Food Psych #150: Disordered Eating & Gender Identity with Sand Chang


Psychologist and trans-health educator Sand Chang joins us to talk about the complex experience of body acceptance for trans folks, the intersections of trans advocacy and Health at Every Size work, the growing body of research around trans folks and eating disorders, the shape-shifting nature of fatphobia and diet culture, and so much more! Plus, Christy answers a listener question about how food restrictions to try to cure acne can exacerbate an eating disorder.

Dr. Sand Chang is a Chinese American clinical psychologist, educator, and writer based in Oakland, CA. Sand identifies as queer, nonbinary, and genderfluid and uses they, them pronouns.

Sand currently divides their time between working at Stanford University’s counseling center, Northern California Kaiser Permanente Transgender Services, and a private practice specializing in trans health, relationships and sexuality, trauma, EMDR, eating disorders, and addictions. As a psychotherapist, trainer, and advocate, Sand is invested in healing and empowerment within marginalized communities and disrupting systems of oppression.

Sand co-authored the 2015 APA Guidelines for Psychological Practice with Transgender and Gender Nonconforming Clients and is the past Chair of the APA Committee on Sexual Orientation and Gender Diversity. They regularly present at conferences and provide trainings on a wide number of topics for health care systems, educators, and organizations. Sand’s upcoming book, A Clinician’s Guide to Gender-Affirming Care: Working with Transgender and Gender Nonconforming Clients, which they co-authored with their colleagues Drs. lore dickey and Anneliese Singh, will be published by New Harbinger in late 2018.

Outside of their professional work, Sand is a dancer, avid foodie, punster, and pug enthusiast. They live in Oakland, CA with their pug Zelda Sesame. Find them online at SandChang.com.



  • Sand’s relationship with food growing up, including how their Chinese-American heritage influenced how they related to food

  • Sand’s first exposure to diet culture and fatphobia, including how unconscious and covert diet mentality was while they were growing up

  • How being involved in dance negatively influenced Sand’s body image

  • Sand’s experience with an eating disorder and over-exercise, and how trauma and coping played a role in the development of their disordered behaviors

  • How positive feedback from weight loss egged on Sand’s disordered relationship with food and the issue with body appraisals

  • Sand’s process of seeking recovery, including the ways in which healthcare practitioners both help and harm individuals attempting to heal

  • How weight bias prevents folks from getting the proper care for their eating disorder

  • Sand’s discovery of size acceptance and fat liberation, and struggling with applying body acceptance to our own bodies

  • Trans healthcare and body image, including the fatphobia and binaries embedded in queer communities and body norms within the trans community

  • Sand’s experience discovering their gender non-conforming identity

  • The growing body of research around trans folks and eating disorders

  • How the minority stress around being misgendered feeds into disordered eating

  • The current limitations within the healthcare field around trans identity and barriers to care for trans folks

  • Gender dysphoria vs body dysmorphia

  • The limitations of the current DSM mental-health diagnoses for eating disorders and for the trans experience

  • The complex experience of body acceptance for trans folks

  • The intersections of trans advocacy and anti-diet, Health at Every Size work

  • Why gender-affirming surgery isn’t a cosmetic surgery and why it saves lives

  • Sand’s experience finding their way back to inclusive eating disorder work

  • The need for the HAES movement and eating disorder work to become more intersectional and move away from the gender binary

  • “White feminism” vs intersectional feminism

  • Sand’s experience with orthorexia, how their experience navigating their gender identity within the healthcare system reinforced their disordered experience, and their path to breaking out of diet culture for good

  • Sand’s path to finding intuitive eating, joyful movement, and body acceptance

  • How diet culture keeps up in the limbo period between disordered and recovered

  • Moving away from the perfectionism around the idea of recovery

  • The positive and negative takeaways from Sand’s time in Overeaters Anonymous

  • How valuable it is to have a community by your side during healing



Some of the links below are affiliate links. Affiliates or not, we only recommend products and services that align with our values.




Can eating in certain ways and cutting out certain foods help cure cystic acne? What are the dangers of trying to heal our skin through food restriction? Can disordered eating contribute to hormonal acne issues?

(Resources Mentioned: Dr. Steven Bratman’s work on orthorexia, Julie Duffy Dillon’s anti-diet resources for PCOS, the Certified Intuitive Eating Counselors Directory, the Health at Every Size Registry)

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Food Psych #135: Body Respect, Weight-Inclusive Care, and Health at Every Size with Lucy Aphramor

Lucy Aphramor

Lucy Aphramor, anti-diet dietitian and co-author (with Linda Bacon) of Body Respect, joins us to talk about Health at Every Size, why we need to be weight-inclusive instead of just weight-neutral, the social determinants of health, the importance of having a trauma-informed focus as a healthcare provider, her struggles with body image in the context of gender identity and sexuality, the importance of prioritizing emotional safety, and so much more! PLUS, Christy answers a listener question about how to handle arguments that stopping emotional eating automatically leads to weight loss.

Lucy Aphramor is an award-winning radical dietitian and critically acclaimed performance poet aka The Naked Dietitian. She practises the weight-equitable approach Well Now that advocates health-gain and body respect for all. Her co-authored book Body Respect, written with Linda Bacon, explores many of the key concepts of Well Now. She subsequently developed Well Now theory to be compassion-centered, trauma-informed and justice-enhancing. Lucy is interested in starting conversations that build a fairer world--and the role of story in this--and co-founded Dietitians for Social Justice with Fiona Clarke. Find her online at LucyAphramor.com.

Grab Christy's free guide, 7 simple strategies for finding peace and freedom with food, to start your intuitive eating journey. You can also text "7STRATEGIES" to the phone number 44222 to get it on the go :)

12/20 is the LAST day to get Christy's newest online course for fellow health & wellness pros, Master Your Anti-Diet Message! Grab it now at christyharrison.com/message.

Share your stories with Storyworth! Get $20 off a subscription with our special URL, storyworth.com/psych.

Give your wardrobe an upgrade with MM.LaFleur by going to MMBento.com. Use the code PSYCH at checkout and MM.LaFleur will donate 10% of profits to GlobalGiving.


We Discuss:

  • Lucy’s relationship with food growing up, including her transition into an orthorexic and anorexic style of eating and movement, and her struggle with IBS

  • Lucy’s experience as a nationally ranked runner, and the current problem with fitspo

  • How coping mechanisms can serve a larger purpose, even if they’re destructive in the end

  • The effect of trauma on our eating behaviors

  • Lucy’s experience finding a feminist therapist, and how they helped her heal

  • The experience of healing from an eating disorder versus healing our body image

  • Gender identity and sexuality, the idea of identity resilience, and understanding our core sense of self worth in our body image journey

  • The value in naming our experience

  • Lucy’s discovery of her queer identity, and how poetry helped her to discover it

  • Lucy’s model of “eating distress discovery,” and the different philosophies surrounding recovery

  • How social oppression affects our mental health struggles

  • Lucy’s experience training as a dietitian, and the ways in which dietetics education reinforce disordered eating

  • Lucy’s experience working in the mental health system, and the ways in which it opened her eyes to social justice

  • Social determinants of health, and Lucy’s process of finding a weight-neutral paradigm that considered trauma’s impact on wellness

  • Finding Health at Every Size, and Lucy’s approach of “Well Now”

  • Weight inclusive vs weight neutral, and the healthism embedded within neutrality

  • Lucy’s and Christy’s experiences finding communities to hold their ideas and exploration

  • Guiding clients away from weight loss and to intuitive eating, and exploring the role of restriction and dieting in someone’s life

  • Helping people to identify and meet their needs and desires

  • The importance of prioritizing psychic and emotional safety

  • Centering health behaviors vs social determinants of health in discussions about Health at Every Size, and grappling with the definition of HAES


Resources Mentioned

Some of the links below are affiliate links. Affiliates or not, we only recommend products and services that align with our values.


Listener Question of the Week

Does stopping emotional eating lead to weight loss? Is intuitive eating a path to weight loss?

(Resources Mentioned: Food Psych Podcast Episode #127)

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Food Psych #127: Intuitive Eating & Health At Every Size FAQs with Ashley Seruya & Christy Harrison

Ashley Seruya & Christy Harrison

This week is a very special edition of Food Psych! Rather than having a new guest on, I felt it was time to have an episode devoted to laying out the concepts and perspectives that we talk about every single week. This episode is ideal for newcomers to the Food Psych crew, for you to come back to when you’re struggling to remain true to the tenets of Health at Every Size and intuitive eating in this diet-culture world, and for you to share with friends and family who need an overview of the philosophy.

My Administrative and Community Manager, Ashley Seruya, joins me this week to pose some burning questions that get to the heart of what this podcast, and the anti-diet movement, is all about. Ashley is a current MSW student at Fordham University and a fellow anti-diet activist and body liberation advocate. She’s passionate about Health at Every Size and recovery, and hopes to one day combine her training in writing, social work, intuitive eating, Health at Every Size, and more to help the world recover from diet culture at large. Keep up with her work through her Instagram, where she shares posts about her beloved pets, self-care, eating disorder recovery, mental health, and more!

Grab Christy's free guide, 7 simple strategies for finding peace and freedom with food, to start your intuitive eating journey. You can also text "7STRATEGIES" to the phone number 44222 to get it on the go :)


We Discuss:

  • What is intuitive eating?

    • The 10 principles of intuitive eating, and the connection between intuitive eating and eating disorder recovery

    • Why gentle nutrition comes at the END of the intuitive eating process, and why rejecting the diet mentality is the FIRST principle

    • The role of an intuitive eating coach and counselor

    • How mental health and self-care play a role in the intuitive eating journey

    • The role of diet culture in disordered eating

    • Recovery as a nonlinear process

  • What is Health at Every Size (HAES)?

    • The weight-neutral approach

    • The truth about intentional weight loss

    • The cost of sustaining intentional weight loss

    • Set-point weight theory, the famine response, and breaking down weight science

    • The history of HAES and the non-diet approach

    • Fat activism and the fat acceptance movement

    • How HAES incorporates intuitive eating, joyful movement, and self-care

    • The importance of size diversity in the HAES movement and embracing the genetic determination of body size

    • The caveat of HAES with eating disorder recovery and weight restoration

  • What's the connection between eating disorder recovery, chronic dieting, Health at Every Size, and intuitive eating?

    • The path of eating disorder recovery to intuitive eating

    • The spectrum of eating behaviors, from full blown eating disorders to disordered eating and chronic dieting

    • Diagnosis criteria and the prevalence of undiagnosed disordered eating

    • The importance of a weight-neutral, Health at Every Size approach to recovery

    • Risk factors of orthorexia

    • Why we don’t have a moral obligation to pursue health, and varying limitations to achieving health

  • I have an eating disorder. Can I do intuitive eating?

    • Which principles of intuitive eating we can practice while in eating disorder recovery

    • Why we need to avoid the hunger and fullness parts of intuitive eating while in recovery

    • The concept of nutritional rehabilitation

    • The relationship between emotional eating and disordered eating, and the importance of not demonizing emotional eating as a coping mechanism

    • Why gentle nutrition and joyful movement should wait toward the very end of the process

    • The importance of working with an eating disorder dietitian with HAES and intuitive eating training in the recovery process

  • I'm gaining weight. Am I doing intuitive eating wrong? How do I cope?

    • The difference between body acceptance, body respect, body trust, body positivity, and body love

    • Letting go of internalized weight stigma and body shame

  • How can I trust my body if every time I try to listen to it I end up face-first in a tub of ice cream?

    • The impact of restriction and deprivation on food behaviors, including food insecurity

    • Biological need for increased dietary intake, including during puberty

    • The effect of shame in feeling out of control around food and binge eating

    • Gender identity and struggling with trans issues and body image

    • Understanding that body trust is a process

    • Breaking down the concept of food addiction

  • How can I eat whatever I want if I'm concerned for my health? You're a nutritionist, so shouldn't you be telling me to eat fruits and vegetables?

    • Mental health, discrimination and stigma, and social situations that determine our health status regardless of nutrition (AKA social determinants of health)

    • The shapeshifting nature of diet culture

    • Diet culture’s effect on the medical model, weight science, and dietetics education

    • An intuitive eating counselor’s role in telling people what to eat

  • How do I make sure I don't turn intuitive eating into a diet?

    • How to avoid the hunger and fullness diet

    • How to recognize and root out subtle diet mentality

    • Using self-compassion to get you through the unlearning process

  • What if I'm "too" fat? Is there a threshold where Health at Every Size doesn't apply anymore?

    • Weight stigma’s influence on health status

    • Fatphobia’s effect on internalized weight stigma

    • Stigma resistance and resiliency

    • The effect of weight cycling on health outcomes

  • Aren't you worried you're promoting “obesity”?

    • The many issues with the term “obesity,” the “obesity epidemic,” and pathologizing larger bodies

    • The truth of size diversity

    • Fat acceptance and reclaiming the word “fat”

    • The genetic and environmental influences on body size

    • Finding the joy in life no matter your size

    • Discovering body acceptance and making room for all people to love their bodies

  • As a person in a smaller body, why are you so vocal about fat acceptance?

    • Thin privilege, and using our privilege to speak out for those more marginalized (AKA becoming thin allies)

    • The universality of body shame

    • The influence of weight stigma on eating disorders

    • The parallels of the fat acceptance movement to other social justice movements

  • Rapid fire

    • What is healthism?

    • What is diet culture?

    • What is fatphobia?

    • What is body liberation? And why have you decided to use body liberation instead of body positivity?

    • Why is body liberation/body positivity a social justice movement? (including fatphobia in woke spaces)

    • How does intersectional feminism and femme empowerment factor into all of this? (including the trans experience and grappling with the patriarchy)


Resources Mentioned

Some of the links below are affiliate links. Affiliates or not, we only recommend products and services that align with our values.

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