Laura Pumillo Nutrition 2024: Nutrition for Every Body!

Laura's distinctive proficiency in addressing eating disorders is not only a product of her extensive experience but is also deeply rooted in her tenure as the Clinical Nutrition Manager at NewYork-Presbyterian/Weill Cornell-Westchester’s Behavioral Health Center. In this role, she not only managed nutritional aspects but also served as the lead dietitian of the dedicated inpatient Eating Disorders Program, now recognized as the Outlook Center for Eating Disorders in White Plains, NY. However, what truly sets Laura apart is her profound understanding of the complexities surrounding eating disorders and her advocacy for a paradigm shift in their treatment and diagnosis. Her approach extends beyond the conventional, focusing on nourishing the whole person. In this unique Delivery Rank’s article, we delve into Laura Pumillo's journey, exploring the insights and skills that make her an exceptional force in the field of nutrition and health education, especially in the realm of disordered eating.

As a Somatic and Trauma Informed Practitioner, how do you integrate somatic approaches into your nutrition counseling sessions, and what benefits have you observed in your clients?

There are many different ways to incorporate somatic work into a session. By somatic, I mean related to the body, the soma. So it's partially somatic. The body aspect is partly based on the polyvagal theory, which emphasizes the significance of the nervous system in dealing with trauma in fight or flight situations. I educate clients about what's happening in their body, specifically in the parasympathetic and sympathetic nervous systems. The sympathetic system is where anxiety originates. Understanding how this manifests in the person is crucial.

Firstly, I educate them about what I notice in the session when they enter the room. I don't immediately delve into their issues, operating as if they are brand new clients. I start by asking unexpected questions like offering a drink and adjusting the lighting. I inquire about room temperature and scents, ensuring the environment is comfortable for them. I have various seating options, considering their preferences and body language.

I pay close attention to their non-verbal cues, noting if they're tense, shaking their leg, or exhibiting protective behaviors like leaving on coats. I offer items like pillows, blankets, or fidget toys to enhance their comfort. This rapport-building phase helps establish trust and a soothing environment.

Moving beyond physical comfort, I delve into questions about their sleep, eating habits, and bodily sensations. I aim to reconnect them with their own physical cues of hunger and fullness, which is a fundamental aspect of my work. This process involves charts and discussions about how they recognize and respond to these signals.

I adapt my approach based on the individual, sometimes incorporating grounding exercises or breathing techniques to help them relax. The ultimate goal is to create a space where they can open up and feel comfortable sharing their experiences.

In the context of eating disorders, this approach helps break down defensiveness and rigidity. Clients often come in with a performance mentality, trying to present themselves in a certain way. By creating a calming and non-judgmental atmosphere, I encourage them to be more authentic.

The benefits of somatic and trauma-informed care include the ability to connect with clients quickly. This approach allows me to understand that their behaviors around food may be rooted in their nervous system's responses. For example, legitimate stomach complaints may be linked to their anxiety rather than a physical issue.

The incorporation of grounding exercises also serves as an opportunity to educate clients about the nervous system and related concepts, seamlessly integrating information into the session. Additionally, constant self-check-ins are essential for practitioners in this field, ensuring they are attuned to their own energy and adjusting their approach accordingly.

Nutrition for Every Body takes a holistic and individualized approach to treatment. Can you share a specific case where this approach led to a significant positive outcome for a client dealing with disordered eating or another condition?

Yes, the standards of practice around it. I'm going to give an example of an objectively underweight, restricted anorexic who doesn't have her period. She exercises too much and abuses laxatives. She came to me asking if I could just, and she was very explicit, help her wean off the laxatives. When she had gone to other people, everyone told her no. No, you can't just go off the laxatives. We need to deal with the entire picture. You need to gain weight. She was horribly, horribly underweight and skinny with no period, restricted eating, and over-exercise. So all of these pieces together. But I said, "This is a woman in her late 20s who's been struggling for well over 10 years, has never been to a dietitian more than on one single occasion. And because they always told her, 'No, you need to go to treatment. We can't do this outpatient. It's too unsafe to taper to work on the laxatives, and you have all these other problems that we have to work on everything at once,' and I said, 'OK, I'm meeting you where you are. I understand. I may have, not may have, I know I would have said I'm concerned about all of these things. But you're saying to me, Laura, I'm not willing to gain weight. I'm not willing to change anything else, but I want to get off the laxatives 100%.' And it took years. I'll be realistic. It took years because she would go off and then go back out a little and then a little return to a lot again. But she's like a year and a half. This is the real percent of my practice. No laxatives. And from the process, she's now, which it was her doing other things, she's getting. She's actually at a normal BMI for her. She should be a little bit more, but her weight is now in a normal body mass index. She's eating way more nutritiously. She doesn't take laxatives, and the number, like that, is something that was unusual. It was considered very high risk. But I have a lot of clinical experience that I usually have. I mean, she has a doctor also, of course, that was seeing her. And I knew that there is a safe way that you can taper outpatient if you can trust that the person is going to listen to you. But it's likely that she wouldn't cut out more than I wanted, which would actually be potentially a risk because the whole point is she can't go off of them. So it's a lot. It isn't something that I could think she would engage in like going faster than the pace that. I recommend it. In any case, all I say is this person, she had no life. Barely no friends, no boyfriend, no job. She couldn't work. She had constant diarrhea. I mean all day, severe. And anyway, she has a full-time job now. She's got friends. She's looking to possibly start a relationship. She's at a normal weight. And she's not over-exercising. But if I hadn't started where she wanted, she just would have walked out the door. That's where the. And there were a lot of ups and downs, but that's a perfect example where I'm willing to say. Know what the best practice guidelines are, but for this individual, I'm using a harm reduction model.

Given your extensive experience in the treatment of various conditions, including diabetes, insulin resistance, and PCOS, how do you tailor your nutrition strategies to meet the unique needs of each client?

Because, as long as whatever they're coming in with, whatever their other comorbidities, the other conditions they have—diabetes, polycystic ovarian syndrome, celiac disease, various GI issues, heart disease, or any other conditions—most people in private practice, this is totally different. If you work in a hospital, they're coming in to see you. Because they trust you, they believe that you're giving them the right advice, and there's a level of respect that you're not talking down to them. So, many of the core values that I operate on are what keep the clients coming in. If there's anything I don't know about their other illness, I'm going to research it and look it up without hesitation. But normally, because of my experience, I have a broad range of experience, and I know certain things about it. For example, someone who's insulin resistant, certain things I want with all of my clients with disordered eating, which is a pattern, a habit of eating specific meals and snacks appropriate for that person. That's very important when you're trying to regulate blood sugars and/or insulin resistance. And I believe breakfast is usually important. Another thing that helps with insulin resistance is promoting healthy movement. Everything would be based on that individual. I am really serious; this isn't just talk about it. It's their goals and their values. People come in and say, "I want to lose weight because I want to fit into size 2 jeans. I don't care how I do it. I'll go on Ozempic to do it." So that's their value. I can feel how I feel about it, and I can choose to treat them or not, but I can't make somebody care about their health like, "Oh, I want to live to be 90, disease-free, and love my body." It depends. I'm looking at what they're asking for, what their core values are, and whether we merge. If we don't, we don't, and I would politely tell them that I'm not the right fit for you. I can make a recommendation, but I don't do what you're asking. I don't personally work with anyone who would be, hypothetically, a size 6 wanting to be a size 2. That's not the work I do. And that doesn't mean it's not their right to do that, but not with me. So there are a lot of skills, if you listen, pay attention, and I can research anything I don't know. I like keeping the core guidelines I mentioned about healthy movement, mindfulness, somatic awareness, a reasonable eating pattern of meals and snacks. Usually, this benefits around 90% of people. They're very inconsistent, saying, "Oh, it's a cheat day" or "It doesn't matter today because I'm working from home, and I'm just going to munch all day." Getting people into routines has many benefits for their health and wellness, kind of across the board. Of course, I would cater it to whatever their condition is. If it was something I really don't treat, then I would prefer to. I've actually had cases where I continued to see someone who needed to see someone else more than once because they had complex GI issues. They also saw a GI dietitian, but just for that, whereas the GI dietitian was not focusing on eating disorders. So sometimes they've seen both just for a little while.

In your practice, you utilize multiple treatment models, including CBT/DBT, motivational interviewing, NLP, and habit change. Can you provide an example of how you seamlessly integrate these models to create a comprehensive and effective treatment plan for a client?

I think I can give you an example of someone who's suffering from bulimia nervosa. So there's binge eating, and there's purging. When I use the term purging in this conversation, I mean self-induced vomiting. So, regarding CBT, I would ask them to keep food logs. They need to write down what they ate, and if it's a binge, they could simply write "binge." Sometimes, the individual may not be willing to specify what they binged on. I'd say, "Okay, if you won't write it, I want to know the time and where you were." Adding some behavioral therapies involves documentation, as the act of writing changes how they eat, a phenomenon supported by data since the '50s. Depending on the person, if they're ready, I'd also integrate the somatic aspect. Before you started to eat, were you hungry? If they say no, considering they've been told to eat breakfast no matter what, I'd inquire further. "I wasn't hungry, but I had some yogurt and a fruit because I had to get to work." "Okay, did you finish it all?" "Yes." "Did you purge?" "No." Then we'd discuss the next time they ate, whether they were hungry, and if they skipped lunch because of dinner plans. This is where we would talk about the pros and cons of that behavior. I'd ask, "What do you think is more likely to happen when you go out to dinner if the last time you ate was breakfast, just a yogurt parfait?" "Well, yeah, I planned on ordering a salad with grilled chicken, but I ended up ordering a pasta dish and eating more bread, feeling horrible, guilty, and sad. On my way home, I stopped at Duane Reade, got a whole bunch of other stuff, and ate M&M's, candy, and cookies, and then threw it all up." This is why I recommend that lunch is needed. You can't go that long; you'll be too hungry, and it changes your brain. I would provide education about biological hunger—how it changes the brain, the chemicals involved. I'd delve into how they felt before and after, creating awareness. Then, I might set up a scale of one to 10 to gauge the likelihood of them eating lunch before dinner. Motivational interviewing comes in here, understanding their perspective. If they mention obstacles, we work through them. Additionally, I'd create a toolkit for coping strategies if they felt the urge to purge. I'd suggest calling someone, going to sit on their patio, taking deep breaths, or employing somatic techniques like touching their upper arms and the back of their neck. Even if they didn't follow through, it's okay. The key is to keep trying, as there's always another opportunity with the next meal. There's no way to fail at this unless they completely stop trying. Eventually, they'll notice differences over time. Perhaps they still overeat, but it's not a binge. It's a learning process.

Can you discuss the role of habit change in your treatment approach? How do you work with clients to establish and maintain healthy nutritional habits, and what role does the somatic approach play in this process?

It's tricky. So if you use the habit change model, what I love about the habit change model is that people usually can use what they call the SMART goal—specific, measurable, achievable, realistic, and time-bound. So that's what's called a SMART goal. In the habit change model, let's assume you set a specific goal. One of the most important things about habit change is that if the present behavior is, in fact, a habit, it's autopilot. It's unconscious. It literally resides in the basal ganglia of the brain, which means you do it on autopilot. We all know, for example, with simple things at home, like deciding to move where the garbage can is; you constantly go over to where the garbage can was. It's a trivial habit, but your brain automatically goes back to where it used to be. This happens with everything in life that's a habit, and the brain chunks things. When you're a kid, you think, "I'm going to learn to put my socks on," but getting ready in the morning involves numerous behaviors—choosing what to wear, brushing your teeth, putting on makeup, having breakfast—all of it falls under "I got ready in the morning." So when it comes to habit change, you must understand that it requires 100% persistence. You can't give up. Meaning, you have to engage to start a new habit. You usually want to place it between something, like if you wanted to start exercising. For example, let's say you decided to do it in the morning—after eating breakfast but before getting in the shower. So you pick something you always do and slot it in between. It still requires a ton of effort because you're not programmed to do it. Even if you don't feel like it, try to make yourself do it for at least five minutes. That effort will build on itself. The thing with habits is that once it becomes a habit, it's autopilot, unconscious. You don't have to do anything about it. The good thing is that you can always build a new neurological pathway. In other words, any behavior that is a habit has a 100% success rate at being changed with time. The element I said was missing before is time and persistence. You cannot give up. I don't care if you try to quit smoking 27 times. Try 30 more times because time and persistence mean you will form a new neurological pathway. But it's like two roads—one covered in trees, branches, and rocks, and the other smoothly paved. Which one are you going to go down? Going down the smoothly paved one might take you to, let's say, binging, while the other one is like, "Wait, stop, slow down my eating, be mindful, chew my food, put my fork down." Repeat these actions over and over until you build a new clear pathway. Then your brain has a choice, and the new one becomes the clear one, while the other gets overgrown. It doesn't go away, which is why anyone who was a former cigarette smoker is at a higher risk of resuming cigarette smoking than someone who never did it. That doesn't mean it's a high risk; it's just higher than someone who never had the neurological pathway. But that's what I love about habits because truly, if the behavior is a habit, you have 100% time and persistence. Don't give up. Don't let it go. Keep at it, and you can change anything, and then that becomes autopilot.

If you would like to find out more about Laura Pumillo Nutrition, visit https://www.laurapumillonutrition.com/