The Ins and Outs of Internal Family Systems

The therapeutic modality known as Internal Family Systems (IFS) has been closely associated with, and so presumably uniquely suited for, the treatment of eating disorders that cause obesity. This preference is exemplified by the literature from a facility called Koru Spring, whose clients are “women seeking treatment for an eating disorder while presenting with co-occurring conditions including substance use disorder.”

This institution’s main areas of concern are described as anorexia, binge eating, bulimia, and Other Specified Feeding or Eating Disorders (OSFEDs). Those OSFEDs include Atypical Anorexia Nervosa, Purging Disorder, Night Eating Syndrome, and Binge Eating Disorder Not Otherwise Specified. The causes are multifarious, including elements of biology, psychology, and the environment.

Substance vs. behavioral

In the overall picture of societal desire to eliminate obesity, there are two schools of thought. One group is more comfortable with the idea of food addiction as a substance issue, while the other philosophy tends to see eating addiction as a behavior issue. (Possibly, a person could have a combination of varying degrees of both.)

IFS is described as “a system of interconnected parts, each with distinct roles.” So, this would seem to imply a tendency to favor the eating/behavior definition. Who is doing the behavior? According to founder Richard C. Schwartz, there is a central Self, and then three main categories of beings, which can each include more than one “part.” There might be, for instance, a number of Exiles in there, each one representing a separate instance of abuse suffered at a different age.

An exact quotation is provided here for a reason, and with the relevant parts emphasized:

Managers: These parts attempt to control and protect by managing daily life and avoiding emotional pain.

Exiles: These parts hold deep-seated trauma and emotional wounds, often hidden away to prevent overwhelming the individual.

Firefighters: These parts act impulsively to numb or distract from pain when exiles are triggered.

The emphasized phrases sound familiar because they describe displacement activity, something Dr. Pretlow has often discussed. The most recent mention would be right up front in the first two screens of his video “Treatment of Eating Addiction and Obesity as Displacement Activity: a Pilot Study“(as presented to the 2025 International Conference on Obesity and Chronic Diseases in Boston earlier this month.)

The inner orchestra

As always, it is interesting to see the same phenomenon interpreted or described differently by different interest groups. For instance, from a website called “Introduction to Internal Family Systems,” we learn that one treatment goal is to “unburden your wounded parts from extreme beliefs, emotions and addictions” (which undoubtedly is a skill good for anybody in this mixed-up world to acquire.) The overriding hope, however, is to learn to…

Shift from the limiting “mono-mind” paradigm into an appreciation of your marvelous, multidimensional nature.

Schwartz has been fond of describing IFS as a way to smoothly conduct one’s “inner orchestra,” saying,

The Self is the conductor, and your Parts are the musicians. With teamwork, they create a beautiful symphony!… At the heart of IFS is the Self — the calm, compassionate core of who you are. The Self isn’t just another Part; it’s your essence. Think of it as your inner CEO, mediator, or wise guide.

So, the Self is likened not only to an orchestra conductor, but to a corporate Chief Executive Officer. (Or maybe even the all-wise and always-loving parent you never had.)

The Managers, as mentioned above, are Parts in charge of maintaining safety and avoiding pain, just like the older concept of generating some displacement activity with the intention of avoiding pain; as a threatened bird might do by taking flight, or by picking nits from its feathers.

A fascinating confluence

The Parts that Schwartz christened as Firefighters play the same protective role as animal displacement activities like feeding. If a threatened creature adopts a casual, fearless attitude and begins to feed, it is just possible that the enemy could actually experience what humans call FOMO, or Fear Of Missing Out. That aggressor might be fooled into believing that some bounty is concealed in the grass, meaning that it should allow itself to be distracted from hostility, stop threatening the designated enemy, and get busy claiming its share of free food.

The inner beings Schwartz called Exiles are versions of the afflicted person, broken off and frozen in time, exactly as they were, years or decades in the past, when some outrageous wrong was done to them. They still don’t know how to escape or defend themselves, and the job of the Managers and Firefighters is to conceal and protect those wounded spirits. The object of IFS is to provide not just symptom management, but actual deep healing.

(To be continued…)

Your responses and feedback are welcome!

Source: “OSFED — What To Know About Other Specified Feeding or Eating Disorders,” KoruSpring.com, undated
Source: “How Internal Family Systems (IFS) Can Transform Eating Disorder Recovery,” KoruSpring.com, 08/06/24
Source: “9th International Conference on Obesity and Chronic Diseases (ICOCD-2025),”
HealthManagement.org, undated
Source: “Introduction to Internal Family Systems,” IFS-Institute.com, undated
Source: “Internal Family Systems: Comprehensive Guide to the Model, History & Applications,”
IFSGuide.com, undated
Image by gdakaska/Pixabay

GLP-1 Medications Get a Major Price Drop As New Research Highlights Benefits for Youth

The cost of two of the most widely discussed GLP-1 medications — Wegovy and Ozempic — is about to drop significantly. Novo Nordisk, the Danish pharmaceutical company behind both drugs, announced that beginning on Monday, November 24, the cash price for each medication will fall by 30%, lowering the monthly cost from $499 to $349 for people paying out of pocket.

The new prices will take effect at 70,000 retail pharmacies across the United States, including major chains such as Walmart and Costco. These reductions apply to customers who choose to self-pay or who lack insurance coverage for GLP-1 therapies.

Dave Moore, executive vice president at Novo Nordisk, emphasized the company’s commitment to expanding access:

As pioneers of the GLP-1 class, we are committed to ensuring that real, FDA-approved Wegovy and Ozempic are affordable and accessible to those who need them. […] Our new savings offers provide immediate impact, bringing forward greater cost savings for those who are currently without coverage or choose to self-pay.

Moore also noted that the price reduction is part of a broader strategy that includes collaborating with telehealth providers, expanding insurance coverage options, and working with U.S. officials to improve affordability for people living with chronic conditions like obesity and type 2 diabetes.

Notably, the previous cash price for Wegovy aligned with the cost of a full dose of Zepbound, a direct competitor from Eli Lilly. With GLP-1 demand still at an all-time high, the price shift marks a significant move in an increasingly competitive market.

High blood pressure in children has doubled

While access to GLP-1 medications is improving, new research reveals troubling trends in children’s health. A comprehensive global review published in The Lancet Childhood & Adolescent Health found that the rate of high blood pressure in children has doubled over the past two decades.

By analyzing data from 443,914 children worldwide, researchers discovered that the prevalence of pediatric hypertension rose from 3% in 2000 to 6% in 2020, now affecting an estimated 114 million children. The authors warn that this surge “should raise alarm bells,” especially given the long-term risks high blood pressure poses for cardiovascular health.

The rise in childhood hypertension parallels other concerning trends, including earlier onset of obesity and type 2 diabetes — conditions increasingly seen in adolescents.

New study shows GLP-1s outperform metformin in adolescents

Adding to the evolving conversation around youth metabolic health, a new real-world study shows that advanced GLP-1 therapies may offer major advantages for adolescents newly diagnosed with type 2 diabetes.

The study, published in the Journal of Pediatric Endocrinology and Metabolism, compared the effectiveness of metformin, a long-standing first-line treatment, with newer GLP-1-based therapies such as semaglutide (the active ingredient in Ozempic and Wegovy) and the dual GIP/GLP-1 agonist tirzepatide (found in Zepbound and Mounjaro).

Key findings include: GLP-1 therapies provide similar glycemic control to metformin but deliver superior weight-loss benefits, which can be critical for managing early-onset type 2 diabetes.

What these developments could mean

Together, these updates paint a multifaceted picture. For one, lower GLP-1 prices may increase access for adults who have struggled with obesity or diabetes but lack adequate coverage. Second, rising childhood hypertension highlights the growing urgency of addressing youth metabolic health. Third, new GLP-1 research in adolescents suggests that more effective early interventions may soon be on the horizon.

We can only hope that as the cost of treatment falls and evidence for early, more comprehensive care grows stronger, the landscape of metabolic health is poised for rapid change across all ages.

Your responses and feedback are welcome!

Source: “Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford,” KFF.com, 11/14/25
Source: “GLP-1 drugs beat metformin for weight control in teens with type 2 diabetes,” News-Medical.net, 11/10/25
Image by Pavel Danilyuk/Pexels 

An Ounce of Prevention, Part 3

As always, it is helpful to look at the various attempts that have been made to turn back the tide of childhood obesity, or at the very least, to prevent the surpassing of its current level. This series highlights why many parents so fervently hope that their children will not become obese, and how some parents want to do everything possible to keep this from happening. Sadly, circumstance has placed in the way of that worthy ambition a major stumbling block, i.e., the very fact that we are human.

If Earthlings are being surveilled and discussed by intelligent observers from somewhere else, our attitude toward food must leave them deeply puzzled. One extraterrestrial scientist says, “You know, I comprehend the ones who never have enough to eat. Their goal is basic survival, to sustain life itself. If they think about food and eating all the time, this is perfectly understandable.”

They just don’t get it

And the Extraterrestrial colleague says, “Sure. But look at the others, the ones who have so much food, they drown in it. They too think about consumption all the time! Build their day around it. Count up their energy units. All kinds of crazy nonsense that wastes the very essence of life they are so avid to preserve.”

The first ET scientist shakes one of its heads and says, “Check out this human specimen I’ve been observing. It does not want its body to increase in size. This could be prevented by causing some energy to be expended. So — and you won’t believe this — it goes out and activates its personal automated vehicle, in order to travel to the gym and — wait, what do they call it? — ‘Do some exercise’.”

It comes with the cream

Those researchers write a paper about how a little thing called “human nature” will always get in the way, warp our perceptions, pervert our best impulses, and waste our time and precious energy as we quarrel over details and side issues. Meanwhile, we are all in the same metaphorical sinking ship, and because of that, the best we can do, here on the Titanic, is to rearrange the deck chairs and play a tune, which explains the importance of Art in our relationship with the Universe.

Human nature has very much the appearance of being a package deal, where we must take the bitter with the better, and where we spend enormous energy to sabotage our own best interests. In the course of trying to solve our huge problems, we are capable of ideas and actions that turn out to be outrageously counterproductive. Often, enormous damage has been done before we figure this out, if we ever do. We humans are such contrarians, we are almost never able to totally stop working against our own best interests.

Parents are in a great position to understand how obesity works because they have gone through the experiences of being a child, an adolescent, and a young adult. Women are especially aware, because they are going to gain a certain amount of weight as expectant mothers, and of course, the fathers will notice the size increase too.

At any rate, it is to be hoped (though rarely achieved) that, once we understand what a drag it is to get out of obesity, we parents will be deeply inspired to instead prevent obesity. It is very easy to say that families should seek help from therapists. The next steps, finding a good therapist and affording the care, are quite a lot more difficult — and the hard part has not even started yet. Even with the aid of a professional, family conflicts and traumas can be incredibly difficult to cope with. Also, now in particular, the societal sources of help are drying up.

At any rate, after taking the long way round, we circle back to the main subject of this sequence, which is the type of therapy called IFS, or Internal Family Systems, about which there are two very important things to know. First, IFS has been widely utilized to address eating disorders and seems to have been promoted as particularly adaptable to this specific spectrum of problems.

Also, “Some patients say it’s destroyed their lives.”

(To be continued…)

Your responses and feedback are welcome!

Source: “The Therapy That Can Break You,” TheCut.com, 10/30/25
Image by lethanhstudio/Pixabay

An Ounce of Prevention, Part 2

Yes, according to one of the most familiar platitudes in English, “An ounce of prevention is worth a pound of cure.” Probably every other human language on earth has an equivalent old saying, because it is just so ridiculously, platitudinously true.

In this context, the meaning is obvious. We try to tell kids: Please make every effort to not be an obese child, because as you grow up and inevitably grow older, something unpleasant is programmed to occur. Most likely, you will wake up and realize it is time to shed those extra pounds, because you’re not a kid anymore. In addition, the effort to lose those pounds will make your life much more difficult than it would have been, if you had never added them in the first place.

Of course, kids never listen anyhow. Maybe some grownups listen, and if they have kids, they might take that warning to heart — especially because they probably know the truth firsthand. It behooves every parent to try to figure out how to get this message across in a way that might penetrate the juvenile mindset.

The oldsters do not say “You’ll be sorry” out of love for the lilting rhythm of the phrase. Hey kids, we know for a certainty that you will be sorry, because we made the same stupid mistakes, and we are now sorry, and we don’t care who knows it.

Monkey see, monkey do

This cannot be said too often: Children are much more likely to imitate what they see at home every day, than to follow precepts that are taught in any other way. A childhood that features unmonitored eating habits is awfully hard to overcome. Not to become a fat kid is a very difficult life challenge. Careless and excessive consumption makes it almost impossible to ever stop being a fat kid.

The great majority of grownups probably have a profound personal understanding of how difficult it is not to remain a fat kid. In other words, most adults grasp, from their own experience, how hard it is to retreat from the categories of “overweight” and “obese.”

But as Werner Erhard has said, “Understanding is the booby prize.” An adult can realize how difficult it is to lose body weight, and grasp the meaning of the sentence all day long, but none of that can help much. It is probably already too late for them, and their awareness and experience do not seem to go very far toward helping the next generation.

Plenty of words out there

There are a lot of words we can use in trying to convey to a child the importance of eating only worthwhile foods, and even then, not too much of them. Here’s the catch. By the time a child can understand the words, she or he has already logged several years of much more convincing communication. Mr. or Ms. Grownup, that kid has had an eye on you from Day 1, clocking your every move. Every single treat, snack, and third helping. It’s all there, on the shelves of their brain libraries.

Why must so much emphasis be placed on the prevention of childhood obesity? Because of a fact that becomes increasingly difficult to ignore with each passing day. We cannot avoid noticing that childhood obesity almost inevitably leads to adult obesity.

Okay, admittedly, there is another possibility, one that is equally damaging. A person can spend an entire lifetime tirelessly, devotedly taking measures to fend off adult obesity; every minute of every day being acutely conscious of the weight-related consequences behind every bite of food. That sounds like zero fun.

A grownup can be in therapy, able to recall and comprehend in exquisite detail every single factor in three decades of life that led to being a 30-year-old who weighs 350 pounds. But… Understanding is the booby prize.

Your responses and feedback are welcome!

Image by endho/Pixabay

An Ounce of Prevention, Part 1

In the realm of wisdom passed down through the generations, one of the most tried-and-true (and trite) sayings is, “An ounce of prevention is worth a pound of cure.” The maxim includes two terms that measure weight, which is very appropriate because weight is the subject here.

In the USA and the world, the emphasis on childhood obesity is a vital part of the overall health picture. Why? Because “As the twig is bent, so grows the tree,” and also because other corny old sayings with the same meaning are found all over the globe and in a variety of languages. They are all truthful descriptions of a real phenomenon.

“Give Me the Child Until He is Seven, and I Will Show You the Man” is a saying whose attribution is contested, but whose veracity is rarely questioned. Adjusting for traditional sexism, of course, it means that anyone who is entrusted with the upbringing of a child, male or female, during those first six years, is pretty much guaranteed to produce a kid trained to their satisfaction.

An even deeper truth is at work here, which is the rule known as “Monkey See, Monkey Do.” In other words: Granted, it is very likely that a child can be trained by deliberate and purposeful instruction. Still, it is even more likely that the kid will pick up the habits and ways that are consistently demonstrated by adults and observed by the child, rather than the ones being programatically instilled. Because, to roll out yet another ancient proverb, “Actions speak louder than words.”

Digression: an impactful best-seller

In 1973, Flora Rheta Schreiber published the hefty (almost 500-page) non-fiction book titled Sybil. Consequently, most people heard about multiple personalities for the first time, as the patient in the book had 16 of them. This is mentioned only to establish that prior to the publication of Sibyl, most Americans had never heard of any of this stuff. Suddenly, the multiple personality concept achieved wide awareness. People — especially parents — were primed and ready to hear more.

Now, granted, the odds of any one particular child developing such a serious problem are slim. Still, it is one of many possibilities. Given the choice, most parents would rather not have a situation like this to deal with, for the sake of the child and of themselves and their other children, and indeed for the well-being of the general public.

In the intervening decades, various branches of the psychological arts have taken on the challenge of rationalizing and working with multiple personalities. Some people are comfortable explaining them as visitors from the past, who previously had bodies and all the other accoutrements of standard human life. These tourists can be accepted as perfectly legitimate echoes of a person’s own previous incarnations, who have returned to work out their karma.

Or maybe…

Another narrative requires absorbing some information about the theories of Richard C. Schwartz, who may be thought of in shorthand as the father of IFS, the initials that must become intimately familiar if the rest of this is to make any kind of sense. IFS stands for Internal Family Systems, the operating assumption and principle connected with Schwartz’s controversial Castlewood Treatment Center. In a very recent article, journalist Rachel Corbett announced right up front and up top,

Internal Family Systems is a widely popular trauma treatment. Some patients say it’s destroyed their lives.

Corbett backed this up by presenting a case study, that of teenager Elizabeth Lerz, who in 2011 convinced her parents that her eating disorder necessitated a stay at Castlewood. They were relieved that she was amenable to treatment and that they were able to afford the hefty fee. What could go wrong?

All too soon, the answer became apparent. Mr. and Mrs. Lerz discovered that after four months of inpatient therapy, their daughter had become a hostile stranger who made horrendous accusations against them. This is not the place to cover those aspects in detail. Suffice it to say that, after enormous legal expenses, followed by 14 years (and counting) of hostile alienation, the family never recovered.

(To be continued… )

Your responses and feedback are welcome!

Source: “The Therapy That Can Break You,” TheCut.com, 10/30/25″
Image by geralt/Pixabay