Understanding Disordered Eating: For anyone whose relationship with food feels harder than it should

There are some questions that sound simple until you actually sit with them.
This is one of those questions:
"Can I work with a dietitian who specializes in eating disorders and also helps me lose weight?" 
At first glance, it feels like a yes-or-no question. But underneath it is a much bigger conversation about recovery, autonomy, body image, health, medical advice, and the beliefs we've been taught about weight.
In this episode, we're unpacking why this question is so complicated for both clients and providers, and why giving a quick answer often skips over the part that matters most.
The real conversation usually isn't just about a referral. A question like this can come from many different places.
Whether you're in recovery, supporting someone who is, or you're a clinician navigating these conversations, this episode will challenge the way you think about weight loss and eating disorder treatment.
Quotes
"Respecting the request and knowing what to do and what you end up choosing to do turns out to be two different things."
"Questions always have something living underneath them."
"The whole premise of eating disorder treatment is neutralizing your relationship with food."
"When something feels intolerable... it says, 'I can't tolerate this feeling, so I need to manage it through food.'"
"Neutralizing the relationship with food is almost impossible because there's always an outside agenda running every food choice."
"There's a difference between someone whose health is genuinely at stake and somebody in real body image distress who just wants relief."
"It isn't about getting it right or wrong. It's about opening up a conversation, opening up the exploration, and seeing what's there."
"The referral is secondary. The conversation and the exploration is the primary."
Frequently Asked Questions
Can you lose weight during eating disorder recovery?
There isn't a one-size-fits-all answer. The more important question is why weight loss feels necessary. In eating disorder treatment, providers often explore what's driving the desire to lose weight before discussing referrals or treatment options. The conversation behind the request is often more important than the request itself.
 
Should someone with an eating disorder work with a weight loss dietitian?
It depends on the individual's situation, but the episode explains why this isn't a simple yes-or-no decision. Before making a referral, it's important to understand whether the request is rooted in medical concerns, body image distress, or something else entirely.
 
Why is weight loss complicated during eating disorder treatment?
Eating disorder treatment focuses on building a more neutral relationship with food rather than making food choices based on weight goals. When weight loss becomes the primary focus, it can make it difficult to separate food choices from external rules and emotional distress.
 
Can you pursue health and eating disorder recovery at the same time?
The episode discusses how health concerns deserve thoughtful exploration rather than blanket assumptions. Some people have legitimate medical questions, while others are primarily seeking relief from body image distress. Understanding which situation applies is an essential part of treatment.
 
Why do people want to lose weight during eating disorder recovery?
For some, the desire comes from concerns about physical health. For others, it's an attempt to escape the emotional pain of body image distress. Although the request may sound the same, the reasons behind it can be very different and deserve careful exploration.
 
What is the goal of eating disorder treatment?
The goal is to develop a healthier, more neutral relationship with food by reducing reliance on rigid food rules and learning to make decisions based on internal needs rather than external pressures. This creates space for healing instead of continuing the cycle of using food to manage emotional distress.
 
What should therapists do when a client asks for weight loss during recovery?
Instead of immediately saying yes or no, therapists can use the request as an opportunity to explore what's underneath it. The episode emphasizes that maintaining the structure of treatment while creating space for honest conversation often leads to more meaningful progress than providing a quick answer.
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This week is the last of our summer throwback series. Next week, we will be back with an all-new episode. Until then, check out this vault episode.
Originally aired as Episode 166, this vault episode takes an honest look at our relationship with exercise and movement, and why it can become far more complicated than it appears on the surface. For many people, movement stops being something that supports well-being and starts feeling like an obligation, a way to earn food, manage anxiety, maintain control, or even punish themselves.
In this episode, we explore the warning signs of compulsive exercise, how movement can become intertwined with eating disorders and perfectionism, and what it means when skipping a workout feels emotionally unbearable. We also talk about the physical and emotional costs of staying stuck in that cycle and the first steps toward building a healthier, more flexible relationship with movement.
Resources
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This week, we are continuing with our summer throwback series.
Originally aired as Episode 174, this vault episode explores a question many people ask: What's the difference between disordered eating and an eating disorder? The line isn't always obvious, especially in a culture where restrictive habits, food rules, and body dissatisfaction are often normalized. In this episode, I break down the key differences, the warning signs to watch for, and when seemingly "healthy" behaviors may be crossing into something more serious.
Whether you're questioning your own relationship with food or trying to better understand a loved one's experience, this conversation offers practical guidance and reassurance. More than focusing on labels, we explore why the impact these behaviors have on your daily life is what truly matters.
Resources
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While we take a little summer break, we'll be rereleasing some of our most powerful and thought-provoking conversations, and this one tops the list.
Originally aired as Episode 175, this conversation remains one of our most impactful discussions on what it truly means to recover from an eating disorder. In this vault episode, I sit down with renowned eating disorder therapist and author Carolyn Costin to explore one of the field's most debated questions: Is full recovery really possible? Together, we unpack what recovery actually looks like, how to strengthen the healthy self, and why hope exists even for those who have struggled for years.
Carolyn also shares insights from decades of clinical experience, including her perspective on recovered clinicians, the evolution of eating disorder treatment, and the tools that have helped countless people move toward lasting recovery. Whether you're on your own recovery journey, supporting someone you love, or working in the eating disorder field, this conversation offers an encouraging and timeless perspective on healing.
Resources
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Now accepting new clients! Find out if we're a good fit! 
 
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In this episode, I'm talking about why orthorexia is one of the most misunderstood eating disorders, how wellness culture can quietly reinforce it, and why the biggest warning sign has very little to do with what's actually on your plate.
Because when grabbing pizza with friends feels mentally exhausting, that's worth paying attention to.
Quotes
"The biggest problem isn't what you're eating. It's what happens when you can't follow the rule."
"A life controlled by food rules is still a life controlled by rules."
"Perfection can become a shield that keeps you trapped."
"Movement can absolutely be good for you. The problem starts when you can't stop. When you can't take a rest day, skip a workout, or change your plans without feeling like everything is falling apart."
"You don't have to be physically falling apart for your eating disorder to matter. The amount of mental energy spent calculating, avoiding, planning, and worrying is reason enough to take it seriously."
"When everyone around you calls your eating disorder discipline, you're fighting more than the disorder itself. You're also fighting a culture that keeps telling you you're doing everything right."
"The question isn't whether movement or certain foods are healthy. The question is whether your relationship with them leaves room for flexibility, rest, and actually living your life."
"Perfectionism can feel protective. If you do everything exactly right, maybe no one can criticize you. Maybe no one can decide you're not enough. The problem is that eventually those rules start controlling you."
"Sometimes the goal isn't eating a different food. Sometimes the goal is proving to yourself that you can break a rule and still be okay."
"If going out for pizza takes more emotional energy than almost anything else in your week, that's worth paying attention to. The problem isn't the pizza. It's what the pizza represents."
Frequently Asked Questions
What is orthorexia?
Orthorexia is an eating disorder that's centered around an unhealthy obsession with eating "healthy" or "clean." The food itself isn't the biggest issue. The problem is when your life becomes controlled by rigid food rules, anxiety around eating, and the fear of doing something "wrong." While orthorexia isn't currently a standalone diagnosis in the DSM-5, it is widely recognized by eating disorder professionals as a very real and serious condition.
 
How do I know if healthy eating has become an eating disorder?
A healthy habit becomes concerning when it no longer feels like a choice. If skipping a workout fills you with guilt, eating at a restaurant causes intense anxiety, or your food rules make it difficult to enjoy everyday life, it may be more than simply wanting to eat well. The biggest sign isn't what you're eating. It's how much control the rules have over you.
 
What is the difference between orthorexia and anorexia?
Both are restrictive eating disorders, but they often focus on different goals. Anorexia is typically driven by weight, body size, or fear of weight gain. Orthorexia focuses on the quality or purity of food and following strict health rules. That said, the two can overlap, and both deserve treatment and support.
 
Can exercise addiction be part of an eating disorder?
Yes. Exercise becomes a concern when it feels impossible to take a day off or change your routine without overwhelming guilt or anxiety. It's less about how often you work out and more about your relationship with movement. If exercise starts controlling your schedule, mood, or decisions, it's worth paying attention to.
 
Why is orthorexia so difficult to recognize?
Orthorexia often looks like healthy living from the outside. People may compliment someone's discipline, dedication, or healthy lifestyle without realizing those behaviors are driven by fear and rigid rules. Because the behaviors are frequently praised, many people struggle for years before recognizing there's a problem.
 
Can you recover from orthorexia?
Yes. Recovery is possible. Treatment often includes creating more structure around eating, gradually challenging rigid food rules, and exploring the deeper patterns that keep those rules in place. The goal isn't to stop caring about your health. It's to build a relationship with food and movement that includes flexibility instead of fear.
 
Do you have to be underweight to have an eating disorder?
No. People of every body size can have an eating disorder. You don't have to look sick for your struggle to be real. If food, exercise, or body image are taking over your thoughts, relationships, or daily life, you deserve support regardless of your weight.
Resources
Be sure to sign up for my weekly newsletter!
Brave on Purpose! - Grab my new book here!
Grab my Journal Prompts Here!
Looking for a speaker for an upcoming event? Let's chat!
Now accepting new clients! Find out if we're a good fit! 
 
LEAVE A REVIEW + help someone who may need this podcast by sharing this episode.
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You can connect with me on Instagram @rachelleheinemann, through my website www.rachelleheinemann.com, or email me directly at rachelle@rachelleheinemann.com