Maggie McKay (Host): Welcome to the Kirby Connections Health Podcast, where we help you nourish your wellness journey with Kirby Medical Center. I'm Maggie McKay. On this episode we'll talk about exploring the negative impacts of diet culture, and weight stigma on food related behaviors with Natalie Feriozzi, Clinical Outpatient Dietician.

Natalie, thank you so much for making the time to be here today.

Natalie Feriozzi, MS, RDN, LDN: Thank you. I'm excited to be here.

Host: So what inspired you to become a registered dietician?

Natalie Feriozzi, MS, RDN, LDN: That's a great question. I've been a Type 1 diabetic for 24, almost 25 years, and at a very young age, I had to learn how to manage a major organ in the body, to be able to just survive. So I had my own registered dieticians growing up and they provided education, counseling and self-management support.

But this really eventually kind of shaped my relationship with food. And I did struggle for a period of time, with my relationship with food. I felt like food was a tool and, I equated it to numbers and success or passing or failing instead of enjoying the food that I was eating. So I actually had a dietician who helped me quite a bit, heal my relationship with food and, the experience created so much empathy within me, just for the struggles of managing a chronic illness through nutrition, and I really strive to be the person that not only could provide education, but could help reshape a person's mindset from being a victim of a diagnosis to now having a direct influence over the outcome of your health.

Host: I love that, that your doctors inspired you to be where you are today. When you mention relationship with food, describe what that means for most people.

Natalie Feriozzi, MS, RDN, LDN: Yes, a relationship with food is really the thoughts, feelings, and behaviors related to what, when, and why you choose to eat. So eating can encompass a physical act, of course, but it also does encompass the emotional and psychological connection to our food.

Host: I always feel guilty when I eat ice cream, but I eat it anyway and I don't care.

Natalie Feriozzi, MS, RDN, LDN: Yes.

Host: And I wish I didn't feel guilty. Because I love it so much and it, it's crazy, but I get what you're saying. So what key factors influence our relationship with our food? When does this process begin?

Natalie Feriozzi, MS, RDN, LDN: Yeah, there's about six, estimating, about six factors that can influence the relationship with food. Of course biological factors. So your physical signs of hunger and fullness and how you feel in response to eating certain foods. Psychological factors like emotions and your mental state at a given time.

Social factors, like people we interact with and our cultural background, economic factors, access to food, the cost of food, our environment like food availability, and marketing at grocery stores and restaurants and personal factors. So those are the beliefs, attitudes and knowledge, and even our past experiences that can influence how we feel about food and how that dictates our behaviors.

Host: And siblings.

Natalie Feriozzi, MS, RDN, LDN: Yes. Family. Yes. The food. That's like an eating environment thing. Yes. Big impact there.

Host: Yeah, I had one, several sisters, but one that was like always talking about food and what we ate and how much, and I'm like, oh my gosh, just eat it. Anyway, how do social beliefs and behaviors influence the perception of our weight and body image? Can you provide maybe an example?

Natalie Feriozzi, MS, RDN, LDN: Yeah, of course. So, cultural norms and beauty standards play a big role in, the influence of how we see ourselves. Different cultures have different ideal body images which dictate what's attractive or acceptable. And this can create a strong pressure to conform and can lead to body dissatisfaction.

Because you're constantly comparing yourself to other people. The media is another example there. So media can set really unrealistic, unattainable standards of beauty. You can internalize that a little bit and then go to extremes to try to achieve a body type that looks like something that maybe is not what your natural body type looks like.

And that also leads to weight stigma. A lot of individuals believe that being skinny equals being beautiful. And this can also lead to extreme behaviors and body dissatisfaction. So even our social interactions and our peer groups and things like that can influence how we feel about ourselves.

And that just further disconnects you from what's called your body autonomy. And body autonomy is that fundamental right to make decisions about your body without guilt or shame. So for an example, I am a 15-year-old girl who wants to look like somebody I see on Instagram or TikTok. My mom did a diet that made her lose a bunch of weight and I feel like she looks amazing, and my friends are taking laxatives to lose weight, so I should probably do the same.

But the reality is, the beliefs about her own body image originated from comparison, which is a lack of body autonomy. They were influenced by mirroring adult role models in her life and how they approached weight loss. And then she normalized that and she normalized the extreme behaviors because her friends are finding success by taking laxatives. So it's, yeah, it can really perpetuate our behaviors.

Host: I have a lot of friends who said, when they were raising their kids, they did exactly the opposite very consciously of how their moms raised them when it came to food and being thin, especially friends who had daughters because they didn't want them to be so obsessed with being thin and but with social media now, it's almost unavoidable, but how do you recommend starting to heal your relationship with food? How does this relate to weight management practices?

Natalie Feriozzi, MS, RDN, LDN: First step would be meeting with a professional. So that could be a registered dietician, a national board certified wellness coach, or even mental health counselors or therapists because we're really going to be able to assess your current patterns and beliefs, and then provide evidence-based information and counseling techniques that will help kind of unravel that web of misunderstandings about health, body image, and even behavioral responses.

So here at Kirby, we really try to be weight neutral. And during a nutrition care process, which is what I do when I'm assessing a patient, I look at multiple things. I don't just look at weight, body mass index. We look at your food history, your activity levels, your lab work. We look at family history, because genetics play a big role in our body composition and health issues we may run into later in life.

So I really try to do a good job of not focusing on weight wholeheartedly because weight does not equal health. And that goes back to our perceived perceptions of what beauty should be. And if I see somebody on the street who's maybe a little overweight, society may think, oh, they have diabetes, they have heart disease.

And that's not always the case. So the best thing to do is just work with a professional as soon as you really want to start healing your relationship with food and understand more about your needs specifically.

Host: Just what is the difference, or is there one, between a dietician and a nutritionist?

Natalie Feriozzi, MS, RDN, LDN: That's a great question. Yeah. So, my title is a Registered and Licensed Dietician Nutritionist, which is a national title. And a nutritionist is not a regulated title. So anybody could go on the internet, for example, and call themselves a nutritionist when they maybe have not received the same level of schooling and training as someone who has a board certification.

So that does bring some dangerous situations on the internet and can again, kind of perpetuate some of that misinformation that's out there.

Host: That's good to know. How can a person know if they have disordered eating tendencies. What percentage of the population in America struggles with this?

Natalie Feriozzi, MS, RDN, LDN: Yeah. So if you, yourself or someone you know, notices that you've become fixated or obsessed with your weight, like let's say in passing someone makes comments about, oh, I look horrible, or I've gained a bunch of weight lately, and we also notice that you're directly changing your behaviors to accomplish this ideal image of yourself; that's a pretty red flag. Pretty big red flag right there. And especially, getting ahead of it, parents can even look out for those little comments that their kids could make about their own body image or if their kids are spending extra time looking at food, counting calories, preparing a meal, or, measuring things really obsessively, if individuals are isolating themselves during eating or after eating, as well as just isolating themselves in general.

Struggling with disordered eating and eating disorders is a very lonely place to live mentally. Some other things we can look out for, like noticeable weight changes. Again, if this is you or someone, you know, we don't want to be making comments about other people's weight or weight changes. Decreased energy, decreased performance in school, decreased cognitive function.

There are lots of things that we can look out for. But within yourself, I would say it really starts with just food noise. Have you heard of that term before?

Host: No.

Natalie Feriozzi, MS, RDN, LDN: Yeah, food noise is just constant thoughts, whether they're voluntary or involuntary, that surround food and food related behaviors. So, let's say you want to have your bowl of ice cream, right?

But in your head you're thinking, I shouldn't have this. This is bad. This is a bad choice. Where does that come from? Why do I believe that about ice cream? And also, why do I not trust myself to make an informed decision about what I eat without guilt or shame? So we could unpack that a little bit. And if you start to notice that within yourself, maybe it's time to, to talk to somebody who can help.

Host: With the Ozempic and Wegovy, et cetera craze, I've heard that you probably should not comment either way ever on somebody's appearance as far as like radical weight gain or weight loss. How do you feel about that? What do you recommend?

Natalie Feriozzi, MS, RDN, LDN: Absolutely. I mean, that's definitely, I don't want to say dangerous territory, but it's a little touchy, right? We don't know how a person feels about their weight or their image. We don't know their experiences, we don't know their health background. Just like you don't know mine and I don't know yours, so.

Typically commenting, even if it is in the form of praise and oh, you look so great. Awesome job; in the back of that person's head, they could be thinking, well, did I look horrible before? And that's still perpetuating a really negative body image, that can lead to maybe more extreme eating behaviors. And 9% of America's population, which is about 28.8 million people in the year of 2023, were estimated to be diagnosed with an eating disorder at some point.

And the prevalence of eating disorders and even disordered eating behaviors and thoughts has more than doubled since 2000. It started at about 3.4% and reached about 7.8% in 2018, and now we're all the way up to 9% in most recent years.

Host: Why do you think that is? Why?

Natalie Feriozzi, MS, RDN, LDN: I think media plays a really big influence in it. We are in a constant state of observing other people's lives. And naturally as humans, I think we do tend to want to mirror some of the things that we watch and expose ourselves to. So I think media plays a really big role in that. And also, online it's kind of uncharted territory. Just like with your question about being nutritionist or a registered dietician.

Anybody can be out there online spreading false information or misinterpreting information and then sending that out to the masses. And that ultimately just creates more work for registered dieticians who then have to unpack all of that and provide evidence-based information.

Host: So Natalie, let's say somebody comes to you and they are interested in losing weight, but they also have an impaired relationship with food. So how do you advise that person?

Natalie Feriozzi, MS, RDN, LDN: Oh wow. I mean, it's okay to want to lose weight. There's nothing wrong with that, first and foremost. So that's probably the first thing I would do is just let them know like, I hear you. I hear that you're concerned about this. Let's explore maybe why. Let's explore some other motivators for wanting to lose weight.

Oh, well, my blood pressure's high. Or I've been diagnosed with pre-diabetes. I'm really struggling to walk up and down stairs. My cholesterol was elevated when I went to the doctor. Those are other parameters that we can monitor that are completely separate from how that person may be feeling about themselves.

And the dietary interventions and lifestyle interventions to target those examples I gave, can also lead to weight loss sometimes. So I find that it creates a much more gentle and open environment if you start exploring other motivators before addressing true weight loss. Because you can lose weight, and those factors may not change. Your cholesterol may not improve, and again, weight does not always equal health.

Host: Right. In closing, is there anything else you'd like to add that we didn't cover or you'd like people to know?

Natalie Feriozzi, MS, RDN, LDN: It's okay to ask for help. It's really hard to take a look in the mirror sometimes and, face that I maybe don't have a great relationship with food and it could be impacting my health. And I would love for people just to be open to starting that conversation with their doctor first and foremost.

Because that's how you would get a referral to a dietician and come to terms with it's okay that I might need some help. And overall, if I meet with a dietician or someone in the health realm, all we want to do is help you help yourself, and help you feel like your best self. And if that's really what you need, it's okay to ask for that.

Host: I love that. Well, thank you so much for sharing your expertise. This has been really informative and interesting. It's such an important topic that we all deal with in some manner. So thank you again.

Natalie Feriozzi, MS, RDN, LDN: You're welcome. Thanks for having me.

Host: Of course. Again, that's Natalie Feriozzi. To find out more, please visit kirbyhealth.org/services/nutrition-care-services or just kirbyhealth.org.

And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Kirby Connections Health Podcast from Kirby Medical Center.