Episode 212: This week on the show Chris is chatting with Registered Dietician Emily Fonnesbeck. They chat about Emily's history with orthorexia and her recovery, perfectionism, infertility, adoption, working with eating disorder clients, and feeding children.
Emily Fonnesbeck is a Registered Dietitian who owns her own private practice in Hyde Park, Utah, working with both local and virtual clients. She specialises in treating eating disorders, disordered eating, body image concerns and accompanying issues. She is also the co-owner of Eat Confident Co. where she offers group coaching programs for women struggling with food and body image. She also co-hosts the Eat with Confidence podcast. She is passionate about helping individuals create a peaceful relationship with food and their body, building confidence in their own natural ability to know how to eat.
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Chris Sandel: Welcome to Episode 212 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at seven-health.com/212.
For the last handful of weeks, I’ve been starting the show talking about the fact that Seven Health is taking on new clients. At the time of recording this intro, which is a couple of weeks prior to this actually airing, more than half the spots are gone.
Client work is the core of the business, the core of Seven Health, and it’s the thing I actually enjoy the most. After working with clients for more than a decade, I feel confident in saying I’m very good at what I do. When I reflect on the clients that have sought out Seven Health over the last couple of years, there’s a handful of areas that really come up the most.
One of the biggest is helping women get their periods back, so recovery from hypothalamic amenorrhea, or HA. This is often the result of under-eating and over-exercising and is almost always connected with a fear of gaining weight and a focus on being healthy. I’ve had clients regain their period after being absent for 10 or even 20 years, often after being told it would never happen again, or clients becoming pregnant who’d almost given up hope of it happening.
We also work with clients along the disordered eating and eating disorder spectrum. Many clients wouldn’t think to use the term disordered eating to describe themselves; they just know that things aren’t right. With these clients, there are symptoms that are commonly occurring: water retention, poor digestion, always cold, peeing all the time, often waking multiple times in the night, no periods or bad PMS symptoms, low energy, poor sleep, low thyroid. There’s also common mental and emotional symptoms: compulsion to exercise or a fear of certain foods, anxiety, low mood or depression, poor body image, and fear of weight gain.
At Seven Health, we believe in full recovery. We’ve had many clients who’ve had multiple stays at inpatient facilities where nothing worked, but through working together, they got to a place of full recovery.
Many clients also come to Seven Health as they want help transitioning out of dieting and so they can start to finally listen to their body. They’ve had years or decades of dieting and just know that nothing works, but they’re really struggling to figure out how to eat without dieting.
Many clients also experience feelings of body shame and hatred, and they’re determined to be a particular size and feel frustrated or even angry by what they see in the mirror. They want to get past this and be able to be present in their life and stop putting things on hold.
In all of these scenarios, we use the core components of what Seven Health is about, which is science and compassion. We focus on both physiology and psychology, so understanding how the body works and how best to support it, but also understanding the mental and emotional side and uncovering someone’s identity and values and priorities and traits and beliefs and how these can be either helping or hindering change.
It’s these kinds of clients that make up the bulk of the practice, and I’m very good at helping people get to a place with their food and their body and even their life that feels out of reach.
If any of these scenarios sound like you and you’d like help, then please get in contact. You can head over to seven-health.com/help, and you can read about how we work with clients and apply for a free initial chat. This will be the last time we’re starting with clients in 2020, and as I said at the start, over half the spots are already gone. So if you’re wanting help, please reach out. The link, again, is seven-health.com/help, and I’ll also include that in the show notes.
Hey everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. This week on the show, it is another guest interview. My guest today is Emily Fonnesbeck.
Emily is a registered dietitian who owns her own private practice in High Park, Utah, working with both local and virtual clients. She specialises in treating eating disorders, disordered eating, body image concerns, and accompanying issues. She’s also the co-owner of the Eat Confident Collective, where she offers group coaching programs for women struggling with food and body image. She also co-hosts the Eat With Confidence Podcast. Emily is passionate about helping individuals create a peaceful relationship with food and their body, building confidence in their own natural ability to know how to eat.
I’ve been following Emily’s work for a couple of years now. I first came across her on someone’s podcast – it might’ve been Christy Harrison’s – and then have subsequently kept up with what she’s been doing, which is a lot. So I finally reached out to her and got her to come on the show.
A big focus of this episode is about orthorexia. This is something Emily dealt with herself for 7 or 8 years, so she knows the experience of this firsthand. We go through her story with it and her recovery journey as well as talking more broadly about orthorexia, both sharing our insights from working with clients.
We talk about Emily’s work in the early part of her career at a weight loss resort, and that while she’s pretty steadfastly against this now, it was actually an experience that helped her see the futility of weight loss and helped her to get into intuitive eating and a weight-neutral and non-diet approach.
We chat about infertility and Emily’s personal experience in this area. We also talk about feeding children and how this has changed for her as she left her orthorexia behind.
I really loved this conversation. It felt like it could’ve gone on for hours more. I hope you find it helpful. Here is me chatting with Emily Fonnesbeck.
Hey, Emily. Thanks for so much for joining me on the show today.
Emily Fonnesbeck: Happy to be here. Thanks for having me.
Chris Sandel: I’m really excited to have you here. When preparing for you to come on and going through your blog and Instagram and the podcast, there really is so much that I want to cover. Orthorexia is definitely a big topic that I want to spend some time on, maybe fertility as well, as I know that can be a struggle for many listeners, and lots more. So let’s just see where the conversation goes.
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To start off with, do you want to give listeners a bit of background on yourself – who you are, what you do, what training you’ve done, that sort of thing?
Emily Fonnesbeck: Sure, that’s great. My name is Emily Fonnesbeck. I’m a registered dietitian. I live in the United States. We live in northern Utah. We’re right on the Idaho border, actually. I live with my husband and our four kids. I’ve been practicing now for I guess going on 16 years.
Newly out of school as a student and a newly registered dietitian, I started practicing at a weight loss resort. That was such a good experience. Obviously very different from what way that I practice now, as currently working with eating disorders, disordered eating and body image from a non-diet, weight-neutral approach has definitely obviously evolved a lot over the years, but in large part because of that, because I started at a weight loss resort where I was able to observe the behaviours and beliefs of a lot of these people who were coming to stay for weeks, sometimes months at a time.
I recognised that the way that I was practicing – which I’d been taught in school, of course, to use BMI to measure health and to cut people’s calories if they didn’t meet a ‘normal’ BMI and to put people on diets – that’s the way I had learned how to practice as a dietitian. I saw that I was actually probably part of the problem, not the solution. That was troubling to me, but it was so good to be in that really uncomfortable place, to have to unlearn so much of what isn’t helpful and to learn new ways of really helping people come to a place of peace and confidence with food and their body that isn’t dependent on diets or weight loss.
Listening and learning from them was big for me, and a huge part of my transition out of a diet-focused approach into something that is a lot more supportive of just trusting your body and listening to what it says and having more flexible eating patterns.
When I left there, I started my own private practice. It was good timing to be able to switch that treatment approach and to be able to help in the way that I wanted to help – and as I mentioned, particularly focusing on eating disorder recovery.
Chris Sandel: You said that working at the weight loss resort has provided some benefits in terms of you now seeing things in a really different light. How long did it take for you to reach that new conclusion? My thought would be as you being a new dietitian, initially – and I don’t want to make assumptions, so correct me if I’m wrong here – but you must’ve been thinking, “Okay, I think I’m doing something wrong. Maybe this is something lacking within me if these people aren’t getting these results.” Is that how it first started out?
Emily Fonnesbeck: That’s very fair to say. I think it’s very easy to question yourself rather than questioning the method or the approach. Like “I just need to get better at this approach in order to really help them meet their goals.” I think that’s really common in weight loss particularly. If people aren’t achieving the goals they want to achieve, very often that comes back on the provider and them just not doing a good enough job.
So it was very eye-opening and very helpful for me to realise that the odds are against me. [laughs] If I’m going to focus on intentional weight loss, statistically, the odds are against the provider and the patient in terms of being able to be successful in that way, especially long term.
Yeah, I think that’s really fair to say, and so important that we recognise that it’s the method that’s flawed or the approach that’s flawed, not the provider and not the patient. Maybe we need to use different therapeutic approaches to truly help the patient be able to overcome whatever struggles they’re having.
I think a really good example of that is – the thing that really opened my eyes the most, I guess I should say, at the resort is how many people coming into the resort could actually meet diagnostic criteria for binge eating disorder and really needed to be in eating disorder treatment, not at a weight loss resort. That awareness was life-changing for me. I really started to recognise that, as you were mentioning, it was method that was flawed, not me or the guest. It was just the method.
So yes, exactly, really coming to understand the research behind weight loss and diets and statistically how it’s really not in favour of sustained weight loss, and to be able to know that there is a different approach – and really, in my mind, being able to switch that to “This isn’t their problem. They need a different solution. They need to be in treatment for an eating disorder. They don’t need to be in treatment for weight loss.”
Chris Sandel: I think as well, maybe recognising that was helpful because – and again, you tell me if this is the case – a lot of the time when people do go in for weight loss, it can work in the short term. They come to the resort, it ‘works’, they then leave, and then you don’t necessarily see the aftermath. So you could be feeling like you’re getting success, but if you’re then seeing this other thing while they’re there, that actually, they’re meeting the requirements for binge eating disorder, that can add an extra layer of breaking through that mirage of “This is working.”
Emily Fonnesbeck: Yeah. It was actually really interesting because we got a lot of repeat guests. That was very normal, for guests to leave and come back because they couldn’t do it at home. That’s kind of their wording. And to see the shame that was operating under the surface there of “I’m flawed, I’m broken, I can’t continue this at home” or “I can’t create long-lasting sustainability with this; this must be my fault” – all of the shame that’s operating under the surface there.
Chris Sandel: How long did it then take for you to somewhat see the light? And while you were there, were there other people that you could confide in where you’re starting to have this ambivalence around how you’re seeing it unfold?
Emily Fonnesbeck: It was interesting because I felt actually very well-respected and appreciated by the owners. I always felt supported by them, so I was able to discuss these concerns with them and talk about the concerns that I was seeing.
I don’t think that they had the life experiences or the perspective that really allowed them to see this for what it was. They were always open to discussion, and I think they felt like they were actually doing – like “Okay, eating disorder recovery can also include weight loss, can’t it?” [laughs] I think it was just a lot of cognitive dissonance in that way.
But eventually it just ran its course. It became really hard for me to be there and very difficult to continue working there, even though they gave me a lot of freedom to teach the things I wanted to teach, like intuitive eating, like the concern with fixation on weight. I was able to teach a lot of those things as I taught classes there and whatnot, and they were very open to those kinds of conversations and exposing guests to different perspectives and ideas around weight and around food. So I definitely had freedom of license to teach those things. It just was difficult.
It felt – I guess the best word for it would be a little bit of gaslighting. The ultimate goal that they were there for was to lose weight, and then I was talking about intuitive eating in this way. I don’t think my message was that it’s a tool for weight loss, but of course, they’re there and learning about intuitive eating at a weight loss resort, and it really got muddled. It got messy. The messages got really messy.
So the time came that it had run its course. I appreciated my time there, but it was time to move on. That was about 6 years into my career when I decided to transition into private practice, which I’ve now been in for the last 10 years. It was such a relief to be able to transition to a place where I did really have a little bit more ownership over the way that I wanted to help people.
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Chris Sandel: I want to spend some time chatting about that piece, but I also want to go back to earlier on for you, starting with your childhood and growing up. How was food in your home?
Emily Fonnesbeck: That’s a great question and one that I’ve really reflected a lot on over the years, especially because I think – I’m sure, Chris, you agree with this – it’s very eye-opening and therapeutic for any of our clients to do the same, to assess what their relationship with food and body image was like growing up, because so much of our adult behaviours can probably be linked to our childhood upbringing and beliefs that were formed at that time.
So I’ve spent a lot of time thinking about this, and to be honest, I think I grew up in a fairly safe environment. Looking back, I can actually see that perhaps my mom was dieting under the radar, but it was never something that she talked overtly about. We didn’t label food as good and bad; it just was. Food just was.
My mom worked full-time as a schoolteacher while I was growing up, but she still cooked dinner every night and we ate dinner together as a family. There were always home-cooked meals. They were just very normal meals, inclusive of lots of different kinds of foods. I really didn’t grow up in a weight- or food-obsessive environment at all.
My interest in becoming a dietitian was actually linked to my interest in running and trying to understand how to best fuel myself for best performance. It was a very positive thing. My interest in nutrition really started out very positively in just wanting to fuel myself well, make sure I’m eating enough and eating adequately and eating often enough in order to perform in the way that I wanted to perform. So that’s where my interest grew.
Chris Sandel: At what age did you get into running?
Emily Fonnesbeck: My high school years, probably starting at the age of 15 or 16. My high school years I was a little bit more interested in running, and became more interested in nutrition, but not in the way of restricting or cutting out foods. Just how this felt, how much I needed to eat in order to run as well as I could.
Chris Sandel: It sounds like you had a good household growing up in terms of food and the messaging you got around food. What about with the coaching in terms of running? Was there anything not great about the advice that you received through that?
Emily Fonnesbeck: No, not at all. I think that’s not common, from what I understand now. But my situation was not that. It was more about performance and eating enough and eating well. I’m sure words like ‘healthy’ were used, and at the time, ‘healthy’ wasn’t such a loaded term as I think it often becomes for people when they’ve struggled with food. I think I had a more flexible view on what healthy eating was, so to be able to hear the term ‘eating healthy’ translated to something that felt really normal and natural and flexible to me, not something that felt restrictive.
Chris Sandel: Definitely. With your teenage years, was there any dieting? I know you said you grew up in this household where that wasn’t pushed by your parents, but from chatting with so many guests and so many clients, sometimes there is that camaraderie that comes about for kids when they’re in their teenage years of going on diets with friends or with siblings. Was there any of that going on?
Emily Fonnesbeck: That’s actually really interesting. I have thought about that. I did have friends that would try different diets and different eating protocols, and I remember thinking it was crazy. I remember at the time thinking, “Why would you do that? Why would you starve yourself like that, or why would you only eat that one food all day, or only drink water?” In my mind it just didn’t really make sense. It didn’t feel logical to me.
I think a lot of that was because I always felt pretty comfortable around food. I think I was naturally pretty good at knowing when I was hungry and being able to stop when I was full, and I didn’t really have a fixation on food. I feel like I was able to think pretty flexibly about it, so to hear those kinds of messages just really didn’t make sense to me at the time.
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Chris Sandel: When you were thinking about “What am I going to study?” and the idea of being a dietitian came up, what did you think you would be doing? Or what were the bits that were pulling you towards that profession?
Emily Fonnesbeck: I think it started out selfishly. As I mentioned, I wanted to learn more about nutrition for myself. When I became interested in dietetics, I took a nutrition course my first semester of college and also started shadowing dietitians at the local hospital. I really loved the class and very much enjoyed the work that I did at the hospital – which is interesting now because, of course, it’s clinical work and was the very last thing I wanted to do after my internship and graduation. [laughs] I did not want to work in clinical.
But that’s actually how it started. I really love science, so going into a health-related field made a lot of sense for me in terms of enjoying the coursework. I really love science. I really love nutrition science, so it felt like a good fit. I loved the science-y aspect of clinical nutrition and calculating tube feedings and all that went into that. I found it really fascinating, at least as a student. So that’s what drew me to it, just for my own interest in nutrition.
But then it evolved into “I really love the science, and I would love to be able to take this into a clinical setting.” That was my goal all through my undergraduate degree and through my internship until I really did get into it during my internship and was practicing as a clinical dietitian and had exposure to other aspects of being a registered dietitian, and I recognised that that was not what I wanted to do. But that is what drew me to the profession in the first place.
Chris Sandel: Then fast forward to after you’ve left the weight loss resort and you’re setting up your own practice. You mentioned that when you were at the resort, you’d been teaching intuitive eating and had gone down that road. Was that really clear in your mind, “This is what I want to be doing”?
Emily Fonnesbeck: Yes, absolutely. I think 6 years into my career, what also very much spurred the interest in private practice is not just professionally what I was realising, but also personally what I was experiencing for myself. I had my own issues with food and body image, and I realised that I needed a new approach for myself too. Those 6 years had run their course, and I needed a change not just professionally, but personally too.
I made it through my undergraduate degree in nutrition fairly unscathed. I feel like I very much continued to keep that positive aspect of why I was studying nutrition and what I wanted to do with it well into my coursework and into graduation. As a registered dietitian, the requirements are to finish an internship and then pass a registration exam. I found out that I was pregnant with our first right when my internship started, and it’s a 10-month internship.
It was a huge surprise. I ended up being able to complete the internship. Prayed every day to be able to finish before I had that baby. [laughs] I ended up having him the day after I finished my internship.
Chris Sandel: Wow. What a year.
Emily Fonnesbeck: It was a year. Luckily I had a very easy pregnancy. I was maybe sick at first, but able to still perform in my internship. That was really rewarding. I wanted to be able to finish well, so I’m glad I was able to. But yeah, that was a big transition out of school and working in this internship into being a mom. And because it was such a year, because it was such a busy, jam-packed year, I didn’t prepare myself well for that transition.
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From what I know now of eating disorders and how they come about, it was very much the perfect storm of likely my biological and psychological and environmental situation that collided to create what became, I think, a coping strategy for myself. I felt the pressures, as many women do postpartum, to lose weight and to heal as quickly as possible. So that, compounded with the fact that I felt like life was so out of control – it was a huge change for me and really played into my Type A personality that really likes to control.
Food and my body became the thing that I could control. I had had such a positive relationship with food up until this point. It wasn’t like there was a lot of red flags or big concerns with exercise or food or body image, really, until I gave birth, until there was this huge life event and life change. I felt this pressure; my body had changed, I’d just given birth, and all of a sudden I gravitated toward controlling food and my body.
It’s interesting to see that happen because I hadn’t ever used food or body image in that way before, but man, it really for some reason became my coping strategy at that time.
Chris Sandel: Was it a gradual process? Because I see for so many clients that it’s a slow process or there’s this one change that then becomes these two changes, and then 6 months later, a year later, they find themselves in some place. But from the way you described it there, it almost sounded like a gun went off and there was a start line and you just started running in that direction.
Emily Fonnesbeck: Yeah, in a lot of ways I do think it escalated pretty quickly. I think essentially what it was is “just get back to the gym as soon as possible, and I’ll start eating less.” I think it started as ‘move more, eat less’, because of course, that’s what I’d learned. In order to lose weight, that’s what you do. Of course, my body had changed with a pregnancy – miraculously and perfectly and exactly how it should have, but of course, in that moment I saw it as a problem that needed to be fixed. So I think that was the mentality I took.
I’m very goal-oriented, and I think this is that psychological component. I’m very goal-oriented and I have a lot of grit, and I want to see things through, and I finish what I start. I think that contributed to this idea of “If this is my goal, I’m going to go 110% in. If I’m supposed to exercise more and eat less, then I’m going to exercise a whole lot more and eat a whole lot less.” I think that’s just my personality in general. That psychological aspect that contributes to eating disorders I think did very much put me at risk.
So yes, it started with that, but I do think it escalated fairly quickly just because of that vulnerability. Over time – I describe it this way: I stayed in a functionally dysfunctional relationship with food for quite a while. I don’t know that I would’ve labeled it an eating disorder at first, but I call it functionally dysfunctional because I think it’s how a lot of people in the world live with food. Because of the culture we live in, because of this mentality of ‘exercise more and eat less’, we tend to be at least a little bit fixated or a little bit obsessed or a little bit preoccupied, at least a little bit, with food and weight.
I stayed there for quite some time of being fixated and preoccupied and ab it obsessed. I think it was easy for me to fly under the radar because I was a nutrition professional, so it was almost expected that I would feel that way or want to focus on those things.
But eventually, what happened is the effects of exercising too much and eating too little caught up with me, so I started having symptoms like digestive issues and fatigue and headaches, muscle aches and joint pain – all of these things that really were just because I wasn’t fuelling my body well enough. But in my mind, I attributed that to the fact that I wasn’t eating perfectly enough, there was something I was eating that was ‘inflammatory’ – which is kind of a buzzword, but pro-inflammatory and problematic, and I needed to figure out what it was and cut it out.
So instead of approaching it as “I have a problem and I need to be eating more and exercising less,” I became more strict with food. I started this quest for perfect eating. What exactly was causing my issues? What did I need to cut out? Could I eat even more perfectly? Specifically things like sugar and gluten and dairy and all of the very villainised foods in wellness culture – the dangerous aspects of wellness culture that really contributed to what I would call slippery slope into elimination diets.
Chris Sandel: Yeah, and I’ve seen that so much with other clients in terms of that approach of “It’s got to be something I’m eating, so if I just pull this thing out or that thing out, then it’s going to get better.”
It’s interesting you say that you were able to fly under the radar because at one end of the spectrum, you’re talking about “I never had any of these issues with food, and then I clearly did and I was eating in a different way,” but you also said you’re very much goal-orientated, so I can understand how then that could muddy the waters a little for someone looking in, thinking “Maybe she’s got this new idea in mind based on the studies that she’s done.”
For a partner or family, if they were wanting to ask questions or were concerned, there’s almost this feeling of “She’s studied this for X number of years. She’s going to be the expert on this,” so maybe you were able to deflect questioning better than someone else because of that ability or because of your degree.
Emily Fonnesbeck: Yeah. That’s actually exactly the comments that I got after I was recovered from an eating disorder. So many friends and family said to me, “Emily, I didn’t realise you had a problem. I just thought you were super smart and knew what you were doing.” That is exactly the comments that I got. “You were a registered dietitian. I just thought you were super smart and knew exactly what you were doing. I didn’t realise that it was a problem for you.”
Now, my close family members I think were able to observe things that maybe more distant family or friends didn’t observe on a day to day basis. But yes, exactly that. It might be harder to address eating concerns with a family member or a loved one that has a degree in nutrition. How do you address that with them? Because you feel like they should know more than you.
And actually, that is exactly what caused so much shame for me in recovery from what eventually became an eating disorder, because I felt like I should know what I was doing. How did I let myself get to this place?
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Chris Sandel: At what point or how long did it take to realize for you, “Okay, this is a problem and this is not good”? Because initially it started out as “This is my goal; I’m goal-orientated,” but at some point that went from being functionally dysfunctional to being an eating disorder. But even when it’s an eating disorder, there’s a lot of people with that going on who are still in the dark and are like, “No, this isn’t really a problem” until there is some point at which they realise “This is now an issue.” How long did it take for you to get to that place?
Emily Fonnesbeck: That’s a great question. It took quite a while because it never would have occurred to me, nor do I even think I wanted to entertain the idea that what I needed was just to eat more. I can look back now and think, “Gosh, how did I miss that? How did I miss that what I really needed was just to eat more food? How did I miss that?” But it was something that really never crossed my mind. It would’ve never actually felt like a solution. So it took a long time to come to that place.
I’m fairly stubborn, and I really like to learn on my own. That’s definitely my personality, “I’ll figure this out.” So I think I did have to learn for myself. I really did have to hit rock bottom, not just once, but multiple times to realise that what I was doing was not at all helpful. No matter what anyone else said to me, I needed to know that for myself. I needed to be ready to make that change.
I think that’s an important aspect of recovery that I really try to value and keep in mind as I help others now. Recovery has to be a personal choice. You can’t do it for anyone else. It has to be something that you recognise, “I no longer want my eating disorder. I don’t want it. It’s not serving me. It’s not helping me anymore, and now I’m ready to let go of it.” It really has to be a personal choice.
I think that’s exactly what started taking place for me – over the course of years, for sure. Cutting foods out in this pursuit of perfect eating was just that slippery slope into elimination diets. I did elimination diet after elimination diet after elimination diet until I was really down to probably a total of five foods that I would allow myself to eat. Of course, you can imagine at that point how malnourished I was and how much I was not functioning well.
My husband was actually the person who helped me see that I had a problem and validated that it was a problem and encouraged me to seek help. Many times over the years – I think he did a few things for me. Ultimately, what helped me seek help was he actually produced an article on orthorexia after we’d had an intense conversation one night about my situation, and he said, “Listen, I think you actually have a problem. I think you have an eating disorder. I don’t think the problem is the food. I think it’s how you think about food,” essentially is what he said.
He produced this article on orthorexia, and I knew the term, but I’d never, ever connected the dots to my own situation until then, until I read that article and I was ready to see it for what it is and was ready to seek help.
I think it took a lot to get me to that point, and I very much attribute that to him, actually, to my husband. I’m asked quite a bit about how to support a loved one with an eating disorder, and I definitely have my husband to use as an example. He was not trained in any of this. He didn’t know what he was doing.
What he did for me, neither of us would’ve been able to describe or label at the time, but essentially what he did over the course of years was he validated and reframed over and over and over again. He helped me feel understood, but he also helped me reframe the situation to allow me to get to a place where I could think more flexibly about my situation. At the first of it, I couldn’t even think about anything other than “It’s because I need to eat more perfectly,” until the end, where I was ready to seek help, where I was able to hold space for another side of the story.
I really attribute that to him over the course of years, being able to get me to that point. What I mean by that essentially is validating and reframing – for example, “I can understand how confusing your digestive issues are, but I wonder if eating more would help with that, if eating more food would help your digestive tract function better.” That’s what I mean. He would validate that it was a struggle and that it was confusing and overwhelming, but also help me see another side of the story.
He’s naturally a very flexible thinker. He’s very relaxed. He’s not impulsive, he’s not reactive. He’s very thoughtful. I think that was a huge gift to me, where I was very much reactive and impulsive. My brain would get very stuck and fixated.
Chris Sandel: That’s amazing that he has that as a skill, or that feels like it’s just his default way of being. That’s fantastic.
Emily Fonnesbeck: Yeah, absolutely. So then I was able to reach out for help because of that conversation and start the process of recovery.
Chris Sandel: Was he then doing a lot more reading and researching on orthorexia after that point as well? My sense is that you did a lot of reading and researching. Did he want to be helping out even more? Or once you got into therapy and had someone else who was going to be doing that role, he became a little bit more hands-off on the topic?
Emily Fonnesbeck: It’s interesting because as I reflect back over those years, I think what he did really well is let me own my own story. He never tried to fix. He offered different solutions, but he really let me own my own recovery. I think he knew my personality, because that is my personality – the same personality traits that got me into an eating disorder were the very same ones that helped me recover. Being goal-oriented, being very dedicated to finishing what I start.
Once I got on the right track, once he helped me find help, I was able to really take over that process of “I’m committed to this. I now realise that I have an eating disorder and I’m very committed to recovering from an eating disorder. I don’t want it anymore. I’m very willing to do the work.” It was excruciatingly difficult to recover from, and he was continually supportive. But just as I needed to come to that place where I was ready and wanted to change, I think he also respected that it was my journey to walk down. He was there to support, but he wasn’t going to do it for me.
I really admire that because being a spouse to someone who has an eating disorder is so difficult. I know how hard that was for him. In fact, we’ve had many conversations about how hard that was for him. But essentially, it was probably harder for him to stand back and let me do it on my own versus getting overly involved in making it happen.
00:41:44
Chris Sandel: Definitely. I’d like to chat about orthorexia, and you can talk about it from your experience, but also we can talk a little more generally for people who are listening. For you, why did orthorexia feel like it was the right label as opposed to say anorexia?
Emily Fonnesbeck: The reason that I think orthorexia resonated the most with me is because the focus was more on perfect eating and the quality of the food, not the quantity of the food. Now, I realise I had gotten to a place where I was overly restrictive, but it wasn’t necessarily because I was afraid of eating too much; it was because I was afraid of not eating perfectly enough, the quality of the food versus the quantity of the food.
I also wouldn’t have said that it was so much about weight. Clearly, when I had started postpartum, so much of that was about weight, but it had progressed to something much different at that point. I think those were the two distinguishing factors where orthorexia felt more descriptive of what I was experiencing than anorexia.
Now, in recovery, though, from orthorexia, I will say that as weight gain happened and as I was eating more, those fears did come up. They did feel more worrisome to me and they did become bigger hurdles in recovery, but I don’t know that it was what motivated the disorder in and of itself.
Chris Sandel: Yeah. What would have been your body image prior to recovery? Was that something that was really concerning you and something you spent a lot of time thinking about? Or it was really only as the changes started to happen that that forced that front-of-mind?
Emily Fonnesbeck: It’s interesting. I don’t know that body image pre-recovery was so much about disliking my body more than feeling like I had control of my body. The motivating factor was definitely control, not body dissatisfaction. I mean, I can’t say that I didn’t fixate on my appearance during the disorder. For sure, that was part of it. However, I think it was more just feeling like I needed to control it. I needed to control how it functioned and how it looked. It was very much a control piece.
Chris Sandel: Was it a therapist – the person who helped you, how do you describe them?
Emily Fonnesbeck: Who I’d reached out to was a therapist when I was ready to get help. It was actually a Saturday night. I called her, and I didn’t think she would answer. I was planning on leaving a message just because I was very ready to make a change at that point, and honestly, I didn’t know what would come Monday morning. How would I feel Monday morning? So I wanted to take advantage of a time where I felt ready to make a change and felt ready to take action in thinking and approaching this from a different perspective.
She answered. She answered Saturday night and I set up an appointment for the following week, and we very much connected. I was lucky to find a therapist right off the bat who I felt a connection with, who I felt a good therapeutic relationship with. That’s who I worked with in recovery.
What was interesting is we didn’t talk all that much about food. What we very much focused on was my perfectionistic tendencies and we worked essentially to overcome that. I think in my heart of hearts, I knew that if I was able to find alternative coping strategies for the anxiety that I was feeling and was able to let go of my perfectionistic tendencies, or to at least find alternative ways of approaching those, I would probably feel more flexible with food. And I was right.
I didn’t necessarily unpack a lot of my beliefs around food with anyone because I also felt very shameful about reaching out to a dietitian to help. I don’t recommend that. Someone in my situation would definitely need a treatment team. It was just very difficult for me to admit to needing a nutrition professional to help me since I was a nutrition professional. Since I wasn’t willing to reach out to someone, I was my own dietitian.
Again, I wouldn’t recommend this, but I put myself on a meal plan and I challenged my fears around food and I unpacked my own beliefs. I did a lot of the same kinds of therapies with myself that I actually do with clients now. For some reason, I was able to stay somewhat objective with myself and really help myself process and heal and recover.
So that’s what recovery looked like for me. That’s what therapy looked like. That’s what the treatment team looked like for me.
00:47:05
Chris Sandel: Nice. You said you did a lot of the things with your food that you now recommend with clients or you think would be good in that kind of a relationship. Can you go into a bit more detail or give some examples of some of the things you think would be helpful in a situation like this?
Emily Fonnesbeck: Yes, absolutely. First I think would be making sure you’re eating adequately and regularly. Because I had such haphazard and chaotic eating patterns in terms of eating adequately and regularly, that was something I did change for myself – creating more regular meal times and snack times. I worked up to something that felt truly adequate, started smaller and worked up to it. That was the first thing.
I also did a lot of values-based work with myself because essentially what I feel like had happened is the eating disorder had hijacked my values. I could see that in so many areas of my life. I was a mom to two young boys, and I wanted to be more engaged and more present in my life and in motherhood, and I valued my faith and I valued so many other things that I wasn’t giving attention. My whole life had been consumed, as is very common with orthorexia, by food and perfect eating.
So I used a lot of values-based work to help me reconnect with what I valued. This is maybe a way to summarise recovery: what you want to do is amplify yourself so that the eating disorder is de-amplified. Essentially, someone who has an eating disorder, the eating disorder voice, the eating disorder itself is amplified in their life. It’s come in and taken over, and they’ve lost themselves. In order to heal and recover, you have to amplify yourself. You have to figure out what you want, what you love, what’s important to you, so that you’re not continually hijacked by the eating disorder.
That’s so much of what I did, values-based work. It was incredibly effective for me to think about what I wanted to spend time on, the kind of person I wanted to be, the things that were really important to me, and intentionally, regularly shift my focus to those things as a way to amplify myself and de-amplify the eating disorder.
Chris Sandel: I use values a lot with clients, because I think you’re right; they can help to be this North Star when you’re making decisions, when you’re reflecting on things. There can be this “Is this in alignment with my values? Is this in alignment with either who I am now or who I want to be?” I think that can be really helpful.
Also what you said about creating some structure. Structure is probably one of the first things – and I’m always client-led, so we have a discussion about what we want to be tackling. But if I’m giving my input, structure is one of the most important things to get some stabilisation, to have this regularity of things coming in. Yes, you were already pretty regular and regimented and rigid in the way you were doing it, but I think that is different to having a structure where the structure is actually about supporting physical health and supporting mental health as opposed to rigid rules that are pushing you further away from those things.
Emily Fonnesbeck: Yeah, I love that description. I love how you described that. I think it’s perfect.
I think one of the other benefits of having that structure that really does support you through recovery is it does open up opportunities to also challenge and break down a lot of the fears and beliefs about food that are holding you back from eating adequately and flexibly and eating in a way that is more peaceful.
And that’s exactly what came up for me. If I’m going to eat regularly, I’m challenging a lot of food rules as I do that. As I mentioned, being able to do that for myself but also doing this for clients, to be able to unpack a lot of those fears.
Something that was very helpful for me, because I had a mind that was so apt to judge a food as right or wrong or good or bad or healthy or unhealthy or clean or dirty – which is very dichotomous, ‘all or nothing’ thinking – so something that was very helpful for me, as I had that support I needed to eat more regularly, what was really helpful is to recognise that I no longer cared if that food was right or wrong or good or bad. I didn’t want to live that way anymore.
The question of whether that food was healthy or unhealthy came irrelevant because it wasn’t helpful to me anymore. It wasn’t helpful to recovery, it wasn’t helpful to my goals. If I wanted to be able to travel with my family without worrying about food, then I needed to be able to eat in a way that was flexible enough to do that. So as meals would come up and I’d be worried about X, Y, or Z that I was eating, it was easier for me to challenge those fears because I wasn’t trying to play the ‘right or wrong’ game. Instead, I was recognising, “Are these thoughts truly helpful to me? Are they getting me where I want to go? Are they helping me meet my goals in recovery?”
That was another aspect of what I helped myself with that I think is very helpful to clients as well.
Chris Sandel: Definitely. When I’m thinking about this from what you’ve described, with your digestive issues being a lot of the driver for you starting to do elimination diets and take out this food and that food, when you’re doing that in the reverse order and you’re bringing foods back in, digestion doesn’t magically get better overnight. In some instances, it will get worse to start with before it gets better. So if there’s this hyper-focus still on “Is this the right food? Is this the wrong food?”, that paying attention can really scuffer your ability to get past that difficult middle phase.
So you being able to say, “I’m attaching this to my values. I’m taking a much broader, bigger picture approach to this and I’m playing the long game,” it gets you out of the weeds and allows you to be able to make a lot of those changes and to keep going with it.
Emily Fonnesbeck: Yes, 100%. I love how you described that. I think you make an excellent point here in that a lot of times, especially when we talk about, for example, intuitive eating being a goal – a non-diet approach and emphasising Intuitive eating and really listening to your body – I feel like I was hyper-focused on my body. I was hyper-focused on every little sensation I had.
Since I’ve been recovered from orthorexia, I’ve done a lot of digging into the research on orthorexia, and it has been associated with symptom somatic disorder. I think that was very healing on a new level, even far into recovery, to realise that so much of what I was doing was hyper-fixation on what my body was saying or what it was feeling, and I had to let go of that.
For example, you brought up the digestive symptoms. I really had to push through what I felt was discomfort to recognise that I can’t go back to restriction, so what am I going to do? Cut out this food because it’s causing my digestive issues? Because I didn’t have any better digestion when I wasn’t eating it. It was still a mess. So exactly, getting out of the weeds to recognise, “No, I’ve got long-term goals here. I’m working towards something.”
And luckily, I very much would suggest that an ‘all foods fit’ mentality is one of the best things we can do for our digestion. Our digestion loves variety. It loves flexibility. I think it functions better in this middle ground and not at extremes. That’s what I found. I really hoped at the time of recovery that if I kept pushing forward and found something that was more flexible and was more moderate and wasn’t so extreme, my digestion would find that same place – and it did. I didn’t know that. There was a lot of trust that I had to put into that. But I knew that I couldn’t go the other way. That wasn’t the answer.
The fact that I walked down that road and knew it was a dead end really did help me realise, “I don’t want to go back there. I have nowhere to go but forward.”
Chris Sandel: Just as a caveat, when I’m working on this stuff with clients, I don’t completely throw symptoms out and say, “Let’s just focus on the long term.” If someone is eating something and every time they eat it, they’re doubled over in pain or they’re getting explosive diarrhea, it’s probably okay to put that food to the side for now and we’ll come back and try it again in a little while.
So it’s not that all of the information and the feedback that you get gets ignored, but it’s more thinking about things bigger picture and realising that some level of discomfort or some level of symptoms worsening are going to occur as part of this, and it’s not that the tiniest little thing should make you go back to what you were doing before.
Emily Fonnesbeck: Yeah, that’s a great way of explaining the nuance there. Always nuanced in that.
00:56:54
Chris Sandel: I know from reading your blog that adoption – I think it was adoption of your third child – was something that really helped as part of this. Can you talk a little about that?
Emily Fonnesbeck: Sure, I’d love to. As I mentioned, I was pregnant with our first child during my internship, which was actually a really big surprise. I’ve had infertility issues for a lot of my life. Actually, menstrual irregularities that turned into infertility issues when I started having kids. So he was a big surprise.
We went through five failed infertility treatments in between our first and our second children. Our second child is adopted here domestically in the States. He was a domestic adoption. He came to us right around where things started escalating into an eating disorder. That was around that same timeline.
Then recovery happened, and I made it to a place that I would describe as halfway recovery. I had made so much progress; I was definitely in a much better place physically, mentally, and emotionally. But I still was a restrained eater. I guess I would describe it that way. It wasn’t full recovery. And I knew that. I knew in my heart of hearts I could still push through a lot of the fears that I had and a lot of the restrictive eating that was still happening. The mental gymnastics and still tracking in some way mentally, I was still doing that. I knew that I could push through that.
So we had these two sons and we started thinking about a third adoption, but I knew that I really wasn’t in a place to take on a third child. And that was very good for me. It was good for me to have that realisation that I still was not in a place where I could continue to move forward with life in a way that I wanted to, like having another child or taking on new adventures and responsibilities or anything else. Life changes felt too big at the time, and that was because I was still somewhat struggling with food – although much better than it used to be.
So that was very eye-opening, and because of that, I didn’t feel ready to have a child then. We decided to pursue an international adoption that we had been told would be at least 2 or 3 years before we would be able to bring her home, and that felt good. It felt good to have some time. It felt good to have this goal to work towards that I was really saying, “I want full recovery by then.” I wanted to be in a place where I could say, “I really feel like I’m fully recovered.”
Because I do actually believe in full recovery. I think there’s some stipulations there. I think full recovery comes with healthy boundaries. Full recovery means that I don’t go on clean eating plans because I know my vulnerabilities. But in a place where I feel fully recovered, with healthy boundaries. I wanted that for myself.
So that became almost a timeline for me. We started paperwork. We started the process, and I did the work that I needed to do in order to bring her home and feel like I was physically, mentally, and emotionally ready for the challenge of bringing home a two-and-a-half year old who didn’t speak English and would need a lot of attention. So it was good to have that timeline, and I’m honestly very proud to say that I was able to do that.
We went to Korea actually twice at the end of the adoption, to first have our court hearing and meet her, and then we went back 6 weeks later to bring her home. I love this story, and I love sharing it because I think it’s exactly what I was hoping for, for myself and for her when we brought her home.
We only had like 6 days’ notice when they told us that we could go back and get her, so we had to take whatever flights we could get. They were non-connecting flights. Both there and back were long travel days. We had like a 28-hour travel day from Seoul back to southern Utah, where we were living at the time, when we brought her home. By the time we landed in Las Vegas, which is 2 hours away from where we were currently living in southern Utah, it was about 1 a.m., and I was so hungry.
I said to my husband, “Let’s go through In N’ Out drive-through and grab something to eat.” So we grabbed something to eat and ate it in our car at 1 a.m., and I shared French fries and a hamburger with our new daughter with no reservations, all confidence, all trust, all respect for my body, and it felt like things had come full circle. I remember sitting there just feeling so glad that I was in this place where I was really ready to take on this new challenge because I had taken care of myself and gotten to that healthy place.
Chris Sandel: That is such an amazing story, which is why I asked you to share it. I think it’s such a great end – and maybe ‘end’ isn’t the right word, but a really good point to signal where you’re at in terms of your journey with this.
Emily Fonnesbeck: Thanks.
01:02:43
Chris Sandel: The other part with mentioning this as well is I know as part of your story, there’s been adoptions and there’s been infertility as part of that. I know for me, working with clients, I work a lot with hypothalamic amenorrhea. For you, was there thoughts around “The infertility is connected to the things I’ve been doing in terms of my eating and my exercise”? Or because there was this preexisting condition that you knew about with your fertility, that didn’t get into it? I guess just getting a sense of how the infertility was for you.
Emily Fonnesbeck: That’s a great question. Like I mentioned, between our first and second sons, we had five failed infertility treatments. My infertility issues did predate my eating disorder. However, because that first pregnancy was such a surprise, I think that is a testament to the fact that I was eating – I had a much healthier relationship with food, my body, and exercise at the time. It created the opportunity for that pregnancy to happen.
So between the first and second sons, we had five failed infertility treatments. It is a period of my life that I would never want to repeat. I swore off infertility treatments from then on out. I’m sure others’ experiences are different, which I totally respect and understand. I just had really negative experiences with infertility treatments, clearly because they were not successful, and it was physically, mentally, emotionally, and financially draining on us.
I think back to that period of time and I actually think that was one thing that fuelled that perfect eating – needing to control. I couldn’t control getting pregnant, but I could control how I was eating and I could control my body and I could control exercise, and there was part of me that felt like if I was more in control of what I was eating, would that help my fertility chances? Again, not really connecting the dots to not eating enough and that negatively impacting fertility.
Clearly these years of disordered eating and an eating disorder did nothing to support my chances of getting pregnant. That’s something that I’ve had to really work through and grieve and forgive myself for, because if you had asked me during those years, the thing I wanted most was to be able to be pregnant. This is a really good example of the eating disorder hijacking my values. If I was able to think more clearly without the eating disorder, I probably could’ve put myself in a better position to realise what my actual goal was rather than control. My goal wasn’t control. That was the eating disorder’s goal. My goal was to be able to get pregnant.
I’ve had to really grieve that and forgive myself and recognise that if I had the chance to go back and change that, would I? I wouldn’t, because beauty from ashes. We brought two kids home through adoption, maybe because I wasn’t in a position to get pregnant because of my eating issues.
It created opportunities. I’ve really had to regret but also be grateful for those years that brought two kids into my life that maybe wouldn’t have come otherwise. Everything happens for a reason, I’m sure.
But then into recovery, after we brought our daughter home, I actually found out I was pregnant 6 months later after we brought her home. It was a total surprise pregnancy, and he’s now two and a half. That was so validating for me, because as I had discussed, I was kind of in this partial recovery place, in limbo for a bit, where things had drastically improved and I was so much better and could function from day to day so much easier – but still somewhat stressed about food.
Aiming for full recovery with bringing our daughter home, and then finding out I was pregnant 6 months later, it was very validating to know that all of that work I had done had put my body in a position to function in the way that it needed to function. Any question in my mind of “Am I taking care of myself well enough?” or “Am I at the right weight for myself?” or any of the questions I had were really put to rest at that time.
I consider that a recovery win and a recovery blessing. It really did feel like icing on the cake in a lot of ways just because of our history with infertility and my food issues, and all of it happening at the same time. I felt like I was able to make peace with both of those things that had been such huge sources of trauma for me, both infertility and an eating disorder. It really felt like I was able to shut that door on both of them and really make peace with it.
Chris Sandel: Nice. It reminds me – I was speaking to a client last week, and we were having a conversation around is she eating healthy, is she doing things that are really supporting her body. I was like, “What do you think is going on? How do you think things are working out?” This is someone who’s very much far along in her recovery journey, and she’s like, “This is the healthiest I’ve been in years. Things are functioning really well.”
I think a lot of her questioning was stemming from the ideas of what we have in our mind about what constitutes healthy or unhealthy food and this really simplified version of what we should eat and we shouldn’t eat. When we match up what she’s doing with that, no, it doesn’t match up exactly how people would talk about a healthy diet. But in terms of the results and how she’s feeling, it is clearly working for her.
That was the conversation we had, and it was really nice for her to be able to make that realisation that it doesn’t matter if your eating looks Instagrammable; it matters much more about how that is then impacting on all the various functions within your body, and for her, it was clearly working, the same way as it was for you in that maybe your orthorexic brain was telling you what you were doing wasn’t the right thing to do, but clearly it was supported because you were then able to get pregnant.
Emily Fonnesbeck: Yeah, that’s amazing. I think that’s such a great way to gauge progress in recovery: to truly be able to redefine health in new ways, like for this client – and even the ability to be able to decide for herself, “Yes, I am in a place where I feel the healthiest I’ve ever been,” and to say that with confidence and trust that that’s true. We often are always looking over our shoulder – whether eating disorder or not. Just culturally, it’s so easy for us to always look over our shoulder and wonder if we’re doing the right thing.
I think that’s a gift that recovery can give you. I think that’s something that someone with an eating disorder who works so hard at recovery is able to do because of that struggle, to truly be able to not have to look over their shoulder anymore because they’ve walked down that road and they’re not going back. They know for themselves that they get to be the one that decides what’s healthy and what’s not for them. Not the Instagrammable – I love that word – version of health, but what truly feels supportive of me and my life. I love that.
01:10:52
Chris Sandel: I know you’ve written a lot now on your blog about your journey and all the things that occurred as part of that. How was it pressing “Publish” on the first post?
Emily Fonnesbeck: [laughs] Yeah. I actually often say that I started blogging for selfish reasons. I think that blogging wasn’t actually to help anyone else – although it was great if it did. To start with, though, it was a way for me to make sense of my story.
That’s something I took from Brené Brown. I’m sure listeners are very familiar with Brené Brown. Her work was very helpful for me in recovery. That’s one of the things she talked about: owning your own story and really being able to describe it and talk about it. In the middle of all that was going on, writing and blogging really helped me make sense of it, really helped me get it out of my head and put it down on paper. And to have to publish it, it had to make some sense. I had to be able to make sense of what was going on and describe it so that I could understand it and readers could understand it.
So quite honestly, blogging for me was selfish. Maybe in my young, naïve self, it was easier to push “Publish” because I knew that it was mostly for me that I was blogging, and I was sharing my story because I wanted to truly own it. I didn’t want to be ashamed of it. I didn’t want to be confused by it. I wanted to truly understand and own it, and that was one of the ways I did it.
Clearly the blog has evolved a lot since then, but those early days were so therapeutic for me.
Chris Sandel: In the early days of the blog, was it then connected to your private practice? I guess when you’re talking about this, my sense would be maybe there was a fear of “If I’m talking about these things and I’m then meant to be a registered dietitian, is this going to drive clients away?” I know you talked about it before in terms of the shame of “I don’t want to get a dietitian to help me out because I should know this stuff.” So was there ambivalence around “If I share this, people aren’t going to want to trust me and what I do”?
Emily Fonnesbeck: That’s a great question. At first, in my private practice, I was very careful about the kind of clients I took on. I didn’t take on any eating disorders while I myself was struggling with an eating disorder. I was very careful about the clients that I took on. I think that helped me feel better about what I was sharing because I knew that I needed to get to a healthier place before I was able to take on more acute care clients. So I think that was helpful at first as well.
I think the other part of it was very much the work I did with my therapist of unpacking my perfectionism and allowing myself to be more vulnerable. That’s something that has stemmed my whole life – valedictorian, perfect grades, perfect student, front row student in every class, intern of the year in my internship. I’ve always been perfect at everything, and I’ve never really allowed myself to be human and struggle.
So I think part of sharing my story was to try to dispel that shame that I did feel about struggling with food. I definitely recognised that maybe it would mean that others didn’t feel like I was the one to help them, but I knew that priority number one was to get to a place where I was able to truly be an effective clinician, and in order to do that, I needed to be imperfect and I needed to know that it was okay to struggle on my own. And through my struggles, I actually think I’m a better clinician because of my experiences, not in spite of them.
I think I had a fair amount of clarity at the time to know that this would lead somewhere good for myself and for my clients, even if it meant risking that clients wouldn’t feel like I was in a place to truly help them at the time – which I totally respected. But as part of my own individual healing, I felt like it was necessary to talk about.
Another big reason that I did blog was because I did start out in my career as encouraging food restriction, encouraging food fears, encouraging a lot of the things that now I discourage. I had promised myself, “If I find a way out of this, if I ever recover from this eating disorder, I’m going to be part of the solution, not part of the problem.” So a lot of what I hoped to share on the blog was to pay penance for that, to right my wrongs, so to speak. To be able to talk about what I was struggling with – not only because I was sharing my story, but also to recognise that all of the things I had been saying had been harmful, not only to others, but to myself.
That was good for me because I was a practicing registered dietitian at the time that I had an eating disorder, and it would be incredibly naïve to suggest that that didn’t influence how I treated others, whether it was at this weight loss resort I was at or in my early days of private practice. I felt the need to really describe the changes that I was making to not only the way I approach food, but also to my treatment philosophies overall, as a way to truly transition away from how I had been talking and thinking about food.
Chris Sandel: I know it might feel like there’s this extra penance to pay because of having the eating disorder and how that maybe steered some of your recommendations, but I would say being a novice and being inexperienced does that as well. If I go back and read some of the things that I wrote 10 years ago or think about the way I thought about things, there’s lots of garbage amongst that. [laughs]
That I think is just the process that you go through as you evolve and you learn more and you become more experienced, and not just in a clinical or scientific understanding side of things, but how to be a better practitioner, how to be in a room better with someone, how to hold space, how to create space for someone – all of those things are learnable skills, but they’re learnable skills that take time, and I don’t think there is any shortcutting that.
So I think all of us who are practitioners in this field, if you reflect upon where you started out and where you are now, if there isn’t some level of cringing or wishing you could’ve done something a little differently if you had known better, that’s probably more worrying. That’s probably indicating there hasn’t been enough development over the years.
Emily Fonnesbeck: I love that perspective. Absolutely. I would imagine that anyone listening – you want to have a practitioner that’s willing to admit that they’ve been wrong or willing to admit that they don’t know everything and are continually learning, right? Sometimes I think we forget that professionals are human too. Allowing our own humanness to show up there I think is good for everyone.
01:18:55
Chris Sandel: Yeah. I think that humanness – you made reference before in terms of having a great therapeutic relationship with your therapist, and I think that goes such a long way and is in some senses the most important thing in helping people, having that good relationship and a relationship of like “We’re going to figure this out together.” From my perspective, if I could go and do things over or do things differently, it would be putting more of a focus on that in the early days and realising how important that was as opposed to reading all the nutrition books.
Emily Fonnesbeck: That’s a great point. Something that has helped me many times over the years when I wonder if I’m doing enough for a client is to first prioritise the client-practitioner relationship. Not so much of coming in to fix or coming in to heal, but creating that relationship.
I appreciate you bringing that back up because that’s very much what I felt like my therapist was able to do for me. I always felt understood by her. I think she did understand me quite a lot, actually. She made lots of comments about how she had had similar concerns or similar struggles with perfectionism, and it was very validating to hear that. I don’t know that that’s always necessary, for you to have had the same life experiences by any means – but just as an example of how she was willing to be human in our session, and it was helpful for me.
I think that’s something that I have learned over the years, as I’m sure you have, Chris, as well: it’s okay to be human in sessions. You don’t have to be a robot. You don’t have to completely ignore yourself. In fact, by bringing your whole self to those sessions, there’s a new layer of healing that could happen for the client. I love that point.
Chris Sandel: Yeah, I don’t think it’s just okay; I actually think it is necessary. I don’t think you can operate from a place where I’m up on a pedestal and you’re down there, and I’m being the one that’s giving you the advice. That doesn’t really work. Or it might work, but it works only so long as the relationship continues on, and once that stops, then someone isn’t helped.
Often the failings with inpatient facilities is there’s this real power dynamic that is skewed, where someone comes in and they’re seen as this feeble person who can’t look after themselves, and “We need to make all these recommendations that are forced upon them to get them to behave and get them to a better place.” The person then typically will follow, or there can be some resistance, but maybe in the end they follow the recommendations – but it’s always following recommendations as opposed to it coming from within them and them learning how to make the choices and the decisions.
So I feel that’s just not in service of someone, longer term. I think the humanness aspect of it and bringing it down so that you are two equals who are trying to figure out a common struggle or a common goal is really the path forward.
Emily Fonnesbeck: I love that point. That’s an excellent point, and I think you bring up something really great about treatment facilities. I don’t think this is true for all of them, but I have had a lot of clients who have had some major trauma from inpatient treatment because of that very dynamic of feeling like they weren’t empowered. They just had to do it because someone was telling them to do it, versus having a relationship with their provider.
01:23:12
Chris Sandel: Yeah. What about with your kids through all of this, in terms of feeding your children? How was that when you were struggling with orthorexia, and how is that now?
Emily Fonnesbeck: That’s a great question. I think I mentioned earlier about my rock bottom moments and how I needed quite a few of them because I’m stubborn. One of my rock bottom moments was realising the effect my eating was having on my kids.
Of course, if I’m in a mindset of controlling food for myself, it would naturally carry over that I would want to control food for my kids. I was the ‘gatekeeper’ of food. I was the one preparing it, I was the one providing it, so it was a natural overflow of a lot of my own struggles.
I remember one Sunday we came home from church, and my son had been given a Kit-Kat bar from his Sunday School teacher. I said, “Let’s go home and have lunch first. Let’s not have that right now.” He came home and he said he was going to go down to his room and change his clothes and he hadn’t come back up, so I went down to find him and he was sitting in the corner, eating this Kit-Kat as fast as he could before I saw.
That was one of the really rock bottom moments where I realised that I’m actually encouraging the kind of behaviours that I really don’t want my kids to have. I don’t want them to eat in secret. I don’t want them to have to shamefully eat something. I don’t want them to have to hurry up and eat something before I see it, and that was exactly what I was watching. So that was one of those times that again helped me see that I wasn’t being the kind of mom that I wanted to be, whether it was food or otherwise. It was just an eye-opening moment for me.
I’m glad to say that as I healed my relationship with food, by association, they became much more trusting of me with food and being able to eat Kit-Kats in front of me and being able to navigate food in more flexible ways.
I do think I’ve had to have more straightforward conversations with my oldest, who was probably five or six at the time of the Kit-Kat incident. He was older, so over the years I’ve had more straightforward conversations with him about what I was struggling with and why food used to be the way that it was and how that’s changed, because I wasn’t in a healthy place and now I am. I think that’s been healing for him and me, to be able to be very open and honest about that – in obviously age-appropriate ways as he’s gotten older. He’s now almost 16.
So that’s been good, to be able to have those straightforward conversations. My others were young enough that I don’t know that it has had as much of an impact. I mean, clearly my last two, they didn’t see any of the eating disorder. So straightforward conversations with him and just luckily being in a much better place with food to be able to raise kids in a more positive environment.
Chris Sandel: You said obviously you had these thoughts around food and then ostensibly through that, that impacted on your children, but I wonder – often what I find when talking with clients is that “there’s one rule for me and then there’s a rule for everyone else.” It can almost be like, “Oh, that’s okay for those people, but it’s just not okay for me.” I just wonder how much of that was part of your story and they were able to have things that maybe you weren’t because that was different for them.
Emily Fonnesbeck: I think that’s fair. As I mentioned, at my worst I was down to eating five foods. By no means was I making them eat exactly what I was eating. So for sure, my rules were different. But in my mind, I was doing what needed to be done for myself. I was doing what needed to be done for them. It was too strict, it was too restrictive. There was not enough trust and respect for their bodies in making food decisions.
So yes, absolutely, the rules were different, but at the same time I really felt like not letting them eat sugar or not letting them eat X, Y, or Z, or limiting it to only so many times was helpful. I really believed that I was doing them a favour. If I look back, it was all fuelled with so much anxiety and worry that I recognise that that was a good sign that I was not on the right track. But at the time, it felt like I was doing something helpful for them.
Again, going back to this story with the Kit-Kat, that was a good realisation that I’m not doing good. What I was doing was not helping them, and it helped me see another side of the story.
Now, we all eat the same. I eat the same things my kids do, they eat the same things I do – obviously within reason, because food preferences are different, and that’s normal. And man, it’s just a lot easier to feed myself and a lot easier to feed them, and so great that they can see me eating the same things that they are.
As I started recovery, I remember my oldest seeing me eat pizza for the first time and being like, “You never eat pizza! Why are you eating pizza?” Or “I’m so excited you’re coming to dinner with us, Mom!” They would be so excited to see these new changes and new differences. Or “Oh my gosh, Mom’s eating ice cream! That never happens!” That was very rewarding and kept me wanting to heal and wanting to recover.
Chris Sandel: And also, I’d imagine, a good reminder of maybe “I didn’t realise they were noticing this as much” or “This really proves the point of how bad things would be if this is the comments they’re now making.”
Emily Fonnesbeck: Yeah, because no kid should have to worry about if their mum’s going to eat X, Y, or Z at dinner. In my opinion and expertise, I don’t think that that is necessary for kids to have to think about or worry about. We all just eat dinner together. So, exactly, recognising that if they’re making that comment – “Man, it did get pretty bad for you to have noticed.”
Chris Sandel: I’ve got an almost three-year-old now, and it is so enjoyable – we very much follow the Ellyn Satter Division of Responsibility – knowing that I put food on the table and then my job is done. I’m not having to force someone to eat broccoli or force someone to have some chicken or anything along those lines. It’s “This is what there is; you can have, from this, whatever you want in whatever quantities you want. My job is not to force you to eat anything.”
Emily Fonnesbeck: I love that point. It is less stressful for everyone, including the parents, to use that Division of Responsibility of Ellyn Satter’s. It’s a more enjoyable experience for you, and less stressful. There’s less overthinking, much less worrying about if you’re doing a good job feeding your kids or not. It’s rewarding for both parties, the kids and the parents.
And I can see that in myself, how much less stressful food is in general with kids, knowing that I am just going to do my job and I’m going to trust them to do theirs. The struggles happen when we cross that line over into trying to control our kids’ jobs. And that’s exactly what I was doing and exactly what I mean by it always felt disconnecting and anxious and worrisome. Those feelings should’ve been feedback for me that something was off. I just thought that was normal. “This is just a normal part of feeding kids.”
Maybe this is helpful for listeners to recognise. If you’re feeling anxious and if you’re feeling worried and you’re always second-guessing yourself with feeding your kids, it doesn’t have to be that way. That’s helpful feedback. Those feelings are helpful feedback that something’s off, and it could be better.
Chris Sandel: Definitely. I also recognise that there’s no way I could do this if I had real strong preconceived notions of what he should be eating or any sort of orthorexic tendencies because by saying that mealtimes aren’t stressful – I mean, that’s not completely true; there is always stress, or can always be stress, at a mealtime with an almost-three-year-old. But it works because you trust the bigger picture principles.
There are meals where we will sit down and all that is consumed is some white rice or a couple of handfuls of grapes or just a piece of chicken and nothing else. If I’m putting on my real strict nutritionist hat, I can come up with all the reasons why there should be X, Y, and Z other food that needs to be accompanying this meal and all of those things.
But by being able to recognise the longer term benefit of having him become a competent eater and figure this out – just noticing there’ll be times where he really does want more protein, and there’ll be times where he really does want more carbohydrates, and there’ll be times where he only wants to eat one or two things and there’ll be times where he eats a whole variety of things all in one meal. I think you have to be in a certain place for that to actually work.
Emily Fonnesbeck: That’s a really great point, and I love it, because it very much hits home personally with something that I think was very helpful in my recovery to recognise. It’s just that I needed to get rid of any of my own biases around food or eating patterns or weight in order to do two things.
One, to feed my kids in a way that I wanted to – and to truly support them in creating a healthy relationship with food and their bodies, I needed to give up those biases. I needed to challenge them. I needed to let go of them. Like you had said, get rid of those preconceived ideas of what they should eat or how they should look or all those biases that I think are very natural for us to develop in the culture that we live in.
Two, if we’ve been trained in nutrition, and like you say, we put on that nutrition hat and we want to be more objective about it, I knew I needed to do that for my kids and I also needed to do it for my clients. It wasn’t really an option for me to go back to having those biases or judgments about food. I needed to adopt the all foods mentality to truly be effective as a clinician, to not go into sessions biased on what they should be doing, what they should weigh, what they should look like, what eating patterns they should or shouldn’t have. I needed to let go of those so I could be in that position to hold space and to look at things in different ways and to truly dig deeper and understand. So I love that you brought up that point about preconceived ideas.
01:35:12
Chris Sandel: I know you said before that when you were first writing the blog, eating disorder clients or patients weren’t the people that you were working with, so it felt safe to be writing. What was it like to then transition into working with that population? Was there a fear of “This could be triggering, and maybe I can’t work with this population in the end because it’s going to bring up too much stuff for me”?
Emily Fonnesbeck: I actually think this is the safest place for me to be. I say that maybe even somewhat selfishly. I don’t think that I could practice in any other area of dietetics. I could not be a registered dietitian anywhere else. Maybe there’s a few. But I think in terms of my own wellbeing and my own personal views on the way that I want to approach food and body image for myself because of my history, this is a really safe place for me to be.
I think it did need to get to that point, and I don’t know the exact time where that switched. I think it was a much more gradual process than a flip of the switch. But to really come to a place where of course my history will always influence my work, but not because I’m still struggling and feeling triggered by things people have said, but because I understand them personally, because I have that personal experience. When they say something, I can truly say, “I’ve been there. I get that. I understand.”
I think that makes me more effective, but I needed to get to a place where I could sit with someone and I could hold their hand and nothing they said would’ve triggered any of my own issues. I needed to be truly healed in order to be able to lead someone else in the recovery process.
So I think it was a gradual thing of taking on different kinds of clients. Some of the clients that I work with now, I would never have dreamed of working with in those earlier days, but I feel much more confident in doing that. And a lot of that is not just because of my own personal recovery, but like you had mentioned before, just how we evolve as practitioners and we learn more and we become better at what we do.
It was a natural progression, to be honest, but man, I feel really safe here. I feel like it’s the only fit for me, to be honest.
Chris Sandel: Because of your experience with orthorexia and obviously coming on podcasts and talking about it or writing about it, within all the various eating disorders, is it orthorexia that is making up more of your client base than others?
Emily Fonnesbeck: That’s probably fair to say, yes. I would say that a large percentage of my clients probably struggle with restrictive eating patterns, orthorexia, a lot of the food fears, elimination diets being that rabbit hole into orthorexia – because I talk about it so much, so oftentimes they connect with that.
But I also have other clients that struggle with different kinds of eating disorders or even different kinds of disordered eating. I think that’s the beauty of treating eating disorders: there’s so much the same. There’s so many similarities in terms of the struggles, and there’s so many similarities in terms of the therapeutic approaches that would help someone make peace with food and their body. And of course, the way we talk about it or the struggles that we process and unpack might be a little bit different, but that’s what I would say in terms of treating eating disorders.
One thing that I would offer – this comes up a lot in sessions, and it’s coming up for me right now, so I’m going to mention it – I think one of the biggest lies an eating disorder tells someone is that they’re different or they’re special or they’re unique. For example, I get a fair amount of inquiries from those that are looking for a dietitian to be on their treatment team, and they’ll say something like, “I’m wondering if you can help me because I kind of have a unique case” or “I’m wondering if you can help me because my eating disorder is a little bit different.”
I understand that. Everyone’s situation is different, and every situation is unique. Also, recovery from an eating disorder, while the process could be a little different and it’s not linear for anyone, there’s so many similarities. I think it’s actually problematic that a lot of people who struggle with eating disorders feel like “This advice would work for everyone else but me. I’m kind of different. My situation is different. Therefore, that doesn’t totally apply to me, so I need to make sure I’m finding someone to help me that recognises that the usual recommendations don’t totally apply to me.”
I think that is a tool of the eating disorder to keep itself safe. I bring that up here only because while eating disorders definitely manifest in different ways and the behaviours are different, the way that you’re healing from those may be a little bit different, so much is the same. Anyway, I just want to offer that to think about.
Chris Sandel: You and I are on the exact same page on this. Interestingly, I released a podcast recently with a past client, and this was one of the take-home messages that she wanted to get people to understand: you are not unique, you are not special in terms of your eating disorder. There are things that need to be done to help you get better.
I agree, and I also think this comes from this false siloing of “This is one eating disorder, this is a different eating disorder,” like orthorexia is different to anorexia, which is different to binge eating disorder, and creating these false differences between all of these, where actually at their core, there’s a lot of overlap and a lot of similarity.
The reason why that can be difficult is that people read all the different symptoms that are associated with anorexia and they’re like, “Well, I tick some of those boxes, so yeah, definitely, or I tick a lot of them, but there are these other things that are going on that means that doesn’t match up, so it definitely can’t be that.” Then they read the list for orthorexia and they can see there’s some of these things, but not these other things. You get into this place where you feel like you don’t match up to all of the descriptors, so basically every eating disorder becomes an atypical eating disorder because you’re not matching up entirely with the descriptors.
But I also think – and this connects to what you said – this is fuelled largely by the eating disorder. Constantly when I’m working with clients – and this happens a lot more in the early stages, and I think probably prevents people actually reaching out to start with – is there’s always this search for another way of recovery. Like, “How can I do recovery where I don’t have to put on weight?” or “How can I do recovery where I don’t have to give up exercise?” or “How can I do recovery with these other conditions that I want to be able to have?” and this sense, and probably a false sense, that “There is this alternative; I just haven’t stumbled upon the website or the blog yet or the person talking about it.”
I find this a lot with people researching reverse dieting or all of these different things that promise people this way of being able to recover without really facing up or dealing with any of their greatest fears around putting on weight or having to change things in any drastic way. It really speaks so loudly to the eating disorder of like, “Yes, this is what we’ve been after. This is what we’re wanting.” From my perspective, that stuff is just a mirage, and it doesn’t get people to where they want, but it sells really well or it makes people constantly have that search for what is going to be the alternative.
Emily Fonnesbeck: That’s a great description of the problem, all of it – the different diagnostic criteria that we may not totally meet, and then all of the alternative therapies that are touted as a solution that often feel like an easier road rather than the recovery road. And I know the clients who I work with put a lot of trust in me, and I don’t take that lightly whatsoever. I realise the trust they’re putting in me in saying “This is what’s going to work for you.”
But often that is exactly what’s required: to reach out to professionals and let them guide you, and letting it be a therapeutic relationship and a collaborative approach, but not necessarily feeling like you’re the exception to what we know works in eating disorder recovery.
01:45:16
Chris Sandel: Definitely. I want to find out more about the Eat Confident Collective. This is something that you run. Can you talk about this?
Emily Fonnesbeck: Absolutely. My business partner, Stephanie, and I have a group coaching program for women who struggle with food and their bodies. We call it Eat Confident Collective. It’s a monthly membership program where we teach on various topics relating to intuitive eating, exercise, self-care, body image, and all of the things that wrap up in there, with regular coaching each week.
One of the reasons that we created it is, first, walking this road can be pretty lonely. It’s like swimming upstream, thinking about food and your body in new and different ways that you haven’t been conditioned to culturally. It’s often like swimming upstream. So we wanted to create a group coaching program with a community of women who could support each other.
It’s incredible to watch. It’s incredible to be a part of. We, I know, are biased, but we say it’s the best group of women on the internet because it’s so great to see them show up for each other and support each other. I think there’s something actually really healing and therapeutic for an individual who is cheering someone on, doing the same things that they’re hoping to do.
The other reason that we wanted to create this group coaching program is because we know that often, getting help can be cost-prohibitive. One-on-one sessions are an investment – and often are necessary, depending on the individual. Our group coaching program is not for someone with an active eating disorder, but it is for women who want to have support and coaching in creating a more peaceful relationship with food and their body, and it is a more affordable option. We love to be able to provide that.
Chris Sandel: For you, are you enjoying doing it with Stephanie? I know for some people, being an entrepreneur or a solo entrepreneur can feel lonely or can feel isolating. Is there something enjoyable that you’re getting out of this being a partnership?
Emily Fonnesbeck: Absolutely. Private practice is kind of like living on an island, and I love it in so many ways. I love the individuality. I love the flexibility of private practice, but there is something so rewarding in working with someone else and collaborating with someone else and bouncing ideas off someone else. I think the quality of what we do there is because of that – because there’s two of us, because there’s two different perspectives that are offered, because we can feed off of each other and we can collaborate together in how to make it the best possible experience for our members. And it is good to have a friend to work with sometimes. [laughs]
Chris Sandel: Nice. We have covered a ton as part of this, and I want to thank you for being so open and talking about your story and for being able to share everything you know. Is there anything we didn’t cover that you were hoping we’d chat about?
Emily Fonnesbeck: No, I think this was a very good comprehensive view. I hope there’s some really good nuggets to take away for listeners.
Chris Sandel: Nice. I guess my only other question is like, when do you sleep? [laughs] You’ve got four kids, you’ve got a private practice, you’re running this other thing – it sounds as though you have a very full-on life.
Emily Fonnesbeck: Yeah, it’s a full life. I like to say full versus busy. It’s not all rainbows and sunshine over here all the time. There is obviously always growing pains and learning how everything fits together all of the time.
But when people ask me this question, I think it’s really important to respond and recognise that this is what recovery gave me. I think for years, my eating disorder, my preoccupation with food and my body just stole so much of my life – and I have a lot of regrets around that. Maybe I’m making up for lost time, I don’t know, but I feel like I have my brain and I have my values back and I have my life back, and I’ve chosen all of it. I’ve chosen to have four kids, I’ve chosen to have two businesses. I’ve chosen all of it.
I also choose to take care of myself, so I do sleep. But that’s testimony to what’s possible when you’re not struggling with food and weight.
Chris Sandel: Definitely. I think that’s a really good testimony and a great place to end. Thank you so much for coming on the show. I really enjoyed this.
Emily Fonnesbeck: Thank you for having me.
Chris Sandel: That was my conversation with Emily Fonnesbeck. I felt like we covered a lot, and I hope that there were many things you got out of hearing Emily’s experience with orthorexia and her recovery journey with it and our discussion about eating disorders more generally.
As I mentioned at the top of the show, Seven Health is now taking on new clients. If you’re interested in working together or just finding out more, you can head over to seven-health.com/help. That is it for this week’s show. I will be back next week with another new episode, so stay safe and I’ll catch you then.
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