Interview: Treatment for Eating Disorders Using an Integrative Approach

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Carolyn Ross: “Treatment for Eating Disorders With the Integrative Approach”

Morty: Hi Carolyn. Thank you so much for being willing to be part of our podcast series on treatment for eating disorders.

Carolyn: Thank you for having me on, Morty.

Morty: My pleasure. This is Morty Lefkoe with our weekly podcast and interview. We’re very fortunate today to have Dr. Carolyn Coker Ross. She is a physician who has some unique approaches to treatment for eating disorders.

We’re going to talk to her for a little while. She’s worked with Dr. Andrew Weil who is one of the major names in integrative medicine and she’s done a lot of really interesting things. I’m personally interested in hearing what she has to say myself.

So Carolyn would you mind just introducing yourself and telling us where you’re located, and then how you got started in this field.

Carolyn: I’m located in Denver although most of my work is located outside Denver. I travel all over the country and also to some other countries to talk about eating disorders and addictions. And I work as a consultant, primarily currently in this drug and alcohol rehab facility that also has an eating disorder program called “The Ranch,” which is near Nashville, Tennessee.

I’m also a writer. I’m working on my fourth book as we speak.

Denver is my home base though. I got started working with eating disorders through my work with obesity, which I’ve always considered as part of the spectrum of eating disorders.

Eventually I then became a medical director for an eating disorder center in San Diego where I was practicing. And then later worked at Sierra Tucson and was the head of their eating disorder program. And now, as I said, I’m a consultant for The Ranch’s eating disorder program.

Morty: So did you actually work with people directly yourself or do you work through a clinic or are you just a consultant to the clinic?

Carolyn: I do all of the above. I have my own private practice in Denver where I work with people individually. I also do supervision of–or training I should say–of therapists in the centers where I consult. I often will sit in on client interviews or therapy sessions with sessions and also in groups. I do a little bit of all of that.

Morty: How would you describe the problem? I personally call it emotional eating. Because from my point of view, overeating is really the result of eating when you’re not hungry because of emotional reasons for the most part.

Carolyn: Are you speaking just of the eating disorder that is called emotional eating or are you speaking of all of the eating disorders?

Morty: I guess there are some emotional problems in anorexia or bulimia too, but I’m speaking mainly of overeating, which is the problem that most of the people who’d be listening to this podcast are having a problem with.

Carolyn: Well my favorite saying is “It’s not about the food, it’s about the pain.” And I think eating is often in response to some discomfort. Whether it be related to emotions at work you’re experiencing, or stress or trauma or neglect. Beliefs that you have that are related to past experiences. All of those culminate in discomfort or pain, and we usually overeat to work through the pain or to numb ourselves from the pain.

I just recently read an old interview dating back in the 1990s with Oprah Winfrey who stated that she never realized that she felt stressed–which is hard to believe–because she ate her way through it. I think that’s a typical experience of people who are overeaters. They may have even lost track of the reason why they are overeating. But there is that pain that then leads to overeating behaviors.

Morty: What is your basic theory as to the source of why people end up eating rather than something else, if they have pain? Number two is, what’s your basic approach to helping people resolve that problem?

Carolyn: I think that most of the issues usually start with experiences that we’ve had when we were younger. I can give you the example of a client that I had some years ago who was a compulsive eater. He had a lot of sibling rivalry with his older brother. So when he got to be bigger than his older brother, for the first time in his life he felt safe. His older brother couldn’t beat him up.

This seems like maybe a small thing but we’re seeing a lot of this come up with kids who are getting bullied. Then ten years down the line they have overeating and obesity issues. And they can point back and say, “I was bullied, I was teased, and that’s when things began.”

From there, people starting in that moment have emotions that come up that often they may not tell anybody about or they may not have someone who responds to it in an appropriate manner. Then those emotions lead to beliefs that then create a kind of dynamic in their lives where they are that they may even have forgotten.

So in the case of the young man for example who had the older brother beating him up all the time, his belief that he’d formed in that time period was “Bigger is better”. Because bigger was safer for him. For many women you see that too. Women who’ve been abused or raped. They may feel that being bigger gives them a safety factor. Those beliefs then drive the behaviors. But I think underlying all of that is what I call a lack of soul satisfaction.

Many people are not able to express themselves authentically because of the reasons that I just mentioned. So part of them is really shut down.

What I find in all the eating disorders is that when you are able to really get back in touch with your true self, who you really are, whether it be “I am a powerful person, I don’t need to be heavy in order to be safe” or “There are other ways that I can get my needs met without using food.”

Beyond that, if your career is satisfying if your relationships are satisfying, then food becomes much, much less important.

Morty: What are the kinds of beliefs you find? Is your conclusion then that the primary source of overeating, emotional eating, is beliefs?

Carolyn: No, I go one step further Morty. I believe that beyond the core beliefs is this desire of the soul for expression. I think we have experiences in our lives that in some ways kill a part of our souls. Like when a child is bullied or when a child is abused. You’ve heard the expression that when you abuse a child, it takes away a part actually of who they could be. That’s what I’m talking about.

I think the beliefs are one level at which there’s a lot of work to be done. And once you can help people get back in touch with those beliefs, then the next step though is to help them understand how those beliefs came about and how those beliefs have actually stolen who they could have been.

Morty: What is your technique or what is your approach to both eliminating the belief and dealing with the soul expression? Merely letting people know they have the beliefs or that they’ve suppressed them? Their expression is sufficient, is it?

Carolyn: No. The best way to tell you about this is to tell you about a patient I saw who lives in the Bay area. She was severely anorexic. Now this is the opposite end of the spectrum but the problem is exactly the same. She was very, very successful in her career but not happy with that career. She’d been anorexic since she was a young child and had issues with her family and lots of younger child issues. So she became aware that her belief was “In order to be loved, I need to be thin.”

Many people who are obese feel the same. That they can’t have a relationship. They can’t have the life or the job they want. They can’t change careers. They can’t have children until they become thin. This really steals a big portion of your life. And for her, it had been over two decades that she had been struggling with her disease.

She decided to go back to school although she was still in the throes of anorexia, continued working on her disease and got her degree, developed a new career in which she was extremely happy and eventually started regaining her weight without any further treatment.

I think that is just an illustration that a lot of people say “I’ll be happy when I lose weight.” What I tell my patients is, “When you get happy, you’ll lose weight. So it’s really about looking at the big picture. We focus so much on the number on the scale and “If I can just get that number down then everything would work out.” But a hundred percent of the people I’ve worked with will admit that even when they were at their thinnest, their lives weren’t still where they wanted them to be.

So it’s really a process over time of identifying those beliefs. Getting the experience of how those beliefs have affected your life. That can be through experiential therapies like psychodrama or somatic experiencing. Using the body to help you do guided imagery that gives you a felt sense of the effects of those beliefs. Then as you get that felt sense, you can start to take action. To change the things that need to be changed. Starting with the belief, just making a statement about what you want in your life and then starting to just go through the process of making those changes.

Morty: So are you saying that basically, doing things that will make you happy and changing your experience of life will get rid of the eating disorder or is there a step in the middle there someplace?

Carolyn: Well the step in the middle is the one that we have been talking about. Which is recognizing the influences that have caused the overeating. Was it neglect when you were younger? Was it trauma? Was it abuse? What are the things that have caused your problem? Were there emotional issues that then led to beliefs? So awareness is the first step.

Then the second, third, fourth, fifth step is working through and processing what happened to you with someone who’s qualified to do that. So it’s just like any other process. Like the grief process. You lose a loved one, you can cry for months but then it’s still not over. So you have to work on different layers of the emotional overeating until people start to see that the deepest layer is “What’s going to satisfy my soul?”

One of the questions I ask in some of the conferences I do is, “If you were to focus on doing the things that satisfied your spirit, your soul, your deeper self, how would your food intake be different? How would your level of activity be different?”

I think it’s connecting to that deepest urge that we all have inside of us. I’m not talking about religion. I’m talking about that deepest urge that we have to be fully ourselves and to express ourselves fully. When we are able to do that, a lot of other things fall into place. But you have to do that groundwork which usually occurs in therapy or with groups.

I have a book called The Binge Eating and Compulsive Overeating Workbook. And I’ve had so many people come up to me in talks and say, “You know, I’ve used your workbook. That helped me get into understanding what happened to me and become more aware of my beliefs and make those changes.” And so on.

So there are different ways you can do it. But you have to do that groundwork.

Morty: What influence did Andrew Weil have? I read that you had a two-year fellowship in Integrative medicine with Dr. Weil. How did that affect your approach to treatment for eating disorders?

Carolyn: My entire approach for treating eating disorders is an integrative medicine approach. I’ve done that from the very beginning at my first position in Sierra Tucson. What that means essentially from my point of view is really looking at the whole person. So you’re not just looking at what’s happening to the body, what the number on the scale is, how many calories someone eats. I don’t even look at calories anymore.

It’s really about looking at all of the influences. That could be spiritual influences. It could be physical, mental, emotional, et cetera.

As well, in the integrative approach, which I describe in my books–obviously I use nutrition because that should always be the first tool for anybody who has any of the eating disorders. But we also use dietary supplements to help the brain function better.

Many people with eating disorders including those who are overweight or obese have nutritional deficiency. They’re undernourished even though they may be overweight. So we use supplements to replace nutritional deficiencies. To support mood. Because emotional eating is directly connected with our moods and particularly people who suffer depression or anxiety etc. But even without that, having your moods be more stable is also very helpful.

Then also, supplements are important to help with digestion and absorption of the foods that you eat. And amino acid therapies that work with the brain to help reduce cravings and improve cognitive functioning and decision making. All of that.

Morty: I read that you developed your own line of supplements. Did you research what was needed by people who are overweight and have an eating disorder?

Carolyn: Absolutely. It’s called the “Basic Recovery Support.” I also have a new formula called the “Crave Free Formula” which involves the use of the amino acids such as tryptophan and tyrosine and those that help reduce cravings. Both of those formulas are available on my website. If people are interested, there’s a lot of information on them.

We did do research that looked at the use of those supplements and found that they help with sleep and also with reducing digestive problems. The research showed both of those areas that it was a statistically significant benefit over and above the use of traditional Western therapies such as sleeping pills or Metamucil for digestion.

Morty: I want to ask you some more questions. But for people who are interested we’ve got to give your website and that’s carolynrossmd.com. That’s C-A-R-O-L-Y-N. Carolyn Ross R-O-S-S and then because you’re an MD, Carolyn Ross M as in Mary, D as in David, dot com. So carolynrossmd.com.

Carolyn: I also want people to know that I do have another website which is called “The Anchor Weight Management Program” site. That’s www.findingyouranchor.com. That’s my weight management program where I offer webinars. I have a webinar weight management program that’s running right now and we’ll have another one starting next month.

The reason it’s called “The Anchor Program” is because of what I was saying to you. Being anchored is being really true to yourself and accessing your inner strength rather than looking to external sources for validation, the “Yes you’re pretty, yes you’re thin enough, yes you’re okay. The number on the scale makes you okay.” It’s about really looking inside for that inner strength to give yourself what you need.

Morty: So you basically have courses, you have individual treatment, you have internet courses, you have books. You’ve done a little bit of all of it, right?

Carolyn: That’s right. Yeah.

Morty: If somebody wanted to work with you directly do you work with people on the phone or Skype or do they have to be in your area?

Carolyn: No, I work with a lot of people by phone. And if they’re interested enough they go to findingyouranchor.com and they can either send me a message about a webinar or about individual consultations via that website. Or about programs in Denver.

Morty: But your programs are in Denver though.

Carolyn: The in-person programs are in Denver, but like I said, right now I’m running a webinar program, which is a group program for weight management. This one is a four-week program. In August we’ll be starting a ten-week program by
webinar. So if people live outside of Denver they can still work with me in a group setting via the webinar.

Morty: How would you describe the difference between your approach and the hundreds of other approaches? Is there a specific way in which you would distinguish it?

Carolyn: Absolutely. I can tell you the biggest difference is I do not believe in dieting. I don’t use a diet, I use simple guidelines for nutrition. The biggest thing that I can guarantee to people is not that you’re going to lose fifty pounds in two days. Which I think is–you know, all of the studies have shown that diets do not work no matter how nice the diet is or how hard you try. So my goal is to put people in a path where they can have lifelong success rather than just momentary success.

So I can guarantee people that they’ll stop feeling uncomfortable around food, they’ll be more able to choose foods, they’ll be able to eat the foods they like and not gain weight and they’ll lose weight. But slowly. And they’ll also stop hating their bodies. I think that once you do those two things–if you hate your body, why would you take care of it? So starting to have that partnership with your body–you know, the body is really where all of the knowledge and the wisdom is on what you need to do to be successful in reaching a healthy weight.

Instead of working with the body, most diets are about punishing the body, depriving the body, beating the body up with exercise. Look at “The Biggest Loser.” That’s a great example of how you’re not working with your body. Most of the people who go through that, well they may lose weight on the show but they do not keep that weight off.

So that’s the big difference. I’m not as focused on getting you to that rapid weight loss. People who go through my program do lose weight, but more importantly, they learn to keep it off.

Morty: I understand and agree with that totally. I also tell people who work with us the same thing. That gaining weight or losing weight is a function of so many things. Your endocrine system, the kind of food you eat, etc. What I can guarantee and certainly what you do is you’ll stop emotional eating, you’ll stop eating when you’re not hungry. You’ll stop eating for emotional reasons. And that usually will lead to a loss of weight. Losing weight is the consequence of dealing with the emotional issue, which is really the source of the problem.

Carolyn: Yeah and I think that also it’s important for people to refocus on their health first, and then weight. If you start eating not good foods–again, I don’t believe there are good foods or bad foods–but just eating foods that your body likes and that make you feel good, not emotionally good but physically good, then I think that emotional eating can definitely be reduced or gotten under control. We all do a little bit of emotional eating but it shouldn’t be to the point where it’s making you get fat or where it’s compromising your enjoyment in your life.

Morty: One other question. Have you ever done any research or any follow-up on the people to see if it lasts? Because there are so many people who are able to stop eating using willpower for short periods of time. So sometimes it looks like some sort of treatment has worked but when the willpower runs out, they’re right back where they started. So in order to see that any particular treatment plan really works you need to be checking in three or six months or even a year later. Have you ever done any follow-up like that to see what the long-term results are?

Carolyn: Some of my patients I’ve been working with for more than three years so I do have follow-up for those people. And like I said, the big important thing is that they are able to lose weight but more importantly, able to keep it off. I don’t have a large sample in my practice right now where I could do that follow-up. But in one of the other treatment centers where I worked at, we did follow-up for two years and found that people were keeping off at least ten percent of the weight that they had lost. That’s really better than the industry standard.

Again my goal is if you can learn to keep it off–I think most people learn how to lose weight. But they don’t know how to keep it off. So learning those skills will help you in the long run to eventually reach that weight. What I do is what I call the “Step Approach,” which is to help people lose a certain amount of weight like ten percent and then to maintain that weight for several months. Then lose another five to ten percent and then maintain. So again you’re really getting the muscle to keep the weight off.

Morty: Great. Well thank you so very much, this is really interesting material. It’s a different approach, it’s a more spiritual approach that seems like a lot of other weight loss, eating disorder, or treatment programs should include.

For people who would like to follow up with Carolyn, you can reach her at findingyouranchor.com and you can find out about her group program webinars there or you can find out about individual consultation programs with her. She also works as a consultant in a couple of clinics and you can find out about those clinics if it turns out that’s the best way for you to go. So findingyouranchor.com and also her other website is carolynrossmd.com.

So thank you so much Carolyn, I really appreciate your time.

Carolyn: Thank you Morty. It’s been great being on with you. Thanks again.