What are some of the common myths about binge eating disorder? Why should food be neutral? How is a binge characterized by feeling more than quantity? In this podcast episode, Dr. Cristina Castagnini speaks about debunking the myths around binge eating disorders Marianne Miller.

MEET MARIANNE MILLER

Dr. Marianne has been in the mental health field for 26 years and has specialized in eating disorders for the last 11 years. She was a full-time academic for 12 years and had a part-time eating disorder practice for much of that time until she left the university and went into private practice full-time in 2018. Dr. Marianne loves working with eating disorders as a therapist and a coach, and she takes a non-diet, feminist approach that helps people of all genders live empowered authentic lives. She embraces the Health at Every Size model and is LGBTQIAA+ affirming. Dr. Marianne recently launched the self-paced Inevitable Binge Eating Recovery online program to help high-achieving professionals regain their mental and emotional energy by shifting their relationship with food to be fully present in their life.

Visit Dr. Marianne Miller's website and connect on Facebook, Instagram, and LinkedIn.

IN THIS PODCAST

  • What is misunderstood about binge eating disorders
  • The feeling over the quantity
  • “Food is just food”
  • The medical industry is not blameless

What is misunderstood about binge eating disorders

One of the most common misconceptions about binge eating disorders – and eating disorders in general – is that there is a certain body “type” from binge eating. This is untrue.
If you took all of my clients that I’ve seen over the past 11 years and you lined them up and you said, “Okay, pick the ones which have binge eating disorder”, you wouldn’t be able to guess because their body sizes completely vary. (Marianne Miller)
You cannot tell just by looking at someone whether they have an eating disorder or not, and that includes a binge eating disorder. Another common misconception about binge eating disorders is that because there isn’t an “obvious” tell about them, many people do undiagnosed or do not seek out medical or mental health help until much later.
It’s a shock to many people to think, “Yeah, wow, I actually might have [a] binge eating disorder … I thought I just stress-ate or emotionally-ate.” (Marianne Miller)

The feeling over the quantity

A binge eating disorder can be characterized as moments through a day or week when a person overeats to a level of discomfort or pain, repeatedly, and without being able to stop. There is no set amount that is considered “too much” which quantifies the limit of eating. Rather, binge eating is characterized by the feeling of being “out of control”.
A lot of times it’s the feeling [of being out of control] and then a sense of shame and despair that they feel afterward … and then also the preoccupation with food, eating, and body image. (Marianne Miller)
For almost everyone, a binge eating session is closely followed by deep feelings of shame that can make the whole cycle worse. Therefore, seeking professional help is a good way to start breaking the cycle and stop the pattern of binging.

“Food is just food”

There is no such thing as a “good” food and a “bad” food. Food is fuel, and some foods have more fuel or are more nutrient-dense for your body than others. Giving food a moral value is a one-way ticket to starting to judge yourself unfairly. If you give food a moral value and maybe call it “bad food” and restrict it, it may become something that you obsess about and often want because you have told yourself that you cannot have it because it’s “bad”. This is one of the ways that black-and-white thinking about food can make an eating disorder worse.
Let’s just have those foods every day so [that] they’re not “cheat day foods”, they’re just food, and [my clients] are like, “What!?” (Marianne Miller)
When food is neutral and that “appeal” of “giving in” to the “bad food” is diminished, that power it might’ve held dissipates. View food neutrally, and make your choices from that point. Realize this: binge eating disorders are brain disorders. People with binge eating disorders have areas of their brains that are not working as efficiently or effectively compared to people without binge eating disorders.
It’s also very much a genetic thing … and the environment flips that genetic switch and makes people more susceptible. For me, it was my family of origin environment that flipped the switch. (Marianne Miller)

The medical industry is not blameless

Unfortunately, a large portion of the medical industry has close ties with the diet industry, and realize this: their model is based on you failing so that they can make money. Be careful about whose advice you are listening to, because sometimes they will be trying to sell you a service or product that is not actually good for you. Medical practitioners have also been known to suffer from eating disorders, so this disorder truly can impact anyone at any place in life.
[The medical field]is saturated in diet culture and I have clients who are physicians and they got no training on this, yet … other physicians are dishing out to other clients this kind of crappy advice that’s very steeped in anti-fat bias views, [and] their own beliefs about diet culture and … in some cases its products they’re pushing. (Marianne Miller)
Binge eating disorder has nothing to do with willpower. It is a brain disorder and can be resolved, but not by “knuckling down” and forcing more judgment on yourself.

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MEET DR. CRISTINA CASTAGNINI

  I am a licensed Psychologist and Certified Eating Disorder Specialist. While I may have over 20 years of clinical experience, what I also have is the experience of having been a patient who had an eating disorder as well. One thing that I never had during all of my treatment was someone who could look me in the eye and honestly say to me "hey, I've been there. I understand". Going through treatment for an eating disorder is one of the hardest and scariest things to do. I remember being asked to do things that scared me. Things I now know ultimately helped me to get better. But, at the time, I had serious doubts and fears about it. If even one of my providers had been able to tell me "I know it's scary, but I had to go through that part too. Here's what will probably happen...." then perhaps I would not have gone in and out of treatment so many times. My own experience ultimately led me to specialize in treating eating disorders. I wanted to be the therapist I never had; the one who "got it". I will be giving you my perspective and information as an expert and clinician who has been treating patients for over 2 decades. But don't just take my word for it...keep listening to hear the truly informative insights and knowledge guest experts have to share. I am so happy you are here!

THANKS FOR LISTENING

Did you enjoy this podcast? Feel free to comment below and share this podcast on social media! You can also leave a review of Behind The Bite on Apple Podcasts (previously) iTunes and subscribe!

Podcast Transcription

[DR. CRISTINA CASTAGNINI] Behind the Bite Podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at practiceofthepractice.com/network. Welcome to Behind the Bite Podcast. This podcast is about the real-life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome. Well, hello everyone. Welcome to the show. I am so excited today and I just want to jump into the show, and I know that I just do that sometimes I don't have much of an intro. The reason for that today is because I have a guest with me who is also an eating disorder specialist and she's here to debunk a lot of myths and set the record straight about binge eating disorder. I know there are so many myths and so much confusion, at least that I hear in my office in patients and also out there outside of my office about binge eating disorder. So I'm so thrilled to have with me today Dr. Marianne. She is an expert, like I said and she's been in the mental health field for 26 years and has specialized training in eating disorders, and she's been working with patients for the last 11 years to help them get into recovery. Before that, she was a full-time academic. She did that for 12 years and had a part-time eating disorder practice for much of that time but then she decided to leave the university and went into private practice full-time in 2018. Dr. Marianne loves working with eating disorders as a therapist and as a coach, and she takes a non-diet feminist approach that helps people of all genders live empowered authentic lives. She embraces the health set every size model. Dr. Marianne recently launched the Self-Paced Inevitable Binge Eating Recovery online program to help high achieving professionals regain their mental and emotional energy by shifting their relationship with food to be fully present in their life. [DR. CRISTINA] Marianne, welcome to this show. I'm very excited to have you here. [DR. MARIANNE MILLER] Oh, thanks so much for having me. I'm glad to be here. [DR. CRISTINA] So I was, I'm interested to know a little bit about personal life and just wondering if you'd be willing to share a little bit more about you so people listening can know a little bit about you and who you are, how you got here. [DR. MARIANNE] Sure. Well, it's an interesting story. I didn't set out to be an eating disorder therapist. I took a roundabout way to it. I was an English Literature major in undergrad, and then I actually spent a year in Siberia where I was doing some like, pastoral counseling. That's when I really fell in love with therapy so I decided to come home and go to graduate school, and I got my Ph.D. and said, nah, I think I really want to be an academic, but I still want to have the side private practice. So that's what I did. I was working with a lot of chronic pain, people with chronic pain in my private practice, and a lot of them had disordered eating behaviors. The university where I was teaching taught an eating disorder class and so I sat in on it that summer and read all the textbooks, and I just fell in love with it. So I just really dived into a ton of training. I'm in San Diego, the University of California at San Diego, their eating disorder center is here. It's like one of the top ones in the US and they do a lot of training for local professionals. So I did that for about three years, got a, had an eating disorder specialist supervisor for a year and really leaned into that in my private, part-time private practice to the point at which I love that so much more than my academic work. So about five years ago, I left academia and turned my part-time private practice into full-time private practice. That's the professional route. The personal route is I'm myself from recovered for an eating disorder, from an eating disorder. It took, so I actually stayed away from eating disorders for a long time, because it was just hit too close to home. I had an eating disorder starting from around like the time that I was probably seven or eight and up in through my early 30s, so it was about 25 years. And it took a lot of different forms from more of the binge eating, bulimia type, to anorexia. I had a phase back to binge eating, so back to bulimia and my bulimia was binge eating plus over exercising instead of purging. So that like went round around the merry-go-round until I was, I injured my back from over exercising. I literally got my Ph.D. in December of 2003, and I injured my back in January, 2004. So I couldn't exercise at all and that sent me into a binge eating disorder spiral. When I came out here to San Diego to be a professor, I was just suffering a lot with my back pain, but also suffering with my eating disorder and I was able to find an amazing eating disorder therapist and get help and find a support group that was very helpful for me and was reading of my own and was able to recover completely. That was happening about the same time as I was moving from chronic pain to eating disorders and I vividly remember asking my therapist, like, "Can I do this with me being just barely recovered and getting training and stuff on this?" She looks at me straight in the eye and said, "Marianne, you've lived it." I said, "Oh, okay." And although when I have eating disorder clients in my therapy practice, I don't talk about my own history appropriately but it's, I get the sense that they know that I really get it. Even though their eating disorder or binge eating issues may look different, do look different than my experience I really get some of the pain and the suffering that they go through and how hard things are. I think they feel it at like a cellular level, honestly. So, yeah, it's, I'm really, really passionate about helping people recover because it has been such a huge, it's made such a huge difference in my own life that I just can't imagine not doing what I'm doing because seeing people recover is the most gratifying thing and this is really my life's purpose. [DR. CRISTINA] Thank you for sharing that. I totally echo what you're saying. I love that you are, again, putting out the message I really try to promote on the podcast, which is recovery is totally possible. We're going to talk about myth and things that people erroneously think about binge eating disorder today, but I think in just the umbrella of eating disorders, people have the erroneous belief that you can never fully recover from an eating disorder that you always struggle a little bit with it. I really hope people get the message loud and clear that that's absolutely not true, that you really can fully recover and you're here saying it. I say it almost every podcast. I've went through that myself and I really think that it's important to hold onto that belief because if you do tell yourself, oh, I won't fully recover, then that becomes a powerful statement and a belief system. [DR. MARIANNE] I completely agree. I mean, I didn't believe it myself, and I went to a support group that promoted like this notion that you're, for the rest of your life, you're going to have this. That, I mean, it was helpful in that I was with other people who suffered similarly, but I ended up leaving the support group because I was like, ah, I just don't buy into that. I believe that you can recover. The person who sent that message to me was, I mean, not personally, although I do know her now professionally, but Jenny Schaffer, who wrote Life Without Ed, and I started hearing about her and how she would walk around conferences with t-shirts that said recovered period, on it, and just what she has shown in her books and her talks and everything. So that was the first glimpse into the facts that recovery is possible. So she really helped me. [DR. CRISTINA] Yeah, no, just to even hear that like, oh wait it's possible? That's, exactly it's powerful. Thank you. [DR. MARIANNE] Yeah, totally. And it's very different than I think what a lot of therapists are taught in graduate school. I mean, a lot of professors believe, to be honest, I bet, professors I have heard say, yeah, you're going to struggle with it for forever. I'm like no, actually not. But thankfully the class I sat in on, the professor did not believe that and did believe in full recovery so that was helpful. [DR. CRISTINA] Switching over to binge eating disorder, I still hear in my practice over and over again people coming in and they have even for themselves a struggle even believing that they have been dating disorder because there are so many erroneous like messages out there and beliefs about the illness. I know it was the last one to get put into the diagnostic manual probably for that reason. But what are you hearing, like, what do you typically hear that is maybe misunderstood about binge eating disorder that maybe is, are the hurdles for people coming in to reach recovery or engage in treatment? [DR. MARIANNE] That's a great question. So if you took all of my clients that I've seen over the past 11 years, and you line them up and you said, okay, pick which ones had binge eating disorder, you wouldn't be able to guess because their body sizes completely vary. The reverse is true as well. Just because people are in fat bodies, it does not mean that they have binge eating disorder. Like right now the prevalence rate is around 6%, including all genders and there's more than 6% of people in the US in fat bodies, however you want to define fat bodies. So it's just, it's an unfortunate myth, and it's struggle. So it's a struggle for people because they think, ah, yeah, I'm not going to get help, or I shouldn't get the help I need. I'm just struggling. I just need to focus on eating better, healthier, cleaner, blah, blah, blah and that's just not what they need. They actually need treatment. And it's a shock, it's a shock to many people to think, yeah, wow, I actually might have binge eating disorder. I thought I was just like, just stress aid or emotional aid. [DR. CRISTINA] And I hear that all the time as well, people saying, oh, you can look at somebody and know if they have an eating disorder and that which one they have. That's absolutely not true. [DR. MARIANNE] Yep, and especially with the atypical anorexia. I mean, I know we could have like five podcasts on that, but like even that you cannot tell based on people's body size. But with binge eating, which disorder for sure, like people would be shocked at the clients that come in my door in terms of their struggles with binge eating. [DR. CRISTINA] You touched on the, is it stress eating, "overeating?" Do you find that there's a lot of confusion about what those are versus like what an actual binge is? [DR. MARIANNE] I think it's helpful, if I'm going to give them a binge eating disorder diagnosis is go by the diagnostic criteria as they need to have at least one binge week for three months where they're feeling a sense of out of control with food. It's really interesting because they're, what's out of control amount wise for one person is going to look completely different from what's out of control amount wise for other people. So a lot of times it's like the feeling about it and then the sense of shame and despair that they feel afterward. And then also the preoccupation with food eating and body image. [DR. CRISTINA] So somebody is listening and saying, well, I don't think I binge, because I think there is this, ugh, I hear this all the time. People say, oh, I see on TV or I've seen it's depicted that like a binge is like this enormous amount. It's like, there's something in their mind that they have as an idea of like, I don't, I didn't do that, so I couldn't possibly, I just, I'm out of control. I need to watch my portions. I just need to have more willpower. I just digest. What would you say to somebody listening like that who's like really questioning, like, was that a binge, was it not? [DR. MARIANNE] Yeah, that's helpful. Well, I mean, for the diagnosiss, not diagnostic criteria, the binge occurs over two hours. So it may not mean this like 15 minute free for all. It may be for some people, but it may not be. It can last over two hours. Then there's subjective and objective binges too. Objective binges are where anybody in your culture would be able to see that and would be like, yeah, that's a lot of food. And this is an important distinction. It isn't at a food related event like Thanksgiving or some sort of holiday or something where it's Super Bowl Sunday knows for pupil who eat a lot of food. Or again, again, depending on the culture. So an objective binge is like, yeah, that's a lot of food? Then a subjective binge is that someone out, an outsider may say, well, I don't think that's a lot of food, but to the person, it feels like a lot of food and it's causing them a lot of distress. So I still qualify that as a binge, even if it's subjective. Now it might require a different diagnosis if there's other, like, if there's a lot of restriction involved and then if there's some sort of purging activity, then I would do an anorexia, binge, purge, an anorexia. So there's some other factors I'd have to look at but just that sense of feeling like you're out of control around food like, you can't stop. And for sometimes it's someone just eating a lot of food in one sitting, and sometimes it's someone who gets up and down from the couch to the kitchen every 10 minutes for two hours. So it just looks different. It's important to ask the detail of the question and to really educate people's, like, it's not all what you see on TV. It all doesn't look like Dwayne Johnson, The Rock's cheat day. Oh, I hate when people post social media their cheat days. I'm like, not helpful for people with eating disorders. Not helpful. [DR. CRISTINA] So when you're saying that people are like, why isn't that helpful? Like, oh no, that's what I do. I'm so "good" all week, and I need my "cheat day." When I hear that, like, people ask, why is that? What's wrong with that? What do you want to say? [DR. MARIANNE] Well, the goal of binge eating recovery is to make food neutral, so it doesn't have a lot of emotional weight to it. So if you set like one special day where you have foods and restrict the rest of the week then what that means is that you're likely obsessing about those foods and you're feeling preoccupied about those foods all week. And that is another marker for binge eating disorders, when you're obsessed and preoccupied and you're thinking about food, that's my clients, they come to me and they say, "I'm thinking about food eating your body image 80 to 90% of the time." I tell them, "Well, I can get you down to less than 10%, even maybe less than five." They look at me like, I'm nuts and I say, "No, seriously." But then later after they've gotten great recovery, they say, "I remember when you said that, and I thought you were totally lying, I totally didn't believe you." I say, I know. I say, I believe you now. I'm like, yes. So yeah, so the cheat days is a setup. It keeps people, the way that I explain it is, so if I'm going to tell you Christina, don't think about a pink elephant immediately there's like pink elephants flying all around the room, or I become a pink elephant or whatever. So it's important to tell people to not have this sense that certain foods are taboo. It's what it does. There's something about human psychology that we focus on things that people tell us not to focus on. Like you probably weren't even thinking about a pink elephant prior to that but when I mentioned it, you're like, dude, don't think about a pink elephant all of a sudden. Pink elephant's everywhere. So if you tell someone like, no, really, seriously, I don't want you to eat foods X, Y, and Z, they may have not even thought about foods X, Y, Z, but now they're obsessed about foods X, Y, and Z. So the cheat days are really a set up. Then it's, I imagine, I'm not a medical doctor. I'm not a dietician, but from what I know, is that it's really also hard on the body to have such a drastic shift on days of the week versus like on the shift day or the cheat day when you shift over to the cheat day. So yeah, so it's very not helpful. I see it in my clients all the time. They're like, I want cheat days. I was like, well, let's just have those foods every day and so they're not cheat days foods, they're just food. They're like, what? I'm like no, really, I'm serious. They are like, but I want the cheat day. I'm like, yeah, sure. It's like, you want the high, but let's just inhabit those cheat foods and let's just make it food and have it be neutral so it's not, it's like you don't even think about it. Again, they think I'm nuts and again they come to see that I was right. [DR. CRISTINA] I'm going to second that. So anyone listening, this is absolutely true, neutralizing the food, so it's not this forbidden thing that's you just waiting to get and becomes this thing and it, yeah, so anyone listening, I totally agree with her. [DR. MARIANNE] I love the saying, neutralize the food. That makes me think of it like a laser. Like you have lasers, I'm going to neutralize the food, pew, pew. [DR. CRISTINA] It is. I mean, it's hard. I think I went to the treatment as well, and I remember thinking like, how is that possible to have food every day? Like, what? That's what, but it was just such a foreign concept. I don't know how your experience was, but now I think back and I'm like, why was that so hard? It's funny [DR. MARIANNE] Well, I mean, for me, I was just brainwashed. I mean, I had had a very diet culture, saturated family of origin and of course, I grew up in the seventies, eighties. So people just weren't talking about eating disorders unless it was like extreme. The teens I see now just have so much more knowledge and understanding and parents do for the most part than how it was, how it really, even how it was like, I would say seven to 10 years ago. Things have gotten a lot, there's just been a lot better awareness. I think social media has helped too. Like people didn't know about binge eating disorder. They didn't really know that it was a thing, I'll say eight, nine years ago, they didn't know. But now a lot of people come to my office, they're like, "I think I might have binge eating disorder." Or if I mention it, they're like, "Oh, yeah, I've heard of that." So it's changed, which is good. [DR. CRISTINA] Do you find that people struggle to accept that they have an illness versus like, oh, I'm choosing to do this, or I am, it's something I'm doing wrong? [DR. MARIANNE] Yes. So what I do in the first, first or second session is I really educate people on how eating disorders are brain disorders and how if they've, researchers have conducted FMRI studies on people with binge eating disorder and compared them to people without binge eating disorder. So if you have people with binge eating, eating disorder, people without binge eating disorder, and the people with binge eating disorder, they have areas of the brain that aren't working as efficiently and as effectively compared to people without binge eating disorder. And it's also very much a genetic thing and the environment just flips that genetic switch and makes people more susceptible. So for me, it was my family of origin environment that flipped a switch and for a lot of teens and even some adults, the pandemic was a thing that flipped the switch. I mean, you probably saw like I did that eating disorder rates skyrocketed. And we're still seeing the effects of that, so I think that's, I totally lost track of your first question. [DR. CRISTINA] Well, it is more in the sense of people seeing someone like us and we're, binge eating as an illness versus like it's a choice, like I just need to "diet better" or have "more willpower," you know, portion things out better or it's my fault I'm doing this. It's me. [DR. MARIANNE] Got it, got it. So what I say is I say it's not about willpower. It's not a choice. It's a brain disorder. It's not your fault. And I say that over and over and over and over again until they start believing it. I say, it's not your fault, it just this is the brain you got dealt. Then I say, look in your family of origin. What about your extended family, what about your parents, grandparents, aunts, uncles, great aunts, great uncles? Do they have eating disorder? Well, yeah, I mean that's what the research says. That's science. So it's not about willpower. It's really, the notion that it's about willpower really is, has to do with diet culture and how pervasive diet culture is and how they're pushing that belief. Because if the multi-billion-dollar diet industries, if they want to push their products, their programs, their whatever, they're influencing for and they want you to buy all this stuff, they want you to believe that it's something about you that some, something's wrong inside of you that needs to be fixed. And my approach is that no, like it's really you're, you just have a different brain and we just need to heal your brain and treatment does that. We've seen that. It's not about willpower and it's not about a choice. It's just as if you had cancer and you'd need to go through chemotherapy treatment. You wouldn't, one question I ask because I say, you say, well, if you had a friend with leukemia, would you say, oh, you just didn't have enough willpower. That's why you got leukemia. And they say, my clients say no. I say, of course, eating disorders is the same thing. [DR. CRISTINA] I think it is a huge struggle. Like you said, the giant beauty industry really pushes a lot of their own agenda and gets in people's heads and it does get confusing so people are like, wait a minute. It's my, it's a behav, part of it's a behavior. A lot of it's like you said, is the internal workings of the guilt and the shame and what's driving the binge eating behavior. But ultimately, I think people, maybe you could speak on this a little bit, but it's the behavior people look at as the actual binging or the relationship with food. So it seems like, okay, if I can stop the binging or if I can "eat better," "healthier," then that's on me. I hear, I often hear people say, oh, I'm just lazy, or people tell, oh they have family members saying to them, well, I'm just looking out for your health. Maybe I can help you. And even, I mean what, I don't know what your take on is with the medical field, but I often hear medical doctors, such a horrible things that just negate what you and I tell patients. It just as a number like, oh, well let's get you on this program or this diet. Or the worst I ever hear is when they're referred people in larger bodies bariatric surgery. [DR. MARIANNE] Oh yeah, which is so saturated in diet culture, unfortunately. I mean the, yeah, again, we could have like five podcasts on that [DR. CRISTINA] I know. It's so bad about --- [DR. MARIANNE] Yeah, no, I'm serious. Like it's a, yeah, I have a lot to say about that. But yeah, I feel very similarly about the medical field. They're very saturated in diet culture. I mean, I have clients who are physicians, they got no training on this yet these physicians are dishing out, not my clients, but other physicians are dishing out to other clients this crappy advice that's very steeped in their own anti-fat biases and their own beliefs about diet culture. In some cases, it's products that they're pushing. So yeah. And so it just really compounds like all the disbelief that it's, I'm just lazy. What I found, my clients with binge eating disorder, they're the least lazy people I know because they're killing it in every other area of their life and they're working their tails off trying to figure out this food thing. They just can't figure it out. I'm like, yeah, of course not. It's because it's a brain disorder. It's not your fault. It has nothing to do with willpower. Let's get you the right treatment so you can get help and healing. [DR. CRISTINA] I love that you said that. I often say that to people. I'm like, you have tried everything on this planet for years to try to get ahold of this. Like, you're not lazy at all. Like, you've been struggling. This is a lot. Like what? No, it's awful [DR. MARIANNE] I know. Look at the evidence. People, look at the evidence. [DR. CRISTINA] Yeah. [DR. MARIANNE] It's embedded so much that fat equals lazy, smelly, stupid and I'm, for those of you who are listening, I'm in a fat body myself and I am one of the least lazy people that you would meet. I have a huge, very strong work ethic. I am highly intelligent, clearly, and I kill it in every area of my life. I actually have a positive body image. And I smell nice. I meant all of that. So I think that it's, all of those myths need to be debunked because that's what they are, they're myths. [DR. CRISTINA] No, they absolutely are. I mean, this is why I brought you on to talk about like, what were these things out there? Like how do we start having these conversations and getting people to really hear things because I think they are so noisy, that eating disorder voice and the critic is so noisy in everyone's mind and it's so hard. Even maybe the hurdles to people even to come into treatment, like, oh no, I'm not sick enough. I don't really have that. [DR. MARIANNE] Oh, for sure. There, have you, I'm sure you're familiar with Dr. Gaudiani, Jennifer Gaudiani's book Sick Enough. That's good. Almost Anorexic by Jenny Schaffer is also a really good book too, so yeah, it's all good. Again, five podcasts we can talk about. That's just the medical profession and bariatric surgery. I mean, that's a whole thing. [DR. CRISTINA] I'd love, I'd actually love to have you on just to talk about that one topic. [DR. MARIANNE] I'm down. Let's do it. No, it's a lot. I have, I've worked probably like you, I've worked with people who have had it in the past and come seen me. I have had people who've worked with me and then chose to get it. So I have a lot of very different perspectives on it, so. [DR. CRISTINA] All right. Well, I know we're getting out of time here and like I said, I'm definitely going to have you back on to talk about it, this topic. Any last final words for people before we end? [DR. MARIANNE] Just remember that you are deserving of help. You are so deserving of help. Whatever your level of struggle with food, eating and body image is, you are so deserving of help. It is not your fault. It's so not your fault. [DR. CRISTINA] Okay. So how can people find you? [DR. MARIANNE] I'm all over Instagram at Dr. Marianne Miller. You'll see my funny dancing reels and it makes you smile. It makes me smile. I like watch them myself when I'm like, and it makes me laugh and smile. I'm on my website. I have a very active blog Dr. Marianne Miller and I have a Facebook group that people, that's free, that people can join. It's called Redefining Relationships with Food and Body. They're welcome to join. I have a lot of resources there as well. [DR. CRISTINA] I think that'll all be in the show notes as well. Marianne, it is been such a pleasure. I am so glad we connected and we were able to come on. So thank you, thank you, thank you for all of your great information. [DR. MARIANNE] I'm honored, Christina. I appreciate it. [DR. CRISTINA CASTAGNINI] This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.