Podcast Summary

Breaking the Rules: A Clinician's Guide to Treating OCD

Episode: How “skinny-tok” is feeding eating disorder content to teenagers
Hosts: Dr. Celin Gelgec & Dr. Victoria Miller
Guest: Felicity Phillips (Founder, Weight of the World)
Release Date: June 9, 2025

Episode Overview

In this episode, Dr. Celin Gelgec and Dr. Victoria (“Tori”) Miller explore the fraught intersection between OCD and eating disorders, focusing especially on how social media trends—particularly “skinny-tok” on TikTok—are fuelling disordered eating and unhealthy body ideals among teenagers. With guest Felicity Phillips, who brings both her lived experience with an eating disorder and her clinical insight as a final-year medical student, the episode delves deeply into how control, fear, and rituals overlap in OCD and eating disorders and what effective, compassionate treatment looks like.

Key Discussion Points & Insights

Prevalence and Overlap Between OCD and Eating Disorders

• Statistics:
  • 11-41% of people with an eating disorder also meet criteria for OCD
  • 10-17% of people with OCD report current or past eating disorder symptoms
    ([00:34])
• The overlap is “subtle, powerful and frequently misunderstood.”

Felicity’s Story: From Ballet to Advocacy

• Background: Felicity began as a ballet dancer, which contributed to her eating disorder during pre-professional training and medical school pressures.
• Lived Experience:
  • "Seeing both the clinical side as a doctor and experiencing them personally really made me feel compelled to do something in this space." ([02:47])
• Recognition of Gaps: Noted a lack of peer and carer support during recovery, which inspired her to create “Weight of the World.”

Understanding “Skinny-Tok”

• What Is It?:
  • A TikTok trend promoting thinness through before/after weight loss, “what I eat in a day,” body-checking, often under the guise of “wellness” or “biohacking.”
    ([03:59])
• Algorithmic Danger:
  • “If you spent more than two seconds on a diet video, another diet video would come up.” ([04:46])
  • This shapes young users’ feeds almost instantly: “That’s literally just a glance… then the whole feed is like that.” ([04:59-05:15])
• Toxic Comparison Culture: Reinforces “unrealistic and narrow body standards to vulnerable users.” ([03:59])
• Insidious Messaging:
  • Diet-culture content is often masked as health or wellness advice, making it harder to recognize as dangerous.
  • “It creeps in and superficially looks like really helpful content... but it’s kind of nasty stuff underneath.” – Dr. Tori Miller ([05:21])

Weight of the World: Peer-Led Community Support

• Concept:
  • Created to address the isolation of recovery, especially the unique social pressures to diet.
  • Peer support and a “community-driven” approach: connecting those with lived experience, guest speakers (nurses, GPs, dietitians, psychologists), and fostering real conversations about what support and recovery look like ([11:11])
• Education for Community and Professionals:
  • Felicity highlights the abundance of misinformation, even among professionals, and aims for Weight of the World to educate about the realities and complexities of eating disorders.

Personal Reflections on Diet Culture and Body Image

• Permeation of Diet Culture:
  • Hosts share personal experiences of being caught in diet culture, the pressure to “manage” bodies, and the pain of perimenopause-related body changes.
  • “I feel really lonely... I’m searching for other people who will just sit happily with me and just eat or just not talk about it.” – Dr. Victoria Miller ([08:15])
• Resurgence of 90s Culture:
  • Despite perceptions, data suggests we are returning to the high-diet-culture era of the 1990s and early 2000s ([09:44-09:58])
  • Celebrity and medicalization of weight loss (e.g., Ozempic) reinforce dangerous ideals for teenagers.

Common Ground: OCD and Eating Disorder Mechanisms

• Structure, Safety, and Rituals:
  • Felicity recounts childhood rules around eating (e.g., specific number of bites, linked with feeling safe) ([14:00])
• Behavioral Overlap:
  • Both conditions center on compulsions, coping mechanisms, rituals, and the sense of control they offer.
  • ARFID Example: Avoidant/Restrictive Food Intake Disorder often arises as an extension of OCD-like anxiety, not always body image ([15:06])
• Addictive Qualities:
  • Eating disorders often become “addictive,” not just about appearance or weight loss.
  • “You become addicted to a number of their effects… the pure adrenaline that kicks in when you’re starving… you sense of power is very, very intense and you’re not aware that you’re actually becoming very quickly addicted.” – Felicity ([28:25])

Recovery: Challenges, Coping, and Compassion

• Cycle of Restriction and Recovery:
  • Eating is painful, brings guilt, and leaves sufferers desperate to return to “old ways” despite strong motivation to recover.
  • “You can be as motivated as you want, and then you eat that first meal… you feel unsafe, physically unwell, your brain is going wild, and that’s only one meal.” – Felicity ([17:36])
• Urge Surfing:
  • Technique taught in both OCD and eating disorder recovery, but the frequency and difficulty are often underestimated.
  • “Maybe you’ll get through eight urge surfs and on that eighth one you’re like, nah, you know what? Stuff it. I can’t again.” – Felicity ([21:11])
• Celebrating Small Wins:
  • Hosts emphasize the importance of self-compassion and celebrating progress over perfection.
  • “There’ll be moments where you’re like, yeah, I’ve got this... and then again and again... When is it going to get easier? And then you just go back to old ways… sometimes, that’s okay too.” – Dr. Celin ([21:38-22:23])

Social Media: Aspirations and Advocacy

• Weight of the World’s Role:
  • Aims to counteract negative online influences by creating a positive, authentic community and by flooding feeds with real, unfiltered experience ([24:10])
  • “Hoping that people can log on and see... there’s people out there that are bloated after eating a burrito right now... and just offer something else and give people perspective.” – Felicity ([24:20])
• Education and Support:
  • Bringing together professionals to explain realities of eating disorders and removing focus from appearance to lived experience.

Notable Quotes & Memorable Moments

• On Skinny-Tok’s Power:
  • “If you spent more than two seconds on a diet video, another diet video would come up.” – Felicity ([04:46])
• On Coping and Rituals:
  • “I used to eat my food in a certain amount of bites at dinner… if I ate the sandwich in eight bites specifically, my world would stay really safe and calm.” – Felicity ([13:39])
• On the Addiction of Eating Disorders:
  • “You become addicted to... the pure adrenaline that kicks in when you’re starving, you’re high as a kite, sleepless, full of frenetic, unstable energy.” – Felicity ([28:25])
• On Urge Surfing Fatigue:
  • “It sounds so nice... but it’s so much harder than that.” – Felicity on urge surfing ([21:30])
• On Community and Support:
  • “What did I need during recovery? I needed other people on the same journey… so I figured I’d create it.” – Felicity ([07:07])
• On Embracing Messiness:
  • “We’re all a little messy, and that’s the beautiful part of being human. We can celebrate it and embrace it.” – Felicity ([33:15])

Key Timestamps

• 00:34 – The overlap between OCD and eating disorders
• 02:47 – Felicity’s introduction and personal history
• 03:59 – What is “Skinny-Tok”?
• 04:46 – TikTok algorithm dangers
• 08:15 – Personal pain of diet culture, body image in adulthood
• 09:44 – The resurgence of diet culture and celebrity influence
• 13:39 – Childhood rituals and the roots of compulsive eating behavior
• 15:06 – OCD eating disorder comorbidity and ARFID
• 17:36 – Recovery challenges: eating, guilt, and motivation
• 21:11 – The exhausting reality of urge surfing
• 24:10 – Weight of the World: online advocacy and education
• 28:25 – Eating disorders as addiction
• 33:15 – Embracing messiness and self-compassion

Tone & Final Reflections

The tone is open, compassionate, and candid, blending clinical insight with emotional honesty. Felicity’s vulnerability, the hosts’ personal stories, and the focus on community and acceptance make the episode hopeful despite tough realities. The call to “embrace the mess” and celebrate small wins resonates throughout.

Resources & Links

• Weight of the World: Peer support and educational events for those impacted by eating disorders
• Melbourne Wellbeing Group: Training and resources for clinicians treating OCD
• Event Registration & Social Links: Provided in show notes

Closing Thought:
“We’re all about mess, and staying messy!” – Dr. Celin & Dr. Tori ([34:17])