Shireen: Dr. Good talks about social justice in health, her past research on treating binge eating in black women, and her current research on the interaction between binge eating and type two diabetes in African-American.

Podcasting from Dallas, Texas, I am Shireen. And this is the Yumlish podcast.

Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Dr. Rachel Goode is an assistant professor at the School of Social Work and in the Center for Eating Disorder Excellence at the University of North Carolina at Chapel Hill. Her research interests include developing, implementing, and evaluating interventions to address health disparities in obesity and disordered eating outcomes.

Welcome Dr. Goode.

Rachel: Thank you Shireen. I am very excited to be here today.

Shireen: An absolute pleasure having you on. Dr. Goode, can you tell me a little bit about your path to work the psychiatry field and your specialty in eating disorder and obesity research.

Rachel: Sure Shireen. I really think it developed out of my experience as a clinical social worker.

So, I practiced for about five years in college counseling centers and community-based settings, treating eating disorders, disordered eating, people managing their weight. And so, I had the ability to kind of get the range of experience. So, I saw, you know, traditional college age, young women who identified with eating disorders like anorexia nervosa.

But I also saw in a community-based setting clients who identify as African-American, who were experiencing more problems with poverty and who were trying to balance, you know, food insecurity. And so those experiences helped me see a different side of disorder eating. So, between my own personal journey with food and weight and what I was learning clinically, it made me realize we need to know more because I really didn't see enough interventions that really kind of, kind of encompass some of the other reasons that people might develop disorder eating outside of wanting to pursue fitness, what we traditionally think.

And so, it just made me curious and I knew I needed to learn more.

Shireen: And then specifically, how did you develop your professional interest in social justice and investigating racial health disparities?

Rachel: Yeah, I think I was just, I, so I grew up in predominantly white spaces, so I was used to being the, you know, the, the black dot in a sea of whiteness and it, you know, having those experiences, it really just marks you.

And I just knew, I always felt like I didn't belong. And I felt like programs weren't really developed for me. I was always, you know, kind of an add on at the end and it really just became tiresome because I knew that there was a lens, a cultural lens that you know, you wouldn't have, unless you understood some of the cultural factors that might influence eating behaviors.

And so, I really kind of, I think I just wanted to devote my work as a love letter to black women, African-Americans and just to really design something that would work for them to help improve their eating behaviors.

Shireen: You just received funding from the American diabetes association for our project, investigating the interaction between binge eating and type two diabetes in African-Americans.

How did you come to realize the need for this specific approach?

Rachel: Well, I, you know, I feel like I kind of stumbled upon it Shireen. I was just doing some research. I have learned in my other studies that binge eating often develops when individuals restrict their eating. So typically, what we see is individuals often are restricting their eating when it comes to weight loss.

Right. When it comes to, we've learned in food insecurity that individuals restrict their eating. Not because they're trying to, you know, achieve fitness, but because they don't have access to food. And so, it made me curious about how having a diagnosis of type two diabetes might affect someone's restriction of eating.

And so, what we see is that individuals, you know, they are given a new way of eating a new pathway. And so, they are told often, you know, to kind of change their consumption of foods that they are known to them that they love, and they have to eat these other foods. And so, in that experience, though, I imagine when people are feeling restricted, what we see in other areas is that it might kind of swing over into, I can't take the restriction, I can't do it. And then I might end up binge eating, which is losing control, having an eating episode where I lose control over my eating behaviors and also might consume like an objectively large amount of food.

And so, I just got curious to see what has been done. Has there been any treatment for eating disorders with type two diabetes? And it was very little. And we saw that there are high rates of binge eating in African-Americans, but I knew there were no interventions. And so, I thought this might be a great opportunity to work, to develop something that's more culturally relevant, and that might be helpful to treat and improve eating behaviors in type two diabetes.

Shireen: I love it. Do your hypothesis for this research connect or build on the results of your past research into BCD and eating disorders among Black women?

Rachel: Yes, of course Shireen. That's one thing I love about research it, you’re just adding on. And so, what I've learned in my previous studies and what we know, I think about African-American staff food is a common, it's a common coping being mechanism, right?

It is a tool that people have used for so many years just to take care of themselves, especially Black women. We use food to take care of ourselves. And so. You can imagine if food is a coping tool and it's also something that you're trying to restrict and trying to manage, because you now have this new health diagnosis that you're working through.

We might have to maybe have a different approach because food cannot be, if I'm using it to cope. And I also have to watch what I'm eating. It might cause some challenges, some intersections. And so, I think that's one of the reasons we're seeing the binge eating because individuals are again, feeling very deprived and eventually just say, forget it, I'm going to eat what I want to eat. And I just can't take it anymore. It's too hard. And so how can we help train participants to think about their eating differently? Right. I've been, investigating the role of appetite regulation, um, intuitive eating, mindful eating strategies, you know, to teach people to eat in sync with their biological signals of hunger and fullness.

And so, wondering how we might be able to use some of that knowledge that we see helps people reduce binge eating helps individuals kind of begins to kind of achieve some stabilization, you know, in some of their health outcomes. How can we help provide that training as we're helping individuals manage type two diabetes and might then help reduce binge eating, which will improve glycemic control, what we've seen in the literature and might help individuals manage their type two diabetes diagnosis a little bit better.

Shireen: Interesting. I want to step back for a quick second. Do you have any statistics that you can share with us around binge eating? And then more specifically, as you were talking about some of these mechanisms, some of these tools that can be utilized, can you expand on some of those and help us understand what each of those mean?

Rachel: Sure. Sure. So, when individuals get a type two diabetes diagnosis, almost a third or more of individuals who get that diagnosis struggle with some sort of disordered eating and African-Americans have six times the odds of struggling with binge eating when it comes to type two diabetes. And so, our current program, right now, we see that generally, you know, they might help the general population. You know, we have our gold standard diabetes self-management education. But for some reason they just are not as impactful to improve glycemic control in Black Americans. And so that had me wonder if we're missing something right.

If we have not really, if the program wasn't really designed with them in mind, right. I'm sure it wasn't. So how might we be able to take a step back, listen to our population, understand some of the factors that are affecting their eating behaviors and then build with some different modifications to see if we can help people.

And so that really is the goal. What we've learned about appetite, self-regulation is just, how do you, how do you train people? How to listen again, we used to do this when we were children, babies, babies do this really well. They listen to their appetite, they know when they're hungry and then they stop when their body say, I don't want anymore, but they get socialized out of it.

We all do in our culture. We all get socialized out of that process where your body's internal signals no longer become the guideposts that really. God, it's maybe one factor, but it's not often may not be the most relevant factor that affects how much you eat when you eat. And so, our programs, we work to train people to learn how to do this again.

Right. So, learn how to listen again. And we use a problem called appetite awareness training. It was developed by Linda Craighead to help people with disordered eating, but we see that there has some potential benefit to help individuals who are managing. You know, trying to just kind of relearn their biological signals of hunger and satiety.

So, we're really hopeful that this program might just be an opportunity to really help people as they're managing type two diabetes.

Shireen: And I love the approach and in particular, Dr. Goode, because what you're saying is that, one size fits all programs. They do not work. They're leaving a big piece of the population out there.

Um, they're not addressing their needs in a meaningful way. And so that, that truly resonates with me because of the work that we do within specific, the Hispanic community and addressing those things as well. Um, what contributions do you hope to make to the understanding of diabetes and eating disorders among African-Americans, as you're sort of looking head?

Rachel: Well, I hope, a, we can find out what are the factors that are affecting this. We know this behavior is present, but we just don't know why. Right. I think we can come up with a couple of theories, but we don't have a clear answer. And so, as part of the research, we're going to talk to Black Americans who report having type two diabetes and who report this loss of control, eating behavior and listen, and understand what are the factors that are affecting this happening.

We also hope to see how can we improve upon diabetes self-management education. We know generally that the program has a low uptake in the general population. And so maybe we can use some digital methods to improve access to this treatment. Maybe we can add different elements that might be more culturally relevant.

And maybe if we provide some of this additional training in appetite, self-regulation, listening to your biological signals of hunger and satiety. It might provide a pathway so that people feel like they have permission to eat the things, when they choose to eat, which they are going to do, right? We know people are going to make decisions about eating that they're just going to eat some of this, they want to eat, even if it does not align with the recommendations they've been given to manage their type two diabetes.

So, if we can get people to a, we already know they're going to eat these foods, but instead of them having a binge eating episode where they're eating way too much, way too quickly, not listening to their, um, signals. And thereby increasing their, you know, challenges, managing their glycemic control. What about if we train individuals to just kind of tune in right, to pay attention to their signals, to stop eating when they realize I'm not really enjoying this anymore, right.

To make sure that they're moderately hungry when they're engaging in eating episodes. What we see is when people eat intuitively and they are pay attention to their signals, their glycemic control is better. It's better. So how we can help translate that knowledge to this population. And I think it can really be beneficial.

We just got to find the right way.

 Shireen: And I love that you talk about this from an intuitive standpoint, because what you're essentially saying is that the cues are there. We have the signals we've just disconnected and we're not listening to those anymore. And so, the real work to be done, it's just resetting that to be able to understand what the, you know, what is exactly causing this? How can we listen to this better and then be able to understand our own cues and be able to better listen to them in order to make better food choices.

Rachel: Exactly. Exactly.

Shireen: I love it. Um, what improvements do you hope to see made in the treatment and education about diabetes and eating disorders in the future?

Loaded question there.

Rachel: So, then I have no problems answering it's Shireen. So, I think one is to recognize eating disorders can affect anyone. What I think culturally we have believed is that eating disorders are the concern of affluent young white women. Right? And so, if I don't fall in that category, I don't have an eating disorder.

And that is simply not true. We see binge eating disorder is the number one eating disorder in the United States. And it cuts across racial and ethnic lines, you know, and especially in Black Americans, we see similar or higher rates of binge eating. So, we know that this is present in, you know, Black Americans.

We see this present of Hispanic populations. We see these eating disorders are here, but what we also, but we don't see is treatment. We don't see people having access to care. People, even knowing where to go, to get treatment for eating disorders. You know, people often, you know, Black Americans will go to their primary care physician.

That's their primary place to get medical help. But, often the primary care physicians, they don't have eating disorder training in their, it's not part of their curriculum, so they feel very not prepared. And so, we're working on that in our other research projects, you know, across the nation, we're working on helping primary care physicians feel better about that.

But I think we have to just recognize that we developed. One thing, I love about science is we accept the limitations and we have developed treatment programs that have been helpful, but one of the limitations in the sea of racism and the sea, I know of systemic oppression, we did not develop the program to meet the needs of more than, you know, we met the majority.

Racial and ethnic group, but there are others that also, we might have to make some changes. And so, I think we have an opportunity now that we know we have an opportunity to go back and do it differently, right. To do it better, to celebrate what we have learned, right. And how our current diabetes self-management education is helpful.

Right. It helps people to manage their eating. And so, we're just going to go back, listen again and see what we can learn so that we can make it.

Shireen: I love that. And to her, to our listeners who are listening to us, Dr. Good. Can you help provide them some cues on how to identify binge eating? If you can provide some of that to them.

And then where can they go to get the help?

Rachel: Yeah. Sure. Sure. So how I described binge eating is like a snowball that gathers speed. And as the snowball is picking up speed at first, you feel good and you can, so this is you're eating right at first, you were feeling good, but then there's a point where the snowball has gotten so big and you really don't have control over it anymore.

And it's just added, it's rolling down the hill and you're just, you're just kind of like, I'm sorry, I don't have control. That's how often a binge eating episode will feel for individuals, they start off feeling good. And then there's a point where they're kind of disconnected from the experience of eating and they feel like, even though I want to stop eating, I cannot, I just cannot.

And so, what we hope to do is a, to help people avoid. So, the first step is to take them from a binge eating episode to just an overeating episode, right. To help them still be in control. They might still go over, but how we can help them tune in, again, pay attention, eat regularly, that is um, a tool that is also one of the first stops in eating disorder treatment is to help individuals regain normal eating episodes because sometimes people wait so long to eat.

So, let's say you have a job and you're working 12 hours a day, 12-hour shift. You may not have a lunch break, right? You may not have time to eat. And I've heard many of my participants say this in our research studies, they don't have time to eat. So, once they get off, you can imagine how hungry you are. And that might just being so hungry, might facilitate a loss of control eating episode.

And so, individuals may feel. Yeah, I, you know, because they, wait, wait so long. So, we help people start to regain as much as they can to start having normal eating episodes. Right. And then we begin step by step to help them listen again. And to begin to identify, to start an eating episode when they feel moderately hungry, physically, and start to understand the differences between physical hunger and emotional hunger. Cause we get those confused. Right. You know, how do you know when you're physically hungry? Remember our stomach growling. Remember you might feel a little light headed. You may feel just a little weak. You make it a little hangry, you know, how do we find, how do we listen again? And know the difference?

Emotional eating comes on a lot quicker, right? It's often maybe felt in your head, you might have a taste for something in your mouth. Um, something specific. You might be swayed. You see something in your environment and like, oh, I want that. And that might have nothing to do with your belly being physically hungry.

So, we help individuals really try to have as many eating episodes as they can that come from that physical hunger place. And so just to keep that in mind, there are a couple of books that I recommend for individuals to check out. Um, one is called Overcoming Binge Eating, by Chris Fairburn. It's a great, you know, just to kind of a primer.

And then another, I recommend the Appetite Awareness Training book. I think it's been again; it's been really helpful for many of the participants in my study. It's out here, you can buy it on Amazon and it's a great resource to begin to kind of get some fundamental steps. It's by Linda Craighead of some steps to help you regain your normal eating, um, and just to help you in that way. And then another author, her name is Karen Koenig, The Rules of Normal Eating. That's another thing, because for many of us, we don't know that much about it. So, um, yeah.

Shireen: That's very helpful. And we'll link all of these resources up in the show notes for this episode. With that doctor, we are toward the end of the episode, how can our listeners connect with you and learn more about your work.

Rachel: Sure. So, my lab is called livingfreelab.org. You can find us on the web and then I'm on Twitter @DrRachelGoode. And please look forward to hearing more and learn more about your listeners.

Shireen: That's amazing. And to our listeners here, um, head over to our social media, find us on Facebook, find us on Instagram and answer this quick question.

How important are your eating habits to you when you think about your health? So again, head over to our Facebook, Instagram, let's continue the conversation there after the episode and answer this question. How important are your eating habits to you when you think about your health? And with that Dr. Goode, thank you again for your time.

Rachel: Thank you Shireen.

Shireen: Thank you for listening to the Yumlish podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspective.

You can also visit our website at Yumlish.com for more recipes advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first.

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