How to Prevent Eating Disorders and Disordered Eating w/ Dr. Tom Hildebrandt

Summary

Podcast Summary: Raising Good Humans Episode: How to Prevent Eating Disorders and Disordered Eating
Host: Dr. Aliza Pressman
Guest: Dr. Tom Hildebrand
Release Date: April 18, 2025

---

Introduction In this insightful episode of Raising Good Humans, Dr. Aliza Pressman welcomes Dr. Tom Hildebrand, a clinical psychologist and director at the Center for Excellence in Eating and Weight Disorders at the Icahn School of Medicine and Mount Sinai. Together, they delve deep into the complexities of preventing eating disorders and disordered eating, offering parents practical strategies and expert insights.

---

Understanding Disordered Eating vs. Eating Disorders Dr. Hildebrand begins by clarifying the distinction between disordered eating and eating disorders. He explains that while disordered eating involves deviations from healthy eating patterns causing physical or mental distress, it becomes an eating disorder when these patterns dominate and become the primary source of distress.

“Disordered eating often occurs in the context of a lot of things, from depression to stress at school. It doesn't really become an eating disorder though, until that takes on a life of its own.”
— Dr. Tom Hildebrand [02:01]

He further adds that disordered eating is typically a precursor to more severe eating disorders, emphasizing the importance of early intervention.

---

Developmental Trajectory and Early Intervention The conversation shifts to the developmental aspects, highlighting that disordered eating can manifest early in life but often solidifies during early adolescence due to increased autonomy in food choices.

“We see disordered eating can be there very early in life... leading up to the real sort of emergence of most eating disorders is early adolescence.”
— Dr. Tom Hildebrand [03:35]

Dr. Hildebrand stresses the importance of establishing healthy eating environments during childhood to prevent the erosion of these patterns as children gain independence.

---

Establishing Healthy Eating Habits Without Over-Control A significant portion of the discussion centers on balancing the establishment of healthy eating habits with avoiding excessive control or focus on food, which can inadvertently contribute to disordered eating.

“If it's not broken, don't fix it. Think of it as creating a healthy environment around food.”
— Dr. Tom Hildebrand [04:44]

He advises maintaining regular family meals and offering balanced food choices without allowing children excessive autonomy over their diets, which they may not be developmentally equipped to handle.

---

The Role of Family Meals and Modeling Behavior Family meals are highlighted as protective factors against disordered eating. Dr. Hildebrand emphasizes the dual benefits of observation and modeling during these meals.

“If you're eating together, you can see if there is an issue that's there and you can model best practices.”
— Dr. Tom Hildebrand [06:17]

By consistently demonstrating healthy eating behaviors, parents can instill similar habits in their children.

---

Navigating Modern Food Environments and Autonomy Dr. Hildebrand discusses the challenges posed by modern food delivery systems and the increased autonomy granted to adolescents, which can lead to poor food choices influenced by peer pressure and the desire for immediate gratification.

“The food environment is now heavily influenced by this sort of delivery... The messaging is your preference dominates the decision.”
— Dr. Tom Hildebrand [10:07]

He recommends maintaining a structured eating schedule to counteract these environmental influences.

---

Avoiding the Deprivation Mindset A key takeaway is the avoidance of a deprivation mindset, which can lead to secret binges and exacerbate disordered eating behaviors. Instead of outright banning certain foods, Dr. Hildebrand suggests incorporating balanced alternatives.

“Asking particularly an adolescent not to do something rarely has that intended effect... have them add in other things that would compete with it that are more balanced.”
— Dr. Tom Hildebrand [18:23]

This approach helps mitigate the natural response to deprivation, where individuals may compensate by overindulging later.

---

Addressing Peer Influences and Contagion The episode explores how eating behaviors can be contagious within peer groups. Dr. Hildebrand explains that promoting regular eating patterns can serve as a stabilizing influence within these groups.

“Your child can be the source of change too. If your child maintains regular eating, it can actually be containing for the others in the group.”
— Dr. Tom Hildebrand [32:16]

He encourages parents to uphold healthy eating standards as a means to influence their children's social circles positively.

---

Supporting Children with Parental Eating Disorders When parents themselves struggle with eating disorders, it presents additional challenges in supporting their children. Dr. Hildebrand advises focusing on guidelines rather than rigid rules and differentiating the child’s needs from the parent’s struggles.

“Guidelines work a lot better than rules, particularly in an environment that's always changing.”
— Dr. Tom Hildebrand [34:19]

He emphasizes the importance of creating a supportive environment that prioritizes the child's health over parental anxieties.

---

Effective Communication Strategies Dr. Hildebrand provides actionable advice on how parents can communicate with their children about potential eating disorders without inducing shame or blame.

“It's not your fault, but it's our responsibility. We have to make sure that we put you back on a path where you can thrive.”
— Dr. Tom Hildebrand [39:18]

He likens the approach to addressing substance abuse, focusing on support and intervention rather than judgment.

---

Addressing Underweight Concerns and Encouraging Eating For children who are underweight, Dr. Hildebrand advises parents to prioritize health over academic or extracurricular commitments, reinforcing the necessity of regular eating for overall well-being.

“Eating has to happen and the environment has to support that pursuit of health. If it doesn't, it's like saying your health's not that important.”
— Dr. Tom Hildebrand [57:34]

He highlights the critical role of parents in setting health as a non-negotiable priority.

---

Key Takeaways for Parents

1. Distinguish Between Disordered Eating and Eating Disorders: Understand the nuances to identify when intervention is necessary.
2. Establish Regular Eating Patterns: Maintain structured meal and snack times to create a stable eating environment.
3. Model Healthy Behaviors: Demonstrate balanced eating habits during family meals to guide children.
4. Avoid Deprivation Mindsets: Incorporate balanced alternatives instead of banning specific foods to prevent secretive binges.
5. Promote Open Communication: Address eating concerns without shaming, focusing on support and understanding.
6. Seek Professional Help When Needed: Consult eating disorder specialists rather than general dietitians for comprehensive support.

---

Conclusion This episode provides a comprehensive guide for parents navigating the complexities of preventing eating disorders in their children. Dr. Pressman and Dr. Hildebrand offer valuable insights into fostering a healthy relationship with food, emphasizing the importance of structure, support, and open communication. By implementing these strategies, parents can significantly contribute to raising resilient and health-conscious individuals.

---

Notable Quotes:

• “Disordered eating often occurs in the context of a lot of things, from depression to stress at school. It doesn't really become an eating disorder though, until that takes on a life of its own.”
  — Dr. Tom Hildebrand [02:01]

• “If it's not broken, don't fix it. Think of it as creating a healthy environment around food.”
  — Dr. Tom Hildebrand [04:44]

• “Regular eating is our best protection against an eating disorder universally either side, right. Too much or too little, that food choice is toxic at a young age.”
  — Dr. Tom Hildebrand [60:27]

---

Useful for: Parents seeking expert advice on fostering healthy eating habits in their children, understanding the signs of disordered eating, and establishing supportive home environments to prevent eating disorders.

Transcript

[Dr. Hillebrand]

The following podcast is a Dear Media Production. As a parent in particular, you have to be of an ad mindset, not delete. A deprivation mindset will lead to more problems than an ad. So asking particularly an adolescent not to do something rarely has that intended effect in my experience. I don't know about you all, but like, saying don't do this is sort of like highlights that they should be doing it, but instead you add, okay, so if they are, you know, making food choices that are not very good for their health, have them add in other things that would compete with it that are more balanced.

[Dr. Eliza Pressman]

Welcome to Raising good humans. I'm Dr. Eliza Pressman, and today is a different kind of episode because it's a live conversation that we had at the Mount Sinai Parenting center about disordered eating and eating disorders. And we even kept in the Q and A because the questions that came up after our conversation were exactly the questions that listeners like you are having. I learned so much during our conversation about disordered eating and eating disorders. I just want to get it right to you.

[Moderator]

I'm just going to briefly let Everybody know that Dr. Hillebrand is a clinical psychologist and director of both the center for Excellence in Eating and Weight Disorders and the Hilden Preston Davis Living Laboratory at the Icahn School of Medicine and Mount Sinai. He's an incredible resource and we're so lucky to be able to speak with him today. I want to ask some really basic questions, and hopefully I think they're on the minds of parents in general. I think we're certainly an audience that is looking throughout the lifespan to think about how to support our kids to have healthy eating habits and how to prevent disordered eating and eating disorders. So first I just want to clarify the language. Can you help us kind of distinguish between disordered eating and eating disorders so that we know what we're thinking about and talking about?

[Dr. Hillebrand]

Yeah, it's a good question, and not the answer to it is probably a little bit more nuanced than I'm going to give credit credit to. But the best way I think to think about it is disordered eating is exactly what it sounds like when eating sort of deviates from a pattern that has kept you healthy or allows you to, you know, thrive in your life, caused, you know, physical or mental distress or problems and becomes an eating disorder when that kind of pattern takes on a life of its own and it becomes the primary source of distress. So I think disordered eating often occurs in the context of a lot of things, from depression to stress at school Stress in life, you know, we see that affect the way people eat and the decisions they make about food all the time. It doesn't really become an eating disorder though, until that takes on a life of its own. And that eating disturbance creates the primary distress and doesn't seem to be movable. Is not by the person's own will or by intervention easily moved back into a place where they're thriving and healthy again.

[Moderator]

Is disordered eating a predictor of eating disorders or are they kind of separate?

[Dr. Hillebrand]

I think the field is a little torn on this. I would say disordered eating is probably a stop on the pathway to an eating disorder for most people.

[Moderator]

Okay, so how early are we seeing disordered eating? I want to start with disordered eating and then we can move into eating disorders. But how early? What's the developmental trajectory typically?

[Dr. Hillebrand]

I think disordered eating can be there very early in life. Right. And it can be a reflection of the, the context you live in or environment that you live in, as well as life stressors that are occurring in the course of your life. Leading up to when we see the real sort of emergence of most eating disorders is early adolescence. And we see that kind of switch from this pattern that maybe wasn't optimal and maybe a side effect of a different thing takes on a life of its own as that independence starts to transition. Right. We, you know, that independence of decision making around eating and lifestyle starts to transition from directed by my environment and the family and, you know, community I live in, to more of a self directed choice.

[Moderator]

Okay. So when people are thinking about how to set up healthy eating habits for their younger children and, or if they have older kids setting up or resetting healthy eating in the household, how, like how do we balance? I guess, what does that look like? And how do we balance setting those healthy eating habits up with setting habits up about control and too much focus on the healthy eating?

[Dr. Hillebrand]

Yeah, I think, you know, first thing, if it's not broken, don't fix it. I think there's a, an intent, there's this, I don't know, myth of optimization. Right. Like if, if I'm otherwise healthy, but there's a little bit of room to get a little bit healthier with my eating, I can put a lot of effort into gaining, you know, an extra 2% advantage in my eating over whatever is healthy. In trying to gain that 2%, you might lose all of it. And to think of it that way, that that optimization, you know, message sort of can get, you know, overused. Most of us can figure out how to eat on our own. I think the best way to think of it, particularly early on as your kids are developing, is healthy environment around food, right? So kids are going to eat when they're hungry. They're going to eat the food choices that are available and they're going to borrow from the culture that's around them, right? Their family, the environment. That's where they're going to get there and learn how to make their food choices. It's when they get independent in, you know, later childhood, early adolescence, that we start to see some of that loss of the erosion of that environment. It takes on a different life and other things can take over.

[Moderator]

So how important is it to talk about like the food itself or should that not even be a discussion and you're just enjoying a, like a meal time with family and, and food is not part of it. And if you notice disordered eating, where, like, where do parents fit in here in terms of caregiving and support versus pressure?

[Dr. Hillebrand]

Well, I think that, you know, regular eating and family meals are key. Like we, we know that those are protective factors that if you can eat regularly, even as if a parent, if you're not a big breakfast eater, having breakfast for your children growing up, having that pattern be there is actually healthy for them. It helps them regulate in a lot of different ways. That might not even be obvious both in terms of their energy levels, but also just in the way that they sort of engage in their environment. From an eating decision standpoint, the second part of it is a family meal, right? If you're eating together, two things happen. One, you observe, right? You can see if there is an issue that's there, you're aware and it's apparent. But you can also sort of model best practices, right? If the goal is as a family to eat family style and you are choosing, that's modeled. The kids are learning not only from what they see their parents do or their siblings do, but then they're kind of able to get feedback themselves of oh, I ate too much or I felt like that was too much, or you know, I really have a preference for this food or that food. All of that kind of is embedded in that family context and that's where they learn it.

[Moderator]

And how do you feel about, or I guess more balanced would be both how you feel. And what does the research tell us about kind of how we're treating different kinds of food? You know, if we're focused on dessert, family style, portions, et cetera.

[Dr. Hillebrand]

So the key for me, I think this is where I See the most room for gain, which is we give at too young an age, kids too much autonomy over choice for preference of food.

[Moderator]

That's so interesting.

[Dr. Hillebrand]

They developmentally actually can't compute what they need to, to make a good choice at a young age. And by creating an environment where it's always like, what do you want? What do you want? What do you want? You actually are extending yourself as a parent. Because now, I mean, how many parents do we know. Been through this myself, right? You turn into a short order cook, right. Like I have for each child. They have their own preference. And next thing you know, my, my one meal turned into four meals because everyone's got such a different preference. And if I don't do it, I feel like I'm. If they learn early on before they're actually able to make those choices with the kind of things we want them to think about, they will ultimately choose based off of, you know, a, either highly high palatability, right. Which, which can set people up for bad decision making, particularly when they're autonomous, or this sort of alternative of I can seek attention and control in my family by making them do the extra three things that they need to do to make sure that I can eat. You know, I want to go out to dinner with my friends, but now I have this influence over where the restaurant's going to be because I refuse to eat out of pasta. Right. You know, I won't eat that. So now we have to go to this other. That kind of control sends a message to your kid that they have way more power over this whole family than they're probably developmentally able to make or take responsibility for.

[Moderator]

And then when are we sort of giving over a little bit more autonomy? And I guess if they're, I mean, to your point, if it's not, if it's not broken, there's, it sounds like just continue to have family meals, don't really worry about it, offer healthy choices, etc. But as you start to, as, as kids get a little bit older and have a little more autonomy, not necessarily over what is eaten at the meal, but more out in the world, are there signs that we should be paying attention to, to make sure that they're on a path, a healthier path? And I think importantly, has there been an uptick in eating disorders and disordered eating and can we talk about that? I just, I may, I maybe gave you too many questions.

[Dr. Hillebrand]

Well, I think they're, they're related to each other in the sense that, you know, the uptick I think is evidence of an increased and an effort to get our kids recovered from COVID and all the things they lost in it. Part of what we transferred over, part of what we gave back was like maybe way more autonomy and that decision making. And also a food environment that is now heavily influenced by this sort of delivery, whatever you want culture. Right. So yeah, you know how many people now on the regular order in food from all kinds, from anywhere, right? It used to just be like you could just get pizza, right?

[Moderator]

Order it like everything else and everybody having a different item.

[Dr. Hillebrand]

And the messaging in that is your preference dominates the decision. Not the environment, but your preference. And that's where developmentally it's a challenge, right? As a, as an adult you can weigh the. All right, what's the balance here? Like is it just palatability? Am I after or am I just like, I need a meal to get through the day and I can make a better choice? That's a different challenge for my brain than it is for a 13 year old.

[Moderator]

Okay.

[Dr. Hillebrand]

13 year old might very well be influenced by what are my friends getting at this time? I want to be just like them. Or it might be, you know what I, I really don't want to get. I don't want to feel uncomfortable in my own skin, so I better get the safest food or the opposite. I'm really just like, I want to feel good right now. So now I'm going to get the thing that makes me feel the best. I'm going to eat cookies for lunch, right? Like I'm going. And that they will run those either side of those. Those two extremes wouldn't be unusual for a 13 year old who's absolutely otherwise developmentally appropriate making that decision.

[Dr. Eliza Pressman]

Now for a quick break so I can tell you about my sponsors. Did you know that Fast Growing Trees is the biggest online nursery in the US with thousands of different plants and over 2 million happy customers. They have all of your plant and yard needs like fruit trees, privacy trees, flowering trees, shrubs and so much more. And whatever plants you're interested in. Fast Growing Trees has you covered. Find the perfect fit for your climate and space. Fast Growing Trees makes it easy to get your dream yard order online and get your plants delivered directly to your door in just a few days without ever leaving home. Their alive and thrive guarantee ensures your plants arrive happy and healthy. Plus get support from trained plant experts so that you know what to do to support your plants. They're on call to help you plan your landscape, choose the right plants and learn how to care for them. And then there is the indoor plant living. So just having beautiful plants in your home can make things feel better and healthier and more beautiful. I'm currently looking at my beautiful fiddle leaf fig plant, and if it gets dried up or something's going wrong, there's a plant expert on call on demand to figure out what's going on. This spring, they have the best deals for your yard, up to half off on select plants and other deals. And our listeners get 15% off their first purchase when using the Code Humans at checkout. That's an additional 15% off at fast growingtrees.com using the code humans at checkout fast growing trees.com code humans now's the perfect time to plant. Use humans to save. Today. Offer is valid for a limited time. Terms and conditions may apply. Now, I want to just remind you how awesome Wayfair is, because Wayfair, I mean, if you kind of Google anything that you want for home improvements, you're gonna come up with Wayfair because they just have everything and every budget price point. So my recent attempt to obsess on the Internet was for outdoor furniture for lounging and hanging, and Wayfair has so many options. So I was, like, still trying to decide between wicker and teak. Totally open to suggestions, but that's where they have it. That's what I'm fixated on. And this is not the first time that I've found everything that I need on Wayfair. If you go into my office, it is so organized by a combination of Wayfair storage products and frankly, a husband who goes in there and thinks it's fun to reorganize me. And it's all so convenient. You just order online and it shows up quickly. Shop the best selection of home improvements online. Get renovating with wayfair. Head to wayfair.com right now. That's www a y f a I r.com wayfair every style, every home.

[Moderator]

So how are we responding to that decision on either end of the extreme? What. What's the fine balance of knowing when to intervene and how it looks to intervene, especially when it isn't? Maybe if. If it's subclinical.

[Dr. Hillebrand]

Yeah.

[Moderator]

But it feels like this isn't a good idea.

[Dr. Hillebrand]

Yeah, I think, listen, if your instinct as a parent is that it's not a good idea, then you shouldn't do it. Right? You shouldn't let the sort of, like, wave of, you know, kind of norms that have shifted just dominate the. What. What you let happen to your kid. I, I don't, you know, I'm not a big fan of letting adolescents order food. I think that, that there's not enough decision making time between when they have the thought and what they end up getting that allows them for, to set them up to be successful. And I'm a big fan of regular eating. Regular eating tends to protect us against all of the, we'll call them the most toxic or the most dangerous of the eating disorders. And so if your kid can eat on a regular basis and again they might sometimes have a all dessert lunch. But if you know that's better than skipping it even if it's not optimal.

[Moderator]

Because we want them to have food.

[Dr. Hillebrand]

Three times a day, three meals a day, ideally a snack at least, you know, most of them need a snack after school, they'll get it anyway. And if you set the expectation up of not what am I in the mood for at 3 o'clock, but my snack is not a choice, but here's what it is and I'm hungry enough so I'll eat it. And I, you know, I always say this to parents, like how do you know whether your kid is hungry or not? If you present them with a total reasonable, balanced snack and they're like sure, I'll eat that, then they're hungry enough to eat it. If they're like nah, I don't want to eat, I'd rather skip that. But that you present them with a cookie and they say yeah, I'm hungry, that's what I want to eat. They probably want pleasure, they want to feel good more than they want hungry. Right. So that balance is kind of where you're trying to help them negotiate because it's not intuitive. And trust me, the environment wants them to buy the cookie. So all the messaging there is if your mood is low, you're feeling energy is low. Like here's your pick me up, like Starbucks Frappuccino because it tastes really good. It's almost like pretend coffee. It's, it's got a whole meal's worth of energy in it. It's got a whole meal's worth of energy in it. But it just seems like I'm getting a coffee with my friends after school. The alternative being like I'm not going to eat anything, I'm going to skip it because the Frappuccino is too dangerous. I've learned that if I eat Frappuccinos that I'm going to be, there are too many calories I'm going to gain. So now I'm making it, I'm actually hungry, but I refuse to do it because I'm dangerous and it's safe. So like those two extremes are what you're trying to avoid.

[Moderator]

Okay, so if like we are especially sort of in early adolescence as bodies are changing, parents are trying to avoid commenting on bodies, but when bodies are looking, either they're, you know, growing out before they grow up, or maybe they're just growing out because puberty is happening and, and, and, or they're not growing enough. How are we intervening there? Like, what is the point of making it worse, Fixating on it, commenting on it. Let's start with diet culture, I guess, and we can go from there.

[Dr. Hillebrand]

Well, I think as, as a parent in particular, you have to be of an ad mindset, not delete the, a deprivation mindset will lead to more problems than an ad. So asking particularly an adolescent not to do something rarely has that intended effect. It's been my experience, I don't know about you all but like say don't do this is sort of like highlights that they should be doing it, but instead you add, okay, so if, if they are, you know, making food choices that are not very good for their health or that set them up in a pattern that you have them add in other things that would compete with it that are more balanced. You know, that's to my point about the snack in the afternoon, right? Eat a, you know, apple and a banana and I don't know, high fiber crackers or something like that in the afternoon. If you're still hungry after that, sure, you can have a cookie as opposed to I'm hungry, I don't like any of that stuff. I'm just going to eat a cookie. And then next you've had three cookies or you say, you know what, cookies are bad, don't have anything. Then late at night they're going to have seven cookies or the ice cream bowl just gets doubly full at the end of the night as opposed to, and it's a natural response to that deprivation.

[Moderator]

Well, it's funny, I think a very common thing that maybe is in part because there's some social media about it and maybe it's just teenagers, but oftentimes when parents comment in any way, shape or form on what teens are eating, they'll say, you're fat. Shaming me.

[Dr. Hillebrand]

Yeah.

[Moderator]

And so how are we responding to this? And separately there's like something called Almond mom that's all over social media. And I think whenever you're promoting healthy eating, you'd be referred to as an almond mom. I think we can all agree that in most categories with young people, they're going to call, they're. They're going to do what they can to get us to change our behavior. But I think this one pulls it more of a thread.

[Dr. Hillebrand]

Yeah, listen, I think all that messaging, it sort of amplifies or makes extreme ideas that are otherwise founded in good common sense, sort of. You can add almonds or fiber or take any one of the things that we have some evidence for good for you. And you can add them to a diet that still has cookies and cake and ice cream and all the things that we're told not to have. And if you actually mix them together, you get your optimal outcome. It's when you extreme on either side that you create disordered eating or maybe from disordered eating to something much worse. And I think it's. That balance somehow gets missed because it's not a popular message to be, you know, I'm really supportive of health and to do that. I also serve ice cream every night.

[Moderator]

Right.

[Dr. Hillebrand]

You know, somehow that, oh, wait, I'm, I'm like, I'm not a follower. I don't believe, I don't truly believe in the message. Some people can have, can exclude ice cream and not have it and be totally fine. The question is whether or not it's worth the risk. Some people can't. And when they start that exclusion, like I said, it takes on a life of its own, and then we have a totally different problem.

[Moderator]

So introducing, because I think that does come up all the time, is sugar is the root of all evil. So now we're trying to cut sugar out of our fat family life. But now it's become about that versus your point. We're going to include the healthy foods and then sugar is there too. But at some point, are we saying, like, there's been broccoli, there's been fish, there's been fiber, there's been cookies, but there's still more cookies. Like, is there any point at which we say anything, or is this the area where if they're getting the healthy foods, we're just zipping it?

[Dr. Hillebrand]

Yeah, I think, you know, if they're eating a full plate of broccoli and fish and they're having one cookie and they're still not satisfied and they're continuing to eat a whole sleeve of cookies, at that point, it's indicative of a different kind of problem.

[Moderator]

Okay, tell us more.

[Dr. Hillebrand]

Yeah, so if, if they're continuing to eat that, then what we might have is either sub threshold or full threshold binge eating disorder. Right. And that binge eating disorder can come from, you know, two pathways. One is I have kind of an emotional response that I can't self regulate. And so I use food to self regulate that emotional. And it could be stress at work or stress at school, stress with family, stress with, you know, life in general. Right. It doesn't matter where it comes from. But that can be a natural response. And it's like a form of self soothing. So that becomes where an intervention. I have to be able to provide something else other than cookies. I can't just take them away because my kid legitimately has stress that they're not coping with.

[Moderator]

So if we're noticing these things because, you know, and maybe we can get into. Sometimes that's hidden, sometimes it's in plain sight. If it's in plain sight and you can help find other ways to support self soothing, what's a gentle approach?

[Dr. Hillebrand]

I, I just, I think, you know, actually talking to your kid, like, what's really going on? You know, I know you're not that hungry. I know the cookies taste good. I'm, you know, I'm not. And and to say, like, I'm not worried about the cookie choice. I'm worried about what you're not telling me. And no, and it, it's the. Because I know you ate a full plate. You seem satisfied. You had a cookie and then it seemed like you kept going back. And, and so I'm not worried about the cookies. That, you know, one sleeve of cookies does not make a health problem. It's a pattern where I, when I feel uncomfortable, I always go to the cookies. And so I want to disrupt the pattern. The food choice itself is not. Is just what it is. It's. It's something that happens to all of us. I always use the Thanksgiving dinner example. Right. Like when you eat too much on Thanksgiving, nobody thinks you have a disorder because it's normative. Right. And, and we believe it's normal. So like you're, you know, full sitting on the couch, like afterwards, like you know, spending time with family or whatever, and it's just a normative process. But when someone does it on a Wednesday night and they eat that and they at school the next day and you're thinking, oh no, what is, you know, my kids weight's gonna go up, they're gonna get shamed at school, they're gonna like you sort of put that catastrophe on top of it without understanding what it's really about then you kind of set it up like, let me change the behavior. It might be normative. Right. This kid feels uncomfortable. They've learned that food makes them feel better, so they are doing naturally what makes sense to them.

[Moderator]

So, and I think again, because teenagers say more about this than they used to.

[Dr. Hillebrand]

Yep.

[Moderator]

I think there's a very reasonable group that might say I'm self soothing. Like they're totally aware they're doing that. So now what are we saying?

[Dr. Hillebrand]

And you say it's, it's okay to self soothe and you made a choice about cookies tonight for self soothing. My job as a parent is to figure out what do you need soothing from and do you have all the options. Right. That's because I'm on your side. Right. I, I and then if there is a, you know, it's, it's also healthy to set limits too. You know, if I, I'm a big fan of the kitchen's not always open. The kitchen's open at certain times a day. It opens and closed. And if you're hungry, you'll go find, you know, the food then. And I'm not going to give you a hassle about eating time, you know, eating the food choices you make within that time. But the sort of the open kitchen approach I think is part of a, I'll call it a cultural erosion. Right. That food should be available anytime you want, in any context, as long as you feel it necessary. This is a modern problem, right? It's a very modern problem. That food is that available. In fact, it's two taps away from my phone and it'll be delivered to me, to me immediately. That is a modern problem. It does actually doesn't make sense in any way. Not even a hundred years ago, think of how hard you would have to work to get a palatable meal.

[Moderator]

I mean, I actually think that that is also pandemic. Probably had an influence on that because.

[Dr. Hillebrand]

You'Re just home all day in big and big city. But you know, it's now everywhere. But you know, it started in big city because there was a infrastructure to do it. And it saved this restaurant industry. There were all kinds of good things that came from it and soothed us through a very tough time at Covid. And so it does, it has that learning that we can't unlearn. And so now we have to sort of adapt and realize, okay, now that the, you know, the gates are open, food is available anywhere, all time, highly palatable. How do I protect myself against my environment? I have a regular pattern of Eating. I know that I'm never three to four hours away from a time to eat. So there's no amount of hunger that I feel that I shouldn't be able to go three to four hours without you.

[Moderator]

Okay. So if you are concerned that weight is going up, it's less about restricting food and more about restricting times.

[Dr. Hillebrand]

Regular eating is probably, it's the simplest but most difficult prevention strategy to implement if you are a regular eater. I eat my three squares a day with a snack one to two, depending on how many hours I am awake. Then the likelihood of you developing, you know, an excess weight problem or an underweight problem is very low.

[Dr. Eliza Pressman]

Now for a quick break so I can tell you about my sponsors. We spend so much time discussing screens, smartphones, online dangers, all the things, when to get phones. And you can tell that kids are just focused so much on like, when do I get a phone? When do I get a phone?

[Moderator]

So I really appreciate that.

[Dr. Eliza Pressman]

GAB is the leader in safe phones and watches for kids. And they don't have social media apps. There's no Internet browser. There is GPS tracking. So let's say you're kind of ready to let your child walk around, but you're kind of nervous because they don't have a phone. But you don't want to give them a phone because you don't want to open up the whole world of Internet browsing and social media. You, you can have that GPS tracking and they can feel like they can reach you and you can reach them. And everybody gets to listen to music, which is so awesome. It's the closest thing we have to.

[Moderator]

The old school way of being able.

[Dr. Eliza Pressman]

To just listen to your music, which is kind of the dream. But none of the stuff that is dangerous for kids that we have to monitor that we have to be afraid they're going to go down a rabbit hole and find something that they shouldn't have had access to. Protecting your kids has never been easier. For the best deal, sign up to Gab today. No contract [e-mail] humans that's Gab G A B B.com humans gabb.com humans Terms and conditions apply.

[Moderator]

There are so many vitamins and nutrients.

[Dr. Eliza Pressman]

We want our kids to get. It's really hard to get them. There are also a lot of snacks, smoothies that just have kind of junk in them. So I'm excited. There's something called Beam Kids, which is an all in one super powder that just launched. You can get your hands on it today. It has more than 40 essential ingredients to fuel healthy growth, including greens, Korean probiotics, fruits and vitamins. And even better, it comes in a chocolate milk flavor that kids love and it's pediatrician formulated so you can trust it. Beam Kids has 87% less sugar than most common low sugar gummies. And there are just so many vitamins on the market and it's hard to get all the nutrients in. Now of course, ideally we get all our nutrients from having three healthy meals a day and two snacks and everybody's great, but there's a lot to get in there and it can be hard. And beam Kids has 13 times the vitamins than other common kids supplements. Simply mix one scoop of Beam Kids with 8 ounces of milk, shake, stir or froth and enjoy, making it a convenient addition to any meal or drink. Beam Kids is now available [e-mail] humans because you're a listener to my show, you can take advantage of their limited time pricing of up to 35% off plus two free gifts using the code humans. Get your beam Kids and your free gifts by heading over to shop b a m dot com humans and enter the code humans. That's shop b a m dot com humans, and use the code humans for up to 35% off.

[Moderator]

Now how contagious is this? If you're in a cohort of kids, particularly girls, and I know that boys are having increases in eating disorders, but I want to ask about girls first. If you're noticing a friend who is hanging out with your daughter who has a clear eating disorder, is really suffering, is losing weight rapidly, whatever, whatever the physical signs are that you can see, and at what point are you intervening with your daughter mentioning or seeing like in a cluster of friends, group dieting, how are we helping kids along in those environments?

[Dr. Hillebrand]

Yeah, I mean, I would treat it the same way I would if, you know, one of my kids friends was drinking too much.

[Moderator]

Okay.

[Dr. Hillebrand]

Right. You know, it's this sort of like, you know, that behavior is not, it's not our household, that's not how we do it. You know, I'm not a parent of your friend, so I can't tell them what to do. But to realize like that, that that dieting culture, that practice is not what we practice here. And to set that limit, like people are allowed to be different, but that's, it's not how we approach health or not how we approach eating. And you go back to that regular eating and say, you know, the likelihood that your friend has consequences of this is much higher than if you just stick to what's gotten you to where you are now in this healthy place.

[Moderator]

And is it contagious?

[Dr. Hillebrand]

It is contagious, but it, but it's also contagious in the other way. Right. So your child can be the source of change too. So if your child maintains regular eating, it can actually be containing for the others in the group. It's when everyone chases the dieter, right, the extreme dieter, that it loses control and the group can actually be much more contained if someone's like, nope, you know, I'm sticking to this. And then it identifies that aberrant behavior, the extreme dieting more clearly and actually can help someone get help faster. You know, that that kid, once they feel outed from their own group in terms of their balance because they're not consistent, the degree of distress, it becomes more apparent, their parent notices more often, and we can offset what would otherwise be a really dangerous trajectory.

[Moderator]

I want to open up to questions with everyone else here, but I do want to address kind of one thing that, that is more difficult, which is what if the parents or one of the parents is struggling with an eating disorder? How can they help support their kids with healthy eating while knowing? Yeah, not knowing. I mean, maybe there's. Yeah, maybe there's a lack of self awareness. Maybe there is self awareness, but it's just been going on too long and too hard. What are we doing in those cases?

[Dr. Hillebrand]

Yeah, I think, you know, obviously it's easier if someone does have awareness because, you know, then, then you can learn how to, you know, kind of treat your child as their own individual and not part of kind of like your own self set rules in that way. Evening sort of kind of loves to use rules as a way to kind of control and maintain balance. And, and most kids don't need rules, right? They need, they need guide rails, they need the environment to kind of help them in the right direction and then they're able to figure it out on their own. If it becomes too much of a rule, then it can lend itself to kind of that eating disorder, you know, pathway. And we see that happen a lot. Guidelines work a lot better than rules, particularly in an environment that's always changing. And that's what we've seen with the food environment.

[Moderator]

So if parents are concerned that there is an emerging eating disorder, where are they going?

[Dr. Hillebrand]

I would love to say they should all come here, but there's probably no room. It depends on the time of year. Honestly, this is our super busy time of year. We've been doing this for 20 years. And I Can give you a chart that shows you that between we'll call it March 1st and the end of April, the rise in referrals, it exponentially increases. And then from about the last week in August through the second week in October, you see this big, dramatic increase in referrals. And it probably is. It bookends the summer. Right?

[Audience Member]

Yep.

[Dr. Hillebrand]

My camp approvals, my. You know, I end up at the pediatrician. The pediatrician notices. I'm not on my growth curve anymore. Now I get. Oh, right. I better go get this dealt with. It's fascinating, you know, the rate of referrals. Adults, it's a little different. They're kind of more steady. But. But anyone under the age of 18, there is this huge increase from March 1st through the end of April that I can count on every year, keeping us busy. But seeing an expert is. Is what I would say. I think. I wouldn't start with a dietitian, to be honest with you. I think most people go to a dietitian because there's lots of them and they say a lot of things that are really helpful and they're smart and they know a lot about food. But I think, you know, if I'm really concerned about my kids eating. Eating, it's a little bit like sending someone. I'm concerned about your drinking problem. I want to send you to a bartender to learn. Right. Like that. And I use it in jest because that's not really what it is, but it kind of highlights a. My kid is thinking too much about food. And so I'm going to send you to someone whose primary language is the details of food.

[Moderator]

Yeah.

[Dr. Hillebrand]

And so while it may seem reassuring in some sense, it doesn't actually help get away from the problem so easily. Now, there are great dietitians that know this and approach their craft very differently. They used. They're usually, you know, specifically, you know, eating disorder expert dietitians. Right. But an average dietitian won't necessarily know that. They'll use the language that they're, you know, that they're trained in and that they're comfortable with. And that, I think, really kind of masks a problem when we have a disordered eating kid as opposed to helping them.

[Moderator]

Can you give the language that parents can use if they're seeing something going on where they feel like this has gotten to a point where we need outside support, whether it's because they're seeing overt symptoms or whether they have a hunch. What are some ways to sort of approach this, particularly if the child's teenager isn't ready for talking about it.

[Dr. Hillebrand]

Yeah. So I, this is one of those things where I think you, you don't have to be afraid of your kids. If your kid was blackout drinking, would you be afraid to talk to your kid about drinking? Probably not. I hope in most cases not. If your kid is dieting to the point where they're losing and it's costing them health, being afraid of talking to them about them is saying like, I give you implicitly, you know, permission to blackout drink every weekend. And people. No. Right. No parent does that, but they don't think of it that same way because dieting seems somehow less dangerous.

[Moderator]

Well, and also half of the adults they know are doing it.

[Dr. Hillebrand]

Yes. And again, like if your kid is like, I want to be a blackout drinker and if they, at age 30 want to be a blackout drinker, there's not that much you can do about it. They can decide. But until they're, you know, their brains are fully developed and they're off here. Right. We, there are responsibility. Right.

[Moderator]

So we have.

[Dr. Hillebrand]

Yeah, we got it. We have to make that decision for them. And if they can't make it because drinking is just too appealing or dieting is just too appealing, then we have to be able to set that limit and say, I know you're going to hate me, but I can't let you drink. It's not going to work. You've already proven you've tried it. And your friends, they drink and no one ended up at the er they didn't black out from it. They somehow figured out a way to self regulate. I wouldn't want them doing it either. But you've crossed a different line here. And I think that metaphor works really well because most kids will get that right. They don't. None of you know, they know someone who drinks too much and they're like, yeah, I don't want to be like that kid. I don't have that kind of problem. But if you apply that to dieting, the ones who really get stuck, who have problems, it's very similar. And you can use it on either side. Whether it's a binge eating problem that they're doing in secret or whether it's a restrictive problem that, you know, they're denying sort of is dangerous but becomes more obvious as they lose weight and become malnourished.

[Moderator]

So if it's binge eating and it's in secret, what's the approach? What's the language that, that parents are using in that case? Because now you've got two things play. You've got letting them know that this secret isn't a secret, and then also how to help support them.

[Dr. Hillebrand]

Yeah, I would say, you know, the, the best stance to have is it's not your fault, but it's our responsibility. And so I don't blame you for eating in secret or having this. Like, I actually don't think it's your. Your fault at all. I do know that it's not good for you, and I can see just you're distressed enough about. It's our responsibility to make sure that we put you, you know, back on a path where you can, you know, thrive in your life as opposed to be in this situation. And so we're going to do that. We're going to take responsibility for it, and it'll be hard. We're going to do things that are uncomfortable. We're probably going to have conversations like this that we don't want to have, but we're going to have them. Because I'm not afraid, because I care about you that much that I would rather you hated me and respected me for standing up to whatever this bully is in your head that's either making you eat too much or not enough than the alternative. You just sort of let that bully beat me up internally and said, well, you know, if I stay back and I don't intervene, like, eventually you'll figure it out. The other metaphor I use often is kind of like the abusive partner. Right. So if you, if you imagine your kid with an eating disorder, who's on that path of an eating disorder, has an abusive partner in their head that just is ruthless, criticizes them, makes them feel terrible for every mistake, saying, hey, you know what? That's your responsibility. Like, that's on you to fix is really unfair. I don't know if that's ever worked to help get a friend or family member out of an abusive relationship. What you do is you build up the strength of, you know, not the abuser, but the alternative. And so you can approach it as like, I know my kid is different than this. You know, my kid wouldn't. If a doctor said, you're underweight, say, oh, they're crazy, I'm going to diet anyway. They might not like it, but they'd be able to follow through with, you know, pursuing health as best they could. And I know you're. I know something's going on because you're not doing that. I know this is not really you. And that way we separate the sort of nature of our child. From that voice in their head that can take over. And adolescents get that voice in all kinds of different ways, right? That critical. They borrow it from social media, they get it from their friends. Sometimes they pick it up even from family members. Like that voice is there. And if we separate them from it, we have a chance at keeping them safe.

[Dr. Eliza Pressman]

Now for a quick break so I can tell you about my sponsors. So I want to tell you about Great Wolf Lodge so that you can start thinking about taking your family on an unforgettable vacation. Okay, not a vacation because it's a family trip, but it's not even a trip. It's an adventure. A world of fun all under one roof. You don't have to do anything but show up and all the fun and attractions are there. They have water slides, like crazy water slides that look like they are from just a video game or something. In addition to the indoor water park that has everything from water slides to wave pools to lazy rivers, water basketball and the whole thing. But they also have really cute toddler friendly slopes and climbing walls and mini bowling. There is just so much stuff, everybody will be exhausted. And then they even have free daily events like family friendly yoga in the mornings and nighttime family dance parties. And you just bring your pajamas and get dancing. And everybody stays in a themed suite. So the rooms have special bunk bed sleeping areas for the kids and then you get to relax and unwind after what will be a very long day of splashing and playing. Learn [e-mail] greatwolf.com Book now and strengthen your pack at Great Wolf Lodge. Greatwolf.com greatwolf.com okay, this year I am treating myself to the luxe upgrades I deserve with Quince's high quality travel essentials at fair prices. So I have a little honeymoon to take. So I'm getting their lightweight European linen styles and washable silk tops and they have premium luggage options and stylish tote bags. So all of this makes me honeymoon ready. And all the Quince items are priced actually 50% to 80% less than similar brands. So what they do is they partner directly with top factories and so they cut the cost out of the middleman, pass the savings on to us. But they keep the quality and Quince only works with factories that use safe, ethical and responsible manufacturing practices and premium fabrics and finishes, which I love. I have so many of their cashmere sweaters. For your next trip, treat yourself to the luxe upgrades you deserve from quint. Go to quint.com humans for 365 day returns plus free shipping on your order. That's Q-U-I-N c e.com humans to get free shipping and 365 day returns. Quince.com humans I know there are going.

[Moderator]

To be so many questions, so I want to just give a few minutes for specific questions from everyone. I, I know this information. Okay. We have a written question as a pediatrician. How should we address weight at visits for preteens and teens with obesity or overweight?

[Dr. Eliza Pressman]

That's a great question.

[Dr. Hillebrand]

Yeah, I mean, I, I think it's, you know, if you, I think the best approach is matter of fact, as opposed to sort of, sort of reducing health down to like one indicator. Right. So you put it in the context of the larger evaluation that you go through and sort of like, okay, so everything else might be, you know, measure normal developmentally or what you would expect, and weight is higher than you would expect. You could say, you know, the approach is, okay, one of our indicators of health is off here. What's going on? How can I help you get everything back in line as opposed to kind of a. We know lectures about weight don't work. If anything, they just sort of internalize shame. It doesn't mean that you ignore it though. Right? The opposite is just, just as problematic. But I think if you put it in context, it actually can be delivered quite effectively.

[Moderator]

Can we expand that? Because I think that's not just a pediatrician challenge, but a challenge which is, to your point, a lecture about weight can feel so shaming. But what is the balance between that and not saying anything?

[Dr. Hillebrand]

Yeah, I think it's the sort of, you know, you take the person as a whole, Okay, I, I see here all the things that you're doing well in life where you're great, you know, you're sleeping well, you're, you know, have a great social life. It seems like get along with their friends really well. And, you know, your weight is trended up off of your curve right where you're supposed to be or where you expected to be. What's going on there? Is there a way that, that we can help you with that part of your life too, as opposed to, you know what I see, like, your weight is really going up. And I think this is a problem. You ignore the whole other half of the person, you know, 95% of the person when you have a conversation. That's just about that one factor. And I think that's really where it gets in trouble. If you ignore it, like, oh, I can't touch that. I can't, I can't mention anything about weight. Then you, you are implicitly endorsing any problem that might be there. Right. And I, and I think we, you know, as parents, we understand, okay, this is, you know, partially genetics, it's partially environment, it's partially individual. Right. It's all of those things that can't be, you know, sort of one of those. It can't be just the individual that I blame, or it can't be just like, oh, well, it's the environment, there's nothing I can do about it. Or it's just, just your genes. There's nothing I can do about it. I'm a big fan of, you know, assigning blame is, is a pretty useless endeavor. But increasing responsibility is something that we want to do at a family level as well as an individual level. If we can teach that responsibility, then you have a better chance of affecting that trajectory.

[Moderator]

Okay, I'm going to read another question. What about a youngish child who has always been a grazer, just constantly wanting to snack, never eating full meals. If three regular meals and one to two snacks is the goal, how can you start to establish this habit and break the constant snacking?

[Dr. Hillebrand]

Yeah, I think it's, you know, it's about making those times initially pretty sacred. You know, I think of it and you know, if it's a young kid in particularly, the more family members involved as part of that process, usually the better it works. You know, if it becomes more problematic outside of that, sometimes it can be helpful to get an outside opinion, an expert, like our group or others can help with like, how strategies about how to establish that pattern and the individual. Sometimes, you know, if we have kids that developmentally have, you know, are neurodivergent in some ways, the attention might not be there. And that part of the grazing is a side effect of this inattentive kind of pattern where they, they lose interest in eating, in eating about four bites into the meal and they want to go run and do this other thing or do this other thing, and then you kind of like lose the thread on that. And so to engineer a successful meal might require a lot of steps, not just setting that limit, but might require sort of a bigger intervention.

[Moderator]

Okay, I mean, we have, I'm gonna do, I guess, two more. I'll just keep asking you until you have to give. Okay. Can you talk about the metabolic genetic piece to eating disorders?

[Dr. Hillebrand]

Yeah. So I believe that eating disorders are primarily metabolic illnesses that have psychiatric consequences that we've largely ignored. The metabolic piece of this because. And, you know, it's, I think, maybe enigmatic of our time, particularly how we understand psychiatry, but because it primarily affected women, because anxiety tends to be a primary feature of it, it ends up getting thrown into the, oh, it's just a sort of neurotic woman problem as opposed to ignoring, like, well, there might actually be a biological cause. This is not just, you know, the sort of psychiatric refusal to, say, gain weight or regulate their eating. This is actually being driven by something physical that we never asked those questions before. And we're finally. The genetics have been a big part of trying to tell that story. The, the highest degree of loading for genetics, particularly say, for the restrictive eating disorders, are metabolic genes. They're not psychiatric genes. They're not in the brain, they're actually outside the brain. And so I think as we start to understand that, we can actually reduce blame on the individual and say, like, listen, it's like diabetes, like type 1 diabetes, right. This is. You didn't ask for this. You didn't bring it onto yourself. It was like driven by a metabolic process that you were unaware of. That unfortunately means it's also your responsibility. You can't navigate the world the same way that someone who doesn't have these genes can. And you have to take a different kind of responsibility over that. That's an easier conversation to have with someone who's been blamed for their eating disorder for the majority of their, you know, by providers of all kinds, including mental health.

[Moderator]

I wonder how GLP1 research is going in terms of like, shifting the physiology and the thinking that's going on. And I. I'm curious. Well, now it's not fair because I'm getting to ask you more questions that wasn't written, but I'm sure everybody else is.

[Dr. Hillebrand]

I was surprised I haven't been asked you about GLP1.

[Moderator]

Yeah, I'm curious just in terms of disordered eating and thinking and also the physiology, but also the messaging.

[Dr. Hillebrand]

Mm.

[Moderator]

With teenagers.

[Dr. Hillebrand]

Yeah. So. So we have seen more problems than successes. Obviously we have a. A biased sample with GLP1s in our population. We. We've actually seen otherwise healthy people be induced into anorexia from GLP1s that they cannot get. You know, the anorexia now is persistent even though the drug is removed, so it can actually trigger an illness that otherwise wasn't present. I think the effects in folks who are binge eating or who have excess weight of some kind are more limited. Those data are not yet available, but anecdotally I can say the effect is not the same for a binge eater as it is for someone who just has excess weight but no binge eating problem. I think it's again, it comes down to what's contributing to the binge eating isn't the same mechanism that's contributing to excess weight. And so even if they lose weight but binge eating persists, distress can still be just as high. And we see that regularly.

[Moderator]

Okay, I'm going to go back to other people's questions. Can you please address the mind gut connection and the link between feeling anxiety and nausea. Ibs, is that considered disordered eating?

[Dr. Hillebrand]

I think it's a fantastic question. So for our restrictive eating disorders, arfid, avoidant restrictive food intake disorder for those who don't know it and anorexia nervosa, we now have some pretty compelling evidence that part of the side effect of that malnutrition is a disruption in the gut that is pretty remarkable. So your stomach has about a three beat a minute, you know, rhythm. And what happens in ARFID and anorexia, whether it's a side effect of malnutrition or some other trait level problem, is that that's suppressed. And so you could think of it as like now my stomach is not prepared for the food, I need to feed it to get more nourished and my GI complaints go up. So now when you ask me to eat more or to eat differently, my stomach gives me feedback regularly that tells me I don't feel good. And so in the absence of restarting that stomach rhythm, we have like a major metabolic or physiological obstacle to that kind of refeeding process. And so I think what we have is a, you know, kind of a trapdoor effect. If you lose weight and you have this kind of weak stomach, you have now what can be primarily phys physiologically driven eating problem. And we work pretty closely with the GI folks here where we can and helping to, you know, there are some that are just natural, you know, I have true IBS or I have, you know, some sort of food allergy or other gut related problem that just made it harder to eat and then I got malnourished and there are some that it's the other way around. My malnourishment sort of led to a GI problem that now has this trapdoor effect. So I think it's an important distinction and I think when you collaborate well with other experts, particularly on the GI side, we can do a pretty good job of teasing apart who has like a primary GI problem and who has a primary eating disorder. Hi, all.

[Audience Member]

Thank you so much for doing this. I'm going to try to ask this. Clearly you mentioned that as a parent, you do ice cream every night after dinner. And maybe you were exaggerating, but maybe you're not, you know, as a. As a parent who's trying to correct, you know, a generation of unhealthy eating habits that were bestowed on me, which is me and, you know, how many other millions of people listening to Dr. Presley's show. Can you help me navigate the boundary of how much. And I'm going to just put a quote of how much a kid eats. And we know that they determine that themselves, but I'm saying, like, let's say they want dessert after dinner. And my answer is always yes. It's always okay to have a treat after dinner if we want that. And my kids are young, and I find that, you know, is it my responsibility to limit how much of that dessert they eat? And can you talk about my role in both giving them autonomy, but like you said, setting guide rails in terms of the quantity of things that I know are addictive. And I've never, you know, I never mentioned that these things are bad or whatever. I don't give them that idea. It's all about balance. And so I've kind of shut up about it. And I'm curious, what are your thoughts?

[Dr. Hillebrand]

Yeah, I would say, like, you know, if. If your kid is already, you know, saying, I want dessert every night, you know, my first question would be like, are you telling me you're hungry? Because here on, you know, choose a night, Wednesday night, I'm going to give you, I don't know, more of dinner, right? I'm going to give you the. Whatever we just ate, I'm going to give you some more of it. And they're like, no, I don't want that. And then you say, oh, so you weren't really hungry. Okay. Like, what else can we do that would be fun? Or that would be pleasurable. And if it's. If it's a, you know, the family is having dessert, right? Like, then everyone sits around and has dessert together. And it's part of this family process, not one that as a young child, I. It's not fair to ask them, do you want dessert or not? Because the answer is always yes. Right? It's too. It's like, over what? It's like, do you want to play on your phone like Roblox? The answer is always yes. Because it's designed that way.

[Audience Member]

So Can I specify cause I'm going to hate myself if I don't clarify later. They don't always ask, but when they ask, my daughter, who's 6, will ask me, like, she'll be like, can I have an M&Ms? And I'll, and I'll ask myself like, okay, it's the first time this week. Fine, of course. Then she'll ask me how many can I have? And I'm questioning, is that my job to tell her how I feel? Like it's my job, but I want to make sure that I'm also not setting up something where she never has autonomy over making that choice herself and then goes and eats 300 bags of M&Ms. The moment she leaves my house.

[Dr. Hillebrand]

Yeah. So I, I think at age 6, she can't compute that her autonomy is a myth. You know, if she, if you weren't feeding her and you said, okay, go out there and spend for yourself, she would not be able, able to do that. You as an adult might be able to, but she would not. Right. So developmentally that is a, is a, a side effect of our culture. Right. That idea that a six year old is asking, like looking for that feedback, I would say as a six year old, if you want to give her M&MS, you just put whatever you're going to give her in front of her and say like, that's it and there's no more discussion about it. That's the way it should work.

[Audience Member]

Thank you so much.

[Dr. Hillebrand]

Oh, sorry.

[Moderator]

Just very quickly and I appreciate your time. If you have a child who is underweight, do you endorse force eating? Because, you know, oftentimes when you're underweight, you then your stomach smaller and you're not as hungry. So what is your recommendation for how to get a child to increase their intake?

[Dr. Hillebrand]

Yeah, I think, you know, this is one of the hardest, it's obviously the hardest part of our job. Right. And this is the, it's maybe the most dangerous aspect of the illness is underweight or eating disorders. And then it becomes the most difficult to resolve. For all those things that I mentioned, right. Your body works against the natural like increase of weight in a way that's very hard to understand. As a parent, you set the expectations that health comes first. And if they can't eat enough to be healthy, then they also can't do the other things they need to be healthy. Right. Go, you know, exercise every day, play with their friend, like all of those things. And so eating has to happen and the environment has to support that pursuit of health, if it doesn't, implicitly what you do is say your health's not that important. What's important is this other set of things that you want to go do that's not eating. And it's not fair. Right. There's nothing fair about if you have an underweight eating disorder of any kind. Fairness is out the window. There's nothing fair about it. This disease will steal the best parts of you and use it against you to kind of corrupt your life. And so there's nothing fair about that balance because I haven't met anyone yet from 20 years where they pursued an eating disorder willingly, like their body betrayed them on a path towards some other goal. And it got, got them stuck in a way that they then can't get out of. Our job as, as healthcare providers, as parents is to say, like, we understand this is not your fault. You have to eat enough to be healthy. That's my responsibility as your guardian, as a caregiver. And it means more important than say, going to school today. And that's one of the hardest things for I think parents to turn that corner when they come get our help is if your kid didn't eat at all yesterday, refuses to eat breakfast in the morning, but has a test that day, the meal is more important than the test. And once the kid learns that, then they can actually get themselves through that difficult part. But if they don't learn it, it becomes a constant battle.

[Pediatrician]

I just asked one question just as, as a pediatrician talking with many families, some families who are like, show them the growth curve, show how overweight they are and there's a shaming component. And others who are like, don't, don't show them, I don't want them to know it. Like you have all this different agendas of families and we have children who are like, I don't need anything and yet my BMI is at the top of the chart. And you get like, they deny this. What is sort of like kind of our mindset of what I want to make sure I convey with all families, all joint, it sounds like, get the healthy food in set limits and guardrails and don't skip meals and stuff. But if there's just sort of things that we as providers can make sure we share the science, what are those few science things that for all families, I want to make sure they know.

[Dr. Hillebrand]

Yeah, regular eating is our best protection against an eating disorder universally either side, right. Too much or too little, that food choice is toxic at a young age, that it Actually overwhelms them developmentally. So that parents have, whether their kids like it or not, they have permission almost the sort of like charge with setting the food environment for their kids and not letting culture do it. And the science supports both of those things. If you want to prevent an overweight problem or you want to prevent an underweight problem, until there's true autonomy being developed, the kids should not have that much influence over what they're eating. You've been convinced by advertisers that they should I go Back to the McDonald's. Like the happy Meal, Right. That Happy Meal is sort of convincing your kids that they should be able to pursue that, as opposed to parents kind of dictating what the family gets. And Dr. Hildebrandt, quickly on that. When do you think children start to have autonomy or, or you can let them start to make choices? Yeah, I think you. But it's, it's, it's a little fuzzy, right? When, when do you start to say, okay, you can make a choice here? Yeah, I think it, it's obviously different for different meals. Like, school does some of the work for you, right? Because eating lunch at school becomes a necessity. And not everyone can feed, you know, so part of that food practice, the choice comes with, you know, natural school decisions. I would say when they're responsible enough to self initiate their own homework in a, in a way that is responsible, then they can start to make food decisions about what am I going to pack in my lunch or what am I going to do for lunch today? That, that's when they sort of start to demonstrate that autonomy. That's a rough marker. There's no universal one. Like parents know their kids, but it happens. Sometimes, you know, not till someone's 17 or 18. Sometimes you got a kid that can start making that decision earlier in adolescence, 12, 13 even. But it's never unit. It's never all or nothing. It's never like, you know, okay, you turn 12 now, every one of your meals, you get to decide what you want. It's much more gradual. It's the start with, I don't know, breakfast. And if you see it's reasonable, then you give more over. You give more of that autonomy over. And you think of it as a graduated approach as opposed to all or nothing. Thank you. 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.