Diet culture refers to a societal framework that equates thinness with health and moral virtue, promotes weight loss as a pathway to self-worth, and stigmatizes larger bodies. These messages permeate every aspect of life—from advertising and entertainment to family conversations and school curriculums—creating an internalized narrative that shapes how individuals relate to food and their bodies. For many, these narratives are internalized early and become entrenched cognitive patterns that contribute to the development and maintenance of eating disorders. Midway through a clinical training seminar, Jolie Weingeroff—a distinguished clinical psychologist and leading voice in evidence-based mental health care—illustrated how cognitive-behavioral therapy (CBT) provides tools to identify and dismantle these beliefs in a structured and sustainable way.
The Cognitive Architecture of Disordered Eating
At the core of eating disorders lies a set of maladaptive cognitions—core beliefs and automatic thoughts that equate thinness with worth, control with safety, and restriction with success. These thoughts often feel like truths, rather than distortions. Someone suffering from an eating disorder may think, “If I eat more than X calories, I’ve failed,” or “Being in a larger body means I’m unlovable.” These beliefs are not only rigid, but self-reinforcing. Each act of restriction or over-exercising temporarily alleviates anxiety and reinforces the distorted belief, strengthening the neural and emotional link between behavior and perceived value.
CBT works by helping individuals externalize and challenge these thoughts. The therapist and client collaboratively examine the evidence for and against such beliefs, consider alternative perspectives, and test the utility of maintaining these thoughts. The goal isn’t simply to replace negative thoughts with positive ones, but to help clients arrive at more realistic and compassionate conclusions through guided discovery.
Body Image and Cognitive Distortions
One of the most insidious aspects of diet culture is its impact on body image. Individuals with eating disorders often experience a distorted perception of their own bodies, regardless of their actual size or shape. This distortion isn’t merely visual—it’s cognitive and emotional, tied to beliefs about what their body says about their value, discipline, and identity. CBT offers a systematic way to confront and reframe these body-related beliefs.
Therapists may work with clients to identify common cognitive distortions such as all-or-nothing thinking (“I’m either disciplined or lazy”), catastrophizing (“If I gain weight, no one will respect me”), or mind reading (“Everyone thinks I’m disgusting”). These distortions are not only challenged logically but explored emotionally, allowing clients to understand how early experiences, trauma, or cultural influences may have shaped these thinking patterns.
The Role of Exposure and Behavioral Experiments
Cognitive shifts in CBT are often supported by behavioral experiments—purposeful actions designed to test the accuracy and utility of beliefs in real life. For individuals with eating disorders, this may involve exposure to feared foods, wearing clothes that don’t conceal the body, or participating in social situations without compensatory behaviors. These exercises, while anxiety-provoking, are essential for disconfirming irrational beliefs and building confidence in new ways of thinking.
For example, a client may believe that eating a particular “forbidden” food will result in immediate weight gain or loss of control. With support, they might eat that food in a safe environment and record their thoughts, feelings, and outcomes. Over time, these exposures help retrain the brain and reduce the emotional charge associated with certain foods or situations.
Restructuring the Value System
One of the deeper goals of CBT in treating eating disorders is to help individuals develop a value system that is not dictated by appearance or food-related behaviors. Many people with eating disorders have come to conflate self-worth with body size, control over food, or adherence to rigid dietary rules. CBT encourages clients to reconnect with values such as creativity, connection, honesty, growth, and compassion.
This process often involves identifying areas of life that have been neglected due to the eating disorder and taking steps to re-engage with them. Clients are encouraged to set goals that align with their values rather than societal expectations. This reorientation helps weaken the grip of diet culture and supports the development of a more holistic and resilient identity.
Working Through Shame and Self-Criticism
Shame is a central emotion in eating disorders—shame about the body, about eating, and about not being able to control or “fix” the perceived flaws. Self-criticism becomes the internal language through which this shame is expressed. CBT addresses these patterns by helping clients recognize the voice of the inner critic, understand its origins, and develop a more balanced inner dialogue.
Clients learn to differentiate between motivating self-talk and self-punishment. They practice responding to themselves with the same empathy they might extend to a friend. Over time, this shift reduces emotional suffering and improves the ability to self-regulate without resorting to disordered behaviors. While CBT is rooted in logic and evidence, it also makes room for emotional healing through cognitive compassion.
Cultural Sensitivity and Inclusivity in CBT for Eating Disorders
Effective CBT for eating disorders must also acknowledge the cultural and systemic factors that shape individuals’ relationships with food and body. Diet culture does not affect everyone equally. People from marginalized communities may experience compounded body shame due to race, gender identity, socioeconomic status, or disability. A culturally sensitive CBT approach explores how these intersecting identities influence body image and eating behaviors.
Therapists trained in cultural humility listen carefully to how clients have internalized societal messages and make space for resistance. They help clients name the broader systems—such as fatphobia, racism, and sexism—that contribute to their distress. This broader perspective validates the client’s lived experience and empowers them to reject harmful norms, not just on a personal level, but as a form of social advocacy.
Sustaining Recovery Through Cognitive Flexibility
Recovery from an eating disorder is rarely linear. Setbacks are common, and perfectionism can make clients feel they are failing at recovery itself. CBT teaches cognitive flexibility—the ability to hold multiple truths, revise beliefs, and adapt to change. Clients learn that it is possible to have a bad body image day without relapsing, or to feel anxious around food without resorting to control behaviors.
This flexibility is what allows recovery to be sustainable. Instead of aiming for the complete eradication of negative thoughts, CBT helps clients develop the skills to manage them with confidence and grace. Over time, they begin to trust themselves again—to make choices based on their needs, not their fears, and to navigate a world steeped in diet culture without succumbing to it.
The Ongoing Work of Healing
Challenging internalized food and body beliefs is not a one-time event—it is an ongoing practice. Every day, individuals in recovery must choose to turn toward their values, confront their fears, and respond to themselves with compassion. CBT provides the structure and tools to make these choices possible, and more importantly, to make them stick.
Healing from the damage of diet culture is both a personal and collective act. It requires courage to question norms, commitment to change, and support from skilled clinicians. With guidance and persistence, it is possible to rewrite the story the world has told about food, bodies, and worth—and to live a life that is defined not by restriction or control, but by freedom, presence, and self-respect.