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Raising Good Humans
ARFID, Anorexia, Bulimia & Binge Eating: What Parents Need to Know with Dr. Erin Parks
00:52:45
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- [00:01]
A
The following podcast is a Dear Media production. Welcome to Raising Good humans podcast. I'm Dr. Aliza Pressman and today's episode I'm talking with Dr. Aaron Parks, who's a clinical psychologist, researcher and co founder of Equip. Dr. Parks has over 15 years of experience working with adolescents and adults in various eating disorder treatment settings. And then she co founded Equip and is on faculty in the Department of Psychiatry at UC San Diego. This is a really helpful episode to learn about eating disorders. When to worry, when to not worry, things that you can do for prevention, signs to look for. And we're talking about the range of eating disorders from anorexia, binge eating, and also things like arfid, which are a little bit less known more than picky eating. It's serious food restriction. I wanted to talk with Dr. Aaron about ways that parents can support their kids, set up healthy eating in the house and body images, and also when to worry and what to do about it. So I want to start with the basics. I want to sort of calibrate so we're all talking about the same thing. When we talk about eating disorders, what are we talking about?
- [01:29]
B
Such a great question. Eating disorders is actually an umbrella term and there are about 10 different diagnoses that fall under that umbrella. The first one is arfid. It's an acronym that stands for avoidant restrictive food intake disorder. And you can kind of think about it as picky eating gone awry. This usually starts around toddlerhood and. And these are kids who will grow into adults who have extreme picky eating. And this picky eating either impacts them physically, so we will sometimes see a 10 year old who weighs the same as when they were six, or it impacts them socially. It's hard for them to go out to a restaurant or be at a party that's serving food because there's so few foods that they eat. So that is one diagnosis. Another diagnosis is anorexia. I think this is what most people think about. I would say this is like the Hollywood version of an eating disorder is often thought of as anorexia. This usually starts around puberty and it is when someone does not consume enough calories in order to function physically and mentally at their best. So this is often when you'll see people restricting. Restricting can be entire food groups. So people might stop eating sugar, stop eating things that they deem as sweets, stop eating gluten, stop eating dairy, but it could also be just changing the quantity that they eat so they eat less and less at every meal or changing the frequency with which they eat. Another big hallmark of anorexia, though, is the way that it impacts, or I'd say really hijacks the brain. So the brain is always thinking about the body and food and any perceived flaws in the body and feeling like you have to eat less in order to reduce your anxiety and feel better about yourself. The next diagnosis is bulimia. This starts typically around the teenage years. And granted, while I said anorexia starts around puberty, we are seeing about maybe 25% of cases that start later in life. So I'm just saying when generally most of them start, bulimia generally starts in the teenage years. That involves often, usually also restricting, so eating less frequently or a smaller quantity of foods, labeling foods as good and bad, but also sometimes having binges. And a binge is when you eat more in one setting. And than I'm going to put air quotes, a typical person would, during that binge, you feel out of control. You usually feel a lot of guilt and shame. And then to compensate for that binge, you engage in a purging behavior. Most often this is vomiting, but it can also be excessive exercise. It can be taking laxatives or diuretics. And it can also be extreme restricting following a binge. And then the final type of eating disorder I'll talk about is binge eating disorder. This affects the most people. Binge eating can start at all ages, but we see it more often diagnosed in adulthood. And this is very similar to bulimia, where you have these binging episodes, where you consume a large quantity of food at one time, you feel shame, you feel out of control, but you don't have that compensatory behavior of vomiting or excessive exercise. So that's what makes it a little bit different than bulimia. So that, in a nutshell, are some of the different diagnoses under the umbrella of eating disorders.
- [04:34]
A
Okay, so there's so many gazillions of questions that I have. I think for most parents listening, the first concern is like, because I do want to talk about prevention and household habits and stuff, but I also want to talk about what are some of the signs for each of the three categories that you were talking about? Are there early signs that feel like if we could get in right about now, we can kind of either turn the volume down and what this looks like or prevent anything from getting worse or, you know, talk to a healthcare provider. What are some of the signs? And I would say, like, yeah, bulimia, binge eating, anorexia, for all of those, what can we look out for? Especially if kids are on the younger side, meaning their. Their home.
- [05:28]
B
One of the wonderful things about when your kids are young is they're doing the bulk of their eating in your presence. They often have breakfast with you, they often have dinner with you. You see them have snacks. So one of the first eating disorder signs you might notice is a change in eating behavior. So this might be. They have always loved cookies and cream, ice cream, and now they refuse to have it. They're refusing to have ice cream altogether. Well, it's your birthday. Let's have some ice cream. Or it's a really hot day, and we haven't, you know, been in this town before. We're on vacation. Let's GR some ice cream. And they're absolutely refusing. That is a good example of, wait, maybe I should be a little bit worried. Why will they no longer eat their favorite food? Another is if you start to see your loved one label foods as good and bad and really start moralizing foods. So first, why is this a problem? If you start saying that cake is bad and spinach is good, you then think, when I eat spinach, I am good. And. And when I eat cake, I am bad. Your child is not bad when they eat cake. And that's the reason why we don't want to moralize food. So if you start seeing your child group foods into different categories and have very black and white thinking about them eliminating entire food groups, I no longer eat sweets. I no longer eat takeout. I no longer eat things with sugar. That can be another sign, something that comes up a little bit later, and it's not for all kids, is, is if your child falls off their growth curve. So this will happen with both ARFID and anorexia. And so what I mean by that is when you take your child to the pediatrician, you get their height, you get their weight, and they graph it on their growth curve. But they also graph their BMI on their growth curve. So where are they at relative to their height and weight? Your child was in the 60th percentile for BMI when they were 3 and when they were 6 and when they were 9, we'd expect them to be at the 60th percentile when they're 12, when they're 15, when they're 18. If your child has a significant deviation from their growth curve, that is, I would say, a later sign, and it's really time to act. A lot of parents will take their child to the pediatrician, and one of the hard things is. And I'm the same way. You see your child every single day. And that's why, you know, when you go to a Thanksgiving dinner, the relative's like, you've gotten so tall. You're like, oh, yeah, yeah, I guess they have. But I see them every day, so I don't notice the changes as much. Well, oftentimes parents will take their kids to the pediatrician and the pediatrician will say, hey, your 10 year old weighs exactly the same as what they did when they were eight. You're like, oh, I didn't even realize they stopped growing. That's a red flag. Or your 15 year old weighs 15 pounds less than when you brought them here last year when they were 14. I didn't even realize that they were losing weight. Those should be big signs. Kids should continue to gain weight through their adolescence. You know, all the way through. I'd say even 18, 19, 20 years old, you are still gaining weight. You are meant to continue to be growing, and thus your weight should be going up.
- [08:22]
A
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- [10:15]
B
You know what I mean?
- [10:16]
A
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- [11:46]
B
Yes, great question. So for kids who are struggling with bulimia, it often means that they're vomiting after meals. Some things that you might notice are them going to the bathroom immediately after a meal or even more secretively is showering immediately after a meal. So if you notice that they take a shower immediately after eating, that should be a red flag. One thing that you can do to try it out is say, hey, like new family rule, for the first 30 minutes after we eat, you can have unlimited screen time, but we're all gonna stay down here in the family room. See how your child reacts to that. If it's really distressing to your child that they cannot take a shower or go to the bathroom immediately after eating, that could be a sign. I'll also hear from parents that say that they see residue. Kids might get good at purging, but they don't necessarily become clean freaks. And so parents might notice signs that vomiting is happening in garbage cans, in toilets and sinks. Additionally, they might find hidden food in their room. And this is different than your kiddo who like is always Snacking in their room and forgetting to bring their bowls of cereal when you're like, where are all the spoons? Right? That's just being a slob. Right? That's just being a normal teenager. And for some of us adults as well. But I won't let you all see what my desk looks like and how many different days worth of lunch I have sitting out here. But that can be a sign as well if you sense that they're secretively eating. So that might suggest that they are binge eating. Oftentimes when someone is binge eating, though, you're also going to see signs of restriction. So most people who binge eat will try so hard, usually out of guilt and shame, to not eat for 3 hours, 5 hours, 10 hours, and then finally the urge to eat is going to be so great that they're going to eat a large quantity of food at once. And this might be, grab some stuff from the pantry, they take it up to their room and you're going to find like all these wrappers hidden somewhere maybe also they're, they're buying food and hoarding it, waiting to have a binge eating episode that night. So if they're hiding food, if they're secretive about their eating, if they won't eat in front of other people anymore, those can all be signs as well.
- [13:47]
A
And is it, is, is it limited to if they're sneaking it, like if they're in plain sight doing that, does that, is that functionally the same thing or it's totally different?
- [13:59]
B
That's a good question. Oftentimes binge eating is in secret. So if you're watching someone eat a large quantity of food, it is not necessarily a binge if they are just, you know, hanging out with the family and they're chatting and they're laughing. Usually binge eating creates a lot of, is associated with some distressing emotions. People feel shame, they feel guilt, they feel out of control. And also we sometimes see when people are very upset, when they're very sad, very angry. Binge eating or even purging, making yourself vomit will instantly numb you out. So some people use it as a numbing technique. Those are all reasons that I'd be less likely to think of something as binging is when you see it in front of you. Your child just might be really hungry or having a growth spurt or maybe they, I don't know, had to do homework during lunch and missed lunch. And that's why you're seeing them eat a ton at 3 o' clock when.
- [14:51]
A
They get home and could. So, like, if they're with their friends and they're all just like, it's a Friday and we're just gonna party, that's totally not the same thing.
- [15:01]
B
Completely normal. I'm very glad for that clarification. And I think we always have to think about both the physical and the emotional impact, but also the social impact. So much about an eating disorder takes people out of their lives. It brings them inside themselves, where they are ruminating, where they're obsessing about things, where they isolate. But eating a ton of pizza with your friends, I mean, let's think about maybe older kids, let's make them over 21. You're going out in college and you drink a lot, and then at 1 o' clock in the morning, you eat a ton of pizza after a night of drinking. That is a socially normal thing to do. That is not a binge and it's not a sign of an eating disorder. In fact, it's kind of a sign of potentially a healthy relationship with food if you're doing it every single night. Maybe not a healthy relationship with food, but everything in moderation. Food should be fuel, but it should also be comfort, it should be socialization, it should be culture. It should be all these things.
- [15:50]
A
Okay, so I want to address ARFID as well in terms of signs, though. I know it starts quite a bit earlier, but how do we distinguish between more typical picky eating and picky eating that is moving in the direction of arfid?
- [16:07]
B
So many parents will say to me, I knew something was wrong, and I said, you know, my kiddo's a really picky eater. And everyone says, oh, picky eating is normal, they'll grow out of it. And then the next year the pediatrician says they're going to grow out of it. And then the next year, I just keep bringing my concerns up. So first and foremost, parents trust your gut. Parents are usually right. You are going to know your child better than anyone else. So take them for an evaluation. There are free screeners online that you can do. What makes picky eating and ARFID different is that one, it affects their growth. If your kiddo is not gaining weight, that is a very good sign that it's arfid. I do sometimes meet with parents who are doing an outstanding job of trying to keep calories in their kiddo. So their kiddo might only eat six foods, but they're making sure that kid is having a milkshake every day so that they get all their calories so that Kid has ARFID but hasn't fallen off their growth curve. So what you're instead looking at is the quantity of foods that they eat. And I should say there's actually three different types of arfid because nothing is simple or easy. So there's one type of arfid. There's one type of ARFID that you're definitely going to know. This is when a kid has a phobia. So usually a kid will have vomited or choked and then like, I'm not gonna eat, I'm not gonna eat again, or I'm only gonna eat liquid. So that'll be sudden onset and you are going to know, okay, something's wrong. My kid used to eat normally. An event happened, and now my kid is eating less and less frequently, less and less quantity, is terrified of swallowing, is afraid they might vomit. So that's one type of arfid. You're gonna know parents, don't worry, you'll know when that happens. The next type of arfid is a kid who has low hunger cues. So they might eat a wide variety of foods, but after only a bite or two, my stomach's full, I'm not that hungry. And they might also misattribute some of their normal bodily sensations of digestion, hunger, fullness, as, something's wrong, I have a stomach ache, something's wrong. Well, no, nothing's wrong. You just are hungry. Or that's just what digestion feels like. So these are kids that usually tend to fall off their growth curve, but they just take one or two bites and then they're full, they're never hungry. So that would be a sign of arfid. And then the third is this picky eating. These are kids who, especially once you've had more than one kid, it's when you're like, yeah, I know what picky eating is. I also have another child. This is different. This is eating so few foods that as a family, it's hard to go out to a restaurant. This is eating so few foods that they don't want to go to a birthday party. I also kind of like to say this is eating so few foods that they don't eat pizza. It's amazing the number of 10 year olds I meet who are like, Aaron, can you please teach me how to eat pizza? Because they serve it at every birthday party and every soccer party. But I'm terrified, though. I'm terrified and don't want to eat pizza. But can you please teach me to not be terrified of eating Pizza. So if your kid's terrified of eating pizza, that might be a sign, right?
- [18:56]
A
Like, if pizza. That does feel like the line, like, if pizza is not even interesting, this.
- [19:02]
B
Is not even interesting. We've got a big problem. We also sometimes see these kids losing food. So they might, you know, at age five, they had six different things they'd eat for breakfast. They would eat bagels, they would eat frozen waffles. You know, they'd have six things. And then slowly, they only have five things. And before you know it, there's only one thing that they'll eat for breakfast, and it's only the pancakes that you make with chocolate chips that you put in. And you have to make them in bulk on a Sunday and freeze them. So that can be another indicator when the variety of foods that they eat just keeps going down, down, down.
- [19:33]
A
So along those lines, how can a parent know if they're accommodating this pickiness to the point of like feeding into ARFID versus they really just need to get calories into their kids so that this is what's happening?
- [19:50]
B
Yes. I would look at, first of all, how is it affecting your child socially? If your child can't eat at a birthday party or a soccer party, then you're accommodating them. If you are like, it's time to go get treatment. Can your family go on vacation? If you can't because it's impossible to find any place for people to eat, then you're accommodating them. Don't not go on vacation because of your child's eating. If your child is losing weight, or as is often the case with arfid, failing to gain weight so they weigh the same at age nine as they did when they're seven, then it's time to seek treatment as opposed to accommodating their picky eating. And most kids are picky eaters. And our palates are just a lot more sensitive when we're born. And so what we suggest for kids who don't have ARFID is lots of try a variety of foods. I'm not going to make you eat something that you find to be disgusting. It's really hard to eat things that are disgusting. But we're going to have you practice and you're going to try bites of lots of different things. And we're going to make sure you get your calories. So we're not going to say, hey, if you don't eat dinner, you don't get to eat. We're going to say, go make yourself a sandwich if you don't like what I've made for dinner and you're going to have to at least try it. That's at least the approach that we take. In my house, I've got one picky eater and one who is just getting a little bit more adventurous. So I feel your pain. Parents, it's really hard feeding ourselves, let alone feeding other people.
- [21:11]
A
So speaking of in the house, I think, you know, there's so many mixed messages because we have access to social media and there's so many fitness influencers and health influencers and now we've got like, even politically, like confusing messages about what is healthy eating, what are some ways to make sure that we do what we can in our household to foster a healthy relationship with food and also promote healthy eating so that there's this balance between. I'm not going to say anything because I don't want this to be a thing. But also, what if it's gone too far and you've said nothing, but now there's like really just bad habits? Like, what is the secret balance in the household?
- [22:06]
B
Yes. I think first is give yourself so much grace. It's not just our kids who are growing up in diet culture. We are growing up in diet culture. We've grown up in it, we're in it now. And as parents, we aren't just in diet culture, we're also now in the anti aging culture. Right. So we're supposed to both, we're not supposed to just never change as far as our body weight, but also our overall appearance. So for all parents, and particularly the moms, this is incredibly hard and you are navigating it at the same time as your kids. Kids, you're going to mess up, you're going to say the wrong thing. And no one thing you say or do is going to give your child an eating disorder. And in fact, there is zero evidence that parents cause eating disorders, but tons and tons of evidence that parents are in the best position to help their child get through an eating disorder. So number one thing, you're going to mess up, be super, super kind to yourself. We really encourage moderation, Moderation, moderation. Foods are not good. Foods are not bad. Foods are just food. Yes, some foods can sit on a shelf for three years and some foods will go bad on a shelf within. I don't know. I swear with strawberries, all my strawberries are going bad within a day right now. Yeah, exactly. I don't know if it's a Southern California thing, but I cannot get them to last longer. Yeah, that's true. And that does not make one of those foods better than the other. We should all aspire to eat a wide variety of food and eat food for a wide variety of reasons. We should eat to fuel ourselves, but we should also eat to be social. You don't want your kiddo being the kid with weird food issues on their first date. You want them being the kid that has a great personality or who has a really funny story about a trip that they took. Right. And when you are at a birthday party or you're with your friends at 2 o' clock in the morning and you're in college, you should eat that super greasy, probably kind of crappy pizza, right? That's good. There's nothing bad or wrong about that. So help your kids to see you experience food in a wide variety of ways and encourage them to experience it in a wide variety of ways. And this is easier said than done. I mean, I have a 14 year old son who you know, will tease me and he's like, yeah, yeah mom, I know all foods are good foods. And they are constantly fighting the messages that our culture gives them. And I think this is where parents have a real ability to model changing their minds. And so this is where we can say, you know what? I only ever had skim milk in the house because I thought that it was essential to make sure I consumed as little fat as possible. And now I realize there's really some benefits to getting our fats via dairy and I, you know, getting whole milk instead now for my coffee, I don't know, that's just like a little example. But just showing our kids that with new information we adjust our behaviors. And that is what social media and also just life and growing up is, is constantly getting new information. But how can we make sure we're taking that new information and putting it in our existing value system? And our existing value system is that nothing is all good or all bad. Everything can be great in moderation. And all foods that.
- [25:15]
A
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- [29:15]
B
That's like, I love it, though. No, it's fantastic. And I can think of a couple different, very recent scenarios. So first, congratulate yourself as a parent. If your kid is saying to you, I want to eat healthier or I want to look different or I want to lose weight, they are being open with you, and you've clearly created room for them to tell you that. So you should first feel really proud. I think next is it's a great time to tell them the truthism, that we don't have that much control over our weight and our body shape. We have no control over our shoe size. And we have just accepted that we don't have that much control over our height. And we've accepted that as a society, we figured out ways to change our hair, change our breasts, change our wrinkles. And that's fine. We have bodily autonomy, and we can do those things. But we do know that we have a limited ability to change our body through diet and exercise. One of my absolute favorite studies is, it's very, very old, but they took a group of people who are all relatively the same in physical structure, and they had each of them eat an additional, I think, 1500 calories per day. And for most, I mean, that's a lot, right? And for most people, even just eating, I think an extra 300 to 500 calories a day, you might gain a pound a week. Well, so they were eating an extra 1,000 to 1,500 calories a day. At the end of eight weeks, some of them had gained 2 pounds and some of them had gained 22 pounds calories in calories out is just not entirely true. It's not entirely false, but it's also not entirely true. Stress levels, genetics, all sorts of socioeconomic factors, all sorts of things contribute to how our body is going to be shaped. And so I think the number one thing we can say to our kids is totally normal, that you want to change your body shape. That is the most American thing to want to do. So many of us, too many of us are unhappy with our bodies. I wish, I will say to my kids, I wish that I liked my body a bit more. I do things to try to like my body a bit more. But we do live in a society that's constantly telling us our bodies should be different. So of course you're going to absorb those messages and want your body to change. I am. I mean, if you want to. That's what I usually say to my kids. If you want to, I'm happy to talk about ways we can like challenge those thoughts. When your brain is telling you your body needs to change, I am totally here to help you with your diet and exercise and I think you're going to have more energy, I think you're going to be stronger. Maybe it will affect other things that you'll notice and maybe it won't. But I want to help kind of divorce for you this idea that if you just eat certain foods and you just exercise a certain way, your body will look a certain way. Because we don't have that much control in the long term. You might make some short term changes, but your body is going to go back to what your body wants to look like. So that is what I say to them. Obviously my teenager rolls his eyes when I say that because he's a normal teenager and we have a normal mom, teenage relationship. But I think it's something that is worth emphasizing again and again and again that we just have less control than we think we do.
- [32:25]
A
Okay, and what happens if the pediatrician, again thinking that they're being helpful, says something like, you're now you've gone too high on the growth curve and you need to focus on your diet and exercise and now it's like incumbent upon the parent to keep them from turning that into something harmful?
- [32:52]
B
Yes, I, I struggle with some of the questions that get asked in the pediatrician's office on those surveys that every single kid gets. So there's a survey that asks how often, what was it like, how many times per week does your kid have juice? And the answer is supposed to be once a week or less. You're not supposed to give your kid juice, but my youngest has a very hard time, has very low hunger cues and has adhd and with the meds has even more low hunger cues. And it's very hard to keep weight on him. And so he's been having juice with every meal since he was like 3 years old. And it's the same way, like you probably don't need to take an iron supplement if you don't have anemia and you don't need a magnesium supplement if you're not magnesium deficient. Well, you probably don't need to have a glass of juice with every single meal if you don't have a calorie deficit. But if you're a kiddo that I don't know is on ADHD meds or has trouble putting weight on, then having a glass of juice at every meal is going to really help you. So pediatricians have to think about what's the best advice for 80% of the population. And so sometimes they're going to share advice that's not a good fit for your kid. So this really goes back to, you know your child best. If you are hearing that they're having a bunch of body image concerns. If you're watching them having changes in behaviors around their food, this is when you tell the pediatrician ahead of the visit, hey, you're not going to talk at all about food and weight with them. You and I can talk about it after the session if you want, but you know, you're free to have any other conversations with them. And we work with thousands of pediatricians at my company Equip and they really respect that. We also do have these little cards that sometimes people give to their pediatricians. They're like, I don't want to be weighed card or I don't want to know my weight. And that can be really helpful for people who are trying to disentangle weight from health or trying to not have weight be this number that means so much to their kid.
- [34:42]
A
Right. I guess, like, I should check in about this because I'm so curious, but I don't, you know, like, know how this impacts pediatric eating disorders and everything. But I'm wondering, like, what happens with GLP1s in the context of eating disorders. Like, is this, is there research that's looking at a future of they're actually going to benefit because their brain space is less taken up or is it going to be harmful because now there's like an easy access way to not want any food do. Is that something parents should be talking about with their kids? I think this goes into the category of like things that adults might do inadvertently or openly that could be problematic. And I'm, I genuinely don't know what the research says about it, but I'm imagining there's this new, very wide open out there medication that's changing the course of kind of bodies and obesity. And I'm so curious, like, what happens when adults are talking about that for kids.
- [35:51]
B
I asked my son when he was 10, do you know what Ozempic is? And he's like, of course. I'm like, what do you mean of course? He's like, I know. And he's like, is it one of the Kendrick songs? I'M like, okay, it's one of the Kendrick songs. So yeah, there you go. It's in the Zeitgeist every everyone knows. And I mean, I could have never imagined this. Is there a world in which everybody knows the name of a diabetes drug? Like, no. But this has gone beyond. This is clearly part of the Zeitgeist. So if you're listening to this, you could guarantee that your child knows what an Ozempic is or what a GLP one is. They are medications that have been absolutely life saving and life changing for some people. And they've been medications that have been used for esthetic purposes to help people lose weight and they've been medications that have helped people have an eating disorder. All three of those statements are true. And I don't know what it would be for any. I mean, I have plenty of adults in my life that say, like, what do you think, like, about Ozempic? Like, should I go on it? Should I not go on it? Strongly believe in bodily autonomy after the age of 18. I'm definitely going to try influence what's happening with my kids before the age of 18. And I just the same way we should not villainize or moralize food is good or bad, we shouldn't moralize medicine as good or bad. So GLP1s are neither good nor bad. They are a medication. We don't have good research on people who are under 18 taking GLP1s. One of the claims of GLP1s is that they help to reduce food noise. Our hunch, I'll say at this point is that for maybe 70% of people, food noise is actually hunger. So you are hungry. So you're not having food noise, you're just hungry. I like to think about this. It's ever. It's so much easier when we think about things with dehydration. So just imagine I'm like, hey, I'm going to give you a million dollars if you do not drink any fluids for three days. Well, probably before the end of day one, you are going to be constantly thinking about a cold glass of water, maybe even iced tea. Who knows? You're going to dream that night and hear water running. You're going to dream of waterfalls. I mean, for some of you, if you've ever gone to bed drunk, you might have also dreamt about water because you were very thirsty, right? Your brain is going to constantly think about water because your brain doesn't care if you're happy. Your brain doesn't care if you get those a million Dollars. Your brain just wants you to live long enough to basically make other humans. And so your brain will constantly think about water until you drink. The same thing is true about food. If you are not eating enough food for your body, you. You're going to constantly be thinking about food until you eat. So for some people, you're not having food noise, you're having hunger. Now, there are some people who maybe if you think about it similar to substance use, is kind of an easy way to think about it. I enjoy a glass of wine and as someone who has never struggled with substance use disorder, I don't think about the wine again, I don't crave the wine. I don't have wine cues, wine craves or urgings. Right now we think there's a subset of people who, this isn't hunger cues, their body is having. The food noise might be more of a craving type reaction. But the research isn't there yet. And so for kids under 18, until it's been very well studied, I think all parents should do their research, work with their medical team, trust their gut, and find out if it's a good fit for their kid. Now, your kids can get GLP1s off market easily. They're being compounded. You can get them, you know, the same way you can have a bottle of wine delivered to you now, you can have GLP1s delivered to you if they have, if they have access to a credit card. If your Child is using GLP1s to lose weight for aesthetic reasons, that's no different than in the 90s when people were taking fen phen to lose weight or when people are taking laxatives to lose weight. Right. It's taking a medication, not for its intended purpose. While you're still a developing adolescent, I would have a lot of concern while you're still growing, you're supposed to literally still be growing.
- [39:57]
A
And now for a quick break. So here's the deal. Zip Recruiter is a really good business. If you need to find someone pretty much in any industry to be a job candidate, you're hiring and you don't have a billion hours to go through resumes.
- [40:18]
B
So.
- [40:19]
A
So if you're waiting for the right candidates to apply, or sorting through resumes, or trying to get in touch with potential candidates, or finding candidates and finding out they're not actively looking for jobs, this is for you. So the future of hiring is very bright because ZipRecruiter's latest tools and features help speed up finding the right people for your roles. So you save valuable time to do the work that you're actually meant to be doing. So now try ZipRecruiter for free at ZipRecruiter.com humans. Use ZipRecruiter and save time hiring 4 out of 5 employers who post on ZipRecruiter. Get quality candidate within the first day. And if you go to ziprecruiter.com humans right now, you can try it for free. Again, that's ZipRecruiter.com humans Z I P R E C R U I T E R It is the smartest way to hire ZipRecruiter.com humans. Get out there and find somebody awesome. Okay, so what are some of the ways that like parents, especially if they have their own eating issues or body image issues, what are some of the ways you wish you could just like sprinkle them with some language around how they talk about their bodies, other people's bodies, food. Can you leave us with some concrete reframes of things that we might typically say because that's what we grew up with or that is what's popular on, you know, out there on social media or whatever it is. What are some healthier ways to talk about our bodies, our children's bodies, our food, our children's food, the whole thing, or not talk about it?
- [42:10]
B
Yes, yes. Okay. And I have some examples I can give to of things I've heard and I'm like, oh, I would have said that differently or things I've said that I would have said differently too. Because that's what it is being a therapist. Do what I say, not necessarily what I do. We're all trying to get better at what we do. I was at a dinner table and well, I should also remind people that often before someone goes through puberty, in the early stages of puberty, gaining weight is normal. So you will have a kid that's always been in 50th, 60th percentile. Suddenly they're 11 or 12 years old and they've gone up to the 80th percentile. They're about to have a growth spurt. It's going to be okay. It was during that stage that I was at a large dinner and There was a 12 year old and they commented on their belly and said, I really don't like my belly. And you know, the 70 year old grandpa at the table said, oh, why don't you start running? That would make it go away. That is not the response. It came from a place of love. But actually running is not going to make a 12 year old's belly go away. What's going to make it go away is the growth spurt that they had like eight months later. So what's the correct thing to say? There is. It's totally normal to not like our bodies, particularly when our bodies are changing a lot. That would be the perfect response if I could put it into 70 year old grandpa's head. As parents, be very cautious of when you are first criticizing your body. So the same way we hate hearing our kids criticize their body because we're like, you're perfect, you're beautiful. How can you know we made you? It's the same for the parents too. And we're modeling behavior that we're saying is normal. They're not going to believe us when we say your body is perfect. But, oh, can you see my thighs? Like, you should just be glad you don't have feet. Like, that doesn't feel good. So especially if you're genetically related, you're communicating something poorly to your kiddos. Another thing is when you talk about needing to earn food, you know, mom, why aren't you eating dinner with us? Oh, I ate so much, you know, at lunch today. Like, I need to skip dinner. Okay. Instead, maybe I had a really big lunch. I'm still full. Would be better than I have to skip dinner. I haven't earned the right to eat. You don't have to earn the right to eat. Or I didn't go on my run this morning, so I'm skipping dinner. Nope, you don't need to earn the right to eat. Another is pointing out flaws in other people. We are all very good at seeing flaws in other people. And we don't even probably realize how often those types of things slip out. Like, I can't believe she's wearing those jeans. Like, those are things that our kids also pick up on. And what's bad about it isn't that it's immoral. Like, we all judge other people. It's fine. That's why entire magazines and websites exist. But it's because the better we get at judging other people, the significantly more frequently we judge ourselves and we get better at judging ourselves. So encouraging or judging alongside with your kid, that means that their brain is just getting better at being like, I wonder if these genes look good on you. Stronger. Exactly. What can.
- [44:59]
A
Okay, did I. Are there more, More things that you just are like, oh, I wish I could sprinkle that into every household.
- [45:06]
B
I think, again, just not moralizing food. Like, stop eating those cookies. They're Bad for you. They're not bad for you. It's just we want to eat a variety of foods and we're about to eat dinner and I just don't want you to be full for dinner. It's not that the cookies are bad for you. Someone asked.
- [45:20]
A
No, no, no. Sorry to interrupt. I just, I was gonna say, what if they're like, I can have five cookies and have dinner, Leave me alone.
- [45:30]
B
Yeah, I mean, if your kid can have five cookies and have dinner, then great. But you'll, I mean, you know, very, very quickly if they can't, you're like, no. Last night you didn't have dinner the night before? You like, no. And one of the things that we do in this family is eat a wide variety of things. And you're not going to be able to do that if you have five cookies before dinner. And if you have a kid who's in a caloric deficit, who is playing water polo, if is having a high caloric expenditure. Yeah, eat all of those cookies before dinner. And then they'll probably also eat dinner because they need so many calories.
- [46:01]
A
I think, oh, I totally remember eating like a box of cookies after like a day of like hours of ballet practice and then a box of cookies, then I could eat a whole dinner and it just was like, you're, you're growing, you're starving. But okay, so then, and what about the response to comments like about body shaming? Is that sort of like tongue in cheek teenage or middle school kind of comments that are more preying on our fear that we are body shaming?
- [46:29]
B
I mean, I loved when that was a trend. I have not heard it in my house for about a year. So I am wondering maybe the trends are seven of it all replaced it. Right. And hopefully that. And as my kids said, now that the adults know about it, that one will finally go away. I'm like, okay, let's pray. But yeah, I think that if the kid, if a kid said to me, don't body shame me, I would probably say, did you really feel body shamed? And if they did, then great, we're going to talk about it. I did not mean to body shame you. I'm sorry. Like an example that I've heard come up before is, you know, my brother took five cookies and you didn't say anything. But I take even one cookie and you tell me to stop eating them. Like you care about me not gaining weight, but not my brother. And even if a child isn't able to articulate that as clearly, I Think as parents, we can all imagine a scenario where that happens. I think we are probably a little bit more cautious or a little more aware of our female children's bodies as they move through this world because we know exactly how much pressure this world puts on females to look a certain way. It's not even just a certain size. It's so much pressure. And I think there's probably a million different ways we accidentally try to protect them with good intention by maybe telling them to not have another cookie but not saying the same thing to their brother. And kids pick up on that.
- [47:46]
A
Okay, so if a parent is listening to this and they're like, oh, I think there's a problem. I think I need more support. Tell us how they can get it.
- [47:57]
B
Yes. Well, I could tell you about our organization, Equip, and there are also other places to get eating disorder support, but I think that Equip would meet the needs of a lot of your listeners. So we're at www.equip.health. we are in all 50 states. We are a network for all major insurance plans and offer a year of treatment that is both for the physical health aspects of eating disorders. So that's having a dietitian that can help you meal plan, can help reintroduce foods, but also medical team that can help monitor heart rate. For instance, we haven't touched on it, but eating disorders are the second deadliest mental health illness. So while most of you listening will have teens that will struggle with body image and disordered eating, for those who struggle with eating disorders, please take it very, very seriously. And the reason it's the second deadliest. It's the first deadliest is opioid addiction. Second deadliest is eating disorders is because eating disorders affect both the physical health and the mental health. So on the physical health side, we see on medical inpatient units, so this is a medical unit where people's heart rates are so low that their heart is at risk of stopping while they are sleeping.
- [49:03]
A
50%.
- [49:04]
B
5 0. 50% of the kids on that unit had never had an eating disorder diagnosis. Eating disorders come on really, really quickly. All of a sudden, before you know it, your kid has lost 20 pounds. Their heart rate is 35 when they're sleeping at night, and they're in a medical inpatient unit. So if you are concerned that your kid has an er, act quickly. They are going to be okay with your help. And they can be physically very deadly. The other side of it is they're also mentally very deadly. So the physical tends to Mostly be cardiac. You also often have digestive symptoms, cardiac endocrine symptoms, reproductive symptoms that understandably affects your entire physical body when you are not giving it the nutrients that it needs or not feeding it in the right way. But cardiac is the most often cause of death. On the mental health side, the rates of suicide in patients with eating disorders is seven times higher than the rest of the population and is significantly higher than most psychiatric groups. So that is why it has. It's the second deadliest mental health illness. So if you are concerned about your kiddo, the first thing your brain is gonna do is tell you. It's just a phase is what your brain's gonna tell you. Well, it's okay that your brain's telling you that. It's trying to like calm your anxiety. But as a parent, trust your gut and do some investigation. So on our website there are free screeners. You can also call and talk to someone. If the symptoms meet criteria for an eating disorder, you can go talk to your pediatrician. One thing that's a little bit unfortunate is most pediatricians aren't super well educated about eating disorders because they have to be educated about emotional million other things that happen to kids. And so if you feel like you, I hear parents say all the time, I told my pediatrician my kiddos, I think something's wrong. They're like, ah, picky eating is normal, picky eating is normal. And then finally five years later we get the ARFID diagnosis. Or finally two years later, I get the anorexia diagnosis. So if you do think that this is an area that your pediatrician isn't able to help you in, then seek out other experts. What treatment often looks like is working with the entire family to help the kid engage in pro health behaviors. So if they're having the urge to vomit after meals, how can we structure the home so that they can't go to the bathroom or they can't go to the shower, or if they are refusing to eat breakfast, eating very small lunches. How are we going to structure their environment to get them the calories that they need? And sometimes that means, hey, we're going to start breakfast earlier because it's going to take you longer to get through it. I'm going to make your breakfast for you so you don't even have to think about what to eat. And we're going to sit and watch Gilmore Girls as you said, so that we are distracted. We used to have a rule that there's no phones at the table during dinner. Now you can have all the screens that you want to distract you to get through the fact that you have to eat even when you don't want to eat. So those are different ways. But yeah. So our company is called Equip and our youngest patient is three and our oldest patient is 82 and we treat all eating disorders and their co occurring diagnoses.
- [51:51]
A
That's such a phenomenal resource for people because I think a lot of people struggle with like I don't even know if this is an eating disorder. I don't know if I should be worried. And I think having online just check in quizzes is really helpful and then having a resource in every state. Thank you so much for going through all of this so that people can just kind of get a sense of what to look out for. Some prevention and some things that are real flags.
- [52:17]
B
Well, thank you so much for having me. This has been delightful. I really enjoyed this. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.