Weight, eating and body image
This is not a weight loss programme and there is no plan to follow. It is psychological work on eating, on the body you actually live in, and on what a long history of dieting has done to both.
A free 15-minute call first. I usually reply within 2 working days.
You might recognise
- I am fine all day, and then something takes over in the evening.
- I have lost the same weight several times, and I cannot face starting again.
- I know exactly what to eat. Knowing has never been the problem.
- I avoid mirrors, photographs and swimming, and I have stopped noticing that I do.
- The scale decides what kind of day I am going to have.
- I have been given advice about my weight in appointments that had nothing to do with my weight.
Why it happens
Eating is regulated by biology first. Restriction, whether it is a diet, a skipped day, or simply eating far less than your body needs, reliably increases the pull towards food, and it does so through hormones and through attention rather than through weakness. Binge eating usually follows restriction rather than preceding it. Weight itself is not simply a matter of choices. Genetics, sleep, medication, hormonal and metabolic conditions, insulin resistance, pain, mobility, income and time all act on it. In the obesity clinic where I worked for three years, the people who arrived had almost always tried more, and tried harder, than the people advising them. Eating also does psychological work. It regulates evenings, boredom, loneliness, anger with nowhere to go, and the particular numbness after a hard day. That is not irrational, it functions. Removing it without putting anything in its place tends not to hold. Then there is body image, which has a history of its own. Comments in childhood, being weighed in front of other people, an appointment where the first sentence was about your weight, or years of a body being discussed as a problem accumulate into something closer to an injury than a preference. Shame runs through all of it, and shame reliably makes eating harder rather than easier.
How therapy helps here
- CBT for eating patterns
- We look at the actual sequence: what the day did, where restriction crept in, and the specific moment the decision changed. Regular eating usually comes first, because a body that is adequately fed argues with you less, and from there we run experiments instead of adding rules.
- Schema Therapy for long-standing patterns
- Unrelenting standards, a deep sense of being defective, and putting everyone else first show up around food more often than they show up in words. Schema Therapy works with where these began, which matters when every attempt at change has ended in self-punishment.
- Body image work
- Avoidance and checking both maintain distress: never looking, and looking constantly at the one part you hate. We reduce both gradually, work with mirrors and photographs at a pace you set, and pay attention to the language you use about your own body.
- Working alongside medical and nutritional treatment
- GLP-1 medication, bariatric surgery and diabetes treatment change appetite, but they do not settle what eating was doing for you. Therapy addresses the psychological side of these: shifting expectations, identity, and what happens in the evening when appetite is no longer the driver.
What the first sessions look like
- There is no weighing, no food diary you must hand in, and no plan handed to you.
- We look at a typical day and a hard day, in detail, including the evening.
- We separate what belongs to psychology from what belongs to nutrition or medicine, and I will tell you when something is not mine to treat.
- We pick one change small enough to be boring, because those are the ones that hold.
You will not be weighed here, and you will not be told to try harder. I will assume you have already tried more than anyone advising you knows.
What this does not replace
This is not nutritional treatment and not medical care. I do not build food plans, prescribe, or manage GLP-1 medication or post-surgical follow-up. Anorexia nervosa, bulimia at significant medical risk, and a low or falling weight need medical monitoring and usually a multidisciplinary team, which online individual therapy cannot provide, and in those situations I will say so early and help you find the right setting.
Common questions
What does a session cost, and how long is it?
An individual session is 45-50 minutes and costs €130. A group session is 90 minutes and costs €70-100. All sessions are online, in Hebrew or English.
Will you help me lose weight?
No, and it is better to say that at the start. Weight may change during this work or it may not, and I do not treat it as the measure of whether therapy is going well. What we work on is eating patterns, the distress around food, and how you live in your body.
I take GLP-1 medication, or I have had bariatric surgery. Is there a point in therapy?
Often yes. Medication and surgery change appetite, which is a real and useful change, and they leave open what eating was regulating emotionally. People also describe an unexpected loss of identity when a lifelong struggle changes shape, and that is worth somewhere to think.
Do I have to talk about numbers?
No. You decide whether weight, clothing sizes or figures come into the room at all, and plenty of useful work happens without them. I will not ask you to weigh yourself for my benefit.
Is this an eating disorder? I do not think I have one.
You do not need a diagnosis to come, and most people here do not arrive with one. That said, if what you describe suggests a disorder that needs medical monitoring, I will tell you clearly rather than working around it.
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Unsure whether to write?
Write one sentence about what is going on. I will say if I work with that, and if not, where else to look.
A free 15-minute call first. I usually reply within 2 working days.