A call to naturopaths to embrace a weight neutral approach to practice.

Primum non nocere. First, do no harm.

​This is the first tenet of the naturopathic oath we all take on graduation day from college, and the most critical.

​As naturopaths we strive not to add to the burden of problems of our patients. To refrain from further damaging their physical, mental or emotional wellbeing. To not intervene in such a way that will in any way harm.

Doing nothing is better than doing something that will cause harm.

In many ways, we are very good at abiding by this foundational tenet.

And yet... there is something insidious going on within the naturopathic profession that has not been called out. And despite our best intentions, it is doing serious harm to our patients, our profession, and ourselves.

That thing is a weight focussed approach to health. Whether directly or indirectly, promoting weight loss does irrefutable harm.

Even if it's weight loss "for health". Or weight loss "for fertility". Or weight loss just for the sake of weight loss, because "who doesn't want to be a bit leaner?"

To illustrate my point I'll set the scene. The other week I received two emails: one from a very well known nutraceuticals company promoting its weight loss seminar to naturopaths and other natural health professionals. The other was the exact same email, forwarded on to me from a major natural medicine education institution to its students.

This is not okay.

As I'll illustrate shortly, a focus on weight loss does unequivocal harm. This is in direct opposition to the first and most crucial naturopathic tenet.

It's 2019, and I propose that it's time that practitioners in the field of naturopathic medicine universally adopted a non-diet, weight neutral, Health at Every Size approach. For the sake of our clients, our best practice, and for the future longevity and validity of our profession, we must steer the ship away from the weight-centric doctrine it is starting to (and arguably, has) become and back towards true preventative and holistic medicine.

The kind of medicine that naturopathy sprang from. The kind of medicine that does no harm. The kind of medicine that treats the whole person, not a number on the scales.

For some years I've been interested in organic gardening, particularly permaculture. Recently I've taken a deeper dive into this method of 'natural' farming within which is embedded a deep reverence for, and trust of nature. And I've realised that permaculture has some uncanny parallels to the non-diet approach and Health at Every Size movement I am so passionate about in my clinical practice. For the last 7 or so years I've been working with people with weight, food and body image concerns, from wanting to lose a couple of kilograms to life threatening eating disorders.

One of the greatest teachers of this method of farming is Masanobu Fukuoka, author of The One-Straw Revolution. In this book Fukuoka describes his discovery of "do nothing" farming, where he creates situations where nature will do the work with the minimum of interference on his part.

So instead of spending hours ploughing the soil or spending money on adding chemical fertilisers to his crops, he simply chucks the rice straw back on the ground after harvesting it and scatters chook poo over it. Occasionally he sows clover to use as a green manure.

​And that's pretty much it.

And rather than seeing everything turn into a wilderness and watching helplessly as the prickles take over, Fukuoka actually equals the yield of farms that have had these modern high intervention inputs applied to them, with a fraction of the investment of labour and resources.
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Of course by "healthy weight" I don't mean what the BMI deems healthy. I adopt Dr. Rick Kausman's description of your healthiest weight being the most comfortable, natural weight for you - the weight your body naturally arrives at and maintains when we provide the right "soil" (see number 2). So here's what I gathered together in my current understanding of permaculture principles and my more deeply rooted understanding of HAES and the non-diet approach. The biggest parallels between permaculture, and the non-diet approach and HAES as roads to body peace, are:

Starting a baby eating solids is a time of great trepidation for many parents. This might be because this transition from exclusive breastfeeding or formula feeding to family foods (which starts around 6 months and continues until between 18 and 24 months) is a very vulnerable time.

It's a time when patterns like "fussy" or picky eating, or babies not eating enough to meet their requirements can sneak in, leading to malnutrition or failure to thrive. Delays in developmental milestones around feeding can and often do occur unless good feeding and eating practices are set up, ideally from the start.

And of course, there's always the fear of choking.

No wonder this time can be such a big cause of stress for parents.

But in spite of the clear importance of this transition period, I don't think that it needs to be stressful or scary. I actually think that starting your baby on solids can be an enjoyable, fun and even relaxing time for kids and parents.

And in fact, by taking a deep breath and chilling out you can actually help your child learn to feed themselves in a timely manner, get all the nutrition they need, and have fun doing it.

​I have a 12 month old and a 3 year old and they have both been proficient, happy little eaters for as long as I can remember. Here's how I navigated starting my kids on solids when they were around 6 months old, and beyond, all whilst being responsibly lazy.
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I agree with the notion that a witch is a woman (or man, but I'm mainly talking to women within my platforms) in her power. And a woman can only be in her power by regularly listening to, honing, and trusting her intuition.

Intuition is rooted in the body. Think of the words we use to describe intuitive hunches: I had a gut feeling. The hairs on the back of my neck stood up. I felt it in my bones. I knew it in my heart.

Think of the times your intuitive, instinctual nature has kicked into gear. When somebody has stepped into your space and something feels "not quite right". When you know your child is in danger and you check they're still in their sandpit only to realise they're about to cross the road by themselves.

When you sense the presence of a loved one who has passed on, something around 75% of us report having experienced. When you recognise a soul mate or lifelong friend by how your heart feels and the tingles running down your spine. These are usually gut feelings, a body sense. Not calculations you've made in your head.

Dieting and the religion of thinness have cut down many a modern day witch, leaving a gaping hole in our collective wisdom and capacity to heal ourselves and others.

For women whose slavery to the thin ideal has cut them off from their full witchy capacity, intuitive eating is a way to open a doorway to intuitive living. As I once heard another non-diet advocate say, "Intuitive eating, intuitive EVERYTHING."

Intuitive eating asks that we begin listening to the hunger and fullness cues of our bodies. But that's not all. It also offers ways to reject the diet mentality and let go of the religion of thinness so pervasive in our cultural and inherited conditioning. 

One caveat: If you've been chronically dieting, or you're in a semi-starved state, listening to and honouring your hunger and fullness can be difficult and complicated. This is where getting help from a non-diet practitioner can be of great value to re-nourish your body first so you can begin to receive and interpret those messages correctly.

Witches don't diet. It's impossible to be deeply connected to your intuition while you're still tracking macros like there's no tomorrow, you're not eating enough, or you're deadly afraid of carbs. 

Getting a balanced, satisfying and adequate intake of food can ease mood swings, panic attacks, anxiety, and mild depression. Mental health takes a dive when we're in a state of semi-starvation as the body struggles to construct all the neurotransmitters it needs to remain healthy. Intellectual clarity and intuition is improved when the mind receives proper nourishment. 

It's time to stop wasting your energy on the illusion of weight loss or maintaining a low weight as if that's the most important thing in life. It's not. 

Sister, we need you. Now is the time to hone your craft, shine your light and offer your healing gifts, and dieting is only stopping you from reaching your magical potential. The world needs your witchy-poo self, and it needs it now.
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It's a cold Monday morning in late May. I've just breastfed my 4-month old baby and given my 2 and a half year old toddler his single daily breastfeed - after 30 months we are finally down to one feed a day!

With the careful precision of a surgeon I extract myself from the tiny space where I was nestled between my two sleepy babes, hoping the breastmilk knocks them out for just a few more minutes. They have cuddled up as close as possible to me over the night leaving me barely any room. But I don't mind the tight squeeze; I so love being close to them and they to me, keeping each other warm.

Well, I wasn't smooth enough. My boob dairy didn't have the sedative effect I hoped for, and both kids are decidedly bright eyed and bushy tailed, with the toddler beginning his morning routine of jumping on everybody.

My husband reluctantly wakes as you do when you're being jumped on. I take Archie out into the yard to jump on the trampoline with him. His 6am squeals of delight ricochet off the wooden fence and I send a silent apology to the neighbours.

Our jumping serves not only to start burning off my toddler's seemingly infinite energy supply; it's also a warmup for my morning strength training session.

You see, I'm about to head into our garage home gym to lift some heavy ma-fa weights.

​And after I do it I am going to feel like all the pieces of myself, the bits I've given out to my children and others in nurturance over the last 24 hours, are again my own.

Tandem breastfeeding is my current reality and it's not for everyone. Yes, the demands on my body are greater, which is reflected in my needing to eat like a grown ass woman, and take rest very seriously.

But the hardest part of breastfeeding an infant and a toddler at the same time lies in the mental and emotional realms. 

Getting down to one feed a day for my two-and-a-half year old has taken time, and I'm happy with where we are. But this week Archie got sick and I've found myself feeding him three or more times a day. Combine that with the usual multiple wakings for baby Kairi's feeds and you've got one tired, cranky mama at her wit's end.

At times it has made me feel totally insane. I feel like too many people depend on me, and I'm being crushed by the sheer weight of that responsibility.

Such is the nature of tandem breastfeeding.

On the positive side, boobing multiple little people has driven me to take self-care far more seriously than I have in previous years.

Part of that care has involved taking up strength training, mainly in the form of lifting weights.  

And I don't mean doing dozens of bicep curls with 2kg hand dumbbells; I mean lifting serious heavy weights. Let me explain.

When I'm in our garage home gym or with my coach squatting, bench pressing and deadlifting, something lights up in my over-worked, baby vomit covered, under-appreciated mama soul. I feel as though I'm reclaiming my sanity and sense of self-worth, minute by minute, rep by rep.

Motherhood is fucking hard. Most days I feel like I'm carrying the weight of the world on my shoulders. But as I move my muscles against gravity to actively get that bar back onto the rack, I sense not only a physical release but a simultaneous emotional and spiritual release from the enormous psychological weight of being a mother of small children. 

As I rack after each set, I also slowly unload the weight of the world I've been carrying. I am reminded of how strong women really are. How strong I am.

Some neurological, hormonal and psychological magic takes place. In one powerlifting session I can go from bitchy wife and impatient mother pre-workout, to patient, content, soul-satisfied, and loving mama again post-workout.

Such is the nature of weight lifting for mums.
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One way to look after yourself while breastfeeding is through frequent movement throughout the day, and exercise. When approached with care, and once you've been cleared by your doctor and you've ideally seen a pelvic floor physiotherapist (for abdominal separation and to assess your pelvic floor), you've got the green flag.

​Moderate exercise is safe for your baby and does not restrict baby's growth. And it's awesome for your physical and your mental wellbeing.

Strength training (or resistance training) in particular has many benefits for breastfeeding mamas. This is any activity where you use resistance to make your muscles contract, which in turn builds the strength, anaerobic endurance, and - to some extent - size of your muscles.

There are impressive benefits that you get from weight training that you just cannot get from running for kilometres on end, smashing it out on the elliptical, or HIIT (high intensity interval training). When your body is under load, you enjoy benefits that you can't glean from anything else.

One thing I love about weight training is that women can do it all through their fertility journey, all through pregnancy and postpartum, when done with intelligence and when it's tailored to your body and your needs.

When it comes to strength training you have many options to choose from, from traditional weightlifting (e.g. powerlifting with a barbell - which is my jam right now - or using kettle bells, or dumbbells) and bodyweight exercises (e.g. pushups and chin ups), to practices and sports that involve a strength element such as pilates, yoga, pole dancing, aerial and circus arts.

​Women strength train because there are so many wonderful benefits to it including:

• increasing muscle mass and strength
• increasing or maintaining bone density
• increasing metabolism (due to the increased muscle mass)
• improving insulin sensitivity 
• improving joint function
• reducing risk of injury to connective tissue
• reducing psychological stress
• feeling and being more physically capable and independent.

Add breastfeeding to the mix and pretty much all of these benefits are going to become even more appealing, and crucial.
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Personally, the main reason I'm a fan of strength training isn’t just for the physical strength. It’s about psychological resilience and spiritual strength as well. But here are the five main reasons why lifting weights has without a doubt made my life as a mum of two young kids, better.

1. Keeps bones strong and healthy

While we are breastfeeding, oestrogen levels remain loooooow. Aside from vaginal dryness, a libido that's MIA and no periods, another fun side effect of this dive in oestrogen is that during the weeks, months or years we spend breastfeeding, bone mass decreases more rapidly than usual. 

As you may be aware lower bone mass increases the risk of osteoporosis. Broken femurs and carrying babies are not a good mix.

While it doesn't seem like we can completely stop the decline of bone mass while we're breastfeeding, we can slow it down. How? Strength training. In one study lactating women who lifted weights three days a week and did 45 minutes of weight-bearing aerobic exercise three days a week lost significantly less bone mass than women who did not (1).

The added bonus of lifting weights while you're breastfeeding is that you can actually reshape your bones so that in the long run, they become stronger. Although bone loss accelerates during lactation, in the long term it appears that women may have the opportunity to rebuild and create fresh bone (2). Again, a great way to lay down strong healthy bone tissue is by lifting weights.

In short, strength training while breastfeeding is an awesome way to both slow down the rate of bone loss and rebuild healthy and strong bones in the long run. Since bone mass and bone density start to decrease from age 35-40 years onwards (3), and I'll soon be staring at my mid-30's in the face, it seems like now is a good time to get lifting.


2. Increases lean muscle mass 

After giving birth ​most new mamas feel like they've suddenly landed in a new, softer, sorer body. Over the following weeks, months and years, our bodies can remain drastically different or morph in unpredictable ways. 

We may have fat where there used to be none and missing muscle where there used to be bulk - flat mum bum is a real thing!

It's the reason many new mums launch too soon into long duration cardio and high intensity exercise that only increases their risk of injury, stress and cortisol dominance (more on that soon), and why many new mums under eat in order to "lose the baby weight". Sigh.

A totally new body composition after childbirth is something our culture frowns upon. It's also something that makes many women feel is their own fault, which it's not. 

Part of the reason for flabby mum bits where maybe there used to be muscle? Low testosterone.

Testosterone is the main hormone responsible for building muscle which is why women have a much harder time gaining size from strength training than men. Women have 10 to 30 times less testosterone than men.

This is why you need not worry about getting Schwarzenegger-bulky if you weight train - women just can't look like that. Unless they're doing an absolute shit tonne of training and possibly taking some questionable performance-enhancing substances.

Women have even less testosterone during breastfeeding, when our testosterone and oestrogen levels remain low until we reduce and eventually wean our babe/s.

This all means that if you're breastfeeding, building and maintaining muscle and muscular strength is even harder than usual.

And when you're holding an infant in your arms for hours a day breastfeeding, lack of physical strength is going to be bad news. 

One way around this is strength training. Even though it's harder to build muscle, lifting weights or some other form of strength training while breastfeeding will at least maintain strength and reduce your chances of being injured. Which brings me to the next point...

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​3. Reduces your risk of baby-related injury

Weight training not only increases strength in your muscles, but also strengthens connective tissues and joints. Strong joints, ligaments, and tendons are crucial to prevent injury.

When you're lifting babies and/or toddlers all day long, trying to wrangle kids in and out of cars, and using your body to stop your toddler from jumping on the baby for the 137th time that day, injury becomes a real risk.

​Especially repetitive strain injury which I experienced after having my first baby, before I started strength training.

Strengthening muscles and connective tissue will make injury from daily mummy tasks and exercise less likely. 

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4. Releases stress (and maaaan do we need that.)

Lifting weights makes me feel bloody good, so there's a chance it might for you too. There are a bunch of hormones and neurotransmitters at play here, but we'll focus on just two: endorphins and cortisol.

​First, endorphins. As you probably know, exercise and weight training release endorphins. Endorphins are neurotransmitters that prevent pain, improve mood, and alleviate depression, stress and anxiety. Endorphins also give you an alertness and energy boost. 
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Of course not just any exercise will do, and more is not better especially for breastfeeding mums who are already under more physical strain than usual.

This is where cortisol, a long term stress hormone, comes in.

When your cortisol levels are increased for extended periods, and your stress is up, you're more likely to be insulin-resistant and have high blood glucose. 

​Consistently high blood glucose levels along with insulin suppression lead to cells that are starved of glucose. And since those cells are screaming out for energy, you feel hungrier than usual (4). This can lead to overeating and craving all-the-things.

​And, of course, unused glucose is eventually stored as extra body fat above and beyond the extra fat your body needs for breastfeeding. Persistently elevated cortisol also suppresses your immune system and is linked to poorer digestion. 

Running miles and miles a day at 4 months postpartum might release endorphins, but too much steady state cardio also increases cortisol which we know as a nursing mum we do not need. Plus, who has time or energy to exercise for hours a day when you've got kids literally hanging off you?

​Not eating enough - which is a major stress on the body - also increases cortisol, just in case you were wondering. This is partly why the standard recipe of calorie restriction and heaps of cardio is so ineffective and counterproductive for women, especially breastfeeding mothers.

When you're a busy mum the goal is to exercise smarter and more effectively, not harder. Heavy weight training, when approached intelligently, lowers cortisol. As long as you're eating enough and aren't stressed AF, which leads me to my final point...


5. May minimise fat storage... as long as you're not stressed AF

For me, lifting weights leads to a decrease in visible body fat, and an increase in muscle mass. For me.

I didn't actually want to draw attention to this fact and was tempted to leave it out altogether.

Why?

Because I don't want "fat loss" to be the sole reason you start lifting weights. As a HAES dietitian I emphasise that there's nothing wrong with body fat. It's a neutral body tissue and it exists to keep you alive. Having a certain amount of fat on your body says nothing about your worth as a human being and gives surprisingly little information about your health. 

Plus, due to genetics and a host of other factors, fat loss from weight training doesn't happen for everybody, especially if your body doesn't think you can afford to lose said fat. For example, when you're breastfeeding, or you're overly stressed.

As I've alluded to a few times already, excess cortisol from too much stress (i.e. insufficient sleep, over training, under eating) leads to insulin resistance.

This in turn may increase body fat storage above and beyond the body fat range where your body might otherwise be to produce breastmilk.

Basically when your body is under stress of any kind - which includes dieting and over exercise (ironically, the things that people do in order to lose weight) - your body will probably eventually lay down more fat to keep you alive through this perceived threat. This is partly why diets backfire, i.e. they actually lead to long term weight gain, 95% of the time.

The other part of this equation: when you add muscle to your frame, your body has to expend more energy (burn more calories) to maintain that muscle tissue. So when you are at rest, even sleeping, the more lean muscle mass you have, and the more calories you will expend. 

At least, this is the logic so many crazy fitness people use when touting weight training as a fat loss panacea. 

But just because your metabolic rate is higher and you're "burning more calories at rest", doesn't necessarily mean you'll automatically lose weight. If you've gained muscle but aren't eating enough calories to feed that new muscle, it won't stick around for long, if at all.

For me, putting on muscle just means I want to eat more. Which probably helps my body not think it's in a famine, stress the eff out, and slow my metabolism down.

Eating plenty keeps my cortisol levels down, which - you guessed it - minimises fat gain. Does one's head in, especially if you're a dieter.

To summarise, strength training lowers cortisol, lowers insulin resistance AND increases lean muscle mass, meaning you may store less fat than you would if you didn't lift weights. 

​However, if you're coming at strength training with a weight loss mindset, chances are you're also doing other things that will stress your body out such as under eating and doing too much steady state cardio, which will only slow your metabolism down and can lead to more insulin resistance and more fat storage, not less.

A good way to sidestep all this worry about whether or not weight training will result in fat loss? As Nia Shanks, one of my favourite strength coaches says:

But what about weight loss?

Ah, that eternal question about postpartum weight loss. Since I don't weigh myself I can't be certain, but I'm pretty sure lifting weights has lead to an increase in my overall weight.

Yes, an increase in weight. 

I can tell because very few of my T-shirts fit me anymore, and Andreas now struggles when he tries to pick me up. This is all probably due to the fact that muscle weighs more than fat, and whilst I've lost a bit of fat I've also gained significant muscle.

And I couldn't give a rat's arse. I say, take up more space. 

Basically, don't approach strength training with a weight loss mindset. Your body will do what it will do. If you lose some fat and gain muscle mass and overall weight like I have, great. If you don't lose any visible fat nor gain muscle but your bones get stronger and you feel more calm and centred, well that's awesome too.
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​Like Nia, I like to just focus on getting strong. Physically strong, mentally strong, and spiritually strong.

What you eat during the month after you give birth has the power to radically improve your strength and recovery.

And, it is said in Chinese medicine, what you eat and how well you take care of yourself during this crucial time has the power to impact your health 20, 30 or more YEARS down the track.

There are other important things to think about in your Golden Month, which I mention here - but of course, being a nutritionist, I believe the food you eat after having a baby is crucial.

Nutritional requirements during recovery and breastfeeding unsurprisingly increase, and in the case of some specific nutrients, quite significantly so.

If you're breastfeeding your requirements for protein, zinc, iodine and vitamin A literally double.

And to produce milk, you need to be getting more overall calories than even during your third trimester of pregnancy; around 500-600 calories more for the first six months postpartum if breastfeeding exclusively (as recommended by the World Health Organisation), which is an extra meal or 2-3 extra snacks a day.

Of course I don't recommend calorie counting and nothing is set in stone - listen to your hunger and fullness cues and you will be fine. Note: If you have a history of or current disordered eating you may find it difficult to follow your body's hunger and fullness cues, in which case seeing a HAES or non-diet health professional would be super helpful for you.

Even if you cannot or choose not to breastfeed, extra nutrition is required to heal from childbirth and replenish your body after nine months of pregnancy.

And if your kids are more school age than newborn, you need some serious fuel to keep up with all the crazy demands asked of you, mama. You have important shit to do and you need energy and nutrients to do it.

So without going into a huge amount of detail on exact postpartum nutrition requirements, here are the three big nutritional principles from TCM you can aim to follow in your Golden Month. 

And by the way, nourishing yourself well is as crucial in healing immediately after childbirth, as it is 10 years postpartum. These three tips apply just as much years after your last child is born, as they do as soon as the baby is born.

Once upon a time, a beautiful princess decided she wanted to have a baby. So she instantly fell pregnant and ​had a perfect pregnancy where she grew a "cute little" bump and didn't gain weight in any other part of her body. Her face didn't explode with pimples in the first trimester whilst her body adjusted to the crazy hormone fluctuations, and she was never EVER a mega bitch to her husband, the prince.

She kept exercising five times a week and eating one salad a day throughout her whole pregnancy like a respectable lady ought to. Then she had a wonderful birth and the next week returned to her pre-baby body so she could continue her life as a professional fitness model as if nothing happened.

Her belly never resembled a cake sagging in the middle from overdoing the baking powder. She never once accidentally shat her pants or peed whilst reaching for a box of cereal in the supermarket, no way. And her baby was perfect and sleeping through the night by zero weeks of age, just in case you were wondering.  And she lived happily ever after. The end.

...

So many normal and necessary changes happen to a woman’s body - and life - during pregnancy and after birth. And yet society and the media gloss over all the (literally) shitty stuff and instead feed us the unicorn fairytale version of what motherhood and parenting is "supposed" to look like.

No where is this more evident than in the whole idea of getting your "pre-baby body" back.

Diet culture is relentless in sending new mothers messages about needing to fix their so-called imperfections - that they need to "bounce back", lose the baby weight, and flatten their newly soft and stretched tummies within weeks.

Sadly, the way many new mums attempt to live up to this impossible standard is through restrictive dieting and over-zealous exercise, often taken on before the pelvic floor and abdomen have had a chance to repair. Neither of which are in the best interests of mum or baby, especially if mum is breastfeeding.

I work with a lot of yoginis and yogis, alternative lifestyle leaders, animal rights activists, and environmentally conscious folks. I also work in the field of disordered eating.

​So naturally I often find myself in the situation where I'm chatting with somebody who is very keen to heal their troubled relationship with food... but they don't want to budge on their vegan ideals. 
 
This person may have been through the psychological hell that is a full blown eating disorder...

... OR they may fall into the spectrum of disordered eating on the end of the continuum that wouldn't be classified as a clinical eating disorder, but disordered eating and disordered body image - an issue that faces a significant number of women in Australia.
 
OFTEN, they've experienced both.
 
The big question here is, "If I'm actively recovering from a clinical eating disorder - or any other form of disordered eating - can I be vegan and still get better?"

I recently heard from a client who is making leaps and bounds with the non-diet approach... but is now finding it REALLY tough as she puts on more weight and her clothes get tighter.

As her body re-calibrates after years of restrictive dieting - which can manifest as weight gain (temporary or permanent),  her brain is shouting at her to restrict food, lose weight, start vigorous exercise - all the old coping mechanisms that got her into trouble in the first place.
 
Feeling a lot of self-loathing and disconnection from her body and its changing shape, she reached out to me. 
 
It's really common for a woman I'm working with to tell me it’s easier to love her body when she’s “eating well,” exercising, or otherwise doing the things that society tells us are necessary to win the “thin is best” game.

This is totally understandable.

We live in a world that constantly reminds us that our worth is directly proportional to our body fat percentage. Where social privilege and resources are granted or withheld based on how well we adhere to society's narrow range of "ideal bodies". In such a world, it may feel easier to accept yourself when you’re conforming to the rules set by the over culture.

And it's all too automatic to hate ourselves when we do not happen to conform to these unjust standards.

This is where body image work becomes really important.