Eating disorder recovery in a diet culture world

Summary

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Short Wave: "Eating Disorder Recovery in a Diet Culture World"

NPR | April 21, 2026
Hosted by Emily Kwong | Guests: Dr. Eva Trujillo, Maria Friedman

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Episode Overview

In this episode, host Emily Kwong is joined by 17-year-old mental health advocate Maria Friedman and pediatrician Dr. Eva Trujillo to explore the realities of eating disorder recovery in a society saturated with diet culture. They discuss the science behind eating disorders, the physical and neurologic impacts, the importance of compassionate support, and strategies for sustaining recovery even amid digital and media pressures.

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Key Discussion Points

1. Personal Stories and The Rise in Eating Disorders

• Emily & Maria’s Experience: Emily and Maria bond over developing eating disorders in middle school, noting a sharp increase during the COVID-19 pandemic, especially among teenagers who faced isolation and increased media consumption.
  • Maria Friedman (01:00): “You see the protagonists and they're all like, so beautiful. And you're like, do I have to look like that to be worthy to be lovable?”
  • Maria (01:19): “The world was spiraling out of control and now my body was spiraling out of control. And so what did I try to do? I tried to control it.”
• Recognition and Intervention: Maria describes how her restriction escalated (“2 servings of pasta became one...became no pasta at all”) until a health scare led to medical intervention.
  • Maria (01:43): “And it was only when we went to the doctor and they're like, no, this isn’t healthy. Your heart isn’t doing that well. You haven’t had your period in months, where it was like, oh, hey, that’s not really healthy.”

2. The Nature of Eating Disorders

• Not A Choice, But An Illness:

  • Emily (01:58): “Eating disorders are hard to put into words, but they are not choices. They are the neurobiological consequences of an illness that touches all areas of your life.”
  • Dr. Eva Trujillo (02:08): “Eating disorders literally rewire the brain. They’re not just emotional or behavioral.”

• Diversity of Those Affected:

  • Dr. Trujillo (04:31): “The stereotype of the thin, white, affluent teenage girl leaves thousands invisible and undertreated. Eating disorders do not discriminate—men and women, trans, non-binary people, children, adults, athletes, parents, immigrants, indigenous populations, people in larger bodies and those in smaller ones...”

3. Physical and Neurological Impacts

• Impact on the Brain:

  • Dr. Trujillo (05:31): “The brain is deprived of the energy it needs...there’s a reduction in what we call the gray and white matter...the brain is literally shrinking...”
  • Dr. Trujillo (06:22): “Patients often experience difficulty concentrating, obsessive thoughts about food, rigid thinking, poor emotional regulation...may resemble ADHD or depression...the brain is starving.”

• Broader Bodily Effects:

  • Dr. Trujillo (07:19): “Every organ can get affected...metabolism slows...the heart becomes smaller, weaker...bradycardia, which is dangerously slow heart rate, can trigger cardiac arrest even in young people who look healthy...delayed gastric emptying, bloating, bone density drops, hair loss, brittle nails, dry skin—all visible signs that something’s wrong.”

• Hope for Reversal:

  • Dr. Trujillo (06:51): “The good news is that many of these changes can be reversed with full nutritional rehabilitation.”

4. Recovery and Family Support

• Families as Allies:
  • Emily (08:33): “Families can be patients and providers’ best allies in treatment...how should someone approach a loved one?”
  • Dr. Trujillo (08:57): “The most effective way is very compassionate, nonjudgmental...if we don’t validate that suffering...they will close themselves...they won’t speak with us.”

5. Managing Diet Culture and Digital Pressures

• Social Media Responsibility:

  • Emily (09:37): “Eva, you were a part of a consulting panel for TikTok and Meta...on body image and eating disorders.”
  • Dr. Trujillo (09:54): Discusses successful advocacy to ban hashtags like #SkinnyTalk, but notes much harmful content persists.

• Sustaining Recovery Amid Triggers:

  • Maria (10:22): “What makes recovery sustainable, especially given all of these outside influences...from the Internet, diet culture, people around us? And how can we protect ourselves when these triggering images and words will inevitably appear?”
  • Dr. Trujillo (10:42): “Recovery is not just about weight or food. It’s about reclaiming life, identity, and connection...we educate patients and families to be critical about what they see, to use strategies about comparison and body image—change the conversation and you can change your environment and your life...must make platforms safer, smarter, and more compassionate.”

• Community and Systemic Needs:

  • Emily (12:14): “It has to go beyond the clinic—people surrounding the patient also need to be educated and on board.”
  • Dr. Trujillo (12:22): “Medical doctors receive less than five hours in the whole career of eating disorder education. That’s shocking.”

6. Advocacy and Hope

• Prevention and Advocacy:

  • Dr. Trujillo (12:37): “One of the most powerful tools we have is education—not just in treatment, but in prevention and advocacy. I always say, it’s not that I want to change the world, I just want to change the world of one person.”

• Maria’s Ongoing Recovery:

  • Maria (13:43): “I’m trying to really move forward, be like, how can I redefine what is empowering to me? How can I be whole without needing to micromanage every piece of myself? Because with eating disorders, it’s never just about the food. It’s all a manifestation of something more complex...I can learn how to stop sabotaging myself and to just try to learn to be me.”

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Notable Quotes & Memorable Moments

• Dr. Eva Trujillo (02:08): “Eating disorders literally rewire the brain.”
• Maria Friedman (01:00): “Do I have to look like that to be worthy to be lovable?”
• Dr. Trujillo (04:31): “The stereotype...leaves thousands of people invisible and unfortunately undertreated.”
• Dr. Trujillo (06:51): “Many of these changes can be reversed with full nutritional rehabilitation.”
• Maria Friedman (13:43): “I’m trying to redefine what is empowering to me ... learn how to stop sabotaging myself and just try to be me.”
• Dr. Trujillo (12:37): “It’s not that I want to change the world, I just want to change the world of one person.”

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Timestamps for Important Segments

• 00:40 – Maria and Emily share personal experiences with eating disorders
• 01:58 – Framing eating disorders as illnesses, not choices
• 02:08 – Expert insight: impact of eating disorders on the brain
• 04:31 – The wide range of people affected by eating disorders
• 05:31 – The science of how malnutrition impacts the brain
• 07:19 – Breakdown of physical impacts on the whole body
• 08:33 – How best to approach a loved one who may be struggling
• 09:37 – Digital and media landscape’s effect, platforms’ responsibilities
• 10:22 – Sustaining recovery: Maria’s question and expert strategies
• 12:22 – Systemic shortcomings in medical training
• 13:43 – Maria redefines recovery, empowerment, and self-worth

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Conclusion

This episode provides an empathetic, science-based examination of eating disorders, challenging narrow stereotypes and calling for a comprehensive, community-wide approach to support and recovery. The conversation highlights the necessity of digital responsibility, medical education, and persistent advocacy, while offering hope and practical insight for those navigating their own journey or supporting someone else. Maria’s story personalizes a complex issue, while Dr. Trujillo’s expertise underscores the biological, psychological, and social dimensions of eating disorder recovery.

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Transcript

[Commercial Announcer]

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[Emily Kwong]

You're listening to Short Wave from NPR. Maria Friedman is truly one of the coolest 17 year olds I've ever met. We started talking a year ago because she wanted advice on how to start a podcast.

[Maria Friedman]

Hello and welcome to Balancing Act, a mental health and wellness and semi unfiltered podcast.

[Emily Kwong]

Our conversation, though, quickly turned to something else that happened to both of us. We both developed an eating disorder in middle school. Eating disorders among teenagers skyrocketed during the pandemic. Maria's began during the COVID lockdown. She was cut off from her peers and spending way more time watching tv.

[Maria Friedman]

You see the protagonists and they're all like, so beautiful. And you're like, do I have to look like that to be worthy to be lovable?

[Emily Kwong]

And Mareia, who was already struggling with perfectionism and anxiety, started to feel awful about herself.

[Maria Friedman]

The world was spiraling out of control and now my body was spiraling out of control. And so what did I try to do? I tried to control it.

[Emily Kwong]

Eating disorders among teenagers skyrocketed during the pandemic. For Marea, 2 servings of pasta became one serving of pasta became no pasta at all. She had intense exercise goals, all in an effort in her mind to become healthier.

[Maria Friedman]

And it was only when we went to the doctor and they're like, no, this isn't healthy. Your heart isn't doing that well. You haven't had your period in months, where it was like, oh, hey, that's not really healthy.

[Emily Kwong]

Eating disorders are hard to put into words, but they are not choices. They are the neurobiological consequences of an illness that touches all areas of your life.

[Dr. Eva Trujillo]

Eating disorders literally rewire the brain. They're not just emotional or behavioral.

[Emily Kwong]

Pediatrician Eva Trujillo is the president of the International association of eating disorder professionals. She's also the co founder of Comenzar de Nuevo, a leading treatment facility in Latin America where patients from all ages and walks of life learn skills and find a way out.

[Dr. Eva Trujillo]

Recovery is possible, but the brain needs time, food, therapy and compassion to heal.

[Emily Kwong]

Today on the show Going it not alone with your eating disorder. With pediatrician Eva Trujillo, we talk about how eating disorders affect the brain and the body and answer a question from Mareia about how to sustain recovery in a world steeped in diet culture. I'm Emily Kwong and you're listening to Short Wave from npr.

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[Emily Kwong]

Trujillo, you worked with the Academy for Eating Disorders on a list called the Nine Truths About Eating Disorders. It's a great list. And one of those truths is about who has an eating disorder. Who does this affect?

[Dr. Eva Trujillo]

Yes, this is key. The stereotype of the thin, white, affluent teenage girl leaves thousands of people invisible and unfortunately undertreated, underdiagnosed. So eating disorders do not discriminate, that affect people across the entire spectrum of human identity. Men and women, trans, non, binary people, children, adults, athletes, parents, immigrants, indigenous populations, people in larger bodies and those in smaller ones. We know that eating disorders are just as likely and often more likely to go undiagnosed in people from marginalized communities, including people of color, low income individuals, and the LGBTQ population.

[Emily Kwong]

Let's talk about the physical impacts more and I wanna move from the top down, from your head to your toes. How do eating disorders change your brain?

[Dr. Eva Trujillo]

So when someone is malnourished, when someone is not eating all the calories they need to eat regardless of their weight, the brain is deprived of the energy it needs to function properly. There are studies that report that there's a reduction in what we call the gray and white matter of the brain. So that means the brain is literally shrinking and it would lose a lot of the biochemical compounds it has that can help you to determine your mood and the way you think and the way you feel and the way you perceive your environment.

[Emily Kwong]

And how does that feel in the mind of the person who has an eating disorder?

[Dr. Eva Trujillo]

Cognitively, patients often experience difficulty concentrating Obsessive thoughts about food, rigid thinking, poor emotional regulation, and even symptoms that may resemble ADHD or depression. Or families say sometimes my daughter disappear. It's like she's not herself anymore. And that's not an exaggeration. The brain is starving.

[Emily Kwong]

Yeah.

[Dr. Eva Trujillo]

But the good thing, the good news is that many of these changes can be reversed with full nutritional rehabilitation.

[Emily Kwong]

And, you know, thinking about the impacts, it's just so totalizing. You're saying it affects every part of the brain?

[Maria Friedman]

Every.

[Emily Kwong]

But you know, that should come as no surprise because how cells work is they need nutrients to sustain energy. So what happens to the rest of your body over time if a person is malnourished through an eating disorder?

[Dr. Eva Trujillo]

Well, every organ can get affected. For example, malnutrition slows the metabolism and the heart response by becoming smaller, weaker. You know, the most important muscle we have in the body is the heart. So we can find bradycardia, which is a dangerously slow heart rate. And that can trigger sudden cardiac arrest even in young people who look healthy. Also, people can have delayed gastric emptying or bloating or constipation or reflux. And these are not only from what's eaten, but from how the body adapts to starvation or purging. And another area that can be affected is the bone density, which drops, putting even teenagers at risk of developing early osteoporosis or fractures. And going from the top to bottom, as you said, the hair loss, the brittle nails, the dry skin are visible signs that something's wrong. Nutritional.

[Sponsor Announcer]

Yeah.

[Emily Kwong]

Let's talk about recovery. I think a lot of eating disorders are first addressed within a family. Right. Families notice how there's something not okay with my kid or with my cousin or with my sister. And families can be patients and providers, best allies in treatment. So how should someone approach a loved one if they're seeing some of these physical and behavioral and cognitive signs that you're describing?

[Dr. Eva Trujillo]

That is a very good question. I think that the most effective way is to approach, in a very compassionate and non judgmental way, the people who suffers from an eating disorders are already suffering a lot. And if we don't validate that suffering, then we will make them get, you know, feel, feel so much shame and so much guilt that they will close themselves that they, they won't speak with us.

[Emily Kwong]

And part of treatment also is creating an environment for healing. So, Eva, you were a part of a consulting panel for TikTok and Meta, which owns Facebook and Instagram, on safety policies related to body image and eating disorders.

[Dr. Eva Trujillo]

Yes.

[Emily Kwong]

And TikTok banned a hashtag called Skinny Talk, which aggregated a lot of extreme weight loss content, unrealistic depictions of people's bodies. And yet this content, it is still out there, right? Even in advertisements, even on television, whether you have social media or not. So I want to ask you a question that comes from Maria Friedman, a teen mental health advocate who's on the road to recovery herself. She wanted to know what makes recovery

[Maria Friedman]

sustainable, especially given all of these outside influences and pressures from the Internet, from diet culture in general, from the people around us. And how can we protect ourselves when these triggering images and words will inevitably appear because of the world that we live in?

[Dr. Eva Trujillo]

Very good question. First, recovery is not just about weight or food. It's about reclaiming life, identity, and connection. And in today's world, that includes our digital spaces, we do a lot of education to our patients, to our families, to be critical about the things they see, they listen, and to use all the strategies that they learn with us about comparison, about body image being critical. And not only critical, but, you know, one of the things that we know is that change the conversation and you can change your environment and that will change your life. And for example, here in Latin America, when the hashtag skinnytalk came, we are part of the community channel, so we are a community partner. So we put our suggestions to ban that hashtag. We launched the first eating disorder helpline in Latin America that is directly embedded in our website and is also embedded in the app. Because recovery happens in real life, but digital life is part of that reality. That's why we must make platforms safer, smarter, and more compassionate for our people, for our patients.

[Emily Kwong]

So it sounds like how you look at recovery that's sustainable is it has to go beyond the clinic. People surrounding the patient also need to be educated and on board.

[Dr. Eva Trujillo]

Yes, in general, medical doctors receive less than five hours in the whole career of eating disorder education.

[Emily Kwong]

That's shocking because eating disorders have some of the highest mortality rates of any psychiatric disorders.

[Dr. Eva Trujillo]

That's exactly, exactly. But we still have countries, complete countries, without even one specialist in eating disorders. So we need to do a lot of things in education because one of the most powerful tools we have to fight eating disorders, not just in treatment, but in prevention and in advocacy. Because I always say, it's not that I want to change the world, I just want to change the world of one person.

[Emily Kwong]

Eva, thank you so much for talking to me and thank you for everything you are doing for people out there who are struggling with eating disorders.

[Dr. Eva Trujillo]

No, thanks to you for your work because I think this is it takes a village. We need everyone in this,

[Emily Kwong]

And that includes patients like Maria. She's advocating for herself and other teens, imagining a future where she is free.

[Maria Friedman]

I'm trying to really move forward, be like, how can I redefine what is empowering to me? How can I be whole without needing to micromanage every piece of myself? Because with eating disorders, it's never just about the food. It's never just about your body. It's all a manifestation of something that's so much more complex underneath. But now I'm really trying to do the work to separate food and my body from those other feelings in my life so that I can learn how to stop sabotaging myself and to just try to learn to be me.

[Emily Kwong]

This episode was produced by Rachel Carlson and edited by Rebecca Ramirez. It was fact checked by Tyler Jones. The audio engineer was Maggie Luthar. I'm Emily Kwong. Thank you for listening to Shortwave, the science podcast from npr.

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