Rachel Millner, Psy.D.

This post could be summarized as “your eating disorder is not who should be making decisions about movement.” It’s that simple and also way more complicated. And way more challenging than that.
When I was struggling with an eating disorder, I’m not sure it ever really occurred to me that there was any reason to do movement outside of all of the reasons the eating disorder told me to do it.
Pretty much everything I had been taught about movement was in alignment with what the eating disorder was telling me.
It turns out that there are lots of reasons someone might decide to do movement and lots of reasons someone might decide not to do movement that have nothing to do with an eating disorder.
The eating disorder thinks about what’s in service of the eating disorder when considering movement.
When the eating disorder isn’t guiding the decision making, there are so many other things to think about.
Image description: there are two slides. Each has a heading and then neon colored rectangles with text in each one. The first slide says:
SOME THINGS YOUR EATING DISORDER MIGHT WANT YOU TO CONSIDER WHEN DECIDING WHETHER TO DO MOVEMENT OR NOT:
What you’ve eaten or plan to eat
What/how much movement other people are doing
How many calories you might burn
What size you are / how much you weigh
How guilty you’ll feel if you don’t do movement
How long you can move for because otherwise it’s “not worth it”
What movement will burn the most calories/ is the most challenging or tiring whether you like it or not
Whether you’ve
“earned” a rest day or
not
The second slide says:
SOME THINGS TO ACTUALLY CONSIDER WHEN DECIDING WHETHER TO DO MOVEMENT OR NOT:
Do you know that your value and worth have nothing to do with whether you do movement or not?
How are you feeling?
Will you be able to stop if you realize after starting you’re not feeling it?
Do you think movement might help with feeling anxious or depressed?
Are you in the mood to do movement?
Do you have energy or think that movement is going to help give you energy?
Are you in the mood to be sweaty?
Do you typically like the movement you are going to do?

If and when these conversations happen will, of course, vary from client to client. The important thing is not being afraid to initiate them and not being afraid to have them if your client brings it up.
Your bodies are in the room (even the virtual room although that certainly adds another element to this). If you’re in a smaller body and your client is in a larger body, you both already know that.
And your client knows that the lived experience of being in a larger body and smaller body is different. Hopefully you have an understanding of that too.
You need to be willing and ready to talk about it. As someone in a higher weight body who has seen therapists in smaller bodies, when they couldn’t acknowledge their privilege and the things I experience that they haven’t, I couldn’t trust them.
Depending on your relationship with your client, what you’re working on, etc., how all of this happens will vary significantly. If the conversation hasn’t happened, it’s important to check in with yourself and ask are you being avoidant or is it really best for the client that it hasn’t come up yet?
Image description: there is a lime green background with text that says: reminder to providers: If you are in a smaller body and are working with clients in larger bodies, don’t be afraid to name it. Avoiding the conversation by not acknowledging it, may send the message to your clients that you’re either not aware of your privilege or are afraid to talk about fatness. If you can’t talk comfortably about your different lived experiences and about fatness, how can clients trust that their fat body is safe with you.

It’s ***depreventionday and I think one of the ways we can help with ***deprevention is by talking about it openly.
I know that there are so many people struggling to and I wanted to share some of what has helped me as a reminder that
I would love to know what has helped you to stay because I am so glad you are here ❤️
My page is for educational purposes and is not medical advice or therapy. If you are suicidal or need support please text Thrive to 1-313-662-8209
Image description: there are purple backgrounds with yellow text that says:
I’m a psychologist, fat activist, mom of two, friend, sister, daughter and business owner. People describe me as “very high functioning” and I have been suicidal. And what has helped prevent my su***de are not the things I was taught in grad school would help.
Not because those things are never helpful for people, but because I was taught su***de prevention is something we do to our clients; not something we do with our clients. But the truth is no one can prevent my su***de without my consent. And, as a therapist, I cannot work with clients on su***de prevention without their consent.
Consent is su***de prevention.
Some things that have helped me:

- A therapist who responds relationally and not out of their own fear
- Doing trauma work with that therapist
- Medication
- Having weight inclusive providers
- Community
- Reminders that I impact people just like people impact me
- Permission to claim my humanity
- Eating enough
- Permission to rest
- Knowing I have choices including the choice not to stay
- Working to deconstruct harmful messages that I’ve internalized
- Remembering that the people who hurt me are not the ones who get to decide my value and worth
I am so glad you are here
What has helped you stay?

I am not posting this as an invitation to debate the concept of “food addiction” (or process addiction in general). I don’t think food is addictive and I also respect if you feel differently.
What I am wanting to name is that there is so much focus and concern and fear mongering about the idea of “food addiction” and so often the ways that dieting and restricting and thinness are “addictive” and impact the way ones relationship with food feels gets left out of the discussion.
If anti-fat bias wasn’t a thing, if we didn’t hold dieting and restraint up as morally better, if we didn’t idealize thinness, would there even be a discussion about “food addiction?”
Would there be anything left to discuss or would food cease to feel addictive when not being deprived whether physically or emotionally?
Maybe if we dismantle the systems that make us believe that certain foods are off limits are morally superior to others or that we are “bad” if we eat a certain food or “good” if we don’t, we would free those who feel “addicted” to food and free those focused on this debate about “food addiction” to focus on something else- like getting free.
Image description: there is a plain background that has two blue swirls in the top right and bottom left corners with text that says: There is so much focus on the concept of “food addiction” instead of focusing on how ‘addictive’ dieting/restricting/seeking thinness is. Maybe if we addressed the latter it would end the conversation about the former.

It makes me so angry when I think about how so many of us have had our relationship with movement destroyed by anti-fat bias.
Movement isn’t something that needed to be complicated if we were all just left alone with it to explore without judgment or shame or false promises.
And yet it is so complicated because most of us were not just left alone with it to explore without judgement or shame.
We were given directives and rules and told what we ‘had’ to do and what ‘counted’ and ‘no pain no gain.’ We were told movement is about burning calories and about weight loss.
If your relationship with movement was taken from you, the work of healing that relationship is complex and nuanced and takes time. There are so many layers to unpack.
If you are in this process and it’s taking longer than you thought it would or it’s harder than you thought it would be, that is not a failure on your part.
Reclaiming movement from a fat liberation framework is a radical act that takes time.
Image description: there is a lavender background with a white bubble shape in the middle with text that says:
It’s complicated and hard work healing one’s relationship with movement when we were taught that movement would help “heal” our relationship with our body by making it smaller.

Back to school is hard for so many reasons. Many of us adults can probably remember the various feelings connected to going back to school and what was challenging about it.
As kids head back to school, it is an opportunity for us to be for kids what so many of us didn’t have when we were younger- a person who countered harm we were enduring or who believed us when we shared our pain.
Being that person can have a huge impact on that child.
Image description: there are three slides. Each has school supplies around the outside such as paper clips and rulers and text in the middle that says:
In my area, kids are going back to school this week. Back to school is already stressful for many people and I can remember the added stress of going back to school and not being able to wear what other kids were wearing either because they weren’t available in my size or I was deemed to not have the “right” kind of body to wear those clothes.
1 remember the dread of going back because I never felt that I fit in, was bullied, was depressed. Just one person taking what I was dealing with seriously would have had a significant impact on me. As kids head back to school, it is an opportunity for all of us who interact with kids to be that one person. The one person who listens. The one person who believes.
The one person who offers a reminder that there’s nothing wrong with their body. The one person who says bullying is not ok. The one person who speaks up. The one person who offers to help. Being a kid is hard. School is hard.
The challenges kids are going through are real. If you are an adult who has an opportunity to be the one person in a kids life to affirm them and listen; be that person. It can change so much for that child.

I had to get one of my kids immunization records from the online portal the other day and in searching for them I came across this visit summary.
It made me laugh seeing what the doctor wrote in the summary. I remember in the appointment the doctor was clearly not familiar with weight inclusive treatment but did respect my boundaries even though I could tell she didn’t really understand them.
Based on her response in the appointment, I wouldn’t have been surprised if she had summed up the interaction very differently than she did here. And I’m appreciating having this description in the chart.
Image description: there is an image of a visit summary for a doctors appointment. The identifying information has been deleted. There is text that has been highlighted which says: “Mom did not want to discuss weight...the family does not
categorize food as junk food or healthy food”

Bodies are going to do what they do and grow how they grow. We don’t control the size or shape of kids’ bodies or anyone else’s.
Trying to prevent someone from getting fat does not mean they won’t get fat. It does mean they will have learned, not just from the world, but from someone who is supposed to love and accept them, that fat is bad. That they are bad if they are fat.
Spending time and energy trying to control the size of someone’s body (including your own) is really spending time and energy teaching someone (including yourself) to live in fear of fatness, and that if they do get fat, to live in deep hatred and shame of their own body.
Image description: there is a pale pink background with an outline of a flower with text that says:
Trying to prevent your child (or anyone else) from getting fat does not mean they won’t get fat, but it does mean they will hate themselves if they do

Sustained weight loss is nothing to scream about, but in this culture of celebrating shrinking, there sure is a lot of yelling that people who have lost weight and sustained the weight loss do.
There’s so much yelling and celebrating and chatter about it that it’s easy to think that a much higher percentage of people who lose weight sustain the weight loss than actually do.
Maybe one day we will get to a place where the 95% of people who gain weight back will be yelling and celebrating how wise their bodies are, but for now the 95% are usually silent and spiraling in shame and judgment.
So, the stories told skew our perception of what percentage of people sustain weight loss. For every 5 stories you hear about someone sustaining weight loss, there are 95 stories that aren’t being told.
Image description: there is a pale pink background with text that says:
Reminder:
It’s easy to think that more than 5% of people who lose weight sustain that weight loss because those 5% of people are making the most noise while the other 95% are silent in their shame and judgement.

Imagine putting 100 people in a room and asking 5 to yell as loud as they can about how they lost weight and you can too and telling the other 95 to stay quiet. There might be so much noise coming from those 5 people that you think it must be all 100, but that does not mean that the silent 95 have made a sound or that they are any more likely to sustain weight loss than if the 5 would just be quiet and do what they want with their own bodies and not subject anyone else to their yelling

Imagine how many lives would be saved if they stopped investigating fatness and started investigating treatment, interventions, vaccinations, etc. for actual illnesses…
Image description: there are three slides. Each has a teal border with text in the center that says:
I’m not opposed to naming fatness as the cause, or a contributing factor, of something that fatness actually is a cause or contributing factor of. What I am opposed to, and what I see happening all the time, is fatness being named as a cause, or contributing factor, for something that has nothing to do with fatness or named as the only cause, or contributing factor without any further nuance or analysis. (1/3)
What I am also opposed to is naming fatness as the cause, or a contributing factor, in order to profit off of anti-fat bias or off of the belief that body size is changeable. And I am opposed to profiting off of people’s shame and desire for weight loss. I am also opposed to the amount of money spent trying to eradicate fatness instead of money being spent to develop treatment, cures, vaccines, etc. for all of the things that are blamed on fatness. (2/3)
Ultimately if the reality that fat people have always, and will always exist and that anti-fat bias is harmful and that there’s no sustainable way to lose weight nor do we need there to be is held as the truth that it is, then there wouldn’t be a reason to name fatness as a cause or contributing factor- whether it was or not- because we would just be focused on treatment and vaccines and cures, etc. And given that there’s not a single medical condition that only impacts fat people, putting money towards these things will save a bunch of thin peoples lives too. (3/3)

I regularly call out anti-fat bias and name the harms of weight stigma. And there’s a lot of it. Both anti-fat bias in the world and harms of weight stigma. And there’s no end of things to call out and talk about.
Since I call out when places get it wrong, I wanted to share about an experience where a place got it almost right. I say almost because there’s more they need to do. And what they have done had a positive impact on me.
I am considering a trip to in . In looking at their website I couldn’t find information about the size inclusiveness of their wetsuits or weight capacity of their activities.
This is an area where they need to do better. The information should have been easily found on their website and they need to add size to their DEI statement.
Since it wasn’t on the website I called and this is where I had a different experience than I usually do when making these types of phone calls. When the person answered the phone, I asked them if they knew the size range of the wetsuits they have.
The person knew the answer and said that they want their plus size guests to feel comfortable and that the largest wetsuits are also adjustable so can accommodate someone who might need a larger size. The person then told me that there are no weight capacities on any of their activities and that they welcome people of all sizes into their park.
We were on the phone for a total of two minutes and I got off feeling welcome in their park and confident that if I did decide to go I would be able to participate and have a fun day.
All they was make sure the employees answering the phone have the information to make higher weight guests feel comfortable. That’s it. Really simple. Now they need to add the information to their website to make higher weight people feel even more welcome.
I obviously haven’t been to the park yet so I don’t know if the park will be as inclusive as described so of course there’s still some anxiety about it. If I end up going, I’ll report back about whether or not the park actually lived up to expectation.
Image description in comments

I know this can be a complicated and heated topic and that there’s no way to really include the full nuance necessary in an Instagram post.
And it’s also an important topic because the possibility or risk that someone’s story gets disbelieved or negated is a serious one and when we get into statements about parents and eating disorders the risk is great.
I have known and worked with many people who have been clear that their parents have nothing to do with their eating disorder and have been a huge support to them. I have known and worked with many people who, without their parents or caregivers, may not be alive today or would still be struggling many years later.
And I have known and worked with many people who have been clear that their parents did cause their eating disorder. Whether via abuse or weight stigma or neglect or any number of other reasons, they have been clear that without the impact of their parents or caregivers they likely wouldn’t have an eating disorder at all.
To me, what’s most important is that we don’t tell people’s stories for them and that we trust people when they tell their own story.
When someone says their parents didn’t cause their eating disorder, I believe them. When someone says their parents did cause their eating disorder, I believe them.
Image description: there is a pink background with text that says:
There is no one cause of eating disorders
I don’t want to contribute to the stereotype that parents cause eating disorders
I don’t want to negate or gaslight anyone whose parents did cause their eating disorder
It’s almost as if everyone’s story is different and we can trust them when they tell it

Just a reminder that there’s no such thing as “extra weight” or “excess weight.” I know that you may hear bodies described that way. You might have had people describe your body that way.
It’s sadly a common way higher weight bodies are talked about. As if there’s some magic number a body “should” be and anything else is “excess” or “extra.” That’s not how bodies work.
Your body will change throughout your life and weight will change and bodies aren’t a math equation and aren’t meant to be one size or one weight indefinitely.
So, whatever size your body is right now is the size it is. Not “extra” or “excess” or something that needs to change.
I hope that using this language to describe bodies will stop. It’s just another way to stigmatize fat bodies and pathologize them. And the only thing “extra” or “excess” with this way of describing bodies is anti-fat bias.
Image description: there is a pink background with flowers and a box in the middle that says “reminder” and then says There is no such thing as “extra” or “excess” weight

Image description: there are ten slides. Each has a green border with text that says:
Is it really possible to experience fat liberation when there’s still so much anti-fatness in the world?

How does an individuals experience of fat liberation intersect with anti-fatness in the world and what would be different if there was cultural/systemic fat liberation? (1/10)
Here’s the thing- if we wait for cultural or systemic fat liberation to experience fat liberation in our own bodies we will miss out on experiencing the liberation that is available to us. The culture has a long way to go and anti-fatness is still (sadly) pervasive and none of us deserve to miss out on what our individual experience of fat liberation can be while waiting for an oppressive culture to change.(2/10)
Liberation in your own fat body might mean wearing whatever you want to wear, no longer dieting or pursuing weight loss, stopping weighing yourself and not body checking anymore. It might mean that when you encounter anti-fat bias you no longer believe it’s your body that’s the problem or you no longer experience shame in response. Fat liberation may mean reclaiming the word fat. (3/10)
Fat liberation likely means a shift in how you think about your own, and others, bodies. It likely means a deeper understanding of fat politics and the recognition that weight and health are not synonymous and how the weight loss industry profits off of the hatred of fat bodies. It likely means challenging internalized weight stigma and unpacking body hierarchies and knowing that your value and worth have nothing to do with your body size.(4/10)
What individual fat liberation does not mean is that you won’t experience anti-fat bias. It doesn’t mean you won’t encounter situations in which spaces aren’t built for your body or furniture doesn’t support your body or that you aren’t able to do something you would like to do because anti-fat bias prevents it. It doesn’t mean you won’t deal with medical weight stigma or that your family won’t judge your body. (5/10) (Continued in comments)

It’s (which of course every month needs to be fat liberation month) and I’m thinking about the ways that fatness has impacted me and how different it is than what I was taught.
I would have (and did) argue in every which way that fatness would make my life miserable and was something to spend as much time and energy necessary to try to avoid.
But what I was taught couldn’t have been more of a lie. Thinness trapped me. Thinness nearly killed me. It has only been in healing into a fat body that I have found any sort of freedom.
Are you someone who was also taught to avoid fatness at all cost? Or believes thinness will free you? Are you in that space of believing fatness is fine for everyone else but not for you? That maybe it has helped some people get free but there’s no way that could be true for you?
What would it be like to consider an alternative to what you’ve internalized? What would it be like to consider the possibility that it is fatness, not thinness, that will bring you closer to liberation?
What would it be like to explore? To, as scary as it is, let your body do what it’s going to do? To Stop trying to control it and just let it be? In doing this, some bodies will get/stay fat and some will not and what if all will move in the direction of liberation.
Don’t cut yourself off from possibility without even trying. Don’t let anti-fat bias make the decision for you. Don’t let an eating disorder make the decision for you. You might just find that the thing you thought would most trap you actually sets you the most free.
Image description: there are two slides. Each has a border with a heart on top and says fat liberation month. The text in the middle says:
One of the most unexpected things in my life is that fatness has had more of an impact on my liberation than almost anything else. I thought it would be thinness that set me free, but when I was thin in the midst of an eating disorder, I was never more trapped. It was only when I got fat in the course of healing that I was truly set free.(1/2))
(Continued in comments)

Somehow I have 12 year olds. The world is brutal about bodies right now. I can’t protect them from a long list of things I want to protect them from.
But one of the things I’m most proud of is ending the intergenerational trauma of weight stigma and celebrated starvation. They will forever be protected from that in our home. Their bodies will not always be safe in the world but they will always be safe in our home.
Image description: there are three slides. Each has a birthday cake and present on it with text that says:
My kids turned 12 this week. By 12 l had learned to hate my body. I had dieted and been rewarded for weight loss. I had been bullied at home, at school, and at the pediatricians office about my body. I already knew that my life’s goal was supposed to be to beat my body into submission and exist as the smallest version of myself. (1/3)
My kids turned 12 and they have never dieted, know their body’s are safe in our house. Know that access to food will never be based on body size in our family.
Know that life is about so much more than trying to make yourself small. (2/3)
I will never be a perfect parent. I make mistakes all the time. I can’t protect my kids from everything. I can’t be sure that my kids won’t develop eating disorders. But I can be sure that the intergenerational trauma of anti-fat bias and weight stigma and encouraged and celebrated eating disorders ended with me. (3/3)

I missed out on so much when I was struggling with an eating disorder. So many things that I could not possibly list them all here.
And at the time, I thought missing everything was “worth it.” I thought giving up everything for my eating disorder made sense. I thought the people who tried to tell me that my eating disorder was taking me away from my life didn’t know what they were talking about.
When my eating disorder was the most important thing in my life it didn’t matter to me what I missed out on. It didn’t really feel like missing out at the time.
I have talked to many people who are afraid of getting or staying fat because of the fear of missing out on things that don’t accommodate fat bodies. I was scared of this as well.
And, it has been true that there are things that I’ve missed out on because of anti-fat bias. And I hate it every time that happens. It pi**es me off every time.
But when I think of missing out on things while in my eating disorder and missing out on things now, the experience is vastly different.
My eating disorder was the most important thing in my life which meant I didn’t just miss out on things, I missed out on connection with people. I missed out on love and emotions and being present.
Now, I sometimes miss out on things, but I don’t miss out on life. I experience connection and love and emotions and being present. I experience joy and laughter. My eating disorder stole life from me. Healing and gaining weight has given it back.
Image description: there are two slides. Each has a peach and blue background with text that says: Sometimes I think about all the things I missed out on while struggling with an eating disorder. How many celebrations I missed and how much time with people I love and how many days I could have spent with people but spent at the gym instead. I often hear people talk about not wanting to gain weight or stay in their current fat body because they can’t particate in certain things or miss out on certain things because the world doesn’t accommodate fat bodies. (Continued in comments)

I never thought I would have a positive relationship with movement. I definitely didn’t think so when I was exercising because I thought it would help me lose weight or when I had endless rules about exercise in the midst of an eating disorder.
And I for sure didn’t think so watching the relationship some of my family members had with movement and thinking my relationship with movement was destined to be like theirs.
I’ve done a lot of work to heal my relationship with movement and when I reflect on what was helpful, the thing that comes to mind as the most helpful and most impactful thing I did was take an extended break from movement.
I don’t think I could have healed my relationship with movement without that break. It’s not the only thing I did to work on my relationship with movement, but it was the most important thing.
If you are struggling in your relationship with movement and haven’t taken a break, consider if a break might be helpful for you too.
If considering a break from movement increases your anxiety and you notice feeling like there’s no way you could tolerate the break, that might be evidence that a break is exactly what you need.
Image description: there is a scene of nature with a sunset and text that’s says: One of the most helpful and impactful things I did to heal my relationship with movement was to take a break from movement

We are so excited to announce that we will now be offering Ketamine Assisted Psychotherapy with .collings .
We are working in conjunction with a medical team who will be overseeing the prescribing and medical monitoring while we provide the psychotherapy.
We are excited to be able to offer this as an additional option for clients who might be feeling stuck in their traditional talk therapy and may find this helpful for going deeper in their work.
As of this time, KAP is available for clients in PA only. If you are in another state and want to know when we might be able to offer KAP in your state, please reach out.
Image description: there are two slides. The first has a purple border with two images of megaphones and says: IMPORTANT ANNOUNCEMENT!
We are so excited to share that we are now offering Ketamine
Assisted Psychotherapy
(KAP) with Shira Collings,
LPC
Swipe for more details...
The second image has a red role boarder and text that says:
Shira Collings, LPC is providing ketamine assisted psychotherapy virtually in collaboration with, and oversight by, a prescribing physician
As of this time, we are able to provide KAP to people in PA with additional states being added soon
Anyone interested in KAP will have an initial session with Shira to determine if KAP is a good option for
them and to discuss informed consent
You will also have an appointment with one of our collaborating prescribers to determine if KAP is a good option from a medical perspective
Questions or to schedule:
[email protected]