Dr. Marianne-Land: An Eating Disorder Recovery Podcast

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.

Chewing & Spitting in Eating Disorders: Restriction, Sensory Overwhelm, & the Two Paths This Behavior Can Take

Chewing and spitting is an eating disorder behavior that often remains hidden because of intense shame and misunderstanding. Many people do not know how to talk about it, and many providers never ask. In this solo episode, Dr. Marianne Miller offers a clear, compassionate explanation of chewing and spitting in eating disorders, naming why this behavior develops and why it deserves nuanced care rather than judgment. This episode centers eating disorder recovery, ARFID, neurodivergent sensory experiences with food, and the nervous system roots of eating behaviors that are often moralized or overlooked.
Why Chewing and Spitting Is So Often Misunderstood
Chewing and spitting is frequently framed as a single behavior with a single cause. This narrow understanding creates harm. When providers assume chewing and spitting always reflects restriction or compensatory behavior, people with ARFID and sensory-based eating challenges are misdiagnosed or pressured into unsafe treatment. When providers minimize chewing and spitting in restrictive eating disorders, people lose access to support at moments of increasing distress. This episode explains why chewing and spitting must be understood through multiple pathways to ensure accurate diagnosis and ethical care.
Pathway One: Chewing and Spitting in Restrictive and Compensatory Eating Disorders
In restrictive or compensatory eating disorders, chewing and spitting often functions as a way to avoid swallowing food while still experiencing taste. It may emerge during periods of significant restriction, intense hunger, or fear of weight gain. Some people use chewing and spitting to interrupt binge urges or as a purge-adjacent behavior. In this pathway, the behavior reflects deprivation, internal conflict, and rising eating disorder severity. Shame, secrecy, and fear of judgment frequently follow, making it harder for individuals to seek support or speak openly about what they are experiencing.
Pathway Two: Chewing and Spitting in ARFID and Neurodivergent Sensory-Based Eating
Chewing and spitting can also emerge in ARFID and neurodivergent sensory-based eating for reasons entirely unrelated to weight or dieting. In this pathway, the behavior reflects sensory overwhelm, swallowing discomfort, texture sensitivity, interoceptive differences, or nervous system safety needs. Autistic and ADHD individuals may chew food to explore taste while spitting to avoid gagging, panic, or sensory overload. When this pathway is misunderstood as compensatory eating disorder behavior, people often feel pathologized rather than supported. This episode explains how sensory wiring, disability, and safety needs shape this experience.
Why Differentiating These Two Pathways Matters in Recovery
Accurately identifying the function of chewing and spitting is essential for healing. Restrictive and compensatory pathways require approaches that address deprivation, shame, trauma, and rigid food rules. Sensory-based pathways require approaches that build safety, honor autonomy, and work with the nervous system rather than against it. Dr. Marianne explains why a one-size-fits-all model fails and how differentiation creates clarity, trust, and more sustainable eating disorder recovery.
Intersectionality, Bias, and Systemic Harm
This episode also explores how anti-fat bias, racism, ableism, and medical bias shape who receives care and who gets believed. People in larger bodies often experience intense pressure to restrict, which can intensify chewing and spitting behaviors. People of color frequently face delayed or missed eating disorder diagnoses. Neurodivergent individuals are often misunderstood or dismissed when their eating challenges are sensory-based. Understanding chewing and spitting requires naming these systemic harms rather than blaming individuals.
A Compassionate Path Forward
Chewing and spitting is not a moral failure or a sign of weakness. It is a behavior rooted in nervous system responses, lived experience, and survival. This episode offers language, validation, and clarity for anyone who has struggled with chewing and spitting, supported someone who has, or wants a more nuanced understanding of eating disorders and ARFID. Healing begins with understanding, safety, and compassion.
About Dr. Marianne Miller
Dr. Marianne Miller is a licensed marriage and family therapist specializing in eating disorder recovery, ARFID, binge eating, and neurodivergent-affirming therapy. She offers therapy for individuals in California, Texas, and Washington D.C., and teaches the self-paced, virtual ARFID and Selective Eating Course.

When Exercise Becomes Punishment: Body Image, Shame, & Disordered Eating With Dr. Lisa Folden @healthyphit

Exercise is often framed as self-care, discipline, or proof that someone is “doing the right thing.” But for many people, exercise becomes tangled with shame, control, and self-worth. In this interview, Dr. Marianne Miller sits down with Dr. Lisa Folden, a weight-inclusive physical therapist and Health at Every Size ambassador, to explore how exercise shamefuels body image distress and disordered eating, even when it is disguised as wellness or health.
Dr. Lisa shares her personal journey from overexercising, restriction, and rigid fitness rules to intuitive movement rooted in care rather than punishment. Together, they unpack how fitness culture, purity culture, and appearance-based health messaging teach people to judge their bodies and measure their worth through movement, weight, and discipline. This conversation reframes eating disorder recovery through a compassionate, weight-inclusive lens that separates exercise from morality and control.
This episode is especially relevant for anyone struggling with eating disorders, chronic disordered eating, exercise guilt, or a painful relationship with movement.
Content Caution
This episode includes discussion of eating disorders, disordered eating behaviors, food restriction, binge eating patterns, overexercising, body image distress, weight stigma, and shame-based health messaging. Please listen in a way that feels supportive to you.
Episode Overview
In this conversation, Dr. Marianne and Dr. Lisa explore how exercise shame develops and why it is so deeply connected to body image and eating disorder recovery. Dr. Lisa explains how early experiences with discipline, structure, and purity culture shaped her relationship with food and exercise, reinforcing the belief that bodies must be controlled to be worthy. They discuss how fitness spaces often reward pain, consistency, and weight loss while ignoring mental health, accessibility, and individual needs.
The episode also examines how intuitive movement becomes possible when exercise is no longer used to fix or punish the body. Dr. Lisa describes what shifted when she stopped exercising to change her body and began moving in ways that supported her nervous system, energy, and overall well-being. The conversation highlights how ableism and body size bias show up in gyms and wellness spaces, often through subtle judgments about who “belongs” and how bodies should move.
Throughout the episode, Dr. Lisa emphasizes that exercise does not determine character and that body image healing requires separating movement from shame, worth, and identity. This reframing is central to sustainable eating disorder recovery and long-term healing.
Why This Episode Matters
Many people in eating disorder recovery were taught that exercising consistently meant they were good, disciplined, or successful, while rest or inconsistency meant failure. This episode challenges those beliefs and offers a more humane, evidence-informed approach to movement and self-care. It speaks directly to listeners who feel stuck in cycles of overexercising, restriction, binge eating, or chronic guilt around movement, and offers permission to relate to exercise in a way that supports healing rather than harm.
About Dr. Lisa Folden
Dr. Lisa Folden is a North Carolina–licensed physical therapist, NASM-certified behavior change specialist, and anti-diet, weight-inclusive coach. She is the owner of Healthy Phit Physical Therapy and Wellness Consultants and a Health at Every Size ambassador. Her work focuses on helping people heal their relationship with movement, body image, and food, particularly in the context of eating disorder recovery. She is also a writer, speaker, and mother of three.
You can follow Dr. Lisa on Instagram at @healthyphit and read her writing on Substack at DrLisaFolden.
Related Episodes
--Breaking Up With Diet Culture with Dr. Lisa via Apple or Spotify.
--Moralization of Exercise, Eating, & Body Size With Dr. Lisa via Apple or Spotify.
About the Host
Dr. Marianne Miller is a Licensed Marriage and Family Therapist and eating disorder specialist offering neurodivergent-affirming, trauma-informed support for binge eating disorder, ARFID, anorexia, bulimia, and long-term eating disorders. She hosts Dr. Marianne-Land: An Eating Disorder Recovery Podcast and provides therapy, education, and self-paced recovery programs. Check out her website at drmariannemiller.com or her Instagram @drmariannemiller.
Listen Now
If exercise has ever felt like punishment, obligation, or proof of worth, this episode offers a different path forward grounded in compassion, autonomy, and care.

Autism & Eating Challenges: Understanding Sensory Needs, Routines, & Safety

In this solo episode, Dr. Marianne explores how autism shapes eating in ways that many providers overlook. Sensory needs, interoception, routines, and safety all influence how autistic people navigate food. Instead of seeing these challenges as resistance, Dr. Marianne reframes them as intelligent body signals that protect a sensitive nervous system.
Dr. Marianne explains why autistic eating experiences often get misunderstood. She discusses how overwhelming textures, smells, and sounds affect tolerance for certain foods, how interoceptive confusion can disrupt hunger cues, and how predictability reduces chaos during meals. She also explores the deep need for safety and how early food trauma can lead to long-lasting protective patterns.
This episode highlights how autistic people may develop ARFID due to sensory overload, fear, or confusion around internal cues. Dr. Marianne emphasizes the need for neurodivergent affirming care that respects autonomy, consent, and the right to eat in ways that support comfort rather than compliance.
Dr. Marianne also examines intersectionality. Autistic people of color, LGBTQIA+ autistic people, and disabled autistic people often face additional barriers to care and experience higher rates of dismissal. Understanding these intersections helps us provide real support.
Throughout the episode, Dr. Marianne offers a compassionate framework for supporting autistic eating. She centers curiosity, sensory awareness, co-regulation, predictable routines, and respect for safe foods. She encourages listeners to trust their bodies and seek environments that reduce overwhelm instead of increasing it.
Key Topics Covered
Sensory Needs and Autistic Eating
How texture, smell, sound, and temperature influence food tolerance and how sensory overwhelm shapes avoidance patterns.
Interoception and Hunger Cues
Why autistic people often experience muted or confusing hunger cues and how supportive routines help.
Predictability and Routine
Why sameness offers safety during meals and how routine helps regulate the nervous system.
Safety and Eating Trauma
The long-term effects of force feeding, pressure, and food shame and how safety becomes essential for healing.
Autism and ARFID
How ARFID develops in autistic people and why care must support autonomy, sensory comfort, and consent.
Intersectionality and Access to Care
How race, gender, sexuality, class, and disability shape autistic eating experiences and influence the support people receive.
Compassionate Support Strategies
How validation, sensory awareness, predictable rhythms, and co-regulation improve access to nourishment.
Content Caution
In this episode, I discusseeating challenges, restriction patterns, sensory overload, trauma, and ARFID. Please listen gently and take breaks if needed.
Who This Episode Supports
This episode is for autistic adults, parents of autistic children, providers who want to offer neurodivergent affirming care, and anyone who wants a deeper understanding of autistic eating experiences. It is also supportive for people exploring ARFID symptoms rooted in sensory needs, trauma histories, or routines that feel protective.
Related Episodes
Autism & Eating Disorders Explained: Signs, Struggles, & Support That Works on Apple & Spotify.
The Invisible Hunger: How Masking Shows Up in Eating Disorder Recovery on Apple & Spotify.
How Masking Neurodivergence Can Fuel Eating Disorders on Apple & Spotify.
Autism & Anorexia: When Masking Looks Like Restriction, & Recovery Feels Unsafe on Apple & Spotify.
Work With Dr. Marianne
If you want support that honors your sensory needs and your autonomy, you can learn more about my therapy services in California, Texas, and Washington, D.C., as well as global coaching options at drmariannemiller.com. You can also explore my ARFID and selective eating course and my binge eating and bulimia membership for additional tools. You deserve care that meets your body where it is.

TikTok Is Rebranding Diet Culture: The Urgent Harm Behind “Anti-Bloat” & Glow-Up Trends

TikTok reshapes the way people talk about bodies, beauty, and wellness. What looks like gentle self care often hides restrictive eating patterns, thinness pressure, and aesthetic rules that reward shrinking. In this episode, Dr. Marianne Miller explores how TikTok rebrands diet culture by disguising restriction inside trends like “anti bloat,” “glow up,” “clean girl body,” and “body recomposition.”
Dr. Marianne explains why these trends spread quickly, why they create a strong pull for people with eating disorders, and why neurodivergent viewers may feel especially drawn to routines that promise control or calm. She describes how glow up narratives romanticize disappearance and how thinness becomes a transformation story. You will learn how to identify coded diet language and how to stay grounded while moving through online spaces that promote harmful messaging.
What You Will Learn in This Episode
1. How TikTok Rebrands Diet Culture
Dr. Marianne explains how “anti bloat” routines and glow up challenges present restriction as wellness. She highlights how these messages look soft and soothing even though they pressure people to shrink and control their bodies.
2. How Coded Restriction Language Shows Up Online
You will learn how creators use soothing audio, soft visuals, and vague terms to disguise patterns that mirror disordered eating. Dr. Marianne names the phrases that quietly promote thinness.
3. Why Neurodivergent Viewers and People With Eating Disorders Feel Drawn In
Structured routines and visuals can feel comforting or predictable. Dr. Marianne describes how this pull can feel stronger for neurodivergent listeners or anyone living with long-term food struggles.
4. How Glow-Up Culture Romanticizes Shrinking
Dr. Marianne explores how glow up narratives frame thinness as success, transformation, or emotional strength. These stories reward disappearance and pressure people to strive for smaller bodies.
5. Intersectionality and Harmful Messaging
Dr. Marianne names the ways thinness aesthetics reinforce cultural pressures for people in larger bodies, people of color, neurodivergent individuals, transgender and nonbinary people, and anyone who already experiences scrutiny or marginalization.
6. How to Strengthen Your Relationship With TikTok
You will learn practical strategies to identify harmful patterns, curate your feed, follow body liberation voices, and stay centered in your own needs while using the platform.
Content Caution
This episode includes discussion of thinness trends, restrictive routines, and coded dieting messages on TikTok. If you feel overwhelmed or activated, please pause and return when you feel grounded.
Who This Episode Supports
This episode supports:• people recovering from eating disorders• neurodivergent listeners who feel drawn to routines or calming visuals• people in larger bodies who feel erased by glow up narratives• trauma survivors who feel pulled toward control-based content• clinicians, parents, and helpers who want to understand the pressures their clients or teens face online• anyone curious about how diet culture hides inside wellness language
Resources
Listeners may find support through:• body liberation and fat liberation educators• research on social media and disordered eating• neurodivergent-affirming eating disorder resources• trauma-informed recovery frameworks
Related Episode
SkinnyTok & Anorexia: How Harmful Trends Thrive Despite TikTok’s Ban with Jen Tomei @askjenup on Apple and Spotify.
Work With Dr. Marianne Miller
Learn more about therapy, coaching, binge eating support, ARFID resources, and upcoming clinician trainings at drmariannemiller.com. Explore the blog, podcast show notes, and all available offerings.

Eating Disorder Recovery Without Financial Barriers: Project HEAL’s Pathways to Free & Low-Cost Care With Leslie Jordan Garcia @liberatiwellness

What if the problem is not your motivation to recover, but a system that makes eating disorder treatment almost impossible to afford?
In this conversation, I sit down again with Leslie Jordan Garcia @liberatiwellness. Leslie is a wellness strategist, certified eating disorder recovery coach, and Treatment Access Program Manager at Project HEAL. In this episode, we discuss real, concrete pathways to free and low-cost eating disorder care. We also talk about why you cannot separate eating disorder recovery from social justice, intersectionality, and body hierarchies.
Leslie breaks down how Project HEAL removes financial and systemic barriers, how people from marginalized communities can apply, and how providers can join the Healer’s Circle to offer justice-focused, values-aligned care.
In this episode, we talk about
What Project HEAL is and how it works to remove financial and systemic barriers to eating disorder care in the United States
The four major Project HEAL programs and how to apply for:
Community Care groups for BIPOC folks
Cash assistance that covers tertiary costs like rent, pet boarding, and transportation
Outpatient treatment placement with sliding scale and pro bono providers
Insurance navigation support and help with single case agreements
Who qualifies for Project HEAL services, including people in all U.S. states and territories, and how they prioritize folks from communities that are historically and systemically marginalized
How Leslie matches people with “unicorn providers” who are fat positive, HAES aligned, queer affirming, trauma aware, and non Christian based when needed
The difference it makes when someone helps you navigate insurance, access care, and complete applications, especially when executive functioning is low or things feel overwhelming
How economic precarity, layoffs, food insecurity, and shifting insurance policies are driving an uptick in applications for eating disorder treatment assistance
Why intersectional, identity affirming care is not optional in eating disorder recovery, especially for BIPOC, queer, trans, disabled, and fat clients
How Leslie’s social justice consulting work with universities, community colleges, and health organizations helps them:
Reimagine intake forms and client facing processes
Address promotion and salary inequities
Create transformational circles where teams talk about harm, stereotypes, and systemic barriers
How body hierarchies, food moralization, school fitness testing, and lunch shaming fuel eating disorders for kids and adults
Why many people use eating disorders as a survival tool in the context of trauma, capitalism, surveillance, and unsafe systems
What true equity and belonging could mean for decreasing the occurrence and severity of eating disorders
About our guest: Leslie Jordan Garcia
Leslie Jordan Garcia is a wellness strategist, certified eating disorder recovery coach, and social justice consultant dedicated to healing and liberation.
She holds dual master’s degrees in business and public health and has more than a decade of experience across military, public health, and nonprofit sectors. Through her practice, Liberati Wellness, Leslie offers HAES aligned eating disorder recovery support, inclusive movement support, and equity and identity affirming care.
Leslie also partners with organizations like Austin Health Commons and the Hogg Foundation to embed equity and justice into health systems and helping professions. She currently serves as the Treatment Access Program Manager at Project HEAL, where she manages cash assistance and treatment placement and works to match clients with values aligned, culturally responsive providers.
You can find Leslie’s coaching and consulting work at Liberati Wellness and on Instagram at @liberatiwellness.
Inside Project HEAL’s pathways to care
In this episode, Leslie explains how Project HEAL supports people who are struggling with eating disorders and facing financial and systemic barriers to treatment. She walks us through the main programs:
Informed ED (for professionals)A learning program for clinicians and dietitians who are newer to eating disorder treatment. It helps them build skills, reduce harm, and align their work with justice focused values so they can better support clients whose eating disorders are uncovered in general mental health or medical settings.
Community CareA free, BIPOC only, 8 week support and process group focused on body liberation, community care, and healing from white supremacist body hierarchies.
Cash Assistance ProgramA program that does not pay individuals directly, but instead covers tertiary costs that often block access to care. This can include rent, transportation, pet boarding, or other essential expenses so that people can actually attend the level of care their team recommends.
Treatment PlacementLeslie coordinates outpatient treatment placement, connecting people with dietitians, therapists, and other providers who offer sliding scale or pro bono care, especially when insurance does not cover enough dietitian sessions or mental health support.
Insurance NavigationProject HEAL helps people understand their insurance benefits, locate in network providers, and pursue options like single case agreements when an appropriate provider is out of network.
Leslie also mentions a time limited clinical assessment program for people who know they are struggling in their relationship with food and body but have never had a formal diagnosis.
All of these services are free to applicants, and one application can cover multiple programs at once.
Who can apply to Project HEAL
Leslie shares that Project HEAL is U.S. based, and that includes all 50 states, Alaska, Hawaii, and U.S. territories such as Guam.
Anyone in those locations can apply. Project HEAL prioritizes people from communities that have been historically and systemically marginalized, including:
BIPOC communities
Queer and trans communities
People in larger bodies
Disabled and chronically ill folks
People navigating religious trauma and other layered identities
Leslie’s role includes reading applications through an intersectional lens, tracking diversity demographics, and making sure that people who face the largest gaps in access are not overlooked.
She also notes that if the application itself feels overwhelming, Project HEAL can connect applicants with someone who will help them complete it, which is especially important when executive functioning is low.
Intersectionality, social justice, and eating disorder recovery
Throughout the conversation, Leslie and I look at how eating disorders are never just about appearance. They are deeply tied to:
Trauma and chronic stress
How we perceive our bodies and how we believe others perceive our bodies
Economic instability, job insecurity, and food insecurity
Surveillance of bodies in workplaces, schools, and medical settings
Racism, anti-fat bias, ableism, transmisia, and other forms of oppression
Leslie talks about clients who restrict food so their children can eat when jobs cut hours, and how people in larger bodies often avoid eating at work because of constant surveillance and judgment, only to experience intense hunger and binge episodes later.
We explore how body hierarchies, moralization of food, school fitness testing, and lunch policing create conditions where an eating disorder can become a primary coping strategy. Leslie describes how, over time, this can become deeply embedded, with the brain chemistry colluding with the eating disorder to create a sense of safety that the larger system fails to provide.
For Leslie, social justice work is inseparable from eating disorder work. If people had secure access to food, safe housing, living wages, and genuine body equity, many would not need to rely on eating disorders to feel safer, visible, or invisible.
Justice work inside systems
Leslie also describes her justice work with institutions, including:
Facilitating Transformational Circles where diverse team members connect as humans and then talk honestly about processes that exclude or harm people
Supporting clinics that operate in queer neighborhoods yet do not see queer clients, and helping them examine what in their client facing processes is pushing people away
Working with community colleges on salary and promotion inequities, examining reviews, ranking systems, and feedback processes that keep certain groups from advancing
Helping organizations rework intake forms, policies, and internal culture so that equity, belonging, and justicebecome real practices rather than buzzwords
She reminds us that what often gets labeled as “DEI” is actually about justice, accessibility, and belonging for everyone, including veterans, people who breastfeed, people who need ramps and accessible bathrooms, and more.
How to connect with Project HEAL and Leslie
To apply for Project HEAL’s Treatment Access programsVisit the Project HEAL website at projectheal.org and look for the section on Treatment Access. One application lets you indicate which services you want, including cash assistance, treatment placement, insurance navigation, and clinical assessment while that program is still active.
Both individuals seeking care and providers who want to join the Healer’s Circle start on the same site. Providers can share their identities, specialties, body size, languages spoken, and communities they love to serve, which helps Leslie make strong intersectional matches.
To work with Leslie as a coach or consultantYou can learn more about Leslie’s equity and identity affirming eating disorder recovery coaching and social justice consulting at:
Website: Liberati Wellness liberatiwellness.com
Instagram: @liberatiwellness
She currently has a reduced capacity for one to one clients but continues to support individuals and teams through coaching, collaboration with therapists and dietitians, and organizational justice work.
If this episode resonated with you
If you are struggling with an eating disorder and feel blocked by money, insurance, or access, I hope this episode helps you feel less alone and more resourced. There are people and organizations actively working to break financial barriers to care.
If you know someone who could benefit from free or low-cost eating disorder support, especially someone from a marginalized community, please consider sharing this episode with them.
You can also support this work by:
Following @liberatiwellness and @projectheal
Sharing Project HEAL’s application info with your community
If you are a provider, applying to join the Healer’s Circle and offering sliding scale or pro bono care
And as always, thank you for listening and for being part of this conversation about justice, embodiment, and eating disorder recovery.

The Quiet Places Where Anorexia Meets Identity & Expression

This solo episode explores the quiet places where anorexia meets identity and expression. Dr. Marianne Miller speaks to the lived moments where someone learns to hide parts of themselves and how restriction becomes a language for survival. She examines how identity formation, self-expression, and body-based fear interact in ways that often remain hidden. The episode centers queer, trans, gender-expansive, and questioning listeners along with anyone who has felt pressure to quiet their identity in order to navigate the world.
Dr. Marianne describes how anorexia rises when identity feels unsafe, unrecognized, or tightly controlled. She explains how restriction becomes a strategy to manage visibility, vulnerability, dysphoria, and the cultural pressure to stay small. The episode invites listeners to imagine recovery as a process of expanding expression, reclaiming autonomy, and restoring connection to their authentic self.
Key Themes in This Episode
Dr. Marianne examines the links between anorexia, identity, and self-expression. She describes how gender expectations and cultural norms shape the body story. She explains how queer and trans people often restrict to soften dysphoria or to quiet unwanted attention. She explores the way over-performance and people-pleasing silence authentic expression and strengthen restrictive behavior. She looks at the sensory landscape of anorexia and describes how neurodivergent experiences influence embodiment and identity.
She also highlights the role of intersectionality. Race, culture, queerness, disability, and body size shape how someone expresses themself and how safe that expression feels. These intersections help explain why anorexia often becomes a predictable response to environments that restrict identity or punish authenticity.
Why This Episode Matters
Mainstream conversations about anorexia often focus on food without addressing identity, expression, and cultural pressure. Many listeners learn early that their identity takes up too much space. Many learn that desire, gender expression, and emotional truth need to stay hidden. This episode challenges the idea that anorexia develops inside a vacuum. Instead, it shows how anorexia forms inside relationships, systems, and environments that silence real expression.
The episode offers validation for anyone who felt forced to shrink in order to stay safe. It expands the understanding of anorexia so listeners can see their experiences reflected with accuracy, compassion, and liberation.
Who This Episode Supports
This episode supports listeners who navigate anorexia while holding queer, trans, or gender-expansive identities. It supports people who experience identity suppression or dysphoria and who use restriction to manage that conflict. It supports neurodivergent listeners whose sensory experiences shape their relationship with their body and their identity. It also supports clinicians, loved ones, and community members who want a more accurate and compassionate understanding of anorexia.
Resources Mentioned
Liberation-based healing modelsTrauma-informed careQueer embodiment researchNeurodivergent eating disorder literature
Content Caution
This episode discusses anorexia, restrictive eating, identity conflict, gender dysphoria, sexuality, sensory overwhelm, and the lived experience of shrinking to stay safe. Please listen with care and pause whenever your body needs space.
Related Episodes
Queer Mental Health & Eating Disorders: How Stress Shows Up in the Body & Brain With Winter Groeschl, NCC, LPC (@eatingdisorderrevealed): Apple & Spotify.
LGBTQIA+, the Coming Out Process, & Eating Disorders: Apple & Spotify
LGBTQIA+ & Eating Disorders: Apple & Spotify
Learn More and Get Support
Dr. Marianne Miller provides therapy and coaching for anorexia, ARFID, binge eating disorder, bulimia, trauma, and body-based fear. She supports clients across California, Texas, Washington D.C., and internationally. Explore additional episodes of the Dr. Marianne Land podcast for conversations about eating disorder recovery, neurodiversity, identity, embodiment, and body liberation. Check out her website at drmariannemiller.com. Follow her on Instagram @drmariannemiller.

Understanding Harm Reduction: Why "Full Recovery" May Not Be the Goal for Lifelong Eating Disorders

In this episode, Dr. Marianne Miller explores the reality that many people with lifelong eating disorders do not resonate with the traditional idea of full recovery. She explains why harm reduction can offer a compassionate and sustainable path for individuals who have lived with chronic anorexia, long term bulimia, binge eating disorder, ARFID, and other long standing eating disorders. This conversation centers trauma history, neurodivergence, sensory needs, oppression, and the intersectional barriers that prevent many people from reaching what treatment programs often define as full recovery.
If you have lived with an eating disorder for decades, if you have experienced trauma or misdiagnosis, if you are neurodivergent, or if you live in a marginalized body that has faced medical discrimination, you may find this episode deeply validating. Harm reduction gives you realistic recovery goals that respect your lived experience, your nervous system, and your access needs.
What You Will Learn in This Episode
Dr. Marianne explains how harm reduction works in eating disorder recovery and how it differs from traditional recovery models. She shows how harm reduction supports safety, stabilization, and dignity for people who have navigated chronic eating disorders for most of their lives. You will learn why the nervous system sometimes cannot tolerate pressure toward full recovery and why a flexible, collaborative approach can feel more aligned for many people.
You will hear how sensory issues, interoception challenges, executive functioning differences, autistic burnout, and ADHD related overwhelm shape eating patterns for neurodivergent individuals. You will learn how trauma history, attachment ruptures, racialized stress, gender based discrimination, medical fatphobia, and identity marginalization influence both the development of eating disorders and the recovery process.
Key Topics Covered
This episode covers a wide range of topics that matter deeply for people with chronic eating disorders. These topics include how harm reduction supports stabilization when the long term eating disorder has become intertwined with survival. You will hear why the phrase full recovery can feel unrealistic or even harmful for people who have lived with their eating disorder for decades. Dr. Marianne explains how harm reduction creates safety, reduces shame, increases autonomy, and supports people who need a gentler and more individualized approach.
The episode explores the role of neurodiversity in eating disorder recovery. This includes how sensory sensitivities shape food choices, how interoception differences impact hunger awareness, how executive functioning challenges influence meal consistency, and why many autistic and ADHD individuals need accessible, predictable, and customized strategies. You will also learn how intersectional oppression shapes health outcomes for people of color, queer and trans individuals, disabled individuals, fat individuals, and anyone living across multiple marginalized identities.
Dr. Marianne describes what harm reduction can look like in daily life, from maintaining safe foods to creating sensory friendly meals to reducing medical instability in small, sustainable steps. She shares how this approach honors personal history and current capacity and how it helps many people live with more stability and less suffering.
Who This Episode Is For
This episode is for anyone living with a lifelong eating disorder who has felt pressure to pursue full recovery even when that expectation does not align with their reality. It is for people with chronic anorexia, chronic bulimia, long term binge eating disorder, ARFID shaped by sensory needs, and individuals with complex trauma who feel overwhelmed by traditional treatment expectations.
This episode is also for neurodivergent individuals who live with autistic sensory profiles, ADHD impulsivity, interoception challenges, and executive functioning struggles that interfere with eating. It is for people living in marginalized bodies who have experienced medical discrimination or misdiagnosis. It is for professionals who want to learn how to apply harm reduction to eating disorder treatment in inclusive, neurodivergent affirming, and identity informed ways.
Why This Episode Matters
Many people with chronic or lifelong eating disorders feel invisible in mainstream recovery culture. They hear messages that full recovery is the only worthy goal and feel ashamed when their body or nervous system cannot meet those expectations. This episode names that truth with compassion. Harm reduction is a valid and ethical approach that honors lived experience and brings relief to people who need safety more than perfection.
This episode matters because it acknowledges the role of trauma, neurodivergence, sensory needs, and intersectionality in long term eating disorders. It challenges the idea that recovery must look the same for everyone. It shows that you deserve care even if your healing does not follow a traditional blueprint. Your life still holds value and possibility.
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.
Perfectionism, People-Pleasing, & Body Image: Self-Compassion Tools for Long-Term Eating Disorder Recovery With Carrie Pollard, MSW @compassionate_counsellor on Apple & Spotify.
Resources and Support
If you want more resources on lifelong eating disorders, harm reduction, ARFID, sensory based eating, and neurodivergent affirming care, visit drmariannemiller.com where you will find blog posts, guides, and links to specialized support. You can also explore my ARFID course and binge eating recovery membership options if you want deeper help with binge eating disorder, bulimia, ARFID, or long term eating disorder recovery. My work supports clients in California, Texas, Washington DC, and internationally through coaching.
Join the Conversation
If this episode resonated with your experience of a lifelong eating disorder or if you are curious about harm reduction as a recovery model, I would love to hear your thoughts. You can connect with me on Instagram at @drmariannemiller and share what stood out to you.
For More Dr. Marianne-Land Podcast Episodes
To explore more episodes on eating disorders, neurodiversity, trauma, and body liberation, listen to the full archive on your favorite podcast platform.

Chronic Illness, Wellness Culture, & Eating Disorder Recovery: Taking an Anti-Diet Approach With Abbie Attwood, MS, @abbieattwoodwellness

What happens when chronic illness meets wellness culture, diet culture, and the desperate search for answers in a system that continues to fail so many people? In this episode, I talk with Abbie Attwood, MS, @abbieattwoodwellness, an anti diet, weight inclusive nutrition therapist and host of the Full Plate Podcast.
Abbie and I explore how chronic illness, medical gaslighting, and the pressure to find a cure can intersect with disordered eating. We talk about the ways wellness messaging pushes restrictive food rules, how OCD and anxiety deepen vulnerability to this messaging, and how food fear can feel like control when life feels unpredictable.
We also discuss athlete identity, compulsive exercise, thin privilege, masking, neurodivergence, and the grief that comes when illness or injury forces people to rethink who they are. This conversation opens space for nuance, compassion, and the reality that healing happens inside context, not perfection.
Content Caution
We talk about chronic illness, disordered eating, exercise compulsion, and food restriction. Please take care of yourself as you listen.
Key Topics We Cover
How wellness culture preys on vulnerability
Abbie discusses how chronic illness created a perfect storm for disordered eating, especially when wellness messaging promised control, cures, and answers that science did not support.
Chronic illness and the search for control
We talk about how desperation, medical dismissal, and misinformation make people more likely to turn to restrictive food rules and elimination diets.
OCD, anxiety, and increased vulnerability to wellness culture
Abbie shares how her undiagnosed OCD and lifelong anxiety made the rigid, all or nothing tone of wellness culture feel reassuring, while actually deepening harm.
Athlete identity, loss, and compulsive movement
We explore how losing movement due to chronic illness or injury can destabilize identity, trigger grief, and reignite disordered behaviors around exercise.
Masking, neurodivergence, and the pressure to perform wellness
We discuss how neurodivergent masking can hide exhaustion and overwhelm, and how the pressure to perform health or discipline can push people deeper into food and exercise rigidity.
Chronic illness culture, shame, and blame
We look at how chronic illness culture and wellness culture both place responsibility on the individual, leading to shame and self blame when bodies do not behave as expected.
What real nourishment looks like when illness limits capacity
Abbie talks about the need for compassion, ease, adding rather than restricting, and honoring energy limitations instead of forcing strict food rules.
Who This Episode Is For
People navigating chronic illness and food anxiety
Listeners recovering from eating disorders
Neurodivergent folks who feel pressured to mask or follow rigid health rules
Athletes or former athletes grieving changes in movement
Anyone tangled in wellness culture messaging
Clinicians who want a deeper understanding of how chronic illness intersects with disordered eating
People who struggle with shame when illness reduces their capacity
About Today’s Guest
Abbie Attwood, MS, is an anti diet, weight inclusive nutrition therapist, writer, and host of the Full Plate Podcast. She provides virtual nutrition therapy and body image support through Abbie Attwood Wellness and writes a widely loved Substack newsletter on healing our relationships with food and body. You can find her at @abbieattwoodwellness and abbieattwoodwellness.com.
Links Mentioned
Abbie Attwood Wellness Substack: abbieattwoodwellness.substack.comAbbie’s website: abbieattwoodwellness.com
Instagram: @abbieattwoodwellnessFull Plate Podcast
Related Episodes
Breaking Up With Diet Culture with Dr. Lisa Folden, @healthyphit on Apple & Spotify.
How Eating Disorder Recovery Heals Life Overall via Apple or Spotify.
Overexercising, ADHD, & Eating Disorders with @askjenup Jenny Tomei on Apple & Spotify.
How Diet Culture & Purity Culture Fuel Eating Disorders: Unpacking the Trauma Behind the Rules with Cassie Krajewski, LCSW @inneratlastherapy on Apple & Spotify.
Work With Me
If you want support for binge eating disorder, ARFID, chronic eating struggles, or complex eating disorder patterns shaped by trauma, neurodivergence, or chronic illness, you can connect with me at drmariannemiller.com for therapy in California, Texas, or Washington D.C. I also offer global coaching and specialized courses.