S2 Bonus 1 Disordered Eating with Danielle Keenan-Miller, Ph.D.

The pandemic has increased the onset of unhealthy eating habits, which can lead to body image issues as well. In this episode, Dr. Rubin and Dr. Pete welcome clinical psychologist and author Danielle Keenan-Miller, Ph.D. to discuss different types of disordered eating, ways to address it, and how to reconnect with eating as an important and often times joyful part of human experience.

Dr. Keenan-Miller is a psychological scientist, teacher, therapist, and co-author of the book The Binge Eating Prevention Workbook. She is the director of the UCLA Psychology Clinic, and Associate Adjunct Professor of Psychology at UCLA, where she trains graduate students in evidence-based psychotherapy. She has authored over a dozen scientific articles and serves on the executive board of the Association for Psychology Training Clinics. She also maintains a private practice in Los Angeles where she blends the art and science of psychotherapy.

For more tips and wisdom, follow Dr. Keenan-Miller @KnowsPsychology on Twitter.




Nikki:  Pete, I'm really excited because we got another bonus episode here with a new guest for season two. So first of all, hi, Pete.

Pete:  Hey, we're doing the guest thing again.

Nikki:  We’re doing the guest thing again. So building little anticipation here before I introduce our guests.

Pete:  Who is it?

Nikki:  Well, here we go. so we're going to be talking about disordered eating today, which is not a specialty of either feed, or myself and we are…

Pete:  Very good eating.

Nikki:  You are I also am; we've actually got a wonderful guest, a very dear friend and colleague of mine, Dr. Danielle Keenan Miller. And Danielle is a psychological scientist, teacher, therapist, and a co-author of the book, ‘The binge eating prevention workbook.’ It's out now it's excellent. I have it in my office; I've been using it with patients. And Danielle is also the director of the UCLA psychology clinic and an associate adjunct professor of psychology at UCLA, where she trains grad students in evidence based psychotherapy. That's actually how we originally met because I'm a supervisor there. Danielle is also authored just over a dozen scientific articles, and then also serves on the executive board of the Association for psychology training clinics. And she has a private practice in Los Angeles as well, where she blends the art of science and psychotherapy, which is what we like to talk about here on When East Meets West. So, Danielle, welcome. We're so glad to have you.

Danielle:  Hi, thanks for having me. I'm so happy to be here.

Pete:  So impressive. And I started our introduction, as Danielle and I met, I'm looking at your CV, your CV is super impressive. So I think how do you do all that you do, how do you balance?

Danielle:  You know, a part of what I love about my job, actually is that there's a lot of different hats. I love my clinical time. I love my teaching time. I love research, I love thinking about how to get the care into people's hands. So it looks like a lot on paper but it's actually sort of fun to do that task switching through the day.

Pete:  I hear that.

Nikki:  And I say she's very skilled at it. I can know because I see it up close.

Danielle:  Nikki supervises in the clinic I direct and we are so thrilled that she is there.

Pete:  I think she's a good teacher, that's what I always say. So we're going to talk about disordered eating and I don't know where we're starting but I'm wondering could you define for us disordered eating?

Danielle:  Yeah. I think there's not one right answer to that question. But I think of eating being a problem in someone's life, aka disordered eating, when it starts to cause them distress when they're having negative consequences, either in terms of how they're feeling their happiness, their health, their ability to engage in social relationships, or desired activities. When eating is really starting to take up a place in somebody's life that's too big, eating has a role in our life It's essential, it's essential for sustenance. And it's also a huge part of what brings people joy and connection. But when eating starts to grow beyond those boundaries in somebody's life, that's when I start to think of it as a problem.

Pete:  So, Nikki, and I's obsession with dominoes, sometimes takes over our life, Nikki that right, no?

Nikki:  Well, no, it won’t take over my life because I won't feel well. So that consequence stops me from… but we do have a deep love of dominoes that we've mentioned many times on the podcast here. It takes up Pete’s life sometimes I think.

Pete:  Well when I'm able to eat it, but I don't mean to make light of it but yeah certainly, it can cause some pretty significant issues. And maybe we talked about some of the diagnoses that fit into because I know your book is about binge eating specifically.

Danielle:  Yeah, binge eating is certainly one of the sorts of diagnosable disordered eating. Obviously, there's also people are tend to be much more familiar with the other two anorexia and bulimia. Even though binge eating is far more prevalent It's much more of a problem than anorexia and bulimia combined, actually, in terms of young people it affects. But I'd say there's also a wide spectrum of sort of gray area where people struggle with their body image, they struggle with overeating, or eating in a way that's really not about food that's maybe more about their emotions, or about what's happening in their life. And I would think all of that sort of fall under that same umbrella of disordered eating.

Nikki:  As you're talking like, the thing that is coming into my mind is sort of, this may be this problem where there are going to be some people that view eating taking over their life as an issue as a reason they're going to seek treatment. Then some people that view it not as a problem, right? Like it's something positive or something to cling to. I'm just wondering how like, how does that impact? First of all, like, who walks in your door seeking treatment for disordered eating? Actually, maybe I'll just start there, because it's like, 40 questions, bouncing around in my brain.

Pete:  I have 41 but go.

Danielle:  I think that's a really good point. And I think, even for people who recognize that their eating habits are a problem in their life, most people feel enough shame about that, but they don't bring it up. We know people who binge eating never talked to a therapist about it, even if they're in therapy for a different issue.

Pete:  Yeah.

Nikki:  Wow. I didn't even know that.

Danielle:  Yeah, people really think that problems with eating are about willpower, It's some kind of personal failure, It's some kind of moral failure and they struggle, I think, to bring that to therapy. So it's really important for therapists to be actively asking about how people's relationship with food and their body is. But you're right there's also a subset of people who experience their eating problems in a way that I guess an old school terms, who would call ego syntonic. Right, they see it as an advantage and there's lots of social praise for excessively restrictive and rigid eating styles that to me, fall under that rubric of disordered eating. These people can't travel, they can't eat with their friends, they can’t feel happy if they eat something outside of their plan, they're berating themselves. those kinds of styles of living sometimes are actually praised socially [inaudible 06:44] see them as a problem and that's also a big cause for concern. And something that therapists should again be inquiring about and asking about and making space for because that's part of healing.

Pete:  I'm wondering what like your journey to get there, I think, to write this book, which is such a gift because it puts the behaviorism and it highlights this more common. My pure supervisor, hey, Deborah girl, and actually she's a UCLA girl. Oh, I wonder if you guys have ever crossed paths not just linked. But anyway, I disliked some peer supervision with her because I had to face my own binge eating. And I'll talk more about that. But I wondered, your own journey to getting to this book, like what was that like?

Danielle:  Yeah, well, I had never really done any treatment with eating disorders until internship and then that was sort of my major focus on internship. I was working at the UCLA Counseling and Psychological Services Center, which is where the UCLA undergraduate and graduate students get therapy. And because of the nature of the population, particularly that age range, we saw a high degree of disordered eating and eating disorders. And I worked with a supervisor where that was the main focus of our practice for that year. And I fell in love with doing that kind of work mostly because I saw all of these students, mostly women, some men who a huge portion of their mind space was taken up by food, calorie exercise, counting, parading themselves. You could start to peel back the impact of that eating disorder on their mental functioning. They just blossomed and flourished and were these amazingly smart, ambitious, driven and accomplished individuals that had been directing all of this energy into something that sort of doesn't deserve it. And watching them make that shift was such a hook for me, I loved that. And actually, my supervisor from that rotation, she and I have stayed friends and colleagues, and she is the co-author of this book with me, which it was actually her idea. I was really happy to come along for the ride and I think that I'm really proud of us.  

Pete:  Yeah.

Nikki:  Well, having that a book like that out there, I think is helpful in terms of, as you're saying, a few moments ago, Danielle, it's something important for therapists to be aware of.

Pete:  Yes.

Nikki:  And it's helpful for that to be just like, out in the world for the general public. Again, I can imagine somebody, maybe you're saying there's so much shame associated with it, someone struggling with it. individually at home, not telling anyone about it, and how powerful to be scrolling through Amazon and maybe trying to look for, like, how can I work on this and then to have a book that's directly targeting this very common problem is really powerful. I mean, this is how like, just with any psychological struggle, like a lot of ways that people find their way into our offices, right, is that they've done their own research, right? I mean, I don't know if you guys have had that experience where I've had people say, like, I read this thing, or I read this about it and that made me aware that anxieties comment or you know.

Pete:  What's so crazy about this is that you have to eat that's what you said, It's a basic need, everyone has to eat and so I love that it's about making peace with food. One of the things you just also talked about was men and women and so I think it's socially.

Nikki:  You're reading my mind.

Pete:  There it is, again, very good at that. So I wonder if you talk a little bit about that, because I think men certainly have some, we all have shame around. So I also feel that everybody is just morphic in their body perception. I feel like that's like 99% of the people I feel, I'm going to put that out there. But in terms of like being…

Nikki:  Everybody has negative body image thoughts at some point like, there's never been a human that walked this earth that never like, judge themselves because, as we talked about a million times this podcast, brains are wired to judge. we walk around in these physical bodies all the time, there's no way our brains wouldn't direct those judgments towards our physical bodies at some point.

Pete:  Ever. So let's look at the difference of gender, maybe if you could talk a little bit about that.

Danielle:  Yes. Well, sort of what we might think of as the traditional eating disorders, the ones that, you know, people of our generation probably learned about in elementary or high school anorexia and bulimia are far more prevalent in women. And that's obviously because both of those are associated with an explicit focus on weight loss or a desire to have a smaller body. And that's a social standard to which women have traditionally been held much more strongly than men.

Pete:  Yes.

Danielle:  So I think that there's pretty good evidence that those social expectations are part of why women have been disproportionately impacted. The binge eating is actually equally prevalent among men and women. and so I think that there's something a little bit different given that binge eating isn't necessarily about attempts to control one's weight or size. For some people, that's a part of it and those people tend to actually have a much harder time, they tend to have more distress associated with their eating in general but binge eating is special in that men and women are about equally impacted. And I think when we were writing the book, one of the things I had in mind was that I wanted the exercises, we have to speak equally to men and women, because I think men are traditionally really excluded from the eating disorders world they don't see themselves represented, but they really are there. So we wanted to reach out to them and create something that felt relevant to them too. And we have a lot of case examples that are sort of public case examples embedded into the book, including this one, a guy named Joe Julius, who was a college football player who was I think one of the first men to really come forward and struggle with his binge eating in a very public way. And I think highlighting that those people are out there, those voices are out there, those role models for getting treatment are out there is really important.

Nikki:  I read an article, I don't know, it's probably like a month or so ago. Don't quote me on where I read it; it was like some apple news article I found on my phone. Maybe it was like in the Atlantic or something like that.

Pete:  It was your algorithm that sent it to you.

Nikki:  Totally. But it was a fascinating article not about binge eating specifically, but about disordered eating on the whole in men. And it was referencing some current cultural examples like, of course someone like Jack Dorsey, that of Twitter, right. Am I saying that? Okay. So they were talking about examples like Jack Dorsey, how he engages in like extreme, intermittent fasting. And I can't remember the a couple other examples they're using, but they were interviewing a man who was saying, he didn't recognize in himself that what he was engaging in was disordered eating. because all of the cultural examples of men, men are celebrated for those things. Like isn't he innovative? This is the cutting edge of, like, quote, unquote, ‘hacking the body.’ And the author was saying imagine if a female celebrity was engaging in those behaviors, how she would be judged in the media, that immediately, people would have the lens of like, that's disordered eating. So I'm just wondering, Danielle, is that something that has sort of come up for you clinically at all?

Danielle:  Absolutely, and I think, it's that guys of health that gets spread over some kinds of diets that are actually just disordered eating. And it is much easier for men to sort of, I don't want to use the term get away with it, because I don't think they're doing it manipulatively but for those [inaudible 14:26] labeled as problematic. And I think the intermittent fasting thing is a really good one. And there's a whole culture, we might call it orthorexia in our clinical world with like an excessive adherence to the idea of a healthy or clean diet that gets praised. And some for some people in some situations that might work great like, it's all about workability and effectiveness. For a lot of people that approach to eating and diet creates excessive rigidity and a high degree of distress and blame and in their own eating patterns. And it's generally not functional, but it's socially very acceptable.

Nikki:  Yeah.

Pete:  So if you were working with someone like that, like I wonder from the book what's like a one of the top tips or interventions, behaviorally that are recommended in this example, let's say?

Danielle:  Yeah, well, I can't give you one I have to give you two.

Pete:  We’ll take it.

Nikki:  Yeah, that's the [inaudible 15:21].

Danielle:  Eating problems are always about food and not about food and you have to intervene simultaneously those tracks for it to be effective. So the most effective thing you can do in terms of the part that's about food is stop dieting. dieting is the single best way to cause an eating disorder, including binge eating. All diets work in the short term, no long term positive effects of dieting have ever been found in about two out of three studies. they suggest that people who go on a diet end up weighing more than people who don't go on a diet over time. There are lots of both psychological and physiological reasons for that, dieting itself is problematic. So on the part that's about food, eating regularly so that you're not hungry is essential, and so that you don't feel psychological deprivation either, right? Like you could eat 2000 calories a day of baby carrots, but you're going to feel deprived.

Nikki:  Yeah, right.

Pete:  No one ever said, I've had a tough day, I want some carrots.

Danielle:  You need to take care of your body's physiological needs and your psychological sense of fulfillment and satisfaction, or if it's like about food, you need to eat enough, basically. The other thing that I would say, for somebody who's really hooked into this orthorexia trap and getting excessively rigid, it's actually a values exercise. I have one in the book, but I think a lot of varieties of them work like, is what you want on your tombstone to be, Nikki, she only weighed ash or she only ate spinach, right, probably not, no. there are traits and preference so, if you're eating or your feelings about your weight and shape are getting in the way of you living in a life that's aligned with your values as a friend, as a partner, as a parent. then then that helps people get in touch with like, wait, my priorities are way out of line with my values, and that can really open up some new flexibility.

Pete:  Oh, I love that. Yeah.

Nikki:  Well, I was going to say, of course, it’d be helpful If I had mentioned this, my apologies in the beginning. Danielle is also a third wave of cognitive behavioral therapists.

Pete:  Well, everyone knows that now.

Nikki:  Yes, so you know, what I think is really helpful for listeners in obviously, just tying together the theme of the topics that Pete and I discuss here is that, psychological flexibility and, and behavioral flexibility are essential for wellbeing. And so what I'm really hearing what Danielle is explaining today is sharing like, that goes for disordered eating as well. it's like you're saying, like dieting is inherently rigid, that's actually not moving somebody towards being healthier, It's not right. How do you help them do that it's by the letting go and tying things to what's meaningful to them. So that's a very important point to make here.

Danielle:  And sometimes when I'm sharing these ideas with people, both with clients and with sort of members, the lay public, they will fall into a sort of rigid or black and white way of thinking about what I'm saying. “oh, you're saying I shouldn't, I should just eat whatever I want whenever I want, I should eat ice cream all day?” No, I'm actually not saying to go on to the other end.

Pete:  Right.

Danielle:  I'm saying like, all foods can be a part of a healthy diet, and that satisfaction and what makes your body feel fuels and what gives you joy, there's room for all of that in eating. And I think you know, so just in case any listeners are out there thinking like, well, this woman just wants us to eat hamburgers all day. like no, [inaudible 20:14] really won't want in your body. And like I think if you eat in that way, where you let yourself have flexibility, most people are surprised that they also do want the things that they might have thought they were forcing themselves…

Nikki:  Yes.

Pete:  So what was it like to write the book with your mentor?

Danielle:  It was really fun. We are very similar probably in our clinical approach in the room but we come to it from really different places. So I come to it from a really evidence based research scientific stance, and she comes to it from a much more intuitive place where she just emanates. something about her that's just like so warm and validating and authentic and genuine but we end up doing the same things in the room. And so it was really fun to have her say what I this is what I do with patients and me to say like oh let me fill in the studies around why that works or that sort of thing. and we have some parts of what we do that are somewhat different, I'm much more act focused and has a much deeper grounding in some interpersonal kinds of approaches so, it was really fun to complement each other. It was a lot of work, I'm really glad that it was done before the pandemic started. For those of you thinking about writing a book, it’s a lot of work.

Nikki:  I went to, as I love to brag about my beloved people here. Both Pete and Danielle fall into that category, both just wrote books, and I would always with both of them, I told them I'm like, I just can't believe somebody I know wrote this. So amazing, I just tear up about it.

Pete:  She's our PR Danielle.

Danielle:  Absolute.

Pete:  So I'm going to maybe just jump into a little just behaviorally binge eating.

Danielle:  Yeah.

Pete:  Just maybe, we define it yet? We defined disordered eating, but binge eating.

Nikki:  That would be helpful, because I think people might be going, because you mentioned a little bit. I mean, I see clinically all the time, like people are like, what am I over eating, or am I binge eating? Because sometimes people are like, calling it a binge and it's not a binge. Sometimes people are bingeing, and they're saying, I'm just overeating. So I think that would be really helpful, actually.

Pete:  Yeah.

Danielle:  And there aren't, you know, I think a lot of times when people think about the definition of a binge, they want there to be like a calorie cut off or something like that.

Nikki:  Yeah.

Danielle:  Until definition is much more fuzzy it could be much more than someone else would in a given set. And in a similar circumstance is one part of it. So that means like, if you've been fasting all day, or at Thanksgiving, like eating a lot on those kinds of occasions probably isn't binge eating because right, normal for that set of circumstances.

Nikki:  Right.

Danielle:  Eating a lot more than others might in similar circumstances, and it has to cause some kind of distress. So the kinds of distress we often see are people feeling physically ill like they've eaten beyond the point where they're comfortably full, they're starting to feel sick. They're feeling a lot of distress, guilt, blame shame. They're doing it eating and secret is another sign that binges might be sort of clinically problematic. again, but it's like really getting in the way of them living their lives in a healthy and flexible way. So there's not as much rigidity around the definition as some people [inaudible 22:18].

Pete:  I mean, I just had an aha moment. So thank you, because I think the Thanksgiving metaphor was beautiful. I think like that really connected for me of like that's within normal limits of like that holiday. maybe going to like a Sunday football game, you might have an extra hotdog or something or beer that you wouldn't otherwise have. versus like, a Friday night and your couch by yourself with the Oreos and the dominoes and you're like, ‘Oh, I feel really full and I want to puke.’ And that's probably less helpful.

Danielle:   [crosstalk 22:45] than happy experience in their binge eating that it's actually like on autopilot, like they've lost control over those things. And that's really scary for people both because it's just inherently scary to feel out of control of your own behavior. Also, because it makes people discouraged about their ability to think that they can get better because they feels out of control. The reality is there are ways to get control in the binge eating cycle but that moment where people are in there in that binge often feel scarily out of control.

Nikki:  So then can you define like, again, I'm going to guess it's also like a more flexible definition, which I appreciate. And I think that actually is helpful for people rights to know like, it's more like listening to like, what your experiences. How would you explain overeating then to somebody?

Danielle:  Yeah. Again, like, I think, for me, and when someone talks about overeating, the question I'm always asking myself, in my mind is, are they eating beyond what is healthy and supportive for their bodies and their minds? Or are they describing over eating because they're breaking an excessively rigid diet rule that they've set for themselves?

Nikki:  Okay, yeah.

Danielle:  [inaudible 23:58] like one extra cookie, you might have broken some random diet rule you had for yourself, but that's not necessarily over eating. If they're eating and they're uncomfortable, or they're eating to the point that they're eating things that they know they shouldn't be eating, because it's not good for their body. It’s like someone who's lactose intolerant, is eating a pint of ice cream and feeling really sick that, to me, is a sign that there's a sort of a clinical overlay to overeating. It's really important to distinguish it from just breaking a diet rule, which is itself not inherently overeating.

Pete:  What do you think of the quarantine15? Like, what are you seeing clinically or what's your sense about that?

Danielle:  Eating disorders are skyrocketing.

Pete:  I’ve seen it yeah.

Danielle:  [inaudible 24:38] and I think that makes a lot of sense for a number of reasons. The first being that we as a society have lost most of the behavioral cues around eating that we are used to relying on right? when you're working in an office there's a lunchtime, there may not be access to food in between that lunchtime. And, you know, there may be snack time that's in a constrained sort of environment, right. But we've lost those cues that we associate both time and place with eating and I think also, more and more people are turning to food for things that food shouldn't do. used for entertainment, it shouldn't replace relationships, like there's a lot of stuff that people go to food for, and go to other substances of abuse for. frankly, like drinking or drugs, when they have unmet psychological needs so I think that's a little bit of what we're seeing in terms of the prevalence rates.

Pete:  That's so interesting, because for me, you said a beautiful dialectic before that binge eating or the disordered eating is both about food and not about food. And that, to me, sounds also relative to the quarantine 15, because it's both about food and not about food.

Danielle:  Exactly. And we know that one of the things that predicts both binge eating, and overeating is actually food insecurity. And there's a number of people… food insecurity, for financial reasons at the moment, but also lots of people who because of like hoarding, or not being able to go to the store frequently. Or for the first time experiencing the anxiety of food insecurity, and that predicts overeating, and binge eating.

Pete:  I have more paper towels and toilet paper in my garage, then I could probably ever use in the next two or three years. It happens to all of us.

Nikki:  It happens to all of us.

Danielle:  Scarcity leads to hoarding, yeah.

Pete:  Yeah.

Nikki:  Of course, I'm thinking about all roads lead to mindfulness, which I now say on the on this podcast, and I'm wondering, I want to ask both Danielle and Pete here. Like, how do you weave mindfulness practices into binge eating, which is knowing you know, and doing something about how these disorders are treated and that's going to be a part of it. And then Pete, I'm really wondering, how does Buddhism talk about struggles with eating? So whoever wants to jump in, I’m right here listening.

Pete:  Danielle go ahead, you’re the guest. Unless you want me to.

Danielle:  No, I’ll go. So there's actually a whole line of treatments for eating disorders, including binge eating. That's mindfulness based, a program that's called MB eat. And so I think if you want to do that in a really formal way, there are some formal mindfulness programs that are directed at eating. But I think what is often important, people who are having struggles both with their body or with their eating patterns have often lost touch with their intuitive cues around hunger and fullness. They've learned to stop trusting those or stop listening to those. So helping people start to reconnect to what hunger feels like in their body. What is too much hunger, what is enough hunger to eat? What is an illness to stop, what is twofold that you're uncomfortable; using mindfulness to help cultivate those interoceptive exposure and interoceptive cues is really important. And also mindfulness, I know you guys talked recently about beginner's mind, mindfulness can help people reconnect to eating in a new way. if they start to experience food, if you really slow down and taste food, people are often surprised what they actually like, and don't start to eat more mindfully. So I think that those are two really important ways. And the last way is using mindfulness to urge surf when you have an urge to binge or an urge to restrict to say, like, I know what the right behavior for me is to choose next and I'm going to ride out this urge, mindfully. And then when it's when it's past, when I'm on the other end of that wave, I am going to engage in the behavior I know I need to.

Nikki:  So, slowing down and all the ways it's like slowing down to taste what you're eating, slowing down to listen to your body, slowing down to surf the urges that come up to potentially overeat or binge. love me some mindfulness, I mean, it's just so helpful.

Pete:  Well, loving my girls on the west coast, they're talking about surfing and the wave; we could use it over here on the east with all the snow. So in the east with Buddhism, I'm on the fence of whether I read it or not, but we have a meal Gotha that we that we repeat. I won't say the whole thing, but it's about recognizing there's 72 labors brought you this feud that you're trying to receive an offering to consider your practice. you're also trying to like untangle your mind and be free from greed so that's the third thing. and then the fourth and fifth are to support our life we take this food and to receive the way we take this food. So you're looking at like greed because like how many of us have been at like a buffet, we go for a second or third just because we're going to for seconds and thirds. And that could be seen as greed and so again, you're doing it with the with the realization of what you're eating, what you're consuming where it came from 72 labor's brought us this food. you know, and thinking about that and I will say when I first got to Buddhism, I was like sat with my teacher and like, all right, what do I got to do? I got to give up wine; I got to give up meat. like, what do I got to do, because I got to be a good Buddhist, whatever the hell that meant? And the Tibetans will write about this, because if you're in the mountains, you can't farm as easily. So you can eat a crop or plant based diet, you may have to eat animals, and they do so mindfully with respect. So the way that they manage the animal, the way that the animals fair, the way that the animals slaughtered and cooked, is all done in like a procedural, like, honoring way. And so there's the ease, but they know like, how do you respond to that and how do you maybe see that fitting into this Western behavior as well?

Danielle:   Yeah, I think that's all really beautiful, and a different spirit of relating to eating. I think when people come through the door with eating problems, through the door of the clinic, they're often so disconnected from the joy and beauty that food can represent and the fact that we should honor where it came from. And actually, you know, I've been in some groups where we were doing practices where we thought about how the food arrived to the plate that we were at. And it's incredible to watch people who otherwise are feeling quite lonely and disconnected while they're eating. To understand that this is actually an active community, even if you're sitting at the table all by yourself, isn't a singular person's experience. And I think, you know, broadening your horizons to appreciate that is a different and joyful way to relate to eating.

Pete:  Well, as we're getting ready to wrap up. I'm also reminded like silent meals, so like, at sessions when we do like long retreats of silent retreats, silent meals are really powerful.

Nikki:  You know I was going to say one thing that I think is really stood out to me today and getting to learn from Danielle is you've said the word joy a number of times today. And I really appreciate that because I think obviously, people are, you know, they're clicking on this episode and it says, disordered eating. And there might be sort of understandably an expectation of like, this is going to be about all the ‘the bad things.’ And really, what I'm hearing from Danielle is like, it's reconnecting not only to values not only to listening to our bodies and treat our bodies with respect in healthy ways. Also in the service of like, connecting with joy, like in mindfulness, it's not just about experiencing the uncomfortable. it's experiencing the comfortable too and, yeah, food across all cultures, right. Food is such an important way that we get to experience pleasure and connect with those we love and I certainly missed sitting in a restaurant with you guys and doing that. So you know that really stood out to me today. So thank you so much.

Pete:  What a beautiful summary. Yeah, Danielle, this was wonderful. You have any parting words? We really appreciate you bring your wisdom to us today.

Danielle:  Oh, well, I am so glad to have a chance to talk about this with the two of you and to be on the show, which I love and listen to and recommend regularly. So thank you for making space and yes, I would just echo what Nikki said, like I think for anybody who's listening to this, who might be struggling in their body or with food. to like, even open the door to the possibility that there's a way to reconnect and be joyful, and not have that part of your life feel like punishing. I think that that can be a really big motivator for taking a step towards healing.

Pete:  Thank you so much.

Nikki:  This has been When East Meets West. I'm Dr. Nikki Rubin.

Pete:  And I'm Dr. Pete Economou. Be present be brave.

Pete:  This has been When East Meets West all material is based on opinion and educational training of doctors Pete Economou and Nikki Rubin.

Nikki:  Content is for informational and educational purposes only.