people are thinking of anorexianervosa.
They think of someone who isskin and bones, who looks very,
very sick.
It's obvious they're noteating, they're restrictive.
Um and it it's the medical andmedically unstable person that
(11:04):
they're thinking of.
Um, it's clear that there'ssomething going on with food.
But what we don't think aboutis someone in a larger body
who's maybe doing the exact samething and who's also medically
unstable.
And one of my least favoritethings, so trigger warning to
anybody um who's in a largerbody and maybe has been given
(11:26):
this advice, is the medicalprofessional from what is it,
600-pound life.
I think I can't remember thespecific name of the show.
And he tells people in largerbodies, I don't care if you're
hungry, you don't need to eat,you can go days without eating
because of your body.
And that drives me crazybecause I feel like those words
(11:49):
in itself are reasons why peoplein larger bodies who are
restrictive don't seek carebecause they think my body can
handle it.
I've heard that messagingbefore.
This is what other peoplebelieve about my body is that I
should be able to go dayswithout eating because of my
size and my fat stores on mybody.
(12:11):
And that cannot be further fromthe truth.
Um, I will say, to that man'scredit, there is medical
monitoring going on for a lot ofthose patients still.
So if they're going dayswithout eating, I hope that
they're still being medicallymonitored.
But for the person inoutpatient who is going days
without eating, and they'redoing this secretively and
(12:33):
they're not sharing that withanybody, they're not being
medically monitored.
And your body is still going toreact to restriction the same
way someone in a normal umclassic form of anorexia
nervosa's body is going torespond to that.
So that is my long aboutdefinition of atypical anorexia
is you still have the samesymptoms.
(12:53):
You are just at a higher umbody size point than somebody
with typical or classic anorexianervosa.
Dr. Lindsay Ogle, MD (13:04):
Yeah, and that's the same definition that
I have.
And I know that there is a lotof discussion about whether the
term atypical anorexia is evenan appropriate definition
because it is still trueanorexia.
Um, there's we just have theatypical because, like you said,
(13:26):
it's not what what society orclassically we expect somebody
to look like.
Um, but they are it's the samedisease process.
You still are excessivelyrestricting to the point where
it's causing physio physiologicchanges in your body that can
(13:47):
cause harm and that truly doneed medical attention and
supervision.
Um so there's discussion aboutthat definition and what it
should be should be, I guess,termed, um, or if it should even
have its own terminology.
Um, but I do think that havingthe some sort of you know
(14:08):
identifier like atypical, or ifit you know has a different name
later on is helpful just toremind us to look out for this
because it is, again, so oftenoverlooked in the medical world.
Um, you know, obesity medicineis becoming such a more popular
field.
And I do know someone who'sgone through that training that
(14:30):
we get educated on this topic,um, which I think is really
important, um, so we're notmissing that.
But um, other providers who aremaybe are not board certified
in obesity medicine are notgetting this training, and this
may be something that um morecommonly gets overlooked.
(14:51):
Um, if somebody has thisdiagnosis um or suspects that
they may have this diagnosis, umwhat would your recommendation
be for you know moving forwardwith treatment?
Isabelle Bouchard, RD (15:06):
Yes, so good question.
So often as a dietitian, I getasked, who do I need to see
first?
Is that a therapist or adietitian?
And my answer to somebody who'sunsure if they have this
diagnosis, what to do is to juststart talking to somebody, some
professional ideally, who hasunderstanding in the space.
I wouldn't just go see atherapist who has no knowledge
(15:27):
on atypical anorexia.
I wouldn't even speak to amedical provider who has no
understanding of eatingdisorders because that's what
you're trying to understandabout yourself.
So go to somebody who canreally help ask you more
questions, inspire deeperthoughts to identify maybe this
isn't a full-blown definition oryou meet criteria for this
(15:49):
diagnosis, but there's clearlysomething going on here.
And it's wonderful that you areconcerned and wanting to talk
about it and want to address itbecause it doesn't need to be a
diagnosis for it to be aproblem.
And I think we need to makesure that everybody understands
that when it comes to eatingbehaviors, is it is still a
problem, even if it doesn't meetdiagnosable criteria.
(16:12):
There's so much talk aboutthrowing out diagnoses here and
there.
I have ADHD, I have ADD, I havedepression, I have anxiety, I
have, you know, all thesethings.
And just to name the biggestones that come to my mind.
And we just, you know, whenwe're worried about what are
your behaviors, what are yoursymptoms?
How is this impacting yourlife?
Is this a disturbing thing foryou?
(16:34):
Is this a um a big problem inyour relationships and and your
social relationships?
Or is this just something thatyou think about here and there
and but it's not a big deal?
So I would first try to justseek somebody to go to who can
help ask you those thosequestions and inspire deeper
thought.
And then you might end upseeing both a therapist and a
(16:55):
dietitian because oftentimesthis is kind of a two-sided coin
where you have the mentalhealth problems associated with
the eating behaviors, but youalso need a dietitian, someone
who's knowledgeable aboutnutrition and your entire body,
how that's affecting you,whether you're eating or not
eating, the medical part ofthat.
So you might be referred toanother specialist.
(17:18):
And that does, that should notprovoke fear or um concern on
your part.
It's just considering thatyou're getting a full hug, you
know, the therapist on one side,the dietist on the other side.
We're just giving you acomplete hug and treating you as
a whole person and treatingboth symptoms of the coin.
Dr. Lindsay Ogle, MD (17:38):
Yeah, I I love that.
And I love that you touch on,you know, the not always the
exact diagnosis.
It doesn't, I guess, matter toomuch.
And again, to highlight thesediagnoses and definitions are
constantly evolving.
I mean, I've haven't beenpracticing, I've only been
practicing for a few years, likeoutside of residency and in
(18:00):
medical school, and I've alreadyseen some definitions of these
diagnoses change.
And so we're always, you know,redefining and refining our um,
you know, diagnostic criteria.
Um, so those will evolve overtime, but the treatment
principles uh remain the same.
And so I think that that'sreally important to highlight.
(18:21):
And I I always emphasize theimportance of building a team
around you that's going tosupport you, and that'll look
different from person to person.
Um, but I think that that's sohelpful to just have multiple
people that you can reach out toand you know support you on a
journey, and it's something thatis going to be on the span of
(18:41):
months and years and sometimesdecades.
It's not something that isimmediately resolved with one
appointment.
And so having multiple peoplecan just help ensure that you
succeed.
So I appreciate that.
And I wonder if you, you know,you talked about finding like it
sounds like like safe spacesand providers.
Do you have any tips forsomebody who is looking for
(19:03):
maybe an eating disorderspecialist?
Um, what can they is there likea website they can go to where
they're listed, or are therecertain things that um someone
should maybe watch out for onwebsites, like particularly
wording that is you knowincluded on websites or um you
know, flyers or social media forsomebody who is looking for
(19:27):
help in this area?
Isabelle Bouchard, RD (19:30):
So here is my quick and sure-to-work
answer for anybody is find atreatment center, an eating
disorder treatment center.
Those are much easier to findthan individual providers.
So I would find the treatmentcenter and then I would contact
them and say, Who are youroutpatient providers that you
(19:52):
refer to?
Because they have, they takethe time to do the networking.
They take the time to find thesafest people, the smartest, the
most dedicated eating disorderprofessionals in the community
to refer to.
So I could tell you, you know,go to this website, go to this
website, look for this wording,you know, on this person's
profile in psychology today,look for this wording on the
(20:14):
website for the dietitians, butthat gets so complicated.
And I am so exhausted by seeingpeople say that they work with
eating disorders and I don'tknow about them.
They just pop up, they theythink that it's okay to just put
that on their resume of yes, Ido eating disorder work, but
they have no training, theydon't know how to work on a
(20:37):
team, they don't know themedical science behind eating
disorders and the fatalitystatistics behind it and how
serious and grave it is.
So I'm done with telling peoplethat's how to do things.
Now I say go to the treatmentcenters, contact them and say, I
want a list of your outpatientproviders.
Because some of these people attreatment centers oftentimes
(20:59):
have their own private practicetoo.
So they're really good becausethey have seen all levels of
care, they've been well trained,um, or they uh contract with
the treatment center.
Or again, it's just thetreatment center itself has done
a very extensive job of findingthe right providers in the
area.
So I know without a doubt, ifanyone in Missouri were to go to
(21:21):
a treatment center and say, Iam located in this area, can you
please help me find anoutpatient dietitian or
therapist?
I know that I'm on that listbecause I I care.
I've networked with all of thembecause this is my niche.
But the other person down thestreet from me who says that
they do eating disorders, thisis a true th who says that they
do eating disorders, but reallythey don't, I know that they
(21:43):
likely have not networked withthat treatment center because
they don't actually work witheating disorders.
They just say that they do.
So um, so that's how I would goabout that.
Dr. Lindsay Ogle, MD (21:54):
Yeah, that's awesome.
And that takes a lot ofpressure um off of the, you
know, patient or client who islooking for help because, like
you said, that eating disordercenter has already done the
vetting for them.
And you can just get that listand you know, you know, find who
takes your insurance or who'sclosest or whatever you're
looking for, um, and can findsome a trusted provider that
(22:17):
way.
So that's really great advice.
Thank you for sharing that.
Isabelle Bouchard, RD (22:21):
Yes, the insurance piece too.
I didn't even think about that,but they have all that written
down.
So absolutely.
Dr. Lindsay Ogle, MD (22:27):
Yeah, that's amazing because it can be
very overwhelming to findsomebody.
Um, and if it's somebody istrying to find you or your
practice, how would they goabout doing that?
Isabelle Bouchard, RD (22:39):
So we're located in Missouri.
We are hoping to branch out toa few other states because we
have part of our team located inCalifornia.
We have, I'm in Minnesotacurrently.
Um, so we're we're trying tobranch out.
But right now, where majorityof us are licensed is in
Missouri.
So if you are not a Missouriclient, you can still reach out
to me and I can also do my best.
(23:01):
You can treat me like atreatment center and I can do my
best to find you the rightresources.
Um, but for anyone in Missouriwho's seeking care for an eating
disorder, our practice iscalled Bamboo Nutrition.
And we do have therapists, soit's bamboo nutrition and
therapy, but the website isbamboo nutritionrd.com.
And um people reach out overthe phone, over Google, they
(23:25):
email us, they complete the formon our website, um, any avenue,
just do whatever is easiest.
And I also tell people justbecause you submit that contact
form or you reach out one timedoes not mean you are signing up
for nine months of treatment.
You are just starting theprocess to get to know about it.
And that's fine if you back outor if it's not the right time
(23:45):
for you.
Dr. Lindsay Ogle, MD (23:47):
Yeah, thank you so much.
And you have wonderful staff inyour clinic.
And I always include your linkto my new patient so they know
about your resources and theycan sign up whenever you know
they're ready to take that stepforward.
So thank you for all that youdo, and thank you for taking the
time with me to talk aboutemotional eating and atypical
(24:09):
anorexia.
It's such an important topic.
Um, do you have any you knowlast minute thoughts or anything
that you'd like to share beforewe end this conversation?
Isabelle Bouchard, RD (24:18):
I just want to thank you too.
I mean, you always get to havethe final say on these and
praise people, but you deservepraise too.
You're a wonderful provider.
And the fact that you have theknowledge and understanding on
both sides, you know, what it'slike to be metabolically healthy
and then working with people inlarger bodies, but also having
the understanding of eatingdisorders and holding space for
(24:39):
both of those things is so, sotricky.
And it takes a very capable andkind and empathetic provider to
be able to hold both of thosethings at a time.
So I want to praise you forthat.
And thank you for inviting meto come here and speak.
Sorry for baby babbling in thebackground.
If anyone's listening to thisand wondering what that noise
is, that is a six-month-old babywho is loud.
(25:01):
But thank you so much forworking through that with me.
I appreciate it.
Dr. Lindsay Ogle, MD (25:05):
Yeah, anytime.
And hopefully later on we canget together again and talk
about another topic.
I'd love that.
Thank you.
Thank you for listening andlearning how you can improve
your metabolic health in thismodern world.
If you found this informationhelpful, please share with a
(25:27):
friend, family member, orcolleague.
We need to do all we can tocombat the dangerous
misinformation that is outthere.
Please subscribe and write areview.
This will help others find thepodcast so they may also improve
their metabolic health.
I look forward to ourconversation next week.
Welcome to the Modern Metabolic Health
Podcast with your host, Dr.
Lindsay Ogle, Board CertifiedFamily Medicine and Obesity
Medicine Physician.
Here we learn how we can treatand prevent modern metabolic
conditions such as diabetes,PCOS, fatty liver disease,
metabolic syndrome, sleep apnea,and more.
(00:21):
We focus on optimizinglifestyle while utilizing safe
and effective medicaltreatments.
Please remember that while I ama physician, I am not your
physician.
Everything discussed here isprovided as general medical
knowledge and not direct medicaladvice.
Please talk to your doctorabout what is best for you.
Welcome to Metabolic Healthwith Dr.
(00:47):
Lindsay Ogle.
Today we are going to talkabout an often overlooked
diagnosis, but an extremelyimportant diagnosis to review,
and it's called atypicalanorexia.
And I have an expert here totalk about atypical anorexia.
I have Isabelle, who is aregistered dietitian.
(01:08):
She is also the owner of BambooNutrition in Columbia,
Missouri, and Rochester,Minnesota.
She specializes in eatingdisorders and um her bamboo
nutrition clinic.
It started off with justdietitians, but they actually
expanded into aninterdisciplinary clinic and
(01:31):
included therapists.
And with their dietitians andtherapists, they approach
patient care through a non-dietweight neutral approach to help
improve behaviors and thinkingaround food and body image.
So I couldn't think of anyonebetter to have here today to
talk about atypical anorexiathan Isabel.
(01:52):
So thank you for being here.
Isabelle Bouchard, (01:54):
Absolutely.
Thanks for having me on yourchannel.
This is really fun and umsomething I'm very passionate to
talk about.
So looking forward to it.
Let's dig in.
Dr. Lindsay Ogle, M (02:04):
Absolutely.
Well, before we talk aboutatypical anorexia, let's talk
about um emotional eating, whichis extremely common.
And I think we all do emotionaleating at some point.
So can we define what emotionaleating is?
Isabelle Bouchard, RD (02:21):
So I'm going to use my own definition
because I know anybody can justGoogle this and find a
definition that they're lookingfor.
So when I'm in particularworking with clients, which I
mostly work with individualslike you alluded to with eating
disorders.
However, we do find individualswho come to our office and
clinic who are unsure, do I havean eating disorder?
(02:45):
Is this something I need to beworried about?
Um, people often have aconcrete image in their mind of
what an eating disorder lookslike.
So when they don't fit thatmold, they're confused.
But they can definitelyidentify with this concept of
emotional eating.
And for some people, emotionaleating might be when they're
feeling emotional, when theyfeel sad, when they're having a
(03:08):
rise in emotions that they can'tcontrol.
Um, and oftentimes this mightlook for somebody they're in
their car and they want to gothrough a drive-thru, or they
are at home and they raid thepantry.
Um, so it it can sometimes feellike as an emotional, I eat to
excess, I eat to the point ofoverfulness, it's uncomfortable.
(03:30):
Um, but what sometimes we don'tthink about is emotional eating
can also be different emotions.
It can be for numbness, it canbe depressive episodes where it
can be more related to um angeror or um just long-term episodes
of anxiety.
Uh, so it's not necessarily anextreme emotion, but it can also
(03:52):
be used for numbing.
It could be um, it could alsosometimes look like not eating.
So even though in the termemotional eating, you're
assuming you're doing the verbeating, but sometimes you're
not.
Sometimes you're emotional andyou're avoiding food.
Um, so that's that's how Iwould best describe the
definition of emotional eating,is it can look different for
(04:13):
everybody, but also to just kindof break with the concrete
ideas some people have in theirheads of what that looks like.
It's not always black andwhite.
Dr. Lindsay Ogle, MD (04:23):
Yeah, thank you for going over that.
And I love how you brought upit's not always those extreme
emotions, um, because I thinkthat that's like you said, most
commonly thought about are thoseextreme emotions.
Um, and I think it's reallyimportant to bring up the um
numbing aspect because I do seethat quite a bit in my practice
(04:46):
and just with talking withpeople about um emotional
eating.
I think that that's extremelycommon.
Um, and it can get into apoint, I'm sure you see this in
your practice as well, that itjust gets into a habit that we
don't even realize that we areare doing it, are using food for
numbing.
And I think that that's whyyour clinic is so wonderful
(05:07):
because not only do you have thedietitian perspective, but
you're working very closely withthe therapist to help, you
know, bring out those emotionsthat have been numb for so long
when somebody isn't even youknow realizing that they're
doing those behaviors.
Isabelle Bouchard, (05:24):
Absolutely.
I think most of the time you'reunaware of it, or it's
normalized in society of um,yeah, you're upset.
Of course you're gonna go get amilkshake, whatever, you know,
or of course you're gonna eat abag of chips.
Um uh or it's it's common tosee on commercials, you
especially commercials that areselling medication for um
(05:45):
depression, a lot of times yousee lots of food around, you see
garbage piling up.
And so it's just kind ofnormalized that if I have this
condition, this is what I do.
So you immediately go to treatthe condition, but you're not
thinking about the symptoms too,which is complicated because
food, I tell my clients, you dofood, you do food, you eat food,
(06:07):
you make choices about food upto six plus times a day on
average.
So if you're if you're going toignore the symptom of emotional
eating or how you're eatingyour food, the behaviors around
that, this is a problem thatit's gonna create negative
habits, in which even if you didtreat the depression or
whatever the condition is you'restruggling with, the emotional
(06:28):
piece, you could still havethese lingering negative
behaviors with food that couldeventually turn into an eating
disorder, or at least entrap youin this dieting spiral where
your confidence with food, yourconfidence with your body image,
your confidence eating aroundother people can be really poor.
Dr. Lindsay Ogle, MD (06:47):
Yeah, and that brings us to the next
question.
What is the difference betweensomebody who is emotionally
eating or maybe following like astrict diet versus a true like
definition of an eatingdisorder?
How do you go about umdeciphering between those?
Isabelle Bouchard, RD (07:08):
There are sometimes online quizzes.
I think as a provider, as atreatment, as a treatment
professional, I am probablygoing to treat you the exact
same, whether you come to mewith a diagnosis or without,
which side note, dietitianscannot diagnose.
So if you go see a dietitianhoping that they can tell you,
you know, specifically, do Ihave an eating disorder?
(07:30):
If so, what kind do I have?
What is my diagnosis?
Well, we can't even do thatfirst all, first off.
So we don't even try.
But does it change mytreatment?
Probably not, because even ifI'm not going to treat you like
somebody with anorexia nervosawho's maybe even needing a
higher level of care, maybeyou're not that extreme on an
(07:51):
eating disorder where I'm reallyworried about your medical
stability.
Um, I could still use a lot ofthe same tools that I use with
depending on what your behaviorsare.
There's binge eating disorder,there's anorexia, there's
bulimia, there's um some thingslike in between there where it
would fall under this diagnosisof other specified feeding and
eating disorders.
(08:12):
So there's all these treatmenttools in my toolbox that I could
use for you, no matter if it'sa real diagnosis or not.
The bigger thing is proving itto yourself, because we have
clients who I would say aredefinitely ambivalent to
treatment.
Um, and it could also bebecause they're in denial of the
problems that they themselvesare encountering.
(08:33):
So it's more proving it to youthan myself.
Dr. Lindsay Ogle, MD (08:37):
Yeah, well, that's wonderful.
And I I love that approachbecause, like you said, even if
you don't have a clear diagnosisor you haven't been able to
find the right um physician ornurse practitioner or you know,
PA or the, you know, somebodywho can make that diagnosis, you
as a dietitian and your, youknow, your other dietitians and
(08:58):
your therapists can stillprovide excellent care.
Um, and I think that that'sreally important, especially
because there are not a lot ofeating disorder specialists in
the, you know, on the medicalside to make those diagnoses.
And, you know, our hope is thatprimary care doctors and
obesity medicine doctors aretrained and qualified to make
(09:20):
those diagnoses, and most are,but not everybody has had that
specific training.
And I know, you know, during myresidency in failing medicine,
I um chose to do an elective umwith uh at an eating disorder uh
center, and so I had thatadditional training, but that
was something that I sought outmyself.
It wasn't really built in uminto our curriculum.
(09:45):
So um it's not something thateveryone is comfortable with.
So um, like you said, you mightnot, you know, present to the
dietitian um with thatdiagnosis, but that's wonderful
that you're still able to, youknow, help all those patients,
even if they don't have thatclear diagnosis when they come
to you.
Isabelle Bouchard, RD (10:02):
Yeah, and I I appreciate you saying how
eating disorder training isreally something that the
provider has to seek out.
And it doesn't make you abetter provider or a worse
provider if you have thatexperience.
It just helps maybe give you adifferent, different set of
tools in your toolbox that youcan help clients with.
Um that's how I would yeah,describe that.
(10:22):
But yeah, absolutely.
Dr. Lindsay Ogle, MD (10:24):
Yeah, and that brings us ultimately to
atypical anorexia, because thisis something that is often
overlooked.
Um, so let's just start withwhat is the definition of
atypical anorexia?
Isabelle Bouchard, RD (10:39):
So again, my definition would be if I
were to describe this tosomebody, it's someone who's in
a larger body.
So when you think of an eatingdisorder, I feel like most
people are thinking of anorexianervosa.
They think of someone who isskin and bones, who looks very,
very sick.
It's obvious they're noteating, they're restrictive.
Um and it it's the medical andmedically unstable person that
(11:04):
they're thinking of.
Um, it's clear that there'ssomething going on with food.
But what we don't think aboutis someone in a larger body
who's maybe doing the exact samething and who's also medically
unstable.
And one of my least favoritethings, so trigger warning to
anybody um who's in a largerbody and maybe has been given
(11:26):
this advice, is the medicalprofessional from what is it,
600-pound life.
I think I can't remember thespecific name of the show.
And he tells people in largerbodies, I don't care if you're
hungry, you don't need to eat,you can go days without eating
because of your body.
And that drives me crazybecause I feel like those words
(11:49):
in itself are reasons why peoplein larger bodies who are
restrictive don't seek carebecause they think my body can
handle it.
I've heard that messagingbefore.
This is what other peoplebelieve about my body is that I
should be able to go dayswithout eating because of my
size and my fat stores on mybody.
(12:11):
And that cannot be further fromthe truth.
Um, I will say, to that man'scredit, there is medical
monitoring going on for a lot ofthose patients still.
So if they're going dayswithout eating, I hope that
they're still being medicallymonitored.
But for the person inoutpatient who is going days
without eating, and they'redoing this secretively and
(12:33):
they're not sharing that withanybody, they're not being
medically monitored.
And your body is still going toreact to restriction the same
way someone in a normal umclassic form of anorexia
nervosa's body is going torespond to that.
So that is my long aboutdefinition of atypical anorexia
is you still have the samesymptoms.
(12:53):
You are just at a higher umbody size point than somebody
with typical or classic anorexianervosa.
Dr. Lindsay Ogle, MD (13:04):
Yeah, and that's the same definition that
I have.
And I know that there is a lotof discussion about whether the
term atypical anorexia is evenan appropriate definition
because it is still trueanorexia.
Um, there's we just have theatypical because, like you said,
(13:26):
it's not what what society orclassically we expect somebody
to look like.
Um, but they are it's the samedisease process.
You still are excessivelyrestricting to the point where
it's causing physio physiologicchanges in your body that can
(13:47):
cause harm and that truly doneed medical attention and
supervision.
Um so there's discussion aboutthat definition and what it
should be should be, I guess,termed, um, or if it should even
have its own terminology.
Um, but I do think that havingthe some sort of you know
(14:08):
identifier like atypical, or ifit you know has a different name
later on is helpful just toremind us to look out for this
because it is, again, so oftenoverlooked in the medical world.
Um, you know, obesity medicineis becoming such a more popular
field.
And I do know someone who'sgone through that training that
(14:30):
we get educated on this topic,um, which I think is really
important, um, so we're notmissing that.
But um, other providers who aremaybe are not board certified
in obesity medicine are notgetting this training, and this
may be something that um morecommonly gets overlooked.
(14:51):
Um, if somebody has thisdiagnosis um or suspects that
they may have this diagnosis, umwhat would your recommendation
be for you know moving forwardwith treatment?
Isabelle Bouchard, RD (15:06):
Yes, so good question.
So often as a dietitian, I getasked, who do I need to see
first?
Is that a therapist or adietitian?
And my answer to somebody who'sunsure if they have this
diagnosis, what to do is to juststart talking to somebody, some
professional ideally, who hasunderstanding in the space.
I wouldn't just go see atherapist who has no knowledge
(15:27):
on atypical anorexia.
I wouldn't even speak to amedical provider who has no
understanding of eatingdisorders because that's what
you're trying to understandabout yourself.
So go to somebody who canreally help ask you more
questions, inspire deeperthoughts to identify maybe this
isn't a full-blown definition oryou meet criteria for this
(15:49):
diagnosis, but there's clearlysomething going on here.
And it's wonderful that you areconcerned and wanting to talk
about it and want to address itbecause it doesn't need to be a
diagnosis for it to be aproblem.
And I think we need to makesure that everybody understands
that when it comes to eatingbehaviors, is it is still a
problem, even if it doesn't meetdiagnosable criteria.
(16:12):
There's so much talk aboutthrowing out diagnoses here and
there.
I have ADHD, I have ADD, I havedepression, I have anxiety, I
have, you know, all thesethings.
And just to name the biggestones that come to my mind.
And we just, you know, whenwe're worried about what are
your behaviors, what are yoursymptoms?
How is this impacting yourlife?
Is this a disturbing thing foryou?
(16:34):
Is this a um a big problem inyour relationships and and your
social relationships?
Or is this just something thatyou think about here and there
and but it's not a big deal?
So I would first try to justseek somebody to go to who can
help ask you those thosequestions and inspire deeper
thought.
And then you might end upseeing both a therapist and a
(16:55):
dietitian because oftentimesthis is kind of a two-sided coin
where you have the mentalhealth problems associated with
the eating behaviors, but youalso need a dietitian, someone
who's knowledgeable aboutnutrition and your entire body,
how that's affecting you,whether you're eating or not
eating, the medical part ofthat.
So you might be referred toanother specialist.
(17:18):
And that does, that should notprovoke fear or um concern on
your part.
It's just considering thatyou're getting a full hug, you
know, the therapist on one side,the dietist on the other side.
We're just giving you acomplete hug and treating you as
a whole person and treatingboth symptoms of the coin.
Dr. Lindsay Ogle, MD (17:38):
Yeah, I I love that.
And I love that you touch on,you know, the not always the
exact diagnosis.
It doesn't, I guess, matter toomuch.
And again, to highlight thesediagnoses and definitions are
constantly evolving.
I mean, I've haven't beenpracticing, I've only been
practicing for a few years, likeoutside of residency and in
(18:00):
medical school, and I've alreadyseen some definitions of these
diagnoses change.
And so we're always, you know,redefining and refining our um,
you know, diagnostic criteria.
Um, so those will evolve overtime, but the treatment
principles uh remain the same.
And so I think that that'sreally important to highlight.
(18:21):
And I I always emphasize theimportance of building a team
around you that's going tosupport you, and that'll look
different from person to person.
Um, but I think that that's sohelpful to just have multiple
people that you can reach out toand you know support you on a
journey, and it's something thatis going to be on the span of
(18:41):
months and years and sometimesdecades.
It's not something that isimmediately resolved with one
appointment.
And so having multiple peoplecan just help ensure that you
succeed.
So I appreciate that.
And I wonder if you, you know,you talked about finding like it
sounds like like safe spacesand providers.
Do you have any tips forsomebody who is looking for
(19:03):
maybe an eating disorderspecialist?
Um, what can they is there likea website they can go to where
they're listed, or are therecertain things that um someone
should maybe watch out for onwebsites, like particularly
wording that is you knowincluded on websites or um you
know, flyers or social media forsomebody who is looking for
(19:27):
help in this area?
Isabelle Bouchard, RD (19:30):
So here is my quick and sure-to-work
answer for anybody is find atreatment center, an eating
disorder treatment center.
Those are much easier to findthan individual providers.
So I would find the treatmentcenter and then I would contact
them and say, Who are youroutpatient providers that you
(19:52):
refer to?
Because they have, they takethe time to do the networking.
They take the time to find thesafest people, the smartest, the
most dedicated eating disorderprofessionals in the community
to refer to.
So I could tell you, you know,go to this website, go to this
website, look for this wording,you know, on this person's
profile in psychology today,look for this wording on the
(20:14):
website for the dietitians, butthat gets so complicated.
And I am so exhausted by seeingpeople say that they work with
eating disorders and I don'tknow about them.
They just pop up, they theythink that it's okay to just put
that on their resume of yes, Ido eating disorder work, but
they have no training, theydon't know how to work on a
(20:37):
team, they don't know themedical science behind eating
disorders and the fatalitystatistics behind it and how
serious and grave it is.
So I'm done with telling peoplethat's how to do things.
Now I say go to the treatmentcenters, contact them and say, I
want a list of your outpatientproviders.
Because some of these people attreatment centers oftentimes
(20:59):
have their own private practicetoo.
So they're really good becausethey have seen all levels of
care, they've been well trained,um, or they uh contract with
the treatment center.
Or again, it's just thetreatment center itself has done
a very extensive job of findingthe right providers in the
area.
So I know without a doubt, ifanyone in Missouri were to go to
(21:21):
a treatment center and say, Iam located in this area, can you
please help me find anoutpatient dietitian or
therapist?
I know that I'm on that listbecause I I care.
I've networked with all of thembecause this is my niche.
But the other person down thestreet from me who says that
they do eating disorders, thisis a true th who says that they
do eating disorders, but reallythey don't, I know that they
(21:43):
likely have not networked withthat treatment center because
they don't actually work witheating disorders.
They just say that they do.
So um, so that's how I would goabout that.
Dr. Lindsay Ogle, MD (21:54):
Yeah, that's awesome.
And that takes a lot ofpressure um off of the, you
know, patient or client who islooking for help because, like
you said, that eating disordercenter has already done the
vetting for them.
And you can just get that listand you know, you know, find who
takes your insurance or who'sclosest or whatever you're
looking for, um, and can findsome a trusted provider that
(22:17):
way.
So that's really great advice.
Thank you for sharing that.
Isabelle Bouchard, RD (22:21):
Yes, the insurance piece too.
I didn't even think about that,but they have all that written
down.
So absolutely.
Dr. Lindsay Ogle, MD (22:27):
Yeah, that's amazing because it can be
very overwhelming to findsomebody.
Um, and if it's somebody istrying to find you or your
practice, how would they goabout doing that?
Isabelle Bouchard, RD (22:39):
So we're located in Missouri.
We are hoping to branch out toa few other states because we
have part of our team located inCalifornia.
We have, I'm in Minnesotacurrently.
Um, so we're we're trying tobranch out.
But right now, where majorityof us are licensed is in
Missouri.
So if you are not a Missouriclient, you can still reach out
to me and I can also do my best.
(23:01):
You can treat me like atreatment center and I can do my
best to find you the rightresources.
Um, but for anyone in Missouriwho's seeking care for an eating
disorder, our practice iscalled Bamboo Nutrition.
And we do have therapists, soit's bamboo nutrition and
therapy, but the website isbamboo nutritionrd.com.
And um people reach out overthe phone, over Google, they
(23:25):
email us, they complete the formon our website, um, any avenue,
just do whatever is easiest.
And I also tell people justbecause you submit that contact
form or you reach out one timedoes not mean you are signing up
for nine months of treatment.
You are just starting theprocess to get to know about it.
And that's fine if you back outor if it's not the right time
(23:45):
for you.
Dr. Lindsay Ogle, MD (23:47):
Yeah, thank you so much.
And you have wonderful staff inyour clinic.
And I always include your linkto my new patient so they know
about your resources and theycan sign up whenever you know
they're ready to take that stepforward.
So thank you for all that youdo, and thank you for taking the
time with me to talk aboutemotional eating and atypical
(24:09):
anorexia.
It's such an important topic.
Um, do you have any you knowlast minute thoughts or anything
that you'd like to share beforewe end this conversation?
Isabelle Bouchard, RD (24:18):
I just want to thank you too.
I mean, you always get to havethe final say on these and
praise people, but you deservepraise too.
You're a wonderful provider.
And the fact that you have theknowledge and understanding on
both sides, you know, what it'slike to be metabolically healthy
and then working with people inlarger bodies, but also having
the understanding of eatingdisorders and holding space for
(24:39):
both of those things is so, sotricky.
And it takes a very capable andkind and empathetic provider to
be able to hold both of thosethings at a time.
So I want to praise you forthat.
And thank you for inviting meto come here and speak.
Sorry for baby babbling in thebackground.
If anyone's listening to thisand wondering what that noise
is, that is a six-month-old babywho is loud.
(25:01):
But thank you so much forworking through that with me.
I appreciate it.
Dr. Lindsay Ogle, MD (25:05):
Yeah, anytime.
And hopefully later on we canget together again and talk
about another topic.
I'd love that.
Thank you.
Thank you for listening andlearning how you can improve
your metabolic health in thismodern world.
If you found this informationhelpful, please share with a
(25:27):
friend, family member, orcolleague.
We need to do all we can tocombat the dangerous
misinformation that is outthere.
Please subscribe and write areview.
This will help others find thepodcast so they may also improve
their metabolic health.
I look forward to ourconversation next week.
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