Consistent, Not Constant: Rethinking Support

Want to help someone with an eating disorder without turning into the food police? We sit down with eating disorder dietitian Kelly May to get painfully practical about what to say, what to avoid, and how to build support that actually reduces shame instead of fueling it.

We dig into the real goal of support: increasing openness, decreasing isolation, and protecting autonomy, not controlling meals or trying to “fix” recovery with the perfect line. Kelly breaks down why vague, unlimited support often collapses, and how simple agreements made outside the hard moments can change everything. We also talk about the tricky reality of friendships formed in treatment, how to handle food talk in the real world without moralizing nutrition, and why appearance-based comments like “you look healthier” can land so wrong.

You’ll hear concrete language you can use right away, including two phrases that keep trust when emotions spike: “How can I help?” and “I’m so glad you told me.” We also cover how to repair after you accidentally say something harmful, what effective boundaries look like when they include follow-through, and how supporters can address burnout by getting their own support and prioritizing the relationship, not just symptom management.

If you care about eating disorder recovery, HAES-aligned nutrition counseling, meal support, and mental health support that’s compassionate and realistic, this conversation is for you. Subscribe, share it with someone who supports a loved one, and leave a review with the one support question you wish more people would answer.

Show notes:

Trigger warning: this show is not medical, nutrition, or mental health treatment and is not a replacement for meeting with a Registered Dietitian, Licensed Mental Health Provider, or any other medical provider. You can find resources for how to find a provider, as well as crisis resources, in the show notes. Listener discretion is advised.

Resource links:

Alliance for Eating Disorders: https://www.allianceforeatingdisorders.com/ 

ANAD: https://anad.org/

NEDA: https://www.nationaleatingdisorders.org/

NAMI: https://nami.org/home

Action Alliance: https://theactionalliance.org/

NIH: https://www.nimh.nih.gov/

How to find a provider: 

https://map.nationaleatingdisorders.org/

https://www.psychologytoday.com/us

https://www.healthprofs.com/us/nutritionists-dietitians?tr=Hdr_Brand

Suicide & crisis awareness hotline: call 988 (available 24/7)

Eating Disorder hotline: call or text 800-931-2237 (Phone line is available Monday-Thursday 11 am-9 pm ET and Friday 11 am-5 pm ET; text line is available Monday-Thursday 3-6 pm ET and Friday 1-5 pm ET)

If you are experiencing a psychiatric or medical emergency, please call 911 or go to your nearest emergency room.

Transcript

Health Redefined And Sponsor

SPEAKER_00 0:00

Join us as we redefine, reclaim, and restore the true meaning of health. Let's dive into the tough conversations about mental health, nutrition, eating disorders, diet culture, and body image. This is Nourish and Empower. This episode is brought to you by Hilltop Behavioral Health, specializing in eating disorder treatment. Hilltop offers integrated therapy and nutrition care in one compassionate setting. Hello everyone, and welcome to this week's episode of the Nourish and Empowered Podcast. Today we have Kelly May, who is an eating disorder dietitian who began her career in higher levels of care and now works in outpatient practice in Raleigh. She takes a weight-neutral, haze-aligned approach, helping clients move away from rigid rules and toward more consistent, adequate, and flexible eating patterns. Her work is focused on helping people reconnect with their bodies and build patterns that feel sustainable over time. She enjoys collaborating with patients and the rest of their treatment team to support recovery that feels both supported and sustainable. When she's not working, she's usually playing pickleball, oh yeah, in the middle of a home project or hanging out with her dog, Nadine. Oh, I love that name. Oh, thank you. Welcome. Thank you so much for being here today. Thanks for having me. I'm excited to do this. And I know you and Maggie know each other.

SPEAKER_02 1:46

We do.

SPEAKER_00 1:46

How'd you guys meet? Was it pickleball?

SPEAKER_01 1:51

Or do you want me to? Yeah, no, I can I can say it. So, because it's actually, and then we do have to do the trigger warning too. I don't want to forget that. But it actually is a very funny story because I was not supposed to be at pickleball that night. It was in like the fall semester, and I was teaching on Monday nights, and I forget what happened. I think it was like a there was like a Zoom outage or like something happened or Canvas outage, and I couldn't teach my class that night. So I wound up like having this free night, and I was like, oh, okay, like I'll just go to pickleball. Like I didn't have anything else going on. And I wound up going.

SPEAKER_02 2:26

And I never get to indoor pickleball. You I mean, now I do because of you, but I was really never there before.

SPEAKER_01 2:34

Yeah. So like, so Kelly should not have been there. I should not have been there. And one of our other friends, Haley, was there as well. And we were like, I think basically like the only three women that were there. And so I actually thought Haley was somebody else who I had met like a couple weeks prior. So I had like kind of gone up and been like, Oh, I think my husband played against like your husband. And that definitely was not her. But we just started talking, and then Kelly, Kelly kind of vetted me, which was really funny. She was like, Oh, what do you do for work? And I was like, I'm a dietitian. And she was like, Really? Like, what kind of dietitian? Yeah.

SPEAKER_02 3:12

Where I was like, oh no, I'm also a dietitian. And now she's gonna think I'm that type of dietitian. And it turns out we were both good dietitians.

SPEAKER_00 3:23

You, I was like, You're the right type of dietitian. But isn't it so funny how even in the field you have to like get your feelers out? You can't just be like, oh, dietitian, or like, oh, therapist, because like even clinicians with me, they're like, Oh, you're an eating disorder therapist. Can you help me? And then say something really like icky. And I'm like, hmm. Like it's it's funny how you have to do that.

SPEAKER_02 3:46

Yeah, no, exactly. This was like fates, I think that this was universe trying to reward us both for putting ourselves out there.

SPEAKER_01 3:54

Yeah, yeah, yeah. It was a me cute, it was a friendship, me cute, and then we became like very fast friends after that. So and like crazy enough, right? Have had like very similar career paths, which is just so funny.

SPEAKER_02 4:07

Oh, yeah. No, it's so fun to have a friend who I can chat about work stuff with and like bounce some clinical stuff off of, but then also talk about pickleball and have friendships, and so it's so fun.

SPEAKER_00 4:20

I love this. I my heart is so full for two reasons. One, because I'm very protected of Maggie. So, like, thank you so much for taking care of our girl while she's in this like new place. Like, that makes me just feel so happy. But like, friendships are so like people don't realize the true meaning of adult friendships and like making friendships as someone like in their 30s, and how like what that feels at least for me, and like what that feels like, and so like it's just it's so wholesome, right? Because like I know one of my best friends just moved to Arizona. Sam did, Maggie, and so she has to like restart her whole life out there. She has family, but like it's scary.

SPEAKER_02 5:02

No, I think it is. We've talked before about how we almost need to have like a night where we do a little PowerPoint of all of our like backstory and lore. Because it comes out in like little spurts of being like, you might not realize why this is really significant, but we will like go to like networking events in the area, and I'm like, oh, okay, here's a part of like my background that you don't really know about yet, and let me like pull you up to speed so that you might understand why I'm kind of feeling nervous with this person in particular. Or so there's so many fun little things that I think that you actually miss when you've like kind of missed that like early part of your career and developing together that like we get to pull each other up to speed with, but then with the benefit of like being out of it and being able to like talk about the way that it changed us or impact things without being so immersed in it. So it's kind of fun. I really empathize with people who are moving in their 30s and having to make so many changes, but also I think that we know ourselves better the older that we get too, and so we can like communicate about what we need and why we make good friends for each other a lot easier and quicker, too.

Trigger Warning And Disclaimers

What Support Is Really For

SPEAKER_00 6:13

100%. 100%. All right, real quick before we continue, I just want to put our trigger warning out there. We are identifying the following triggers that will be discussed, but are not limited to eating disorders and mental health. Listener discretion is advised. This show is not medical nutrition or mental health treatment and is not a replacement for meeting with a registered dietitian, a licensed mental health provider, or any other medical provider. You can find resources for how to find a provider as well as crisis resources in the show notes.

SPEAKER_01 6:45

Well, Kelly, we're so happy that you're here. And we have been wanting to do more episodes like geared towards support people because I mean, I'm sure you feel the same way as us, but like we get a ton of questions. You know, the supports of people we work with asking, like, what do I say? What do I not say? You know, how do I approach things? They want to help but not be overbearing. So we're so happy to pick your brain today.

SPEAKER_02 7:09

Yeah, no, I'm so excited to pick your brains about this too. I feel like this is one of those topics that is almost like circling around the work that we do with patients, where we spend so much time with them one-on-one and then pour with them, but then like get an email being like, How can I support this certain situation? And those are questions that I've had throughout, I think, all of my career. So I'm like, I don't think that I have all the answers. But I do think that this is one of those topics that is really important and helpful for people to think through. Yeah. Either if they have an eating disorder, figuring out what would feel supportive for them, but also like for family members and friends. And I think one of the areas too that I always think is so interesting is I know we've worked in treatment centers, both me and Maggie have. I don't know about you, Jessica. Okay, have you I think one of the really interesting areas that I've noticed we never really talked about when I was working at high levels of care is what that support looks like for people who meet in treatment. So many of my patients, like some of their closest friends, are people who they've met in treatment. And so, like, what does that support really look like? How do they get it from people who understand what they're going through? Are those always the best people to go to? I feel like it's mixed.

SPEAKER_00 8:25

I love that you brought that up because no one talks about that. And I I absolutely agree because I remember when I like first started working like in the field, like after grad school, working in a higher level of care, PHP, IOP program with eating disorders, like that was my first job out of the gate. And I remember one of the things I was taught was, you know, reinforce that like this isn't a place for friendships to like outside of treatment. And I, as much as you can like logically understand that, it's also so hard because you're emotionally vulnerable every single day in front of all of these strangers every single day. So you're obviously going to build some form of an emotional connection to these individuals. However, it is very dicey because you might be, you know, I know nobody listening can see what my hands are doing, but like you might be hearing your recovery and your peer might be hearing your recovery. So then when both of you discharge, how do you make sure this doesn't like affect the way that you're transitioning from one level of care to the other and like maintaining that strength? So it is hard to know like, do you say yes, or like, do you hold the boundary of like this isn't the place for friendships? It's tricky.

SPEAKER_02 9:44

Yeah, yeah. And I think what was so interesting when I worked at higher levels of care was that we we talked so much about how eating disorders thrive in secrecy, and then we would be creating this weird environment where friendships had to like stay a secret. And then I was like, I don't know if that actually works.

SPEAKER_01 10:06

That's a good point.

SPEAKER_02 10:08

Yeah. So that's why I like outpatient. I feel like we get to have these sorts of conversations and it not be, you know, like when patients are in a higher level of care and we've got these like really strict ideas about what we think would be helpful for them in terms of like ongoing communication or support with each other. I think it's tough when it's like they leave. And could that actually be an environment where we're teaching what support really looks like and how to ask for that and how to say what's not supportive or what they really need?

SPEAKER_01 10:39

I think it's probably helpful.

SPEAKER_00 10:42

Yeah.

SPEAKER_01 10:43

It's a really good point. Because I also feel like too, clients then have had this experience where they want to separate away from those friendships, but they don't want to trigger somebody or they start to recognize like, well, we're at different places in our recovery, and maybe this friendship isn't serving me that well. But then it then all of the like typical friendship breakup emotions come in, in addition to you know, everything that they went through together and like the bond that they have, and it's just it's it's sticky.

Treatment Friendships And Aftercare

SPEAKER_02 11:13

Yeah, it is. Yeah, yeah. I think with some of that, I feel like I have a lot of conversations with my patients about and their and their family or their friends and their supports. I have one patient who often brings a friend in who they live with, their roommate, and like we'll talk in our appointments about like how support is going, which I think is really fun. But I think that one of the things that I always am talking about is like what the goals of the support are. It's not like to control or to convince the person to eat or to stop a certain behavior. But if we think about how eating disorders thrive and secrecy and shame, I think that then some of the goals are around like increasing openness, decreasing isolation, and really in lots of ways, I think supporting autonomy, that the person with the eating disorder is definitely the one who's suffering the most and has the most responsibility to participate in the change process. And so it's really hard. And I think that doing that in isolation is even more difficult. So a lot of just like decreasing shame, increasing openness, supporting autonomy, yeah, but not controlling or convincing. So much of it is just like being with people. I read this book. I don't know if you guys have read Group by Christy Tate. It's like a memoir on being in group therapy. It's really interesting. And uh part of what she talks about is how she had really wanted individual therapy, like just one-on-one with this therapist who she'd heard really good things about. And he was like, Sorry, I am not willing to see you individually. You, but you can join group therapy because I think that that's what you really need. And she was really set, yes, Christy Tape.

SPEAKER_00 13:03

Yes, it is. I obviously immediately went on to Amazon. This one, yes, okay, perfect. Yes, add to car.

SPEAKER_02 13:10

So she says it's so good. She says something in it about how the facilitator told her that she didn't need a cure, she needed a witness. And I think that that's so poignant that lots of times our patients with eating disorders don't actually need us to have like some sort of or don't need their support to have some sort of creative solution or all this knowledge around eating disorders. They just need someone to be there as a witness to what they're going through and to the process of them making changes.

SPEAKER_00 13:41

I love that. I know sometimes when like parents especially are sitting, you know, in our whether it's family therapy or I'm just having a conversation with them outside of a, you know, a one-on-one session, and they'll say, you know, like how am I supposed to support them? Like, what do I do? And I'll always say to them, like, you have to ask the client, right? Like, I could give you 17 different things that could potentially work. None of them could be what your kid needs. Like you, like go to the source. But I also, or and I also love that you said the client has to be a willing participant in the change process because a lot of times clients will want to be seen, right? They want that witness. I love that phrasing so much. Like they want that witness to see what it is that they're struggling with. But sometimes they just want the witness and not to do the work with it. So it is like making sure that all parties understand that, like, you can have the witness, you can have the support. The supports could know what to do. And you, as the one struggling, still have to put forth your side of the coin and like your side of the effort too, to make all of this work together.

SPEAKER_02 14:47

Yeah, I think that's a good point. I feel like support works the best when there is some sort of agreement around it. Support doesn't mean unlimited processing, it doesn't mean unlimited access or availability. None of those things are actually really helpful. But I think that when the boundaries are vague, it doesn't feel supportive for lots of people with eating disorders. I think for lots of us in general, it doesn't feel very supportive when things are vague. But I think that just having some clarity around what is or isn't possible. And also I think recognizing that no request is bad or no desire for support is bad, but not all requests are actually like possible with that person. I think I get a lot of times people who come in who will be talking about what they really need from their partner. And sometimes I think that the way that they're conveying it seems to me like what the partner is trying to convey back is that they're not available for that amount of support that they need or like whatever it is that they would want in the interaction. And so I think that it's like if that's the type of support that you're asking for, it's just not really realistic 100% of the time. So I think we have to be realistic about what you might need to be able to tolerate some conversation around the experience of eating and enjoying food. And like that might be some of your work. And some of their work might be understanding the difference between like talking about physical properties of food, like taste and texture, and temperature and enjoyment, and labeling things as good and bad. And so I think that a lot of times there has to be some sort of agreement that people can come to outside of those intense moments where someone really needs the support to define like what would be supportive and what would not, and what is actually doable and what is not at this time.

SPEAKER_00 16:55

Oh my God. Maggie always clips, you know, sections of our recording to like use on social media, but I feel like I just want your entire thing up because everything you're saying is just so good. Because it's so true, right? Like access and what's realistic are so huge. And I feel like I know I'm thinking of clients who like want their parents to like always check in or to, you know, or they want their husband to be like, oh my god, you're constantly doing a great job. And it's like you can't that person isn't always in the headspace because they're their own person to do all of these things and to like ensure that they can check off all these boxes while they have their own things to do, or like what's going to help you might not be feasible for both parties, right? Or like even if you want someone to tell you you're always doing a great job, one in that one moment you don't want it, and someone goes, wow, great job, and then you're triggered. Like, it's not like you don't always know every second of what's going to happen. And so I just love that you're bringing these pieces into it because I think sometimes the thought or like the theory of what support could look like sometimes it it seems better than what the reality of support looks like really is.

Boundaries And Realistic Support

SPEAKER_02 18:13

Yeah. And I think our our almost default thoughts around support are often like initiated by the supporter instead of initiated by the person who needs support. And so a lot of my work with like meal support with clients when I'm doing it like kind of in sessions, is that I'm having a normal meal with them and I might notice that they're having a hard time. And then it can bring up an interesting conversation where I can say something like, I feel like we know each other pretty well at this point. So I know that the signs that you're giving me are the signs that you might be having a hard time right now. But is there another way that you could let other people know so that they could be just as supportive as I am without them having to collect these nonverbal cues? Because it's so easy for me to collect them when we're one-on-one and there's literally no other distractions going on. But if you want people to notice that you need something and give you the space to ask for it, you might actually need to shift something. And usually that's by speaking up.

SPEAKER_00 19:22

I feel like it's hard, right? Because people want, and listen, I'm culprit of it. If there, if my husband or if I could have the mind-reading capabilities, I would live such a happy life. Sometimes you don't want to have to say what it is that you need because it just feels so uncomfortable and vulnerable in that moment. And so, like, and I agree with you, and like we have the training to be able to pick up on all the little nonverbal things that clients struggle with, right? And so I guess like a question for you is do you how do you work with support systems to be able to either pick up on those cues or how do you work with clients and supports to teach the client how to have a voice while also teaching the support systems how to find the balance between being supportive and not being like the food police and controlling? Does that all make sense?

SPEAKER_02 20:16

I think those are good questions. I think the two biggest things that I'm always teaching parents or support people to have in their back pocket is asking the phrase or asking the question, like, how can I help? And I know that I would say like 75% of the time that lands with the person saying, I don't know. But I encourage them to kind of be a broken record about it and reminding them that they're there to help if they can identify something that would help. And you know, letting them know I'm available if you can think of something. But I think that if they consistently can't, encouraging them to bring it to their providers because we often can identify a little menu of options of things that might be able to help that they could then have in their back pocket to let people know. So I think relying on the phrase how can I help puts some autonomy onto the other person so that they can choose if they want to accept some help or not in that moment, but also define what it is. And then the other one is just saying, I'm so glad you told me. I think that so many of my patients feel invalidated by responses that they're getting from their family or their friends or when they try to share what's going on. And I think that I'm so glad you told me is such a great starting point that keeps things open and can help the conversation flow without having to have there be like an intervention or a goal or some sort of like action points. And I I think that if we're trying to just increase openness and decrease some secrecy and shame, that keeping that communication open and letting them know, like, thank you for communicating with me about this. I'm so glad you told me is such a good place to start. So I think those are kind of the two that I usually give to supporters just to start with and see where the conversation goes.

SPEAKER_01 22:23

I also feel like too, because I when I've done like trauma-informed trainings in the past, like so much of it has been around like we as providers, like model what like a healthy boundaried relationship looks like. Because even as you were saying that, it's like those are two things that I would say in sessions all the time. And I feel like, you know, we kind of emphasize some of that for clients too, where it's like we're really good supports for them, but we're also not around 24-7. And like there are those boundaries in place too. So sometimes I'll even like mirror that relationship with clients as well and be like kind of identifying like how our relationship sort of mirrors, like maybe this is what supportive relationships look like.

unknown 23:04

Yeah.

Two Phrases That Keep Trust

SPEAKER_02 23:04

Yeah, I think that's true. And if you think about like a lot of our role is helping people to like increase their sense of safety around food and to reduce isolation and not going through this alone. I think those are also the ways that people can support their loved ones without being like the food police. It's like you're there to help bring a sense of connection, decrease some isolation, but not to control or convince in any way. I think this is obviously different with kids when part of that like safety is coming from the parents and that it is that like we can't allow children to continue to hurt themselves without some intervention. But I don't know that that means that there's a way that we can necessarily like control or convince in that moment. It might be a sign that more support is needed, that we need a bigger safety net to be able to create that sense of safety. And but I do think that often just having a witness, like having a presence there is one of the things that's the most supportive. And then being able to respond in a way that elicits more openness. So things like, I'm so glad you told me, or that must be really hard. I love the levels of validation from DBT. So I give that handout a lot of times, just from the workbook itself to parents to help them think through what would actually be like a validating response, like thinking about how their child must feel and not like mind reading and telling them, like, you must feel this way, but just being able to imagine like that would be really scary. And being able to empathize with that and maybe feel some of what they're feeling, I think can be a great first step in helping the person feel less like they have to explain and feel more understood in the moment.

Repair After You Cause Harm

SPEAKER_00 25:03

Yeah. Have you ever dealt with, and if you have, how did you handle it with parents saying or just a support person in general, saying something that like unintentionally caused harm to the person?

SPEAKER_02 25:19

I think, well, I think I encourage them to handle it a lot like I handle it, because I'm sure I've said things that have accidentally been triggering to someone in some way, or they've taken it in a way that I didn't mean or I misspoke. And so I think a first one is when someone tells us that they didn't like that we said something, I think we probably responded the same way. It's like, I'm so glad you told me and that we're talking about it, right? And I think owning up to the fact that we're not perfect people and that we're not always going to know what's helpful, what's hurtful or not. And then asking them what would have felt helpful. If you can identify what you really don't want in a situation, you might also know what the opposite of that is. In the same way that we would like to encourage a patient to use opposite action. I think we they can use that to think through what the opposite response would have been and what might have felt supportive about that. And we can talk through that. But I think that support does need to be an open dialogue between both parties, where there's not an expectation of the person who's struggling that their supports would be perfect, and we're not expecting ourselves to be perfect as support people or as clinicians either. So I think it can help to identify that A, we know that we're not perfect and that we can be open about getting that feedback about what would have felt better or what would have felt more supportive. But then also I think that there are probably a few things that I would just encourage all parents or supporters to avoid. And those are probably I think like appearance-based ones. So many of my patients have had the experience of coming back from treatment and hearing like, you look healthier or you look better. And just anything appearance-based, I think, is just a no-go. So I think that's probably a big one.

SPEAKER_00 27:23

Yeah.

SPEAKER_02 27:24

But then also I think things where it's expressing that we don't understand is like things like, I don't get why you can't just XYZ. I think instead of going with that initial like expression of being like, I don't understand why you can't just, I think actually noticing the feeling that you're feeling underneath. Like, I can imagine that if I was saying that, I would be feeling really frustrated. And so if I'm feeling really frustrated, it even if I'm like with a patient and I'm feeling like we're just spinning our wheels on the same few interventions, and I'm like, oh gosh, like what else do I have to offer? I think on the flip side, then I can imagine that the patient is probably feeling also some hopelessness about what else there is out there that could help them. And so taking that feeling underneath that statement of like, why can't you just? And imagining, oh, I bet that the person who I'm trying to support right now is also feeling frustrated with how hard it is to change. Can I have some empathy for that?

SPEAKER_01 28:33

Kelly, what would you what would you say to a situation where a client feels like they've set boundaries several times? Let's say in the example of like, please don't comment on my body in any way, and they constantly feel like that boundary is not being respected.

SPEAKER_02 28:51

I think that is an interesting question because I think it happens all the time. And I feel like sometimes patients don't like my answers around this. I think that it makes sense to me when setting a boundary to make sure that we're also defining what happens if the boundary is crossed, and then to follow up with actually doing that. So if I have like an adult patient who is like, every time that I go home for the holidays, my family is constantly commenting on my appearance, my physical appearance. I think that someone, a patient saying to their parents, like, this is a boundary for me, like you can't cross it, doesn't actually tell the parents much about what comes next. If instead they say, like, it's really uncomfortable for me that we keep talking about my physical appearance. And if we do, I'm going to leave the gathering. Or if we do, I'm going to disengage and you know, call a friend, call a friend or step out. If we do, I'm going to change the situation or change the conversation abruptly. I think there's got to be some follow-through on those pieces. And often I think that we don't define kind of what comes next if the boundary is crossed. And then if we do, we don't actually do the thing. So I think that we've got to define what would come next and actually do those things. And it doesn't have to be so specific that it's like, I'm not going to talk to you for four weeks. But I think that it could be that it's like, I'm going to reconsider if I'm coming home for the next holiday. And then the next when the next holiday comes up, having a conversation about the things that you're considering.

SPEAKER_00 30:40

How do you help a client? I I'm obsessed with all of that. And how do you help a client know that setting that consequence for their parents is okay? Because I can also see them like in that moment for the holiday example you gave of a client being like, well, I'm then just gonna get up from the table and leave. And like then sitting there and being like, okay, so they just made a comment. Now I'm anxious. Like, I need to get up and leave, but are they gonna get mad if I get up and leave? And then spiral because of that shame and guilt of I'm gonna put myself first, but what is the family gonna think about me if I do that? So, like, how do you support a client in knowing that what they do in that moment is okay and is like the right decision? So they feel like they have the confidence and the courage to be able to do that.

SPEAKER_02 31:27

Yeah, I think in the same way that I have catchphrases that I kind of teach support people, yeah. The one that I'm keeping patience a lot for this is like, remember mom, we talked about this, or remember dad, we talked about this. So I think that having that conversation first, really defining like if conversation about my weight continues, I'm going to X, Y, Z. I think it's okay to either decide as soon as it happens that like you're out, or to stop and kind of almost give a warning in a way, where it's like, remember, mom, we talked about this. And if the conversation doesn't change after that, then I think that you've kind of done what you needed to do by putting a pause, kind of helping to shift the conversation some and be like, remember, we talked about this. And then if it's not respected, to step away to do to enforce whatever boundary you had put. It's not as if it has to like immediately crack down. I think we get to define what those actions look like next. But being able to remind someone that you've had this conversation, I think is appropriate, but also compassionate for them. That in the same way that people with eating disorders are trying to change and often struggling to make those changes consistently, the people around them are also trying to make changes and struggling to implement them consistently. And so both parties probably need reminders that we've identified a change that we're trying to make and have agreed upon and kind of centering back on it. And if that in that moment, if something that you've agreed upon is kind of like, nah, never mind not doing it, I think it's totally fair for both parties to take a break from having a conversation with each other in that moment.

Accepting Diet Culture Without Giving In

SPEAKER_00 33:16

Yeah. Cause I think it is hard, right? And I and I love that once once again, I just want to put this whole episode. I mean, I we are putting it up, so that's silly to say, but like I just want to like clip the whole thing. But like I think it's so fair for you, like for what you just said, that support people also have their own feelings. And like we were saying earlier, too, they have their own thoughts, they have their own experiences. And so like the frustration can be on both sides, right? And like just how we would always want our support people just to instantly implement change. But when we think about ourselves, it's not that easy to change, right? Because then recovery would be a blank of an eye and we wouldn't have jobs, which I would be fine with, so people could live their lives, but like it's not that easy. So giving even support people grace at some point is also important because it's not that they don't care and it's not that they don't want to change, it's that change isn't always easy, you know what I mean?

SPEAKER_02 34:14

Yeah, yeah, we're all kind of in this process of trying to change, and I think there is also some space for some acceptance, right? Like some of my patients are in situations where they're like, I don't know, I don't know that I want to have a conversation with this roommate about the conversations that they have about food. And I so I think we do balance, like, what can we talk about and request some changes for? And then what can we practice building some acceptance for? We can't change the whole world. The world is fairly diet obsessed. And so, like, if we have some acceptance for the fact that there is just gonna be a focus in our culture on weight and body sizes, and they're gonna have to learn to navigate through that world, that might change the type of support that they ask for. Someone with an eating disorder might then be able to say, like, okay, when we know that this type of conversation is gonna come up or this type of media is gonna come up, if you notice that it would be meaningful to me if you did check in afterwards with how I'm feeling after we've both overheard that conversation or after we both saw that scene in a TV show or something. If you're ever wondering about how I'm feeling about something, it would be helpful just to ask, you know. But it is our patients' responsibilities to define some of that for the supports around them.

SPEAKER_01 35:39

Yeah. I love how like you kind of said there's sort of this give and take too, because it made me think of, I know Jess and I have had this conversation before of just like like conversations around food versus conversations around nutrition, right? And how like families, like even the example you gave with the client and the husband who's a foodie. It's like there is conversation around food that like does have to happen in life, right? And like there, you know, there is like logistical conversations around food, and that's very different than conversations around nutrition, which can be really triggering and should be saved for us as the dietitian to like be the expert there. So I feel like that's a good example too of just like the give and take and the like we can't change everything, but like we can set those boundaries in place so people feel more supported.

Supporter Burnout And Protecting Relationships

SPEAKER_02 36:21

Yeah, yeah. And I think sometimes it's hardest for our patients who have been at higher levels of care and have had these really firm boundaries around like no food talk at the table. And it would be so weird. Like if Maggie and I went out to dinner and Raleigh, it would be so weird if neither one of us commented on our food at all or even on each other's food to say that looks really good, or to you know, ask about other times that we've had something similar, or to talk about how something was prepared, and not in a way where we're assigning good, bad, like moral judgments around it. But when people are at higher levels of care, I think that talking about food and talking about beliefs around food and kind of like assigning moral value to food, it's so almost nebulous and there's so much nuance there that it's so much easier just to say, let's talk about something different. And I think that having that as a blanket rule makes sense in at a higher level of care. But I think that in the real world, if someone with an eating disorder needs there to be different conversation, I think they need to be able to say things like, can we talk about something different? To bring a conversation to the table themselves, to say, I'm so glad you told me, but I'm not, I can't have this conversation right now. I can't talk about that right now. You know, those sorts of things can go both ways.

SPEAKER_01 37:52

Kelly, what advice would you give to a support person who feels maybe a little like burnt out or helpless or unsure if they're really making a difference?

SPEAKER_02 38:06

Yeah. Well, I think the first thing is to validate that it makes sense that they're feeling burnt out, right? Like eating disorders are really hard, really chronic illnesses that people who don't have them often don't understand what's really happening. And so I think one thing is just validating like it makes sense to feel burnt out in that situation. I think also I like to check in with like parents of patients that I have or their supports about if they're getting support themselves to help them kind of cope with the fact that they're living with someone who has a chronic illness, that is impacting their life too. I think that support people getting support themselves is pretty paramount so that it doesn't feel like they're in it alone. So I think that's one thing is getting support themselves. I think also is setting some boundaries and having those boundaries also not just coming from a place of what is good for the patient and what the patient needs for their recovery, but thinking about what the relationship between you needs. So there could be things that would be really helpful, like patient might really benefit from having dinner with someone and having some supervision kind of every night. And that might be taxing for the relationship between roommates. And so I think that having some boundaries and thinking about not just what's good for the person with the eating disorder, but what's good for the relationship between you two is a good starting point there. And so if it starts to feel like everything is about the eating disorder, seeing if we can find some ways to also make things about the relationship between you two and prioritize those things. And if that happens, if we start prioritizing the relationship between like parent and child too, and eating disorder stuff gets worse, that might be a sign that they need more support than what can really be offered in an outpatient setting. It doesn't necessarily mean I don't think that the relationship is not important. We just need more support. So, and then I think also like measuring the impact in a realistic way, not like did the person change, did the behavior stop, but did we create a sense of openness? Is the environment conducive to change? I think so much of the responsibility with supports is around helping to make an environment that's conducive for the person to implement the changes, not to force the changes themselves. So I think that's that's probably where I would start is making sure that we're prioritizing the relationship and building a supportive environment, but not taking the responsibility for making changes happen. So does that answer your question?

SPEAKER_01 41:03

Yeah, no, that's such a good point, too, of like focusing on the relationship because we also we just had a really great interview with this therapist in Canada, Brianna, and she was talking a lot about like we talked a lot about like how to separate somebody's identity from the eating disorder. But I also think too, like sometimes support people's identities sort of shift as like I am this full 110% support person. And like they lose the actual relationship. And I remember when I worked in an FBT program, like so often some of the goals in like family therapy were like, hey, like go get your nails done together, or like go see a movie, or you know, go to the mall, like go do like something totally unrelated to treatment, unrelated to food, and just like have a relationship with each other again. Because so often, like both parties can kind of get lost in like lost in the eating disorder. Yeah.

SPEAKER_02 41:57

Yeah. Like when parents are asking us, like, how do I prevent myself from just feeling like the food police? It's like, well, you gotta do things that like make you guys feel like parent and child again. We've got to still prioritize those things.

SPEAKER_00 42:12

It's like thinking about what did you guys used to do before the eating disorder came, right? Like and go back, it's almost like going back to the basics, right? Like, yes, this disease, this illness is there, but that doesn't mean that all of a sudden everything is about that. Like you can still live a happy life while you're going through the recovery process and just like reminding everybody of that.

SPEAKER_02 42:35

And I think that that is actually one thing that is really supportive, and we've probably all seen be really supportive for our patients, is them seeing that the people around them still have lives and still have goals and things that they're working on, and reminding themselves that their eating disorder is not the only thing that's happening in the world. And not in a way that it like brings up shame, but in a way that it's like they might want more for themselves too. But when an entire family kind of wraps around an eating disorder and that's kind of what's happening in the family at that time, I think that it can unintentionally reinforce the behaviors as a way of communicating that there's pain or communicating that like there's a need that's there. And I think we want to help people use their words to do that and make requests and then be able to negotiate some about those and say what is or isn't realistic to actually have in terms of support or attention or affection. Not trying to use the behaviors as a way to convey that there's something painful happening.

SPEAKER_00 43:48

100%. Thank God for your night of pickleball, man. I tell you. Thank God for that night. This was so fun.

SPEAKER_02 43:58

I know. So much fun doing this.

SPEAKER_01 44:02

Yeah, this was really, really great. Thank you, Kelly. Of course, anytime. Well, don't don't tempt Jess with a good time because she will send you an email literally later today and be like, round two?

SPEAKER_00 44:16

I've done that to I've done that to a few of our people. And that literally the caption is let's go for round two. Not the caption, the subject, hello. But yeah, so careful what you wish for.

SPEAKER_02 44:28

Well, it was fun. Thank you so much for having me.

SPEAKER_00 44:32

Thank you for coming. Thanks for saying yes.

Where To Find Kelly And Closing

SPEAKER_01 44:34

Yeah. Yeah. Yeah. You are welcome. Welcome anytime. If people want to get connected with you, is there any ways that they can?

SPEAKER_02 44:43

Yeah, I guess. So probably on our website if they're in North Carolina and are interested in working together. Our website is advancedcare, a v-ance care.com. And we have a big group of eating disorder dietitians that I'm a part of. And then personally I'm on Instagram. So they could follow me at Kelly RD underscore. I have like a nice short little handle. I don't know how I got such a good one. So Kelly R D underscore. But that's probably the two ways to try to find me or connect with me.

SPEAKER_01 45:20

That's amazing that you got that handle. I'm always amazed when people, when their email addresses are just like their first name, last name at Gmail. I'm like, wow, that's like unbelievable to me. But yeah, I can't believe you got that good handle.

SPEAKER_02 45:33

I know.

SPEAKER_01 45:34

The first Kelly RD.

SPEAKER_02 45:36

I was apparently the first Kelly RD underscore.

unknown 45:41

Yes.

SPEAKER_01 45:44

All right. Well, thank you so much. Thank you to everybody listening. And if you have any questions for Kelly, please reach out, let us know, and we'll definitely have her back. So we'll catch you on the next episode. Bye. Bye.

SPEAKER_00 46:00

Thank you so much for listening to this episode of the Nourish and Empower Podcast.

SPEAKER_01 46:05

We hope this episode helped you redefine, reclaim, and restore what health means to you.

SPEAKER_00 46:12

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