Problematic relationship with your body and food? Here’s what to do

Yvie: This podcast is recorded and produced on the land of the Wurundjeri people of the Kulin Nation. We pay our respects to their elders past and present, and extend that respect to all Aboriginal and Torres Strait Islander people who may be listening.

Yvie: Welcome to another episode of Let’s Talk, a podcast from Butterfly Foundation. I’m your host, Yvie Jones, and today’s episode is a clear, practical guide for anyone struggling with eating, exercise, or body image and is unsure where to start. We’ll be joined by Butterfly’s Head of Clinical Services, Natalie Spicer, to help walk us through concrete first steps — such as how to prepare for a GP appointment, what to expect in that first meeting, and how to access Medicare-subsidised eating disorder treatment plans, and ways to find bulk-bill or low-cost care. We’ll map alternative treatment pathways and telehealth options, explain how carers and loved ones can support someone safely, and share when a helpline or support group can make a real difference. This episode is about giving you a plan that fits your life in ways that are practical, compassionate, and actionable.

Yvie: So, Natalie, to begin — what are the first steps someone should take if they’re concerned about their eating, exercise habits, or body image, especially if they’re not sure whether what they’re experiencing is serious enough to seek support?
Natalie: I think the key thing is actually in the end of that question, Yvie — people with eating disorders often never feel like their symptoms are serious enough to seek help. So I think it’s about disregarding that barrier, and even if you have just an inkling or a very small idea that you might need some help, that’s the cue for you to go and find it.
Natalie: Something else I wanted to mention is that if someone has approached you — like a friend or a loved one — and they’ve had that conversation with you, then take it away from the perspective of the person themselves. If someone’s said, “Hey, I think I’ve noticed a change in you,” ask that person to help encourage you to seek help too. I always like to lean back on the “Are You OK?” framework: ask, listen without judgment, encourage help-seeking, and then check in with that person.

Natalie: So from a carer or loved one’s perspective, this question is really important too. But essentially, if you are the person and you think you have any inkling of needing some support, or you just realise your head is really full of body concerns or whatever it might be — that’s cue enough to go and have a chat with someone. It might be a friend, it might be a GP, it could be a psychologist if you’ve already got one, or just a trusted person, a colleague — somebody you feel like you can chat to.

Yvie: “Are you okay?” is a great first start, but do you go more specific when you are worried about someone? Do you worry about triggering someone or making them defensive if you say anything? And what are some practical things to say to start that conversation?

Natalie: It’s a really good question, and I think this can be a really tricky conversation — because not only are people often afraid of speaking up when they’re worried about someone, but eating disorders are such a secretive illness. People are often holding onto them for a reason we may not even know — it could be trauma, and a lot of the time it is trauma. It could be about having control over a situation. So that person may become quite defensive.

Natalie: If you are approaching someone, it’s important to be absolutely non-judgmental, and to make sure they know you’re coming from a place of care and love and that you’re concerned about them. It may not even be in that first conversation that you get anywhere — but just planting that seed, letting someone know that someone else has clocked it and is thinking about them, might be enough for that person to click into, “Oh, maybe I actually do need some help, and that is someone I could speak to.”

Yvie: It’s such a tricky one, isn’t it? Because you don’t want to put people offside — you want to be an ally, a friend, a support. Can you walk us through what happens at a first GP appointment for someone concerned about eating or body image issues? What can they expect, and how can they prepare to make the most of the conversation? I know GPs can have short appointments — do we start with even booking a long appointment?

Natalie: I think that’s a great first step — knowing what you want to go in and talk about and booking the correct length appointment. Now, if you get into that appointment and the GP isn’t the right fit, or you’re not feeling supported, it’s okay to move on. You want to go in there knowing you’re going to feel validated and supported. We know that some GPs are more eating disorder-informed than others, so just make sure you find the right connection, because a GP is such an important part of a recovery journey.

Natalie: Once you’re in that appointment, I think it’s really helpful to bring a support person if you have one. If you’re going on your own because you’re still not ready to share this with anyone, that’s also okay. I’d suggest coming in with the thoughts and feelings you’ve been having, any behaviours that might be going on for you, and how often they might be occurring. If you’ve done anything online, Inside Out has a validated tool called “Are You At Risk?” which is invaluable — it’s on the Inside Out website and also on the Butterfly website. You can also do it from a carer or loved one’s perspective. There is a version coming for that, but at the moment it’s just for the individual. Bring the results of that with you.

Natalie: Inside Out also has a tool called the EDE-Q.

Yvie: So the EDE-Q is the Eating Disorder Examination Questionnaire — we’ll provide a link in the show notes. But what do we do with that?

Natalie: If you get results from the EDE-Q, bring those along with you as well, because it’ll help the GP build a picture of where you’re at and what support you might need going forward.

Natalie: Of course, when you’re there, they’ll probably check your blood pressure and temperature. They may order blood tests to see where things are at, because pathology can be affected by eating disorders — although it is often the last thing to change, so you cannot rely on that as a measure of wellness.

Yvie: They don’t weigh you, do they? I mean, they know enough not to — though it might be important sometimes — but it’s so triggering for so many people.

Natalie: It is so triggering. They may weigh you, but you have agency over that. If you feel that’s not what you want, it’s absolutely okay to say, “I don’t want to be weighed right now.” They may ask if you’ve lost or gained weight rapidly — there may be some uncomfortable questions, but they are important ones. You have complete agency over whether or not you get weighed. You don’t need to be weighed.

Yvie: I absolutely understand that it can be a helpful measurement in specific circumstances when required. Personally, I always say no. Sometimes they’re good about it, sometimes they’re not. But I always say something like, “I can tell if I’ve gained or lost weight by how my clothing fits” — I shouldn’t have to offer that justification. But it is something that may help another person to simply say, “I don’t want to be weighed.” Or the doctor might offer, “Can I weigh you, and you don’t look?”

Natalie: Yes, blind weighing is always an option, particularly if the GP is quite concerned about you medically. Blind weighing is very common, and weighing is part of a lot of therapies as well. We’re slowly trying to phase it out, but it is part of some treatments and may be a metric used to look at the bigger picture — not as a singular measure, but as one piece of data. So just be prepared that your height and weight, blood pressure, and pathology may all be requested.

Yvie: Okay, great. And while we’re at the GP — can we talk about Medicare-subsidised eating disorder treatment plans? How do they work, what services do they cover, and how can someone access bulk-bill or low-cost support if cost is a barrier?

Natalie: Sure. We’re very lucky that we have a government that recognises eating disorders, and we’ve come such a long way in the last 20 years. This Medicare plan is actually quite incredible — you get 40 psychology sessions and 20 dietetic sessions, which is quite significant.

Natalie: As part of the assessment, the GP can write this plan for you, or they may refer you to another specialist like a paediatrician or a psychiatrist. It does depend on the GP and their level of comfort, but GPs can absolutely do these plans themselves. As part of that, they will either refer you in that session to someone, or you can find someone yourself — it’s up to you, because sometimes the person a GP refers you to may not be the right fit, and that’s okay.

Natalie: There are some really great databases out there now. We’ve got the Butterfly database, which is getting a new and improved refresh in the next six months. There’s also the ConnectED website, which is the ANZAED — the Academy’s website — and it lists credentialled eating disorder practitioners, same as Butterfly. If you’re looking at treatment options more broadly, the NEDC website has a list of available treatments, including things like Family-Based Therapy and CBT-E (Cognitive Behavioural Therapy). Many of these databases also have the option to filter for low-cost or bulk-bill providers. You can also ask your GP to bulk-bill a session, though it obviously depends on each individual practice and their billing schedules.

Yvie: Just for those who don’t know — ANZAED stands for the Australia and New Zealand Academy for Eating Disorders, which is the peak body for professionals working in the eating disorder sector. And the NEDC is the National Eating Disorders Collaboration, which works on building a national system of care for people with eating disorders, their families, and carers. We’ll have links to both in the show notes.

Yvie: And beyond the GP pathway — what other treatment and support options are available in Australia?

Natalie: That’s a really good question, because recovery may not look like that for everyone. It may look more community-based, or someone may not want to see a GP — and that’s also fine. There is no one right way to recover.

Natalie: There are some amazing tools that are completely free and available to all Australians through federal government funding. There’s Elin, which is an Inside Out tool — anyone can log on and register. It’s designed for people who spend a lot of time thinking about their weight or shape, feel a loss of control over eating, restrict food to prevent weight gain, or who want to support a loved one. It’s completely free, you do it at your own pace, and it’s based on a CBT model.

Yvie: I’ll just jump in here, Natalie — for those who don’t know, the Inside Out Institute is Australia’s National Institute for Research Translation and Clinical Excellence in Eating Disorders. We’ll put a link to that in the show notes as well. Sorry — what other options are there?

Natalie: Depending on what state you’re in, there are state-based services too. Eating Disorders Victoria has its own suite of services, as does Eating Disorders Queensland. There’s also Eating Disorders Families Australia, which focuses mostly on carers and also offers one-on-one sessions.

Natalie: And of course there are Butterfly’s services. Our helpline is available anytime between 8am and midnight Australian Eastern Standard Time, where you can speak to someone who understands eating disorders and is trained in this space. If you’re wondering what to do with all this information, or how you’re feeling, or what’s going on — the helpline can help break that down. It’s a particularly good one to reach out to in that first stage.

Natalie: We also have recovery support groups through the Butterfly helpline — a moderated online chat group run by trained counsellors, and face-to-face groups facilitated by peer workers. I think mentioning the peer space here is crucial. If it’s something you connect with, there’s something really lovely about being around people who can hold hope for you when you can’t hold it for yourself. We also have peer mentoring and carer mentoring, available through EDFA and through Butterfly’s services.

Yvie: Oh, that’s great — because my next question was actually going to be about remote living. All of those options are really wonderful, apart from the face-to-face ones. But what about telehealth? Is that an option for people in remote areas? Sometimes you try to make a telehealth appointment and they won’t see you that way — is eating disorder support something that can be delivered via telehealth?

Natalie: Absolutely. COVID had its ups and downs, but one of the benefits has been the normalisation of remote contact, and the efficacy of telehealth versus face-to-face is now much of a muchness. A lot of practitioners are happy to deliver telehealth services, so people in rural and remote areas can still access the same level of care as those in metro areas — as long as the practitioner is set up to do so, which most are these days. That’s been a really positive step forward.

Natalie: Also, all the virtual groups I’ve mentioned are online — there are only a very few face-to-face groups running, mostly in Queensland and Victoria. National services like Butterfly offer the majority of their services online, so there’s no need to feel alone and isolated, which is such a common experience. Help is there and it’s at the ready.

Yvie: And feeling alone in recovery can be really isolating. So how can someone navigate conversations with friends, family, and colleagues about what they’re going through? Let’s bring it back to the person who has the eating disorder. What do you suggest they share, and when might it be helpful to reach out to a support network?

Natalie: As you’ve just said so beautifully, it is so isolating — and eating disorders thrive in secrecy. Reaching out can be really hard, but it’s important to remember that you don’t owe anyone your story. What you choose to tell people is completely up to you, how much detail you go into, and of course when you’re ready to do so. It’s not an all-or-nothing disclosure — it’s about finding where you’re at right now.

Natalie: I like to think about circles of support — three circles: inner, middle, and outer.

Natalie: Your inner circle is your trusted people. It might be the person who had that first chat with you, a partner, a close friend, a sibling. With them, you might feel comfortable sharing more intimate details of where you’re up to — things that would be helpful for them to know, like distractions that work for you, whether you’d like someone to sit with you for a meal, and your warning signs or red flags if things start to slip.

Natalie: Your middle circle might include colleagues — though I know some work colleagues I’d share more with, and others I definitely wouldn’t. Just remember you don’t owe these people your full story. For extended family or friends you’re not as close to, you might want to just make a general statement about your health and set some boundaries around food and body talk. Something like, “I’m working on not talking about food, weight, or body stuff” — whatever feels comfortable and resonates with you. Because in social situations, as I’m sure we’ve all experienced, there’s always some comment thrown out there about body weight or shape. If you feel comfortable drawing that boundary with your middle circle, that’s a really important thing to do.

Yvie: Just on that, Natalie — it is such an important boundary to make, and it can be so incredibly uncomfortable. Last year I was doing a shoot for a TV show with a producer I hadn’t seen in a while, and she immediately commented that I’d lost weight. I went into that familiar “oh no” feeling — but I gave myself the grace to just say, “I don’t really talk about body image or anything like that.” She was incredibly apologetic, and then she felt really guilty — and that’s a whole other kettle of fish, isn’t it? But I find that just saying it creates almost a ripple effect. That one person hears it and gets it without you needing to have a huge conversation about it. And the more I do it, the easier it becomes. For me personally, because I have such a large social media following, writing it down is actually the easier option — if someone comments on a photo “oh, have you lost weight?” I just immediately say, “I don’t talk about my body in any way.” And people can do with that what they want. Sorry, I just wanted to add that little tidbit.

Natalie: It’s a really important example, because it’s not uncommon at all — in diet culture, it’s almost people’s default thought to go there.

Yvie: As a compliment.

Natalie: Exactly — as a compliment. Without realising how damaging it actually is. So drawing those boundaries is so incredibly important, in whichever way you do it — writing it down, posting it, saying it verbally, putting it in an email to colleagues if you need to. Whatever feels comfortable for you, and whatever is going to help you in the situation you’re currently in. You’ve always got to centre what’s going to work for you — not what’s going to make someone else feel more comfortable.

Yvie: And we seem to be so good at that, don’t we — putting others at ease at our own expense.

Natalie: As a self-confessed yes-person, I am very good at that unfortunately.

Yvie: Women especially.

Natalie: The outer circle — acquaintances — are usually the ones who are going to say the most outlandish things. With them, I think it’s really important to just keep that boundary up as strong as you can. Move on, change the subject. A simple “no thanks” and shift straight along. They don’t need any part of your story unless you want to give it to them. Just a “no thanks, look at this beautiful weather we’ve been having!” — that’s all.

Natalie: I also think it’s really helpful to have a one-sentence script ready for these situations, because when something comes up unexpectedly, it’s stressful and your mind can go blank. Something like: “I’m working with my GP and my team at the moment,” or “I’m trying to avoid diet conversations as part of my recovery.” It draws a boundary, tells them where you’re at as comfortably as you want to go, and having it rehearsed before you’re in that stressful situation can be really useful.

Natalie: And the last thing I wanted to say is that for your inner circle — try to let them know when you’re struggling and what your red flags are. Give them the ability to know what to do, because often people really want to help but don’t know how. You might say, “Can you sit with me when I eat?” or “Can we avoid weight talk tonight?” or “Can you check in with me tomorrow morning to see how last night went?” Setting those conversations up gives the other person a sense of purpose — a permission to check in.

Yvie: Yes, it gives them permission, doesn’t it?

Natalie: Exactly. Which I think is so important and valid, particularly if it’s part of what you need in your journey. And it’s also worth knowing that people are going to have mixed reactions to what you tell them. It is still a stigmatised area — it is improving, as we saw in some reports last year — but there is still stigma around eating disorders. So be prepared for that when you’re talking to people you’re not as close to. Feel free to gently redirect the conversation, do those sorts of things. Just know that that discomfort may come up as you start to have these conversations.

Yvie: You touched on earlier in your response about someone’s story — it’s their journey, it’s their story to tell. I was thinking, for anyone listening who is not the person with the eating disorder, but someone around them — understanding that what that person shares with you is up to them, and what you share from there is incredibly important. If anyone asks, “Have they confided in you?” — I find a really good thing to remember to say is, “It’s not my story to tell.”

Natalie: Yes.

Yvie: Even if you feel like you need help processing it yourself, talk to a professional — we have the helpline and things like that. But it’s really important to remember that it’s not your story to tell. Someone has confided in you, and whether that was a huge confession or a small one, you need to be that ally, and know that this is something they need to share on their own terms with others.

Natalie: Exactly right. It takes a lot of bravery to take that first step and let someone in on that secret — it’s an incredibly scary part of the journey. So not trivialising that, being that trusted source — that’s the most important thing. And I really do love “it’s not my story to tell.” Even in life more broadly, I think that’s an important lesson.

Natalie: I also want to reflect on something you said, Yvie — there is a lot of help available for carers. It is incredibly stressful, not only for the person going through an eating disorder, but for the loved ones supporting them. There are carers’ groups, carer mentoring through EDFA, and Butterfly does that too. Finding that trusted professional source to debrief with is really the best thing.

Yvie: That’s my second-to-last question for you, actually — when might someone benefit from calling a helpline or joining a support group? Let’s talk about both sides: the person themselves, and also their support network.

Natalie: Whenever you feel like you want to discuss something you don’t feel comfortable sharing with anyone else, or you can’t get into a therapist soon enough — the people on the helpline are trained counsellors who get it. They’ll be able to assess your symptoms, assess where you’re at, or just be an ear to listen, to validate. So reach out at any time.

Natalie: Recovery support groups are there for anyone and everyone, no matter what stage of your journey you’re in. We have four groups running each week in different formats — online chat groups, face-to-face options — so whatever modality suits you, there’s something there. It’s a chance to meet like-minded people who are going through something similar and who can provide hope, because eating disorder recovery can be a really winding journey. At any point that you want some support, that’s the best time to reach out.

Natalie: And for carers — as soon as you’re concerned or worried or you see something you’re not sure about, just give the helpline a call, send an email, or start a web chat. We send out resources, it’s a service you can keep coming back to — there’s no cap on contacts, so call as many times as you need. And carer support groups are there for exactly what we’ve just described. Knowing you’re not alone — because both the person with the eating disorder and their carer can feel incredibly alone in this — is so important. Help is there. Recovery is possible. There is always a light, and there is always somebody out there holding hope, even when it may not be you at that moment.

Yvie: I really like that you used the word “hope,” because that really is what it’s all about for both sides. Knowing there are people out there who understand what you’re going through — I think that gives me personally the most hope. And I know for a lot of people, that’s all they need: people who will just listen, and the knowledge that hope exists.

Yvie: Natalie, my last question — from your clinical experience, what do you want people to know about recovery, particularly for those who might be hesitating to reach out?

Natalie: I think from a clinical background — and honestly more from a prevention standpoint — the earlier you reach out, the better the outcome. I’m not trivialising how incredibly hard it is to recognise that something’s off and to ask for help. But the earlier you do, the better the outcomes. This has been studied, there’s research on it. So have that uncomfortable conversation, or go see the GP. There’s no wrong time and no right time, there’s no “not sick enough” or “not well enough” to seek help. It’s just you, and where you’re at, and how you’re feeling — and only you will know that.

Natalie: Take that first step. I know it’s scary. But if you get in early and start with treatment, the outcomes are going to be better, and you’ll be on the path to recovery — which is sometimes a very winding one. Some days will be really great, and some days will be dark and hard, and some behaviours may come back. But just know that one bad day doesn’t set you up for the next two weeks. It’s one day, one meal — you move on to the next. Recovery is a winding path and it is a difficult path, there’s no lying about it. But there are going to be good days. You’ve got your team around you, you’ve got people who love you. Just take that first step.

Yvie: That’s a really great set of takeaway messages. I’m no expert — I only have lived experience — but I do make this podcast, and that theme of “earlier is better” just keeps coming back in almost every episode. I’m really glad that you as a clinician with your expertise were able to reinforce that today.

Yvie: Natalie, thank you so much for your time.

Natalie: No worries at all. Thank you — it’s been a pleasure. It’s always nice to meet face-to-face, or screen-to-screen!
Yvie: Thank you for all the work that you do. It’s invaluable.

Natalie: Thank you very much, Yvie.

Yvie: A huge thank you again to Natalie for sharing her incredible experience and knowledge for this episode. And that’s a wrap from me — this is my final episode. I’m so glad to have been working with the Butterfly Foundation on this podcast. It’s something I’ve held very dear to my heart, and I wish you all the very best going forward.

Yvie: For everyone listening on — next month you will have a new host, and I hope you enjoy that. If you’re concerned about an eating disorder — for yourself or someone you care about — please reach out to the Butterfly National Helpline at 1800 33 4673. That’s 1800 ED HOPE, for a free, confidential conversation with one of our specialist counsellors. Alternatively, you can chat online by visiting butterfly.org.au and following the prompts at the top of the page.

Yvie: To find out more about today’s episode, check out the helpful links in the show notes and on the Butterfly website. Head to butterfly.org.au/podcast and click through to this episode. You can find additional resources around eating disorder treatment and management plans in the show notes.

Let’s Talk is produced for Butterfly Foundation by Yvie Jones and Sam Blacker from The Podcast Butler, with the support of the Waratah Education Foundation. Our Executive Producer is Camilla Becket, with support from Melissa Wilton and Kate Mulray.