Julie Mai is a registered dietitian and binge eating coach who helps women heal from the restriction and shaming that may come from diet culture and make positive changes in their lives. Healthing spoke with Mai about what drives people to binge and why just a handful of almonds is not the solution.

What does binge eating mean?

Mai: Binge eating is actually a psychological diagnosis that is different from overeating, compulsive eating or emotional eating. Those are just terms. Binge eating disorder is a period of excessive overeating in large volumes. And it needs to happen at least once a week for three months in order for it to be classified as binge eating disorder.

You use CBT, cognitive behavioural therapy, in your coaching. Combining this therapy in weight loss treatment is relatively new. How connected is mental health to weight?

M.: It’s very connected. If there are people who have obesity and they’ve been struggling to lose weight for so long using the traditional methods like nutrition and exercise without any luck, sometimes it’s because they have an undiagnosed binge eating disorder. The treatment looks completely different from how you would treat weight loss.

The treatment is twofold: there’s the emotional work and the nutrition side. On the nutrition side, the gold standard treatment for any eating disorder actually is something called “mechanical eating.” In today’s world, you may have heard of “intuitive eating” — where you eat when you’re hungry and stop when you’re full. It sounds really great, but for someone experiencing binge eating, that’s not good advice. Whereas mechanical eating is like it sounds — you’re eating on a schedule every three hours because you can’t rely on your hunger cues.

So that’s what we do on the nutrition front because we don’t want you to have a large binge or go a long period of time without eating because you don’t feel good. Then you have that binge and restrict cycle, so we have to cut that out. On the emotional front, we work on cognitive behavioural therapy as well as dialectical behavioural therapy, or DBT. DBT is all about emotional regulation skills that become really important for people who binge eat because often it’s triggered by emotions. Some of us have grown up conditioned that some emotions are negative and should not be felt. When you’re upset, for example, your parents will tell you, ‘You’re OK, it’s fine.’ So we grow up not having those emotional processing skills because we’re used to just distracting them away. And that’s how it can show up as food being that strategy. We’re having to learn these skills now as adults, instead of using food as a coping mechanism.

CBT challenges our beliefs regarding food. We’re so used to there being a moral judgment on food as being good and bad for you. So we’re working on unlearning that because that’s not helpful. It gives food power over us versus us having the power over food.

There was a time decades ago when diet culture was front and centre of just about everything. Do you think this is still the case?

M.: I really think it’s getting better, and for Gen Z, specifically. I think we have been children of parents who grew up around diet culture. There’s the concept of an “almond mom” that Gen Zs talk about. This is what gives me hope. I’m a TikToker myself, and that’s where you’ll see it. It came from just an episode of Real Housewives. There’s a scene where Bella Hadid the model says to her mother, who’s also a model, ‘I’m feeling really weak.’ And the mother says, ‘Just eat a few almonds and chew them slowly.’

There’s a whole conversation now about people who grew up with “almond mothers” — mothers who were fad dieting — and how that has affected the children now. We talk about how it sparked food sneaking, where these children feel like they can’t just freely enjoy food. If they want to enjoy a sweet or something we call “fun foods,” then they have to hide it. Their mother is also making food comments, like shame-based comments and they just don’t want to hear that. So then food sneaking becomes a behaviour. Shame is actually part of the criteria for binge eating disorder. And as adults, it could be coming home from work, having a binge and hiding the wrappers from the husband, or not being hungry for dinner with the family.

Food restriction is one way people try to lose weight. Why is this strategy flawed?

M.: For many reasons, strictly scientifically speaking, we know our bodies can only keep up restriction for so long, and then we end up binging. Your body’s going to find homeostasis — or balance — either way. Whether all of the 10,000 calories are in one day or distributed over seven days. Another reason food restriction doesn’t work is that, from a human behavioural standpoint, food is all around us and it’s very difficult to maintain that level of discipline or restriction. Plus, when you have chronic calorie deficits or you’re eating below the amount of calories your body needs to keep you alive, your metabolism really slows down and then you end up holding onto more weight as a result of restrictions.

Do you have any advice for parents of young women who may be weight-conscious? 

M.: For young women, it’s really touchy age. We know that once females hit puberty, a lot of things are changing. This is a very high-risk age for eating disorders to develop. So families can prevent that, hopefully, through creating a safe environment for the child. That safe space means we’re not making judgment-based comments on weight, appearance or food.

What’s the most rewarding part of the work that you do?

M.: I think being able to create that safe space for people. Talking about food sneaking, for example, these are things that people sweep under the rug. The clients I’m seeing have never spoken about this to anyone, let alone acknowledged it themselves. Usually when you’re binging, it’s very quick because you’ve got to be sneaky, you hide everything. You don’t even acknowledge it. So finally being able to let that out in our sessions is really rewarding.

Diet culture has failed us and, in some part even the health-care resources that are available for people with binge eating disorder — there’s very little out there. For someone experiencing it, I want them to know that it’s valid if they’re feeling really alone and lost because intuitive eating is not for them, or weight loss is not for them because actually, it was never about the food.

Read the other interviews in this series: Gillian Mandich, happiness expert, on what it takes to be happy; Dr. Sean Wharton, who envisions a future of obesity management that looks very different; Tedi Nikova, a weight loss coach focused on helping people improve unhealthy relationships with food; and Dr. Vera Tarman who helps people understand that food addiction has nothing to do with willpower