Kathryn: Today we have Nicole Moreno. Nicole, I’m so excited to have you on the Imperfect Thriving podcast. Welcome to the show!

Nicole: Thank you so much, Kathryn. I’m absolutely delighted to be here.

Kathryn: So first I would just like to know a little bit more about your story and how you got to where you are today.

Nicole: Oh, my goodness. It is a long time story. So we will do the Reader’s Digest version of the story, which I love that the audience of this show will get that joke because I think younger folks do not quite. So yeah. So my background, I’m a registered nurse. And as part of my professional career, I did a lot of work in community and preventative health. And I’ve been working for more than 18 years in the profession, in a variety of settings. And I really enjoyed doing the preventative health aspects, like, you know, helping families to be more physically active and. Eat healthier. So that was a big part of my practice. I went back to school to get my PhD and focused on wellness.

Eventually I got a job teaching at a couple of universities that was sort of my first stop after the PhD and started doing research in weight management. So it kind of shifted. Prevention to intervention and doing a lot of behavior role, you know, weight management programs and participating , kind of watching how people went through the programs, what happens with their weight, what happens with their mood. And I was in academics for about eight years.

And at the same time, I also unfortunately had developed an eating disorder of my own. So I’ll take us off to that little track for a second. I was 31 when I developed my eating disorder. And I think most of the time, many people think that eating disorders are, you know, for teenagers or young teenager, that young women that have eating disorders, but that’s simply not the case. And we’ll talk about that a little bit more, I know later but anytime there’s big changes in life. And especially if you have the genetic susceptibility, the personality, it’s sort of like a perfect storm of factors that come together and a feeling of being out of control. One thing we like to control is our food intake and the amount of exercise that we do. And of course you combine that with doing weight loss research. And I developed many of my own issues. I had recovered from anorexia, so it was a lot of restriction, a lot of compulsive exercise. So I was really struggling with my body image and my relationship with food.

And the last study I did as an academic, I sat down with 13 men and women who were, and I’ll do this in quotes, successful at weight loss. And I listened to their full life histories around weight. I did, it was called a focus life history just around their weight stories. And I was just, I was, it was an amazing study, but I was just so upset when I listened to their stories because I heard all about their negative body image and the number of diets they had been on unsuccessfully, how preoccupied they were with calories and tracking and how disappointing it was to get on the scale. And it wasn’t budging.

And then there were some more extreme behaviors that they were talking about and just the impact that it had on their day to day life, their mood. There was panic. If they had to go out to eat or to a wedding, what am I going to do? What am I going to eat? And I sat there one day in my office and I thought I’m a thin person who is recovering from an eating disorder. They’re doing the same behaviors that I am doing. And we are giving them the green light to do that.
And it is impacting my health overall and it is impacting their health overall. And so I made a decision at that point that I could no longer participate in doing weight loss research and shifted my expertise into disordered eating and eating disorder recovery.

Kathryn: Wow, what a story there. I’m trying to keep up with all the different parts that I want to know more about as you’re telling me that amazing story.
And I won’t, I’m sure that I will forget some of them, but it really sounds to me like as someone who has not experienced, at least severe disordered eating. I’m sure that I’ve had some form of disordered eating, cause I’m not perfect. But as someone who hasn’t experienced this specific thing, it sounds to me like it was absolutely totally and completely ruling the lives of the people in that study. It’s not just about your relationship with food, it takes over your mind. And when you’re in your head, living with these worries and these stresses in your mind, you are not out in the world, enjoying your life.

Nicole: I a hundred percent agree, eating disorders can hijack your brain for sure. And the other downside is that you’re not participating in your life whatsoever. I mean, it’s completely isolating. And you can become completely disconnected so you can be physically present, but you’re not present at all.

Kathryn: And if you don’t mind me asking , as one studies, one person who studies behavior to another person who studies behavior, what do you think it was that led to your disordered eating?

Nicole: That’s such a great question. I definitely have the personality attributes of the perfectionist. I have..

Kathryn: Yeah can you tell me a little bit more about that. Like what are the personality traits that sort of make it easier to have an eating disorder?

Nicole: I definitely think that many people with eating disorders, they want to be accepted, want to do everything right. All the time. If they’re not doing things right or perfectly, then there’s this tendency just to freeze or abandon or not progress forward. And I think it’s easy for people who have a perfectionist way of being to create a lot of rigid rules for themselves.

Kathryn: Amen to that.

Nicole: Keeps us safe. It keeps us safe within the, you know, perfectionism. It’s like, okay, well, I’m just going to, I’m never going to attain perfection, but I’m just going to keep rewriting these rules in order to try and keep myself safe and in the right direction. But I think like those personality traits, can really, really come out, like being eager to please, things of that nature.

Kathryn: Okay. So that’s definitely one thing that led to yours that also leads to other people having disordered eating. What else?

Nicole: Strong genetic association, for sure and some coexisting anxiety too. I do think many, really all of the clients that I see do have issues with anxiety and depression.

Kathryn: And I would argue that it is the need for perfection that leads to those as well. I think at the top, it sounds like they’ve got this personality trait, that sort of trickles down. So tell me, I did not know that there was a genetic association. Can you tell me more about that? That is so troubling yet interesting.

Nicole: It is. If you have, it’s specifically a parent, but most likely a mother or an aunt that has an eating disorder. I mean, it’s like nine, I think I’m not going to get this number correct. It’s something like you’re nine times more likely to develop an eating disorder yourself. So there’s a strong genetic component to it that if you’ve had women, especially my line of work focused on women specifically here, you know, if you have women in your family who have had struggles with disordered eating or an eating disorder. Well I think one, there is the actual genetic piece there’s also if they are struggling, you’re probably hearing about their body hatred. You’re watching them restrict their food intake. You’re watching them weigh themselves and beat themselves up every day. I think it’s really both of those things.

Kathryn: Yeah you answered my next question before I could even ask it, how much of that is nature and how much of that is nurture. So it’s hard to separate those two. Okay. So there’s the personality component. There’s the genetic association and a coexisting anxiety or depression. Is there anything else that you see that kind of goes into that mix?

Nicole: Yes, dieting. And that I hear the same story, a lot in my office from my clients. There is this belief system that gets developed early in their life, that they must be thin. They must be pretty, they must control their weights or else their life is going to be very difficult.

Kathryn: There’s an ideal picture that someone creates in their mind and it really, really makes it terrible. What is the word I’m looking for concoction when you put that ideal picture with a personality of wanting to please, wanting to be perfect, and wanting to be the best you can is what it sounds like to me.

Nicole: Exactly. Yes. And that’s sort of the perfect storm, situation. And I did I’m I’m never going to remember who said this exactly, but not everybody who diets develops an eating disorder, but everybody who has an eating disorder has dieted.

Kathryn: Okay. Yeah. That makes sense. Yeah. Okay. So if there’s anything that I’ve learned in my counseling and consulting practice, it’s that each one of us has a relationship with two things, money and food. How do we develop a healthy relationship with food? And what does that look like?

Nicole: Such a great question. I would say that the healthy relationship with food that I would define that as being, we’ll talk about a little bit about the work that I do with intuitive eating, but that really comes from the inner wisdom of the body to guide us, to tell us what to eat, how much to eat, when to eat. Babies are naturally intuitive about their eating and they are going to tell their parents right away if they’re full, if they don’t like something, might spit it out right on you.

Kathryn: Or refuse to eat anything that’s not an orange vegetable.

Nicole: Exactly. Yes. And that changes. And I imagine that’s incredibly difficult.

Kathryn: You start to realize that when their skin starts turning orange, but anyway.

Nicole: That’s funny.

Kathryn: Go ahead.

Nicole: So, you know, I think that developing a healthy relationship with food it’s a little complicated because we did have an intuitive relationship early on, and I no way want to throw parents under the bus here. There’s very well meaning parents who provide a lot of rules to their children around eating. Don’t eat this. This is good. This is bad. Clean your plates. Those sorts of things that begin in our early lives to disconnect us from our inner cues of hunger and fullness and satisfaction.

Kathryn: Yes. So things like clean your plate, I’m sure that I am guilty of sort of taking my children a little bit away from their intuitive way of thinking, as children. What can we do as parents to nurture that healthy relationship with food, any do’s and don’ts that you could share about that?

Nicole: Absolutely. Do give yourself compassion. You do not have to be perfect at it. Offer a variety of foods in your home, a variety of foods at meals. I like the work of Ellyn Satter. She’s a registered dietician and she developed something called the “eating competence model” and the division of responsibility. So it’s the parent’s job to provide the food. And it’s the child’s job to decide what and how much they want to eat.

Kathryn: Oh, that’s perfect. It’s so simple, but so helpful. Yeah. Okay. I love that. I love that. That now we have a very easy way to nurture that good relationship.

Nicole: Absolutely.

Kathryn: So, yeah. How does dieting interfere with a naturally healthy relationship with food?

Nicole: Well, it is a totally external thing. So if intuitive eating is the internal. Your body guide to tell you how you know, what, how much and when to eat, diets are the opposite of that. They are going to dictate from an external source, authority source that you should only, and there’s a lot of shoulds in here, you should only eat this much. You should only eat these foods. You should only eat at these time. And again, that keeps us completely disconnected from what our body needs, what our, what we want.

Kathryn: So I guess I should have asked you first, if you can explain exactly what intuitive eating is.

Nicole: Yes. So intuitive eating is, eating in a way that we allow our bodies to, guide us in terms of, you know, eating when we’re hungry and stopping when we feel full and letting our body be the guide. We are the expert of our body. We are the expert of our taste preferences. We have a budget for food that we need to stay within. We have, I call it somebody’s eating world. There’s a lot of things within your, your eating world.

Kathryn: Sure.

Nicole: Yeah. And so it’s really just coming back into touch with what feels good in your body rather than having somebody else tell you well you need to eat these super foods, or you need to go on the Keto or intermittent fasting. And those are very disconnecting for us.

Kathryn: So this might be a bit of a silly question, but like, what if my body keeps telling me all it wants is potato chips?

Nicole: That’s such a great question.

Kathryn: What do I do then? What do I do with that? Because on one hand, I mean, I want to be healthy, right? I mean, I don’t want to just eat potato chips. So how do I marry those two things together? If all I’m craving is potato chips.

Nicole: Well, I think that’s interesting to tap in and get curious about sort of what might be going on that is sort of driving that desire to have potato chips.
And if that’s really a desire that you like, I just really want to have these they’re comforting. They’re crunchy. They taste really good. I assure you if you gave yourself permission even to eat the nothing, but potato chips, you would get sick of them pretty quickly and you would naturally want to start eating something else.

Kathryn: Okay. So I get that. When it comes to intuitive eating, like in that particular example, wanting potato chips, could it be that my body needs salt? Ah, there it goes my microphone, that my body needs salt or it needs something.

Nicole: It very well could be. I like to think, is it coming from above the neck?
Is it like a persistent thought that I have to have potato chips that might be disconnected from the rest of your body? Or is it sort of from below the neck? Are you getting cues that you are hungry and maybe something very salty sounds good right now and would be very satisfying.

Kathryn: So how do we figure out which one it is?

Nicole: Ah, such a great question. Yeah. Well I think it is tapping into, is it a repetitive thought in my mind? Like, I want potato chips. I shouldn’t eat potato chips. Oh. But I really want potato chips, but I really shouldn’t eat them. Or are you feeling things like, you know, a little bit of emptiness in your stomach. Are, you know, you feeling maybe like, hmm, that might sound good, but you know, Apple sounds good too. And so does the sandwich, so maybe you’re just hungry. And it’s not just the potato chips that you want.

Kathryn: Okay. So what I’m hearing is we really have to try to get out of our heads and any kind of limiting thoughts that we’re having and let our body tell us out of our heads, into our bodies.

Nicole: Exactly. Yes. And that takes a lot of practice. It doesn’t just happen one day that you wake up and you’re an intuitive eater , because there is a lot of, you know, dieting mentality and thoughts and belief systems that are there and really becoming aware of those. Are those, you know, dictating your eating or is it the internal that’s dictating your eating?

Kathryn: Yeah. So like with any mindfulness in any time we’re trying to develop a deeper awareness, we’re going to have to peel the onion and get past all of the shoulds and all of the things that we’ve internalized from our culture and society before we really can listen to our bodies.

Nicole: Exactly.

Kathryn: Okay. So. we alluded to the fact earlier that it is easy to think that disordered eating is something that happens to young women and adolescents in their teens and early twenties. But tell me about your experience with women in midlife and disordered eating.

Nicole: Yes, we do think that it is mostly just younger women. And I see all genders, all adult ages in my practice, but I do have a good number of men and women that are in the middle age group. And I think it is really important to know that we’re becoming more aware of the fact that there is disordered eating and there are eating disorders among middle aged women. In fact, the rates around 3% of women over 40 have an eating disorder. That may not seem like a lot, but if you think about the population of women, even just in the U S alone, that those numbers can be staggering and that’s not counting the people that have, you know, a sub threshold eating disorder or disordered eating that never gets detected. So, I do think it is very important to know that eating disorders can develop in midlife if somebody’s not had one before. Somebody can have a relapse in midlife and we can talk in a minute about what makes us vulnerable at this stage in our lives.

Nicole: And we can also have somebody who maybe has that subthreshold disordered eating, or has had an eating disorder for a very long time that it becomes exacerbated in this stage. So it really is all three of those that women may, you know, fall into. If there’s been something underlying, especially body image issues for many, many years, menopause is a big, period of vulnerability for women to develop eating disorders.

Kathryn: Ah, and is that because they’re that our bodies changed so much and the way our, our weight, the way food affects our body is different at menopause?

Nicole: Yes. Well, eating disorders, there are three distinct time periods where eating disorders are most prevalent for women: puberty, around the childbearing or childbirth and then menopause. And all of those times we are having changes in our hormones. And so yes, having your estrogen level decline will one: when our ovaries aren’t producing estrogen anymore, we do put on adipose or fat tissue around the middle in order for that tissue is an active endocrine tissue that develops estrogen to help protect our body from bone loss and from, you know, heart disease. And things of that nature and estrogen’s really important. So we need to have it and our body will naturally help us produce it when we’re no longer producing it in our ovaries. But unfortunately we have put a problem stamp on the, you know, weight gain around the middle is something that needs to be managed or taken care of. And so, yes, that definitely makes women who are in perimenopause and then post-menopausal also, but not as much, really perimenopausal times more vulnerable.

Kathryn: Yeah. So there’s a physical change in our body. Bodies going on in those three different time periods that have to do with our different levels of hormones. But I would also imagine we each have a picture in our own minds of how we look and that we should stay that way. And then it’s probably difficult to separate from that picture during those times as well. Would you agree with that?

Nicole: A hundred percent. Yes. And I mean, there is this narrative around, you know, wanting to keep it young and anti-aging, and having to do a lot of extreme things, things to keep ourselves young looking rather than normally focusing on grieving the fact that body changes are inevitable. Like nobody looks the same at 80 as they do when they’re 15. So, you know, part of that’s just coming to terms with yeah my body is going to change and so is everybody’s and it’s hard and that’s okay.

Kathryn: Yeah. So that’s another area where if we are rigid with our or rules, it is going to cause us problems. So that’s why I’m always working with my clients about moving from rigid rules and shoulds to psychological flexibility. That is another area where we need to work on that, for sure. So let me see. I had so many followups that I wanted. Oh, so. Yeah what are some other things that may cause disordered eating to pop up or at least come to the surface in midlife?

Nicole: Well, I do think that, you know, there’s so much going on at midlife. And one thing I just love about your podcast is talking about all the different domains of your life. You’re welcome. I really do think that our relationship with food affects every single domain that you talk about here. You know, it is the body changes in the changing body image. And I also think that there’s a lot of stressors in midlife. I mean, if you’re a part of the sandwich generation and you’re taking care of children and you’re having aging parents to care for, you’re losing your parents. Kids are going off to college. Maybe your relationship with your spouse and partner has changed. I think a lot of stressors can, you know, and big life changes also put women at risk in mid age , for developing disordered eating and/or eating disorders.

Kathryn: Yeah, absolutely. What if, I, or one of our listeners thought, hmm, I’m not loving my relationship with food right now. I don’t like the path that I’m going down. I may either be at a disordered eating or I might feel like that’s the trajectory that I’m heading on. What should we do for ourselves?

Nicole: I really think it’s important to reach out for some help and at least get an assessment from somebody who specializes in disordered eating or , the National Eating Disorders Association has a great self test. And there’s also resources on there to find somebody in your area who might be able to just do a consultation with you. My big platform is that I believe that everybody, no matter what age they are, can heal their relationship with food and deserves to have treatment for it if they want to do that. Because there can be a lot of shame involved with , you know, developing, disordered eating in midlife, “Oh that’s something that happens to young people, oh, my doctor won’t believe me because I’m not thin enough to look like I have an eating disorder.” But you know, it is really important to seek out the help of a professional.

Kathryn: And so let’s look at it from another perspective, what should we do for a friend if we are concerned? And we think one of our friends might be struggling with their relationship with food. What’s the best way. What’s the best thing we can do to help that friend.

Nicole: I think being an active listener and just asking very broad, but gentle questions. “Tell me about how things been going with food” or “I’ve noticed that , you know, you’re not eating as much as you used to when we would go out to lunch together.” I guess, in other non pandemic times you know, or “I noticed that you know, you’ve been saying a lot of very negative things about your body. Is that something you’d like to talk about?” You know, really just being a listener and , you know, just sharing if you’re very concerned. “Can I support you in, you know, finding somebody close to our area that might be able to help, are you open to that?” And I just think being a good friend and a support and a good listener.

Kathryn: Okay. Thank you for that. So let me backtrack just a little bit and ask how does an unhealthy relationship with food or disordered eating impact our health and wellbeing overall as women in midlife?

Nicole: Oh my goodness. Every single dimension of our health. And there are multiple dimensions. The physical health wise, there are many risks to eating disorders. I think particularly for women in midlife, I’d be very concerned about bone mass. That would be one of my very big concerns, a lot of gastrointestinal issues, anxiety and depression, changes in sexual desire and sexual functioning. So those would be kind of on the physical and mental health wise. But I also think just from like a social health perspective, there can be a lot of isolation, a lot of pulling away withdrawing and, you know, loneliness is a big health risk. Sometimes we don’t think about that. Stress, chronic stress. And, you know, just from like a spiritual I’m thinking of all of the different domains that you talk about, that spirituality and faith, that sometimes there can be this sort of emptiness within when you’re dealing with these issues. And so maybe, you know, not really attending to that necessarily at first, but you know, certainly, you know, that’s just for disordered eating. If we’re talking about, you know, full blown eating disorder, I mean, purging and, you know, heavy restricting. Both can cause cardiac arrest. It’s very serious. And , the other thing that takes people’s lives with eating disorders is death by suicide. Certainly. I mean, there are some very severe risks. These are deadly, complicated illnesses, but they are treatable.

Kathryn: Yeah. So I really am hearing that it affects your mental everything to do with your mental and physical health. So , I just hope if there’s anybody out there listening to us today who feels like your eating is out of control or that you’re struggling in that area , please know that you are worth getting help for yourself , that your family and your friends value you and that we want you to find the help that you really need . So I think when we were talking earlier that you had a tool or something to share with our audience.

Nicole: Sure. Yes. Well, I do work with all sorts of eating disorders, but I have a special place in my heart for binge eating disorder, helping people who are struggling with emotional eating. And yes, if you go onto my website and sign up for my newsletter. You can receive, I have a free guide that’s called ” Help, I can’t stop bingeing!” And I’m happy to provide that for free. And it gives you a couple of reasons why we might binge eat with a couple of first steps you can take to start to heal.

Kathryn: We will put this in the show notes, but will you share your website with us now?

Nicole: Of course, it’s www.Nurtureconsultingllc.com.

Kathryn: And so you are based in Atlanta, correct? Or the Atlanta area?

Nicole: Correct.

Kathryn: Do you work with clients in all parts of the country so that if somebody in Birmingham wanted to work with you, would that be possible without them having to drive to Atlanta?

Nicole: Yes, I have a multi-state nursing license, which means that I can practice in more than 30 States. So I can do virtual sessions with clients outside of Georgia.

Kathryn: Okay. So if y’all are feeling like you need help in this area, Nicole would definitely be someone you could reach out to for help. I have a million more questions and I certainly hope that we can talk again sometime, but I like to wrap up every podcast with asking each of my guests, what is one imperfect action that you think we could all take today to move closer to our best lives?

Nicole: Oh my goodness. I would say, think about what you really love to eat. And eat it sometimes soon, whether it’s the potato chips or ice cream or something that brings you joy and pleasure to start to reconnect yourself back to, the fact that, you know, food is for fuel, but it’s also for pleasure too. And so I would encourage you to do that with, you know, some attunement and lots of enjoyment.

Kathryn: Oh, well, I absolutely love that. And I have loved having you on the show today. Thank you so much, Nicole, for being here.

Nicole: Thank you so much, Kathryn, for having me. It was so much fun.

Kathryn: Great. And so I just want to remind all of you what Nicole is urging us to do. And I love it because I think letting ourself let go of all the shoulds and the expectations that we heap on ourselves, that food is something that we should be able to enjoy. And maybe we don’t enjoy ice cream every day, but this is where once again, we want to lean in to psychological flexibility in a way from this rigid thinking of I can never have ice cream, I can never have potato chips. And let yourself just enjoy. And I love that and I’m going to be thinking a lot today about the one thing I want to enjoy tonight. I haven’t decided what it is, but it’ll be something really good. So , until we meet again here next week, go out and take imperfect action towards your best life.