← Good Inside with Dr. Becky
Good Inside with Dr. Becky
When Food Feels Scary: Eating Disorders in Kids & Teens (Early Signs & What Helps)
00:40:56
When food starts to feel tense, restrictive, or obsessive at home, it can send a parent into panic fast.In observation of National Eating Disorder Awareness Week, Dr. Becky sits down with Dr. Erin Parks, Chief Clinical Officer at Equip Health, to talk about eating disorders and disordered eating in kids and teens—what the early signs look like, what’s happening emotionally underneath, and how parents can respond without escalating shame or control struggles.Eating disorders affect an estimated 30 million Americans in their lifetime. They are common. They are serious. And they are not caused by “bad parenting.”
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- [00:00]
A
Caregiving is one of the biggest sources of stress for parents today. The data shows that most parents spend nearly every waking hour focused on someone else. And if you feel depleted, that's not failure. That's the reality of how much you're carrying. Another thing the data tells us is this. Almost three quarters of parents say having a stronger network of trusted caregivers would improve their mental and emotional health. And I see that play out all the time. When parents have real support, the mental load lightens a bit and they become more present, calmer, and more regulated. Care.com makes it easier to find that kind of support with background check caregivers reviews and filters for the exact skills you're looking for, whether it's infant care, before or after school, help camps, daycares or senior care. And rightnowcare.com is offering something they've never offered before. For a limited time, use the code Good35 to get 35% off a premium membership plus a free subscription to Headspace. Because when you have support, you can show up as your best self for the people you care for and for yourself. There are some topics in parenting that feel especially loaded, that make our heart race. And food and eating disorders. Those are two of them. This week is National Eating Disorders Awareness Week, and I really wanted to create space for a conversation that feels empowering, steady, relieving, actually helpful, not sensational, not fear driven, not filled with rules and morality. Eating disorders and disordered eating are far more common than most of us realize. They affect an estimated 30 million Americans over the course of their lifetime. Which means if you're listening to this, this topic probably touches your life as a parent, maybe in your childhood, or as a partner or friend. Today I'm joined by Dr. Erin Parks. Erin is a clinical psychologist who specializes in eating disorders. She works every day with teens and families, navigating these concerns. And importantly, Erin and I both struggled with eating disorders in our earlier years, so this is personal to both of us. Erin is thoughtful, grounded, and tuned into the deep emotional experience underneath food struggles. This conversation isn't about diagnosing your child, and it's definitely not about perfect meals or saying the perfect thing. It's about understanding. Understanding what's really happening underneath, understanding what our job is as a parent and understanding next steps we might take. I have a feeling that at the end of this episode, you're going to feel more oriented, more aware, more empowered, not more panicked. And I'm so excited for you to meet Dr. Erin Parks. I'm Dr. Becky, and this is Good inside. Okay. So many things I want to ask you, but I just want to kind of ground this conversation around eating disorders, disordered eating, with what you're really seeing right now with families, teens, younger kids, around food, like, what is showing up most and what's kind of most pressing, most relevant right now.
- [03:12]
B
I think the two things is that, first of all, it's increasing and more of it. And I hear parents worrying about either their child's picky eating. Is this a problem? Is this not a problem? It seems to be getting worse. Or about how their kids are feeling about their bodies and trying to eat healthier and control what they eat. And parents are asking me, should I worry or should I be celebrating? So the two things I'm probably hearing the most.
- [03:37]
A
Increase in picky eating.
- [03:39]
B
Increase in picky eating.
- [03:40]
A
And in eating disorders.
- [03:41]
B
And in eating disorders, yeah. The rates of eating disorders have been steady for about 100 years, and since 2020 have been going up, up and up.
- [03:50]
A
And then this other category of things, not to say that there's not overlap, I just want to see if I'm getting this right. To mirror back is there's this category of like, my kid wants to eat healthier and is healthy, something to celebrate, is healthy, sometimes a cover for control or rigidity. Is that kind of the debate, the space you're seeing a lot of as well?
- [04:08]
B
Exactly. Because there's so much content coming out right now about the correct way to eat, the correct way to feed your kid. And I'm having parents say to me, my kid is freaking out because they're like, if kale is healthier than spinach, should I not eat spinach and only eat kale? And they want to do the right thing as parents, and then the kids want to do the right thing as kids. And yet what is right is very much in air quotes because there is no one right way to eat.
- [04:34]
A
I want to actually take what you said in the categories them and maybe jump into them one at a time. Let's start with what you just ended with. Healthy eating or rules around eating, or. One of the things I think about a lot is morality around eating. I always think with parents that's like, morality is often the thing we want to avoid, Right? What are the good foods? Right? Is it kale and spinach, or is it no carb or no this or fat? Or there's always some latest thing. And so just when a parent comes to you and they're like, is this something I should be concerned about? Or how should I intervene Just walk me through, like, if I'm saying that to you, okay, I'm seeing my kid come. I don't buy that anymore. And this isn't good. And I read this thing online. I saw this thing on TikTok. My friends aren't eating this food anymore. And I'm saying to you, okay, is this a good thing? Is my kid becoming more empowered? Is this a concerning thing? Just talk to me.
- [05:21]
B
By the time a parent asks me, even if it's just on the soccer field, is this a problem? Answer is almost always yes. I really can count on one hand how many times the answer is no. There's something about us as parents that when our gut says something is off about food, we don't listen to it right away because we're consuming the same diet culture. We've been drinking from this fountain of look different, look younger, be smaller, since we were also born. And so when we see these behaviors in our kid, our gut says something's wrong. And then we start saying, okay, it's probably just a phase. Probably making too big deal. Too big of a deal out of it. So by the time I finally say it out loud to someone, the answer is yes. Yes, you should be trusting your gut. Yes, something is off.
- [06:04]
A
Yeah. My guess is also, it's not always a binary. No, it's not a problem. Yes, it is a problem. Hey, there's something rising to the level of your gut thing. You're thinking about it. You're wondering about it. Like, let's just be more curious about it. Let's look into that together as opposed to either or.
- [06:20]
B
Exactly. So if your child is saying, I want to eat healthier, and what that looks like is they start eating a wider variety of food. They start eating what you are eating at dinner. They start ordering new things on the menu. When you go out to a restaurant, that probably doesn't make you worry. And that is a form of eating healthier. But when your child says they want to eat healthier and they're no longer eating birthday cake at their cousin's birthday party, they are stopping eating their favorite foods. You're concerned they might be losing weight. That's when your gut is saying, wait, this. Eating healthier isn't a good thing. So your gut naturally goes off when you're picking up on them taking away things they used to do instead of simply adding.
- [07:04]
A
And I'm just. I'm picturing this parent with this kid. What comes next? Like, let's say a parent's thinking, okay, this whole shift, it's maybe under the COVID It's been labeled healthy. But there's something in me saying, I don't know seems a little different from just that. Do I just notice for a couple of weeks? Do I collect some kind of data? Do I talk to my kid right away? If I do, you know, what would that be? I'm gonna put out another option. Do I say, I made a new appointment with a therapist and nutritionist and you need to do that? Like how? What are the next steps?
- [07:37]
B
I would talk about it frequently, and I would start now because it's something that all of us are constantly receiving information about how we should eat, how our bodies should look. And so it can also be a constant conversation in your home. So when your kid tells you they want to be healthier, I usually ask, well, tell me what that means. I'd love to help. We all want to be healthy. Healthier can mean going to bed at an earlier time, which is usually not what a teenager means when they say they want to eat healthier or be healthier. But reminding people that eating healthier is one aspect of health and seeing is health what they're really after. I also like to ask them why. And I will hear things like, oh, I want to be faster at my sport. Or, well, I don't really know. But everyone's just. I mean, I should, shouldn't I? And that tells me something too, this I should. They're already shoulding themselves. They're already deciding that there's a good way to be and a bad way to be. And they think that eating a certain way. And it goes to your earlier point around the morality of food and we need. I'm. I mean, I am a human who grew up in America and a woman who's trying to embrace aging while not wanting to age, right? So I get the mixed messages that we all receive, but it's really, really difficult. And we accidentally say, I ate well, I ate poorly. I'm gonna eat so poorly at the super bowl party, or I eat bad at the party. And so kids are around this moralization and the behavior that they claim to want, like, eat healthier, be healthier, is sometimes about trying to be perfect, be better, find a binary that doesn't really exist.
- [09:14]
A
I just want to double click on this morality thing because I know I've talked to parents who will say to me, and I'm sure you hear this all the time, but sugar is bad. But my kid doesn't have celiac. But gluten is bad. Gluten leads to inflammation. And I'm not here to debate any of those truths, but I'm sure that comes up a lot where how do I figure out food and morality? Especially if there are families and adults who really do believe and maybe with good data. But why can't we talk about things as good or bad? If there's certain data or science to support that, how do you manage? I'm sure. Do you see that?
- [09:54]
B
I see it constantly. I mean, I live in Southern California, like a land of no sugar and no gluten. It's hard. I really, really personally struggle with it because I remember the 90s when bagels were a healthy breakfast item and I miss it. My 14 year old son came home and he's newly at high school and I can feel him picking some stuff up and he has been more cautious around the sugar. And so I asked him, I'm like, max, what's going on here? And he's like, I'm like, I know friends who just don't eat sugar and you seem to feed us so much sugar. And I'm like, you're welcome is what you should. I would like to hear a thank you. No, but kids want to do the right thing. And so when I talk to other kids or parents about it, I remind them that while you are still developing, the number one thing you need is calories. Period. And where are calories? They're in sugar, they're in carbs. That's where calories are. If you were anemic, I would be figuring out how to get you more iron. But what you are doing is going through growth spurts. They have so much movement between walking to classes and all the activities they're in and the sports. And they are growing. So what they need is calories. So the healthiest thing is calories. And the easiest way to get that for them is carbs and sugar. If as a family you're deciding to be gluten free or sugar free, there are all sorts of different ways to feed your kids. We do a lot of cancer metaphors in the eating disorder community and I like to remind people that we would never give our child poison unless they had cancer and needed chemotherapy. So similarly, if in your household you're like, we don't eat gluten or we don't eat sugar, but I'm gonna make this change because my child now needs something that is different because they've developed an eating disorder or their disordered eating is making us worried about their health,
- [11:39]
A
I think that's really helpful and One more level, practical for the parents who are thinking, how do I manage a situation actively where it's true my kid notices I'm not eating a certain thing, but I don't want that to be fully absorbed by them. What language do you recommend people use or what type of conversation starters?
- [11:56]
B
I think it's two things. Sometimes it's what you say and sometimes it's adjusting your behaviors. My child once saw me not finish a milkshake and I heard about it for a month. He knows that I have struggled with disordered eating before, an eating disorder before, and it made him hyper aware. And I had no idea that he knew any of these things, that he even paid attention to what I did for a living. And so they're always observing, even when we think they aren't. So sometimes the solution is to talk to them about it and say, hey, I use the sports metaphors as well. You're gonna have kids on your soccer team who have knee issues. They're going to do stretches that you don't do before and after practice, and that kind of stinks for them. They have to spend these extra 30 minutes doing this and that. That is what they have to do because of their knee issue. Well, maybe there are people in our household who eat different for different reasons. Maybe dad is watching his cholesterol for health reasons and so he has eliminated some foods. That's what he has to do. And though sometimes the solution is also examining your own food habits and the ways in which they're communicating things you don't want your kids absorbing.
- [12:59]
A
I. I just want to say, Erin, I really love the very reality based part of that answer. And there are times when, yes, we can label it to our kids. You're right, I'm not eating this. And I have my reasons. And look, in our family in general, we believe that the way I do things shouldn't always be the way you do things. We actually love the way you guys do things differently as kids. And then there's other times where it is true. If you never eat certain types of food or if it feels very rigid, that behavior sometimes speaks louder than anything we say. And if you have a kid who's especially observant or especially people pleasing or especially looking at all the time and becoming rigid, sometimes, there's nothing that I can say that's gonna be as powerful to my kid as saying, I'm gonna have dessert tonight. Right? And there's a reality of that that I think it's like, okay to just name. So we're kind of along this topic and I wanna transition to it. Control. How do you see the relationship between disordered eating, eating disorders, proper control? Are there any signs that a kid, way before eating stuff develops, might be prone to them, given their relationship with control in general?
- [14:07]
B
A lot of people who struggle with eating disorders also struggle with anxiety. So they want to do things right, they want to do things perfectly. So that might be something you see early on. They see anxiety around perfectionism, anxiety, rigidity. We also see something, it's a fancy word for knowing when you need to pee, but this altered interoceptive awareness. So these are the kids who can play sports through an injury. They can stay up studying through the fatigue. They can ignore the calls and the social plans of their friends and just keep working on that project. That is an incredible skill. I think a lot of success comes from having this tunnel vision. And if you take that tunnel vision and direct it towards changing your body or changing the number on a scale, that's exactly what I think is so hard as a parent is you're like, I want to praise that they stayed in the gym the extra hour. I want to praise that they stayed up late working on that project. And at what point are we praising behaviors that we don't want to see in ourselves? As adults, we all talk about trying to figure out how to turn off, about how to know our own intrinsic worth, but what we're doing is praising behaviors that can lead to burnout, can lead to an eating disorder. I really caution people around exercise. When you see your kid exercising despite having an injury, exercising longer than their friends, especially in boys and men. So I just want to remind people that 40% of people with eating disorders are male. So this is affecting teen boys just as much as teen girls. But it's usually missed in boys because when a boy stays longer in the gym, it's praised. And then especially if you're at the gym instead of going to a social activity, what's better for a 15 year old's development than going and seeing friends in person? Something we want all of our kids to do more of not being in the gym.
- [15:54]
A
And look, and just for all the parents listening, right? I think, look, there's part of that, that of course that moment's gonna say, wow, you're working really hard, right? So I think again, and I think we're similar, no, no rigidity there either as a parent, but it's just such a good moment as a parent to pause and say, okay, if I have a kid like that and it's like, oh, my goodness, Erin, are you talking about my kid? Huh? Is there just a nuance there I want to reflect on even if I don't change anything yet? Yeah, it's kind of amazing. My kid pushes past the type of signal or pain that would stop someone else in their tracks. That can be used as a superpower. But, ooh, that also, that could flip on them too. And if I think about it in that nuanced way, maybe there are moments instead of just praising, I say, hold on a second.
- [16:41]
B
One of the things that's unique about eating disorders is we haven't really found a gene per se, that's passed from parent to kids, but we know it's very heritable. Like 86%. I want to say 85, 86. But what we have found is that it's a neurobiological based illness. And so that the pathways in the brain that are in charge of things like interoceptive awareness, attention to detail, that is what's being passed on. So if your kid has these behaviors, there's really high chances you do too. And it gives you an opportunity to say, like, I'm sure our children have seen both of us push through fatigue and get work done. And I'm proud of that. I'm glad that they've been able to see that. But how can I also make sure I'm saying to them, I'm burnt out and I'm exhausted. Mom's been on too many planes. Mom stayed up too late, too many nights in a row. I'm going to go hang out with my sisters. I'm going to skip work tomorrow and do something fun. And so it's modeling for them, figuring out when to use it as a superpower and when it's starting to hurt my quality of life.
- [17:47]
A
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- [18:52]
B
One of my favorite things and how I fell into eating disorders is because they really are about regulating emotions. And as someone who has very big emotions, I love just the honest talking about the ways in which eating disorder behaviors really serve people. They work until they don't work anymore. So what we see from a lot of the kids and teenagers that we work with is that they experience the same emotions as everyone else, but just at a louder volume. And if you are genetically predisposed to have an eating disorder, and you might find that when you're really stressed out, not eating actually makes you feel better. So for most people, if you don't eat, you maybe get hangry, you get grumpy. But for people who are prone to have an eating disorder, not eating actually relaxes you. I tell parents, I'm like, imagine you're gonna go on stage and give a presentation to 100 people, 500 people, whatever's gonna terrify you. And if someone offered you your favorite breakfast right before you went on stage, you'd be like, absolutely not. Your stomach would be in knots. You wanna eat that afterwards? Well, that's what the stomach of someone with an eating disorder or who's prone to have an eating disorder often feels like. So not eating actually relaxes them, regulates their emotion.
- [20:00]
A
Yeah.
- [20:00]
B
For kids who struggle with binge eating and purging behaviors, they also tend to also struggle with self harm behaviors when they feel that really big emotion. Making themselves vomit numbs them out instantly. It just brings them from a 10 out of 10 to a 0. Now usually shame comes after that, and then they're back on the wheel of having really high emotions. But really reminding parents that these are serving a purpose and not to vilify them. Even in the eating disorder community, people are like, well, I have anorexia, that's the good eating disorder. Whereas, you know, bulimia, making yourself vomit is the bad eating disorder. That is not true. And I tell parents, if you think your kid is vomiting, they are. By the time you think that they are, they are, because eating disorders are so secretive. But don't freak out, don't act as though that's the worst thing your kid could ever do. There are no Worse eating disorder behaviors and they're serving a purpose for them. So give them an opportunity to share with you when it's coming up and let's help them to not give in on that urge.
- [20:58]
A
Yeah. And just as a metaphor there, like, I think about how many of us, I don't know, we scroll on our phone at night, even though obviously we know that's not a good idea, or we're saying we're going to go to the gym in the morning, but we snooze and we're like, well, I didn't do that. Even though we know it would have made us feel better and approaching that, someone came to us and was like, why are you on your phone? You know, not to be on your phone. Why are you snoozing? Like, obviously go to the gym. I don't know anyone who's like that is so helpful. I'm now going to change my behavior. Like, thank you. No, Right. And actually what helps us change the behavior? Because also so many of us can be self critical. Right. And is okay. Being on my phone at night must do something for me.
- [21:36]
B
What is that?
- [21:37]
A
Right. That's the start of, well, could I get that from somewhere else or what am I looking for? Snoozing in the morning. Like, what's going on there beyond maybe being tired? Is it, do I feel bad about my body when I go to the gym? And I kind of want to avoid that feeling. Like, we also regulate our emotions through maladaptive behaviors. Right. And that carry is a practice to be curious. And I think what you're saying with restricting, binging, purging on the surface, if we meet it with why are you doing that? That doesn't make sense. We're actually not getting to the source. Like, what is this doing for my kid? Doesn't make you permissive. It actually makes you able to start figuring it out.
- [22:11]
B
And how can you help do that for them until they have the skills to do it?
- [22:15]
A
Say more.
- [22:16]
B
It goes back to kind of what you were saying about control. People think I am going to get control of my thoughts by controlling my food. All I think about is my body. All I think about is food. You know what? I'm going to start controlling exactly what I eat and that will make my thoughts go away. That is the lie of eating disorders. Because it just makes it worse and worse and worse and soon you're. You know, I had a mom call me once and her child was 15, had just gotten back from residential. She's like, Erin, she is sobbing because she can't figure out if it's 15 blueberries or a third, a couple blueberries. Because apparently 16 fit in there and she doesn't know what she should eat. And that's an example that the eating disorder is actually in control. And so what parents do to help their child recover from the eating disorder is the par. Take control of eating. You don't have to think about this anymore. I'm going to tell you what you're eating for breakfast, for lunch, for dinner. You don't have to like it. You do not have to compliment me. And you are even allowed to swear during it. I'm going to sit next to you and provide comfort while you do this hard thing. You've been using restricting to help regulate your emotions. I'm going to help you regulate them in a different way until you have those skills.
- [23:20]
A
Yep, kind of. And I. This is always my favorite metaphor, but. Oh, you're actually showing me you can't be the pilot of your food plane anymore.
- [23:28]
B
I love that.
- [23:29]
A
Is that what it is? Yes.
- [23:30]
B
I absolutely love that.
- [23:31]
A
It's not because you're a bad person and it's not because you won't be able to again, but I can see that. And so I'm stepping in because I love you and I want to keep you safe. And I'm gonna pilot this until you can take the reins again.
- [23:44]
B
I absolutely love that. And I'm gonna use that because most parents call me and they say I need to not be involved in their treatment because I will make it worse. Because my teen tells me they don't want me there because this is about control. So I should give them the control to get through their eating disorder. And I remind them, your kiddo can't do this. Like, if your child was struggling with substance use, you wouldn't sit and wait for them to take the alcohol out of the house. You would go and get all the alcohol out of the house.
- [24:09]
A
I'll write that one down. Yes.
- [24:12]
B
And we talked to 50 different teenagers who started our family based program, and zero of them wanted their parents involved, which is totally normal. And I said to their parents, I'm like, you should be happy. That is a developmentally appropriate response. But when I ask the parents, why do you think your teen doesn't want you involved? The parents are like, they think I'm gonna make it worse. They think I don't know what I'm doing. They hate me. Oh, I get emotional here. When I ask the teens why you don't want your parents involved they say, I don't want them to know how bad it is and I don't want them to worry. And when parents know that, they're like, get out of the way, I'm coming in. At the end of the study, all of them, except one were so glad their parents were involved. And they also said, I wish they'd gotten involved earlier, Aaron. And it was incredible because every parent was thinking, am I making a mountain out of a molehill? Is this just a phase? Am I making it worse by getting worried or bringing them in to see you? And in the end, every kid said I needed my parents sooner.
- [25:11]
A
You know, I think a lot about being long term greedy as a parent, not maximizing or optimizing for immediate ease or happiness. But as a parent, I'm thinking about who my kid's going to be five months from now, five years from now, 15 years from now. And I think with this type of treatment, it's short term thinking, which we all have. They're going to be mad at me. Okay. Long term greed would actually say, hold on, I want to maximize my kids emotional health, physical health, I'm willing to put up with. Yeah, they might be short term pissed, but I love my kid in this long term way and I want to set them up and that can maybe help push past a little bit.
- [25:48]
B
Yes, families talk about being stronger also when they get through treatment. And the parents also say they're like, I am so much more emotionally regulated than I was before. It does take something special to tolerate your kids not liking you, especially when it's multiple days and weeks and months in a row sometimes as eating disorder treatment can be. But I love that the long term greedy, the reward is there. You both get a healthy kid, but you also have a kid that is so grateful that you helped them get well.
- [26:14]
A
You know, one of my, when my kids were younger, one of the things I would say around our own screen time rules or bedtime rules, but it's kind of the same thing, is my number one job is to keep you safe. And also it's to kind of make decisions that I believe are good for you long term, even if you're pissed at me in the moment. And I'm just going to say this, I love you enough to make those types of decisions. And this is one of those moments. And I kind of felt like a badass every time I was saying like I'd have to like work myself up. But then I heard myself say it. And by the way, just to be clear, it wasn't like, their kids were like, that was really an A mom. No, they then do the thing. They're like, you're annoying all my friends, whatever. But if you kind of set yourself up instead of in an apologetic way, in this, like, bold way, I feel like I was then ready. I was like, okay. So I said, my part, you're going to do your part, you're going to complain. Short term, everything's going according to plan and we're just going to keep walking down that path. I think one of the most memorable moments of my private practice. I can picture her in this moment exactly is this. And it's not eating disorder related, but I think there's such a parallel. She's 15 or 16 and she was cutting. Got referred and I asked her for a session. How long has this been happening? Two years. I was the first therapist she saw and I said to her, okay, well, your parents, you told me, also have known. How come you didn't see a therapist? Just curious. Me or anyone. She's like, oh, well, I told my parents she was so snarky. I told my parents, oh, so you think I'm fucked up. I'm the messed up one in the family and I'm just gonna go and lie or not talk and I'm gonna waste all your money. And Erin, my heart always races, okay? Because same thing I think she then just got silent and like, her whole demeanor changed. And she looked up at me after like a minute and I just kind of. For some reason, you just shut my mo. She's like, can you believe they let me make that decision? It was from this, like, snarky teen to this. I'm also crying like this really young. And can you believe they let me pilot the plane when I was showing in clear as day sign that I couldn't do it and my rude words were enough for them to take their hands off the wheel, like. And I always think about that because I think we take. I respect kids deeply, but we take their snark, like, way too seriously. And under it is so often such desperation and shame and fear. And by the way, I don't think it's teen. In our worst moments, we just want someone to kind of say, I'm not taking this at face value because I love the heck out of you and you need a different level of help.
- [29:03]
B
My favorite to go to a hopeful story and why I'm just always like, parents, be involved, be involved, be involved, be involved. Don't think that your absence is what your kid needs. It's your presence. There was a child who was trying to weight restore and she needed to have about 3,500 calories a day to weight restore, which is pretty normal if you don't have an eating disorder. You only need a couple extra 100 calories a day, but if you do, you become hyper metabolic and you need to eat a lot. And they could not figure out how to get enough calories on her. And so she had been the same weight for, I don't know, eight weeks. And the mom and dad were just kind of scratching their heads. And one day the dad came into my office. He's like, I figured it out. He was so triumphant. And he realized we'd been talking about the neurobiology of eating disorders and how consequences are more salient than rewards when someone struggles with anorexia. And that's why we play through the pain, that's why we stay up studying, because you gotta get that a. And he's like, I figured it out. You know, what's a big consequence is when she shows up late for school and everyone in first period turns and looks at her when she comes in, he's like. So I started making this high caloric shake. It was like an 800 calorie smoothie. And then he's like, I drove her to school every single day of the week. And he's like, I'd say to her, hey, listen, I don't have any meetings until 9:45, so I can stay in the car with you as long as it takes to finish your smoothie. I talked to the school counselor. You can walk into first period late, finish that smoothie in seven minutes every single day. Never got late to first period. But what was great about it is I didn't give them that idea because I don't know their child as well as they know their child. And so empowering parents to be remember that they are this child's parent. They are the one that can help them get better.
- [30:38]
A
Go back to what you're saying about cancer. Like, I don't know any parent is like, my kid doesn't want chemo. So. But they're 16 and one day they're gonna have to figure it out by themselves. And so I'm gonna let them make this decision. Like, I've never heard that.
- [30:48]
B
Never, never, never.
- [30:49]
A
We are kind of talk. I know we think a lot about good insight, about boundaries as part of our role. And I think the big difference, and it's so many of us experience this so differently that we have to reformulate it in our head is that these type of boundaries and assertion of what I think is parental authority without aggression is not something you do to your kid, it's something you do for your kid. And I think your whole model of eating disorder treatment is it's something you're doing for your kid, you do it
- [31:14]
B
for them and you do it with them, and you go through it together. You know, I talk with families when your kid is in crisis, whether it's depression or an eating disorder or self harm. I'm like, choose two things. Like, I don't want to hear about their grades improving or they're not swearing in front of their little brother or.
- [31:29]
A
Right.
- [31:30]
B
And one of the first things that goes is the no phones at the dinner table rule. And I'm like, if they need to, I don't know, watch Gilmore Girls on their phone in order to distract themselves to eat the meal, then that's what they should do. And you're going to do it with them. You're going to figure it out. You're going to sit and watch the show with them, get engrossed in something.
- [31:46]
A
Now let me ask you, you know, we focus a lot on repair at good inside for the parent listening who's thinking, shoot, shoot, I've missed it. What do you want to say to them or where do they start?
- [31:57]
B
So first, be so, so kind to yourself because you have been raised in this culture, this culture that. Well, also, if you're a parent, you are after having dealt with the be smaller, you know, look different, meet America's ideals of beauty. You're now also hitting the don't age, don't age, don't age. Something that there's nothing we can do about that.
- [32:18]
A
We can't live forever.
- [32:19]
B
We can't live forever.
- [32:20]
A
Yeah.
- [32:21]
B
So just be kind to yourself and calling it out is the best thing that you can do for your whole family. And again and again and again and again, you can say, oh, you know, when I had that ice cream last night with you, I noticed my old thoughts of feeling bad about it come up. I mean, I'll give an example with Maksima. When my son was 9, my eldest son was 9. This story just gets me still. He came home and actually we were getting ready for bed. So he was like in his underwear. This is still the days when the underwear was like colorful or had characters on it. They're so old now, the kids. But when he was nine and he grabbed his belly and said, I want to get rid of this, I heard that cold Showers would help. And the first emotion I felt was anger. I'm like, how did this get in my house? Right. He's a nine year old boy being raised by a parent who specializes in eating disorders. And so I want all parents to know that even someone who's worked so hard for all foods fit. My kids see me eat all different foods. It's going to get there because the culture, the society, their peers, it is everywhere. So don't get too mad at yourself. And you have this incredible ability to model that all foods fit, that you can change your behaviors, that just because you did something once doesn't mean you have to do it again.
- [33:36]
A
Yeah. You know, someone said to me it's like a proverb. I can't remember who originally said it, but, like, the best time to plant a tree is 20 years ago. And the second best time is right now. You know, the other thing I just want to give parents listening who feel like it's too late is I feel like when we're in it's too late mode, we're doing the thing we all do. We look back and we think about all, I could have done that. And that was a sign. And I didn't pay attention to that in the way I wish I did. And we all do that. And I don't think we could take that away. But what we don't add, I think, is this gaze forward where we're like, okay, my kid is 13, my kid is 23. However old they are, there's actually so many more years ahead than behind. And that's not to convince myself out of my guilt, but just to add, okay, like, I'm actually a lot earlier today than I am 10 years from now than I am. And there's, I think there's like hope and like a balance to that too.
- [34:24]
B
Yeah. My mom still wants me to be happy today, just like she did when I was 14. My mom still wants me to enjoy my life today, and so that'll be true too. And that story with Max, I had to tell my anger to move to the side for a second, but it was an opportunity for me to say to him, hey, did someone say something to you about your belly or is it something that you say to yourself? And he's like, oh, I say to myself. And I got to say, I'm like, you know, my brain says a lot of bad things about my body to me sometimes too. He's like, really? And like, yeah. And then we talked about, like, how do we talk back to our brain when Our brain's kind of a jerk. So it's the same skills we use for other things. But it was really an opportunity to remind our kids that this is a human condition. I think a lot of parents are tempted, as I am to say, what? No, you're not fat? Or you're beautiful? And instantly correct their thought for them, which, as you said, doesn't work. But additionally, it then signals that there's a right and wrong. There are kids that come in all shapes and sizes and might grow up to be an adult of all shapes and sizes.
- [35:29]
A
Yes.
- [35:30]
B
I remind my children that it would be nuts to be like, let's change your shoe size. No one's trying to change their shoe size. And they're like, this is a mom. What are you getting at?
- [35:41]
A
Right.
- [35:41]
B
They get very annoyed, but. And yet we try to change everything else. Our hair, our skin, our body shape, our weight, and just reminding people the futility of it. So if you instantly tell your child, no, they are not fat and they are beautiful, you've now told them that beautiful means not fat, and they aren't that. Well, they've got, as you said, Becky, a lot of life left. And one of the only inevitable things is that we are going to age, and our bodies are supposed to change weight as we age.
- [36:11]
A
You know, I'll never forget something my supervisor said to me once when I was in my postdoc and I was working on an eating disorders team, and we were talking about our own relationships, our bodies part of supervision. And she said, you know, it's interesting. I grew up, and I was never a big fan of my body. But she's like, I grew up in a family where. And we kind of talked about this idea of, like, your pie chart of self worth, and if your body doesn't make up the hugest percentage of it, like, okay, I don't like my body right now. Like, okay, moving on. And she said she got married. Her husband said to her, you might not be your own type. Oh. And it was, like, so beautiful to think about. Maybe we are not all, at all points in our life gonna say, I love my body. Maybe I don't love my shoe size. I don't know if I'm obsessed with my height. I'm 5:1. On a good day, I'd like a few more inches, you know, but as long as that or my relationship with my belly or my arms isn't, like, such a huge percentage of that pie chart, I can move about the world in a freer way.
- [37:13]
B
Oh, I really really love that. The goal isn't for our children to always like their bodies. Our goal is for our children to navigate the world and find joy more of the time than not.
- [37:24]
A
When you said that, that gave me chills. And like the goal isn't right for our children to always like their bodies. The goal is for our children to try to like themselves amidst a whole range of challenging experiences and feelings they're going to have in a million different areas for the rest of their life. Can you talk a little bit about the importance of kind of National Eating Disorder Awareness Week? I think that's. I'd love you to highlight that.
- [37:45]
B
Yes. So couple things. I mentioned that 40% of people who have eating disorders are male and I say that as often as I can because men are being overlooked. Once we started treating patients of all ages, the number of 40 year old men who sought treatment who had wanted to get care for decades but didn't feel like there was any place safe to go, thought that eating disorders were just a girl disorder. So I want to say that. So Eating Disorder Awareness Week helps remind people that everyone gets eating disorders. People of all ages, all shapes and sizes, all ethnicities, all races. I think another thing that's important is that if you are having any concerns, that means there probably is a problem. On a medical inpatient unit where I used to work, which is similar to all medical inpatient units across the country, half of the kids who end up on a medical inpatient unit, they're there one because their heart rate drops below 45, because they have become malnourished and they don't have an eating disorder diagnosis. And most have been sick for less than three or four months. So just want to remind people that eating disorders happen so fast they thrive in secrecy. So parents, if your gut is saying something's off, then you're right. I remind people that bad things don't happen. For asking your kid, if you think your kid's vomiting, ask, are you vomiting? So many people say to me, I think my kid is vomiting. And I say, what did they say when you ask them? I didn't ask them. What are the reasons you don't ask them? They'll make it more secret if I ask them. Or maybe they're not doing it and they'll start doing it. Or maybe they'll get mad at me. Most of the time when you ask your kid, they tell you the truth and they're so relieved someone asked. So Eating Disorder Awareness Week is telling parents, trust your gut, Trust your gut. No one Knows your kid as well as you. And there's real reasons to act quickly. Eating disorders are the second deadliest mental illness. And since they happen so fast in kids, there's no such thing as getting treatment too early.
- [39:41]
A
You know, I think about this Mr. Rogers quote I've always loved when you say, ask if it's nameable, it's knowable. Love that your kid might say no. But you're also probably gonna get a parent sense in their response, right?
- [39:55]
B
And you also can ask things more than once. There's no. I mean, I think about how often I ask my other son Sam, if he turned in his homework. I never thought, like, I'm only allowed to ask that once.
- [40:04]
A
Let's end with this. A parent is listening right now, feeling, and I imagine there's a mix of more empowered, more knowledgeable, maybe also scared, ashamed, worried. What would you most want them to know?
- [40:17]
B
They hold the key to everything being okay. It is all within their control. They've got this. Bring in a village, Use your village, Talk to your kid, talk to your pediatrician, talk to an expert. There are outstanding treatments for eating disorders, outstanding medications. Your child will get through this just like they get through anything else. And they're gonna get through it with you, probably.
- [40:45]
A
There are so many things that stand out from my conversation with Dr. Aaron Parks. But the thing that's loudest for me right now, and I just wanted to share with you, is remembering that it's not too late. That if you have a gut sense of, ooh, is this a problem? It probably is something to pay attention to and that we are optimizing for our kids health and their long term mental health. Not the immediate moment about whether or not they're happy with us. That really, really stuck with me. And I find that really empowering. And I hope you do too. All right, let's end the way we always do. Place your feet on the ground. Place a hand on your heart. And let's remind ourselves, even as we struggle on the outside, we remain good inside. I'll see you soon.