Dr. Marianne-Land: An Eating Disorder Recovery Podcast

If Recovery Feels Unsafe Right Now: A Guided Moment for Eating Disorder Recovery Fear

This brief guided episode is designed for moments when eating disorder recovery feels unsafe, overwhelming, or frightening. It is meant to be listened to when fear spikes, urges intensify, or doubt about recovery takes over.
Rather than offering education or advice, this guided moment focuses on nervous system support. Dr. Marianne gently names why fear can surge when eating disorder behaviors loosen and why this response does not mean recovery is failing. The episode centers the experience of being in the middle of recovery, when the body is adjusting to change and searching for safety.
Listeners are invited to pause, slow down, and orient to the present moment without needing to make decisions, take action, or push through discomfort. This guided listen affirms that fear during recovery often reflects protection, not weakness, and that safety can come alongside change.
This episode can be replayed as often as needed. It is especially supportive for people in eating disorder recovery who experience panic, urgency, or nervous system overwhelm when behaviors begin to shift.
Content Caution
This episode discusses eating disorder recovery and fear responses. No weights, numbers, or specific behaviors are described. This is a gentle, non-instructional guided listen.
How to Use This Episode
This guided moment is best used during periods of heightened anxiety, uncertainty, or fear related to eating disorder recovery. Listeners may choose to listen while seated, lying down, or moving gently. There is no requirement to follow instructions or reach a particular outcome.
Who This Episode Is For
This episode is for adults in eating disorder recovery who feel unsafe when change begins, people experiencing recovery anxiety or fear of letting go, and anyone who needs nervous system support rather than information. It may also be helpful for clinicians and providers to share with clients during acute moments of distress.
About Dr. Marianne Miller
Dr. Marianne Miller is a licensed marriage and family therapist, eating disorder specialist, and host of the Dr. Marianne-Land podcast. Her work centers neurodivergent-affirming, trauma-informed, and liberation-focused approaches to eating disorder recovery. Dr. Marianne also offers a self-paced course on ARFID and selective eating designed to prioritize safety, autonomy, and nervous system care. Learn more at drmariannemiller.com.

Eating Disorders as Safety Systems: Why Letting Go Can Trigger Fear

Why does eating disorder recovery sometimes feel more frightening after change has already begun? In this solo episode, Dr. Marianne Miller explores a critical but rarely discussed phase of eating disorder recovery: the point where behaviors start to loosen, yet fear, panic, and urges intensify instead of easing.
This episode reframes eating disorders not as irrational habits to eliminate, but as safety systems shaped by the nervous system. Dr. Marianne explains how restriction, binge eating, purging, rigidity, and food avoidance can reduce threat, create predictability, and manage sensory or emotional overwhelm. When those behaviors begin to shift, the body may respond with alarm, even when recovery is wanted.
Rather than focusing on early recovery or long-term outcomes, this conversation stays inside the middle of recovery. The place where letting go feels destabilizing, progress triggers panic, and people begin to question whether healing is actually safe. Dr. Marianne unpacks why fear at this stage does not signal failure, lack of motivation, or resistance, but reflects survival-based nervous system logic.
This episode also centers how neurodivergence, trauma histories, and intersectional oppression amplify fear during recovery. For autistic and ADHD individuals, transitions, loss of structure, and sensory changes can intensify nervous system activation. For people with chronic trauma or marginalized identities, eating disorder behaviors may have provided protection in a world that felt unsafe long before recovery began.
Listeners will hear why the belief that “safety comes after behaviors stop” often backfires, and why scaffolding, autonomy, pacing, and compassion are essential when eating disorder behaviors start to loosen. This episode is especially relevant for adults with long-term eating disorders, people feeling stuck in recovery, and clinicians seeking trauma-informed, neurodivergent-affirming approaches to eating disorder treatment.
Content Caution
This episode discusses eating disorders, recovery-related fear, and nervous system responses to change. No weights, numbers, or explicit behavioral instructions are included. Listener discretion is advised.
What This Episode Covers
Dr. Marianne discusses eating disorders as safety systems, fear of recovery, anxiety during eating disorder treatment, and why symptom spikes often occur after progress begins. The episode explores the role of the nervous system, trauma, neurodivergence, and intersectionality in eating disorder recovery, and explains why grief, panic, and doubt can emerge when behaviors that once felt protective start to loosen. This conversation also highlights why safety, autonomy, and nervous system support must come alongside behavior change, not after it.
Who This Episode Is For
This episode is for adults with eating disorders who feel afraid to let go of behaviors, people experiencing recovery anxiety or fear of change, and anyone who feels stuck in the middle of eating disorder recovery. It is also for therapists, providers, and caregivers who want to better understand why eating disorder behaviors can feel necessary, and why fear does not mean someone is failing at recovery.
Related Episode
An Open Letter to the Body: Listening to the Part That Fears Getting Better on Apple and Spotify.
About Dr. Marianne Miller
Dr. Marianne Miller is a licensed marriage and family therapist and eating disorder specialist offering therapy, consultation, and education rooted in neurodivergent-affirming, trauma-informed, and liberation-focused care. She is the host of the Dr. Marianne-Land podcast and the creator of a self-paced course on ARFID and selective eating for adults and providers. Learn more at drmariannemiller.com.

Low Heart Rate in Athletes: When “Fit” Can Signal REDS or an Eating Disorder With Dr. Megan Hellner & Dr. Katherine Hill, MD (AthleatMD)

What does a low heart rate really mean in athletes? When is it a normal adaptation to training, and when is it a sign that something is medically wrong?
In this interview, Dr. Marianne Miller speaks with Megan Hellner, RD and Katherine Hill, MD, co-founders of AthleatMD, about one of the most misunderstood issues in athlete health. Together, they unpack how low heart rate, underfueling, and performance pressure can intersect in ways that are often minimized or missed entirely in both sports medicine and eating disorder care.
Content Caution
This episode includes discussion of eating disorders, Relative Energy Deficiency in Sport (REDS), medical instability, low heart rate, weight loss, body image pressure, and athletic injury. Listener discretion is encouraged.
What Is Relative Energy Deficiency in Sport (REDS)?
Relative Energy Deficiency in Sport occurs when an athlete’s energy intake does not meet the demands of training, daily functioning, and, for young athletes, growth and development. Dr. Hill explains that REDS can occur with or without an eating disorder and that many athletes develop REDS unintentionally due to intense schedules, high training loads, or lack of accurate nutrition guidance.
Although REDS is a relatively new diagnostic framework, its medical consequences are not new. Energy deficiency affects nearly every system in the body, including the heart, bones, hormones, digestion, immune function, and mental health. Importantly, many athletes with REDS do not appear thin, which contributes to how frequently the condition is overlooked.
Low Heart Rate in Athletes: Fitness or Medical Red Flag?
A low resting heart rate is often praised as evidence of elite fitness, yet this episode challenges that assumption. Dr. Hill and Dr. Hellner explain the difference between mild athletic bradycardia and dangerous cardiac suppression related to undernutrition.
They discuss why heart rates in the low 40s or 30s should never be automatically dismissed as “normal for athletes,” particularly when fatigue, injury, missed periods, or hormonal suppression are present. The conversation highlights how REDS and malnutrition can compound athletic adaptations, leading to serious medical risk while athletes are reassured that nothing is wrong.
Where Eating Disorder Care and Sports Medicine Fall Short
Athletes often exist in a gray area where eating disorder treatment programs and sports medicine settings fail to fully meet their needs. Drs. Hellner and Hill describe how eating disorder programs may underestimate the importance of athletic identity, while sports environments frequently minimize eating disorders and REDS altogether.
This disconnect can result in rigid activity bans, delayed diagnosis, or false reassurance that prolongs harm. The episode emphasizes the need for individualized, multidisciplinary decision-making that considers medical stability, psychological safety, and the athlete’s relationship with sport.
Body Image Pressure and the Athletic Aesthetic Myth
The conversation also explores how appearance-based expectations shape athlete health. Dr. Hellner introduces the concept of the athletic aesthetic myth, which falsely assumes that performance requires a specific body type.
Dr. Marianne and her guests discuss how coaching culture, social media trends, and gendered body ideals increase risk for REDS and disordered eating. They also highlight the growing visibility of elite athletes across a wide range of body sizes, challenging the belief that leanness equals success.
How AthleatMD Supports Athletes With REDS and Eating Disorders
AthleatMD provides virtual medical and nutrition care for athletes across many states, serving competitive, recreational, and former athletes. Dr. Hellner explains how assessment focuses on weight history, growth patterns, labs, training load, injury history, and relationship with food and sport, without assuming intentional restriction.
Treatment centers on nutrition restoration, medical stabilization, and education, with approaches tailored to the athlete’s sport, goals, and developmental stage. For many athletes, restoring adequate energy intake improves both health and performance in ways they did not expect.
Who This Episode Is For
This episode is especially relevant for athletes experiencing fatigue, injury, or declining performance, as well as parents of young athletes, coaches, therapists, dietitians, and medical providers. It is also an important listen for anyone questioning whether “fit” always means healthy in sport.
Related Episode
Eating Disorders & Athletes: The Pressure to Perform on Apple & Spotify.
About Today’s Guests
Dr. Megan Hellner and Dr. Katherine Hill are the co-founders of AthleatMD (@athleatmd), a virtual, multidisciplinary practice specializing in medical and nutrition care for athletes with eating disorders and Relative Energy Deficiency in Sport (REDS). Their work focuses on bridging the long-standing gap between sports performance and eating disorder treatment.
About the Host
Dr. Marianne Miller is a Licensed Marriage and Family Therapist and the host of Dr. Marianne-Land: An Eating Disorder Recovery Podcast. She provides neurodivergent-affirming, trauma-informed care for eating disorders, including anorexia, bulimia, binge eating disorder, and ARFID, and works with clients in California, Texas, and Washington, D.C. Learn more about working with Dr. Marianne and explore her courses and podcast at drmariannemiller.com.

Why Some Eating Disorders Don’t Resolve: Understanding Chronic Patterns & What Actually Supports Change

Why do some eating disorders continue for years or even decades, despite treatment, effort, and a strong desire for change? Long-standing eating disorders are often misunderstood as personal failure or lack of motivation. In reality, persistence usually reflects unmet needs, nervous system strain, and environments that have not supported safety or regulation.
What “Chronic” Really Means in Eating Disorder Care
In clinical settings, the term chronic simply means persistent over time. It does not mean static, untreatable, or hopeless. Many people with chronic eating disorders experience periods of stability, partial recovery, or symptom shifts rather than full resolution. Progress often occurs in layers rather than in a straight line.
Chronic eating disorders appear across diagnoses, including anorexia, bulimia, binge eating disorder, ARFID, and mixed presentations. What matters most is not the duration of symptoms, but the function those symptoms continue to serve.
Eating Disorders as Nervous System Survival Strategies
Eating disorder behaviors frequently operate as survival responses. They may regulate anxiety, reduce sensory overwhelm, create predictability, or provide relief from emotional distress. When behaviors serve a regulatory purpose, stopping them without replacing that function can feel destabilizing rather than healing.
Persistence is rarely about effort. Many people with long-term eating disorders have engaged in extensive treatment and tried multiple approaches. Without safety, the nervous system will continue to rely on familiar strategies.
Trauma, Chronic Stress, and Ongoing Threat
Long-standing eating disorders often develop in the context of trauma that never fully resolved. Ongoing stressors such as medical trauma, anti-fat bias, racism, ableism, financial insecurity, chronic illness, or identity-based harm can keep the nervous system in survival mode.
When threat remains present, recovery models that assume safety already exists often fall short. In these environments, eating disorder behaviors may remain necessary for coping.
Neurodivergence and Unmet Support Needs
Neurodivergent people experience chronic eating disorders at high rates, yet are frequently underserved by standard treatment models. Sensory sensitivities, executive functioning challenges, and interoceptive differences can make eating overwhelming in ways traditional care does not address.
Without accommodation, eating disorder behaviors may persist because they reduce sensory or cognitive overload. Recovery requires adapting care to the person, not forcing the person to adapt to the model.
Autonomy, Power, and Control in Recovery
Eating disorders often become closely tied to autonomy, especially for people who have experienced chronic control or invalidation. Decisions about food can feel like the last remaining area of choice.
When treatment removes autonomy without rebuilding agency, symptoms often intensify. Collaborative, consent-based care that honors choice can create safer conditions for change.
What Actually Supports Long-Term Change
Sustainable change in chronic eating disorders is built through safety, curiosity, and flexibility. Emotional, sensory, and relational safety allow the nervous system to shift. Curiosity replaces judgment by asking what the eating disorder provides rather than focusing only on stopping it.
Accommodation, harm reduction, and connection play central roles. Reducing risk, improving quality of life, and supporting nourishment without demanding perfection create space for gradual change.
Rethinking Recovery for Chronic Eating Disorders
Recovery does not need to mean the complete absence of symptoms to be meaningful. Increased flexibility, reduced fear, fewer medical crises, and a fuller life matter. Chronic eating disorders reflect complexity, not hopelessness.
Who This Episode Is For
This episode is for people living with chronic eating disorders, providers working with long-term or complex cases, and anyone seeking a trauma-informed, neurodivergent-affirming perspective on eating disorder recovery.
Content Caution
Discussion includes eating disorder behaviors, long-term symptoms, trauma, and systemic barriers to care.
Related Episodes
Relapse in Long-Term Eating Disorders on Apple & Spotify.
Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify.
Navigating a Long-Term Eating Disorder on Apple & Spotify.
Why Eating Disorder Recovery Feels Unsafe: Facing Ambivalence in Long-Term Struggles on Apple & Spotify.
Perfectionism, People-Pleasing, & Body Image: Self-Compassion Tools for Long-Term Eating Disorder Recovery With Carrie Pollard, MSW @compassionate_counsellor on Apple & Spotify.
Learn More
Explore neurodivergent-affirming, trauma-informed resources for eating challenges at drmariannemiller.com.

When Eating Feels Unreal: Dissociation, Trauma, & the Hidden Side of Eating Disorders

Why does eating sometimes feel distant, foggy, or unreal? Why do meals happen on autopilot, with little connection to hunger, fullness, or satisfaction?
In this solo episode, Dr. Marianne Miller explores the often overlooked role of dissociation in eating disorders, especially when trauma and nervous system overwhelm are present. Many people experience eating as disconnected or numb, yet rarely receive language or support that explains why this happens.
This episode breaks down how dissociation functions as a survival response, not a failure of recovery. Dr. Marianne explains how trauma, chronic stress, and loss of bodily autonomy can shape the nervous system and disrupt interoceptive awareness, making it difficult to sense hunger, fullness, and internal cues.
Listeners will learn how dissociation connects to common eating disorder patterns such as restriction, binge eating, and rigid routines. Rather than viewing these behaviors as resistance or lack of motivation, this episode reframes them as nervous system strategies designed to manage overwhelm and threat.
Dr. Marianne also centers neurodivergent experiences, including sensory processing differences and shutdown responses that often get missed in traditional eating disorder treatment. She explains why pressure-based approaches frequently fail neurodivergent people and why safety, accommodation, and choice are essential when eating feels unreal.
This episode offers a trauma informed, neurodivergent affirming perspective on recovery, emphasizing that healing does not come from forcing embodiment. Instead, recovery unfolds when the nervous system learns that eating can be safe again.
In this episode, you will hear about:
Dissociation and eating disordersTrauma and nervous system responses around foodWhy eating can feel unreal or disconnectedInteroception and disrupted hunger and fullness cuesNeurodivergence, sensory overwhelm, and eating challengesWhy traditional eating disorder treatment often misses dissociationWhat actually supports recovery when eating feels unreal
Midway through the episode, Dr. Marianne shares more about her self-paced ARFID and Selective Eating course, designed for people whose eating struggles are shaped by sensory differences, trauma, and nervous system needs.
Related Episodes
How Childhood Trauma Shapes Eating Disorders & Body Shame (Content Caution) on Apple & Spotify.
Childhood Trauma & Eating Disorders on Apple & Spotify.
Using EMDR & Polyvagal Theory to Treat Trauma & Eating Disorders with Dr. Danielle Hiestand, LMFT, CEDS-S on Apple & Spotify.
Trauma, Eating Disorders, & Levels of Care with Amy Ornelas, RD via Apple or Spotify.
Content Caution
This episode includes discussion of eating disorders, trauma, dissociation, sensory overwhelm, and nervous system responses around food. Although no specific behaviors or numbers are described, some listeners may find these topics activating. Please take care of yourself and listen in a way that feels supportive.
This episode is for anyone who has felt confused, frustrated, or unseen in eating disorder recovery and wants a framework that finally makes sense.

Navigating Nutrition in Long-Term Eating Disorders With Jaren Soloff, RD @wholewomennutrition

What changes when an eating disorder has been part of someone’s life for 10, 20, 30, even 40+ years? In this conversation, I’m joined again by my friend and longtime collaborator Jaren Soloff, RD, IBCLC, the founder of Whole Women Nutrition. Together, we talk about why nutrition work looks different in long-term eating disorders, and why the starting point is almost always the same: safety.
Jaren shares how decades of reinforcement can make symptoms look “functional” on the surface, while the eating disorder quietly shapes identity, routines, and self-worth. We explore the common pattern of minimizing, the fear that can spike when restriction loosens, and the tender reality that for many people, the eating disorder has served as protection, especially in the context of criticism, attachment wounds, body-based judgment, and the impossible standards placed on women across the lifespan.
We also get practical. Jaren walks through what it can look like to make food feel safer through small, doable steps, including DBT-informed tools, sensory supports, and intentionally planned “after-meal” structure that helps the nervous system ride out discomfort without snapping back to restriction. If breakfast feels impossible, or discomfort after eating feels like a dealbreaker, this episode offers compassionate, concrete ways to build tolerance and trust, slowly and steadily.
Finally, we talk about the midlife reality so many people face: body changes through perimenopause and menopause, and the way those changes can collide with long-standing eating disorder beliefs. Jaren explains why metabolism may shift with long-term restriction and aging, how loss of lean muscle mass can affect energy needs and health, and why increased fat storage in midlife can be an adaptive, protective process for bone health. We also name the risks of GLP-1 medications for people with eating disorders, including concerns about appetite suppression and the potential for additional lean muscle loss, especially for women in perimenopause and menopause.
If you have felt “broken” because your body doesn’t respond the way it once did, or if you’ve carried an eating disorder for decades and wonder whether change is still possible, this conversation offers a grounded, compassionate path forward. You deserve care that moves at your pace, and support that treats safety as the foundation, not an afterthought.
In this episode, we cover
We discuss why long-term eating disorders require a different nutrition framework, how safety often sits at the center of recovery work, and why minimizing can keep patterns in place even when someone appears to be “functioning.” We talk about learning to tolerate discomfort after eating, building self-soothing skills, and using DBT-informed, sensory-based strategies to create new neural pathways. We explore perimenopause and menopause, including changes in estrogen, lean muscle mass, metabolism, and body fat distribution, and we name how ageism and sexism shape body fear in midlife. We also discuss GLP-1 medications and why they can be especially risky in the context of eating disorders.
About Jaren Soloff, RD, IBCLC
Jaren Soloff is a registered dietitian and international board-certified lactation consultant. She is the founder of Whole Women Nutrition, where she provides nutrition counseling and lactation support for adolescent girls and adult women, and supports families in raising competent, intuitive eaters. Jaren brings both professional experience and the wisdom of her own recovery journey to her work, with a steady emphasis on compassion, collaboration, and safety.
Related Episodes
Orthorexia, Quasi-Recovery, & Lifelong Eating Disorder Struggles with Dr. Lara Zibarras @drlarazib on Apple & Spotify.
Navigating a Long-Term Eating Disorder on Apple & Spotify.
Why Eating Disorder Recovery Feels Unsafe: Facing Ambivalence in Long-Term Struggles on Apple & Spotify.
Pregnancy, Postpartum, and Eating Disorder Recovery With Jaren Soloff, RD on Apple and Spotify.
Connect with Jaren
Website: WholeWomenNutrition.comInstagram: @wholewomennutrition

The Hidden Pain of Midlife Anorexia: Why Coping Breaks Down & What Heals

Anorexia does not disappear with age, and midlife is often when its deeper pain becomes impossible to ignore. In this solo episode, Dr. Marianne Miller explores why anorexia can resurface or intensify in midlife, especially when long-standing coping strategies stop working and the nervous system reaches its limits. This conversation names what so many people experience quietly: hormonal shifts, burnout, identity changes, and unprocessed trauma colliding with a culture that continues to demand shrinking, control, and silence.
Dr. Marianne unpacks how perimenopause, menopause, chronic stress, and cumulative life demands can destabilize eating patterns that once felt manageable. She explains why restriction is not about willpower or vanity, but about protection, regulation, and survival, particularly for those who have lived for decades navigating pressure, responsibility, and internalized expectations. The episode also explores how midlife can awaken old wounds related to body, gender, sexuality, safety, and belonging, making anorexia feel like a familiar refuge during times of upheaval.
This episode centers the emotional logic of midlife anorexia and highlights how neurodivergence, sensory processing differences, and reduced masking capacity can further complicate eating and recovery later in life. Dr. Marianne offers a compassionate reframe of what healing can look like in midlife, emphasizing nervous system support, steadiness over control, truth-telling, and sustainable care rather than rigid recovery ideals.
Listeners will hear a vision of recovery that does not ask people to go back to who they were, but instead supports becoming someone who no longer needs old coping strategies to feel safe. This episode speaks directly to adults navigating long-term or chronic anorexia, relapse in midlife, and the quiet grief that can surface during major life transitions. It is also a vital listen for providers seeking a more humane, trauma-informed, and neurodivergent-affirming understanding of eating disorders across the lifespan.
Dr. Marianne closes by reminding listeners that midlife can be a turning point not because of force or discipline, but because deeper understanding becomes possible. Recovery at this stage can mean honoring the body’s needs, allowing rest, naming pain that was carried alone, and receiving support that fits one’s lived experience.
Related Episodes:
Why Is Anorexia Showing Up Again in Midlife? You're Not Imagining It on Apple & Spotify.
Welcome to the Jungle: Eating Disorders in Midlife & Our Personal Recovery Stories with Amy Ornelas, RD on Apple & Spotify.
More Resources:
If this episode resonated, you are invited to explore therapy with Dr. Marianne Miller, who offers specialized support for people navigating anorexia, chronic restriction, ARFID, and eating disorders shaped by trauma and neurodivergence. Go to drmariannemiller.com for resources and help.

When Eating Disorders Involve Self-Harm: Breaking the Cycle & Rebuilding Safety

Have you ever wondered whether your eating disorder behaviors have shifted from coping and self-regulation into self-harm?
In this solo episode, Dr. Marianne Miller explores the overlap between eating disorders and self-harm and explains how eating disorder behaviors can gradually become harmful even when they begin as attempts to cope. She examines eating disorder recovery through a trauma-informed, neurodivergent-affirming, and liberation-focused lens and offers clarity without shame or blame.
WHAT YOU WILL LEARN IN THIS EPISODE
Dr. Marianne explains how eating disorders can function as self-harm and how trauma, dissociation, sensory overwhelm, and chronic stress shape eating disorder behaviors. She discusses neurodivergence and eating disorders, including how autistic and ADHD individuals may rely on eating patterns for regulation. She explores common self-harm behaviors that often co-occur with eating disorders, including cutting, scratching, burning, and other forms of injury, and explains the shared emotional logic behind these behaviors.
She clarifies the difference between self-regulation and self-harm and explains how eating disorder behaviors can shift between these roles over time. She outlines how to recognize when an eating disorder moves from regulation into harm by identifying warning signs such as rigidity, shame, dissociation, physical consequences, and isolation. She also describes what breaking the cycle can look like by focusing on safety, agency, and flexible coping rather than punishment or control.
THIS EPISODE MAY RESONATE WITH YOU IF
You question whether your eating disorder behaviors feel punishing or unsafe.You live with a long-term or chronic eating disorder.You experience self-harm urges alongside an eating disorder.You identify as neurodivergent and struggle with sensory or interoceptive overwhelm.You want a trauma-informed, non-shaming approach to eating disorder recovery.
KEY TOPICS
This episode explores eating disorders and self-harm, eating disorder recovery, self-harm behaviors and eating disorders, trauma and eating disorders, neurodivergence and eating disorders, dissociation and eating disorders, restriction and binge eating, ARFID and sensory overwhelm, building safety in eating disorder recovery, and trauma-informed eating disorder therapy.
CONTENT CAUTION
This episode includes discussion of self-harm, including cutting and other forms of injury, eating disorders, trauma, dissociation, and suicidal thinking. Please listen with care and take breaks as needed.
RELATED EPISODES
Autism & Anorexia: When Masking Looks Like Restriction, & Recovery Feels Unsafe via Apple & Spotify.
Recovering Again: Navigating Eating Disorders After a Late Neurodivergent Diagnosis (Part 1) With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify.
Minding the Gap: The Intersection Between AuDHD & Eating Disorders With Stacie Fanelli, LCSW @edadhd_therapist via Apple & Spotify
ABOUT DR. MARIANNE
Dr. Marianne Miller is a licensed marriage and family therapist specializing in eating disorders, including ARFID, binge eating disorder, anorexia, and long-term eating disorder patterns. She takes a neurodivergent-affirming, trauma-informed, and liberation-focused approach and hosts the Dr. Marianne-Land podcast.
WORK WITH DR. MARIANNE
Dr. Marianne offers eating disorder therapy in California, Texas, and Washington DC, and provides coaching worldwide. Learn more at drmariannemiller.com.

Anti-Fat Bias in Healthcare: What 270 Fat Patients Reported & Why It Matters With Vinny Welsby @fierce.fatty

In this episode of Dr. Marianne-Land, I speak with fat activist, TEDx speaker, author, DEI expert, and podcast host Vinny Welsby (they/them) about anti-fat bias in healthcare, weight stigma in medicine, and the real-world harm fat patients experience when seeking medical care. Vinny, who shares extensively about fat liberation, weight-inclusive care, and dismantling diet culture on Instagram at @fierce.fatty, brings both lived experience and data into this conversation.
This episode centers on Vinny’s survey of 270 fat people, in which 99.25% reported experiencing weight-based discrimination in healthcare. These findings expose how common medical weight stigma, anti-fatness, and provider bias truly are, and why so many fat people delay or avoid healthcare altogether.
Weight Stigma in Healthcare: Survey Data and Lived Experience
We break down what those survey results actually mean for patients. Vinny shares stories of medical dismissal, misdiagnosis, delayed treatment, and humiliation in healthcare settings, including being told to lose weight instead of receiving appropriate medical evaluation. We discuss how weight stigma shows up through provider assumptions, lack of size-inclusive equipment, routine weighing without consent, and dismissive or dehumanizing language.
This section highlights how anti-fat bias in healthcare leads to worse physical health outcomes, increased medical trauma, and deep mistrust of medical systems.
Medical Trauma, Nervous System Effects, and Avoiding Care
We explore how repeated experiences of weight stigma activate the nervous system and create medical trauma. Even scheduling an appointment can trigger fear, shame, and exhaustion. Vinny and I talk about how this chronic stress contributes to people avoiding preventive care, delaying diagnosis, and experiencing worsening health conditions as a result.
This conversation connects anti-fat bias, mental health, eating disorders, and healthcare avoidance, naming how the system often blames fat bodies for the very harm it causes.
Intersectionality: Fatness, Gender, Queerness, and Neurodivergence
A major focus of this episode is intersectionality. Vinny shares how anti-fatness intersected with being trans, nonbinary, queer, neurodivergent, and disabled, and how shame around body size limited access to identity exploration and self-expression. We talk about how weight stigma compounds oppression, especially for people with multiple marginalized identities.
We also discuss how white privilege can reduce some harms while never eliminating weight-based discrimination, and why weight-inclusive healthcare must address racism, transphobia, ableism, and fatphobia together.
What Weight-Inclusive Healthcare Actually Requires
We challenge the idea that good intentions equal good care. This section explores what weight-inclusive healthcare truly requires, including provider education, consent-based weighing, size-inclusive furniture and equipment, respectful language, and accountability when harm occurs. We discuss why many providers believe they are weight-inclusive while continuing to practice weight-centered and stigmatizing care.
Unlearning Anti-Fatness, Shame, and Diet Culture
We close with guidance for beginning the process of unlearning anti-fatness. Vinny shares how shame thrives in isolation and how bringing it into the light reduces its power. We discuss diet culture, binary thinking, and how critical thinking helps people question harmful beliefs about weight, health, morality, and worth.
This episode invites listeners to ask who benefits when people are taught to hate their bodies, and how compassion, curiosity, and community support healing.
Who This Episode Is For
This episode is for fat people, eating disorder survivors, clinicians, healthcare providers, and anyone who wants to understand how weight stigma in healthcare causes harm and what needs to change.
About My Guest: Vinny Welsby (They/Them)
Vinny Welsby is a fat activist, DEI leader, TEDx speaker, bestselling author of Fierce Fatty, and host of the Fierce Fatty Podcast. They work with individuals through Fierce Fatty and with organizations through Weight Inclusive Consulting, providing education and training on dismantling anti-fat bias in healthcare and beyond.
You can find Vinny at fiercefatty.com and on Instagram at @fierce.fatty.
Related Episodes
When Doctors Harm: Medical Weight Stigma & Eating Disorders on Apple & Spotify.
Having Anorexia in a Larger Body: Navigating Medical Anti-Fat Bias & Lack of Care with Sharon Maxwell @heysharonmaxwell on Apple & Spotify.
Content Caution
This episode includes discussion of medical trauma, weight stigma, eating disorders, healthcare discrimination, and systemic oppression.
The harm described in this episode is real, widespread, and systemic.

When Autonomy & Sensory Needs Drive ARFID: Why Pressure Fails & Choice Heals

In this solo episode of Dr. Marianne Land, Dr. Marianne Miller explores one of the most overlooked drivers of Avoidant Restrictive Food Intake Disorder, or ARFID: the powerful intersection of autonomy and sensory needs. This episode unpacks why pressure based approaches consistently fail people with ARFID and how choice, consent, and nervous system safety create real pathways toward healing. Rather than framing ARFID as defiance or avoidance, this conversation centers ARFID as a protective response rooted in sensory overwhelm and a deep need for bodily autonomy.
Why Autonomy Matters in ARFID
For many neurodivergent people, autonomy is not optional. It is a core safety requirement. Dr. Marianne explains how pressure around food activates threat responses in the nervous system, often leading to shutdown, panic, or increased food avoidance. When autonomy gets removed through medical pressure, family conflict, or exposure approaches that override consent, ARFID symptoms often intensify. This episode reframes autonomy not as resistance, but as a stabilizing force that helps people survive overwhelming eating environments.
Sensory Processing and Nervous System Safety
Sensory sensitivity plays a central role in ARFID. Texture, smell, temperature, and unpredictability can trigger immediate nervous system distress. In this episode, Dr. Marianne explains how these sensory reactions are involuntary and protective, not behavioral choices. Safe foods become anchors that help regulate the nervous system, and honoring sensory needs becomes essential for sustainable eating disorder recovery. When sensory experiences are respected, the body no longer needs to protect itself through restriction.
Why Pressure Fails and Choice Heals
Pressure based interventions often backfire in ARFID treatment. Dr. Marianne explores how even well-intentioned encouragement can teach the nervous system that eating is unsafe. Pressure increases fear, deepens avoidance, and damages trust. In contrast, choice restores safety. When people with ARFID control the pace, timing, and nature of food exploration, curiosity becomes possible. Choice supports regulation, builds self-trust, and creates space for gentle expansion without retraumatization.
A Neurodivergent-Affirming Approach to ARFID Recovery
This episode highlights what ARFID care can look like when it centers consent, collaboration, and sensory attunement. Dr. Marianne discusses how liberation-centered treatment prioritizes nervous system regulation over compliance, honors lived experience, and rejects one-size-fits-all exposure models. Recovery becomes sustainable when dignity, agency, and sensory truth guide the process.
Intersectionality, Identity, and Autonomy
Autonomy carries different weight depending on lived experience. Dr. Marianne addresses how fat individuals, disabled individuals, neurodivergent people, and those with chronic illness often experience repeated violations of autonomy in medical and social settings. For many, eating becomes another site of control and harm. This episode situates ARFID within broader systems of stigma and explains why restoring autonomy is especially critical for people with marginalized identities.
Who This Episode Is For
This episode is for anyone living with ARFID, supporting someone with ARFID, or working professionally with eating disorders and neurodivergence. It is especially relevant for listeners who have felt harmed by pressure based treatment, misunderstood by providers, or blamed for sensory needs they cannot control.
Related Episodes on ARFID
ARFID Explained: What It Feels Like, Why It’s Misunderstood, & What Helps on Apple & Spotify.
Why Sensory-Attuned Care Matters More Than Exposure in ARFID Treatment on Apple & Spotify.
ARFID, PDA, and Autonomy: Why Pressure Makes Eating Harder on Apple & Spotify.
Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works on Apple & Spotify.
Listen and Learn More
If ARFID has shaped your relationship with food, your body, or your sense of safety, this episode offers a validating and science-informed perspective. To learn more about Dr. Marianne’s virtual, self-paced ARFID and Selective Eating Course or to explore therapy and educational resources, visit her website drmariannemiller.com.