Healthy Matters - with Dr. David Hilden

S05_E01 - Food, Feelings, and Freedom from Eating Disorders

• Hennepin Healthcare • Season 5 • Episode 1

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10/12/25

The Healthy Matters Podcast

S05_E01 - Food, Feelings, and Freedom from Eating Disorders

With Special Guest: Dr. Melissa Eisenmenger, PhD, LP

Binge eating disorder, Bulimia nervosa, Anorexia nervosa - there’s a chance you’ve heard of these, but do you really know what they are?

Eating disorders are complex and affect both our physical and mental health, and unfortunately, the number of reported cases has doubled since the year 2000(!!).  Obviously, food is an essential part of our lives and something many of us find great joy in, but for others, the relationship is much more complicated, oftentimes leading to dangerous outcomes.  But who gets eating disorders?  How and when do they develop?  And what can be done to identify, diagnose, and get help to those who need it?

Social media, diet advertisements, and diet culture are big contributors, but they’re not the only culprits.  On Episode 1 of Season 5, we’ll sit down with Dr. Melissa Eisenmenger (PhD, LP), a psychologist at Hennepin Healthcare who’s helped countless people who suffer from eating disorders.  We’ll have an open and honest conversation around the causes, diagnoses, and treatments of these all too common conditions, as well as discuss ways you can support anyone you know who might be affected by them.  We hope you’ll join us.

The National Eating Disorders Association (NEDA) website is an excellent source of information and resources for anyone seeking help.

We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)

Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.

SPEAKER_01:

Welcome to the Healthy Matters Podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, health care, and what matters to you. And now here's our host, Dr. David Hilden.

SPEAKER_03:

Hey, hey, everybody, and welcome to the first episode of season five of the Healthy Matters Podcast. I am your host, David Hilden. I am so glad you've stuck with us through four incredible seasons of the show. Thank you to everybody for listening, and thank you to my numerous guests from Hennepin Healthcare and beyond. Today, we're going to talk about eating disorders. You know food is supposed to bring us comfort in life and nourishment from grandma's famous chocolate chip cookies to a late-night pizza run. However, for many people, food can also be a source of fear, anxiety, and serious illness. Eating disorders affect nearly 30 million people in the United States alone, and nearly 15% of all women will experience one in their lifetime. But what makes these conditions so common? To help us unpack all of this is Dr. Melissa Eisenmenger. She is a clinical psychologist and someone who knows this topic inside and out. Dr. Eisenmenger, thanks for being here.

SPEAKER_02:

Thank you for having me.

SPEAKER_03:

Could you start with some of the basics about eating disorders? What are they? Or you know, just define it for us if you could.

SPEAKER_02:

Sure. So eating disorders broadly are complex and serious conditions that not only affect mental health but also physical health. And we can see disturbances in things like thoughts, behaviors, and emotions as they relate to food, eating, and one's relationship to food. And also disturbances in the way that people see themselves in terms of their body weight, shape, and size. And these disturbances cause quite a bit of distress for people, an impairment in functioning. I'd like to point out that a key difference between disordered eating and an eating disorder is not only in the frequency and intensity of the symptoms in behaviors, but also in how much food tends to dominate, disrupt, and really permeate lots of different areas of a person's life.

SPEAKER_03:

I had heard the word eating disorders decades ago, although I do have to admit, not much in medical school. But I had not heard the term disordered eating to maybe the last decade. Could you tell us a little bit more about that? So is disordered eating just an adjective for people who have a troubled relationship with food, or is that a diagnosis?

SPEAKER_02:

So disordered eating is not a diagnosis, and it is more when clinicians see something like maladaptive eating patterns. I have some examples of that that are pretty specific, like something called orthorexia, for example. I don't know if you've heard that.

SPEAKER_03:

No, but what's orthorexia?

SPEAKER_02:

Yeah, so orthorexia, the term has been around for 25 to 30 years, but it's coming to more of the attention of medical professionals and dietitians. And orthorexia is when somebody becomes really fixated on a circumscribed diet and they might have really very rigid rules around what can be eaten or when things can be eaten. And there are lots of different examples of orthorexia, but orthorexia is one example of something that we can see either coming into or going out of an eating disorder. And so that might be, again, one example of that maladaptive or disordered eating.

SPEAKER_03:

Is that always a bad thing? Is it always a disorder leading to a full-blown eating disorder? Or is that just is it all you know what I'm getting at? Is it always a bad thing?

SPEAKER_02:

Aaron Powell So it's more of a matter of degree. And again, I would say how much um a pattern of disordered eating is disrupting a person's life and causing that distress and impairment in their lives.

SPEAKER_03:

Aaron Powell We're gonna talk about specific diagnosable eating disorders a little bit in the show, but could you just kind of give us um uh why do people get these? What are there risk factors for developing eating disorders?

SPEAKER_02:

Yeah, there are lots of different risk factors, and it's probably a combination of those risk factors that contribute to somebody developing an eating disorder. So some of the different categories can include things like psychological factors. So things like depression, anxiety, trauma, post-traumatic stress disorder, difficulties with coping, having a lot of stress and few coping skills can be things that predispose somebody to developing an eating disorder. The other thing is environmental factors. So things like bullying, pressures from family or friends or peers to lose weight, certainly social media, diet culture. Another element can be temperament. So specifically, we know that things like perfectionism can contribute to the development of an eating disorder. And then finally, there are genetic and biological factors that can also contribute.

SPEAKER_03:

So lots of different risk factors. Right. At the beginning in my intro, I mentioned some pretty staggering statistics that a lot of people have eating disorders or have experienced them at some point in their life. Why are those numbers so high? And the follow-up to that is is it going up? Is it down? Is it stable?

SPEAKER_02:

Yeah, so those numbers are really high. And again, in part, there's probably no one reason. Social media and again, diet and diet culture really probably contribute to those high numbers, as well as things like social pressure to achieve this sort of thin ideal.

SPEAKER_03:

Why are women affected more than men? But men are as well. I think we've got to be clear about that, right?

SPEAKER_02:

Yes, so absolutely. So women do tend to be affected more than men, and that can also be for a variety of reasons. So biologically, women might be more predisposed because of things like hormones and brain chemicals called neurotransmitters. There might be sociocultural influences. So again, I'm thinking about social media, how diet advertisements tend to target women. Women feel more pressure to be thin. There are a lot of things out there on social media that again target women and sometimes even make it seem very easy to lose weight or to go on one of these fad diets. There might also be a bit of diagnostic bias. Eating disorders are primarily seen as a women's problem. And so that might mean that for men, it goes unrecognized, underdiagnosed, and undertreated. And then finally, if we think about mental health conditions such as depression and anxiety being comorbid with eating disorders, we know that those mental health conditions also affect women more than they affect men.

SPEAKER_03:

So why are they on the rise?

SPEAKER_02:

An interesting fact is that eating disorders doubled between 2000 and 2020. So the rate doubled.

SPEAKER_03:

It's gotta be social media.

SPEAKER_02:

Absolutely. So a large factor here is social media.

SPEAKER_03:

Well, that's staggering.

SPEAKER_02:

Yes, it is.

SPEAKER_03:

Doubled in the last 20, 25 years, and it's roughly the same time as social media.

SPEAKER_02:

Yes, absolutely.

SPEAKER_03:

I want to delve into that a little bit more. Is that an intentional thing? Or is this, I mean, are there organizations or companies that are just marketing, or is this like an amplification of what used to happen in the middle school lunchroom and the pressures there? Now it's just more amplified. Do you get what I'm saying?

SPEAKER_02:

I do maybe more so the latter. And so you're right in that eating disorders existed before social media. Now there are a lot of forums that people can go on in social media targeting different, you know, fad diets again and different ways of eating, different ways to lose weight. Social media influencers might contribute a great deal to how people believe that they should look or kind of a stigma even against obesity or being overweight. Another thing that has contributed to the rise, really interesting though, is with the onset of the pandemic, the COVID-19 pandemic. And so I know that the National Eating Disorders Association saw a pretty drastic rise in calls to their helpline between 2019 and 2020, in the same months in 2019 and 2020. And so, you know, the pandemic led to people being much more isolated, having meals socially a lot less often, being more sedentary, having constant access to food, and kind of being out of a normal day-to-day routine.

SPEAKER_03:

And sitting on their screens.

SPEAKER_02:

Absolutely. Yeah. Absolutely.

SPEAKER_03:

Yeah. So many people think that eating disorders are all about maybe vanity or I'm just dieting, I'm dieting, and it just went a little bit too far. It's a little bit more than that, I think, um, probably. Is can you briefly address that notion?

SPEAKER_02:

Absolutely. So first let me address the piece about vanity. So it can be sort of a damaging oversimplification to think that eating disorders are because of vanity. Most of the time, eating disorders start out as a protective function for the person. It gives the person a sense of structure. It gives the person a way to cope with internal or external chaos. It gives the person a way to cope with stress or emotion dysregulation. As an eating disorder takes hold, what can happen is that then we start to develop these ideas about what our bodies should look like. And that tends to fuel then more disordered eating.

SPEAKER_03:

Let's shift and talk about the various types of eating disorders. Could you talk us through what the big ones are?

SPEAKER_02:

Sure. So binge eating disorder entails eating binges, of course. And so eating binges have two different sort of criteria that we look for. One is eating a very large quantity of food in a discrete period of time, usually two hours or less. And this would be an amount of food that would go above and beyond what most people would eat in a similar period of time. And the second thing for an eating binge would be a loss of a sense of control over one's eating. And this is really a hallmark of an eating binge, and it distinguishes overeating from an eating binge.

SPEAKER_03:

That you simply can't stop?

SPEAKER_02:

Right. So some people say that they can't stop. Some people say that they started out intending to eat a certain amount, and then before they knew it, they were getting, you know, a third or fourth helping or ordering more food. It can be an urge that people have to continue eating, even though they feel very uncomfortably full. So for binge eating disorder, the binges are one piece of it. But then there are also things like, again, eating until feeling uncomfortably full. Eating large amounts of food, it can be a lot of distress, feelings of guilt and anger and frustration and disgust around an eating binge, eating rapidly, or eating alone because you're embarrassed about eating.

SPEAKER_03:

Is that the same as bulimia nervosa?

SPEAKER_02:

So it's not. That's a really good question. So bulimia in bulimia nervosa, there are eating binges. So that eating a very large quantity of food and a loss of a sense of control over one's eating. But then there are also compensatory behaviors that a person intends to kind of correct for the overeating or binge eating and are also meant to prevent weight gain. So when I say compensatory behaviors, what I mean by that are purging by vomiting. It could be use of laxatives or use of diuretics. It can be excessive fasting or restriction, or it could also be excessive exercise.

SPEAKER_03:

Who uh is most at risk for those two? The binge eating disorder and the bulimia nervosa.

SPEAKER_02:

So those two are a little bit different in terms of who's at most risk. Um, for binge eating disorder, we really see more of kind of broad brushstrokes over who is affected by that. It can be people of normal weight, it can be people who are obese, it can be people who are underweight, you know, eating disorders in general. There's some research to suggest that it affects different racial and ethnic groups pretty similarly for those living in the United States. For binge eating disorder in particular, it tends to affect women just as much as it affects men. For something like bulimia, on the other hand, it's much more common in women, probably three to four times more common in women than in men.

SPEAKER_03:

So that compensatory mechanism, is that largely to maintain a weight, to not gain weight? Is that largely why?

SPEAKER_02:

It is, although it doesn't always end up in reduced weight or people being underweight. Um sometimes people with bulimia are of normal weight or are overweight.

SPEAKER_03:

Okay, turn to anorexia nervosa, if you could, please.

SPEAKER_02:

So anorexia nervosa is defined by restriction of calories or energy intake in relation to what one really needs to maintain a healthy weight, and so people can become very underweight. There's an intense fear of gaining weight or becoming fat. And there can be distorted perceptions on what one's body looks like. There can be lack of insight as to how serious the disorder has become, and there can be a sense of self-worth that is unduly influenced by one's body weight, shape, or size.

SPEAKER_03:

Aaron Powell Is this one mostly in girls and women?

SPEAKER_02:

It is, again, about three to four times more likely to affect girls and women.

SPEAKER_03:

Aaron Powell So those differences in males and females. Could you comment a little bit about the effect on the transgender community?

SPEAKER_02:

Absolutely. So we know that transgender and non-binary individuals have higher rates of all of those eating disorders that I just mentioned in relation to their cisgender counterparts.

SPEAKER_03:

Aaron Powell When do these typically develop? I know there we've just talked about three separate diagnosed eating disorders, but when do they typically develop?

SPEAKER_02:

That is stratified based on the eating disorder itself. So for something like anorexia nervosa, we tend to see the development between roughly ages of 12 and 15, sometimes coinciding with the onset of puberty. For something like bulimia nervosa, the median age of developing something like that would be closer to 18 or 19 years old. And then for binge eating disorder, it tends to be a little bit later, so around age 21. Although it should be said that all of these things can be diagnosed much later in life.

SPEAKER_03:

We're gonna talk much more about what it's like to diagnose, treat, and get support for all of these after the break. We have been talking to Melissa Eisenmanger. She is a doctor of psychology and a colleague of mine here at Hennepin Healthcare in downtown Minneapolis. We're talking about eating disorders. We are gonna take a short break, and I hope you'll join us when we come right back.

SPEAKER_00:

When Hennepin Healthcare says, we're here for life, they mean here for you, your life, and all that it brings. Hennepin Healthcare as a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more at Hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

SPEAKER_03:

And we're back talking with Dr. Melissa Eisenmenger. She is a psychologist and we are talking about eating disorders. So, how are they typically diagnosed?

SPEAKER_02:

Yeah, so eating disorders in particular can be really challenging to diagnose, in part because people tend to be relatively secretive about the disorder, because again, we need to think about that protective function that they serve for people. So, unlike things like medical conditions or even some other mental health conditions, people don't necessarily want to be treated for their eating disorder because it is serving that function. And so sometimes it does come across in a medical visit for people when there's something that is noticed in terms of a drastic weight change or something that might come up on abnormal blood work. It might be something that's noticed by family or friends that's brought to somebody's attention. But again, these can be really challenging to identify and to get people to talk about.

SPEAKER_03:

Who typically diagnoses them?

SPEAKER_02:

So mental health professionals can diagnose eating disorders, and that would be based on the criteria that we talked about for each of those eating disorders.

SPEAKER_03:

Is it true that the diagnosis is sometimes delayed because it because of what you've just said, people are a little bit more secretive about it. Maybe they don't have a mental health professional, maybe they have a pediatrician, maybe they have a family doctor, a general internist like me.

SPEAKER_02:

Yeah. And so you're right about the delay and diagnosis. And we also know that the longer diagnosis is delayed, the longer treatment is delayed. And so these eating disorders can become more dangerous over time for a variety of reasons. But yeah, absolutely. Probably primary care offices are maybe kind of the first line of identification and getting somebody into treatment for eating disorders.

SPEAKER_03:

What are some of the common treatment approaches?

SPEAKER_02:

That's a really good question. So for something like bulimia and binge eating disorder, CBT or cognitive behavioral therapy has been shown to be effective. And cognitive behavioral therapy revolves around the idea that our thoughts, emotions, and behaviors are all linked. And so CBT for something like an eating disorder would focus on thoughts that perpetuate and maintain an eating disorder. For example, there's an enhanced form of cognitive behavioral therapy for eating disorders, which has a little bit more psychoeducation specific to eating disorders.

SPEAKER_03:

Where do people find a professional that is skilled in CBT?

SPEAKER_02:

Yeah. So if I see somebody in need of treatment for an eating disorder, what I usually do is refer to somebody who has a specialty in eating disorder or an eating disorder program like the ones that we have here, some of the programs that we have here in the Twin Cities.

SPEAKER_03:

Say more about those if you could. Are those outside of your psychologist, your primary doctor, there are specialty programs. And in the Twin Cities, we have some of them. I'm sure if you are listening to this in California, New York, or Texas, you probably have them as well. What are those programs like? What happens there?

SPEAKER_02:

So usually programs, people get treatment based on how severe their eating disorder might be. And so it might be a combination of individual and group therapies on an outpatient basis. It might be residential treatment, but uh a combination of individual and group therapy is usually what is offered and what is best.

SPEAKER_03:

Is there a role for medication?

SPEAKER_02:

So I'm not a prescriber, so I don't want to speak too much about the medications. What I would say that I consider is having somebody that is hooked in with a prescriber who is familiar and has expertise in working with eating disorders. You know, I believe that some of the medications that are prescribed for things like depression and anxiety, which can be comorbid with an eating disorder, are actually contraindicated for some people with anorexia and bulimia. So I don't want to speak too much to the specifics of what those medications are. It's not necessarily my wheelhouse.

SPEAKER_03:

That's a good approach. I do prescribe medications every day in my life as a primary care doctor, and I wouldn't do this once without someone's expertise. I think that that's a really good point to note to if you, a loved one, or you are wondering if you have an eating disorder or you've been diagnosed with one, the right treatment approach is not to rely on your primary care doctor to give you something in a pill bottle. What you said at the beginning is far more important. Cognitive behavioral therapy, get the right supports that you need in or outside of a program, but you need somebody who knows this field very specifically. What about nutritional counseling? Does that happen in I I assume it happens in treatment centers. Is that a good route to go?

SPEAKER_02:

Yeah, absolutely. So treatment centers usually have dietitians on board again who are familiar with, have specialty in eating disorders. So nutritional nutritional counseling is incredibly important, whether we're talking about binge eating disorder, anorexia nervosa, or bulimia nervosa. Some programs I believe also incorporate physical therapists to help people get a healthy sense of, you know, movement and what healthy exercise looks like.

SPEAKER_03:

I'm gonna move to it to something a little bit maybe harder to hear. What are some of the consequences that you see of untreated eating disorders? It can be serious, right?

SPEAKER_02:

It absolutely can. And as I mentioned earlier, the longer an eating disorder goes untreated, sometimes the more dangerous they become. For anorexia nervosa specifically, it's the mental health disorder with the highest rate of mortality. And so that that mortality risk increases as the years go by. Risk of malnutrition with something like anorexia or bulimia nervosa, an electrolyte imbalance, especially again as these things kind of proceed over the longer term. For something like binge eating disorder, if that is leading to overweight or obesity, that can also have or end up leading to health complications.

SPEAKER_03:

So true physical uh uh health complications. And some of them, I r I remember when I was a child, the most famous one uh of all, um the woman with the most beautiful voice you've ever heard in your life, Karen Carpenter, was on the front page of a news Newsweek or something. None of us had heard of it. And she had died of anorexia nervosa. And and that was what it opened um many of our eyes. I was just a kid, uh um, but I remember it um kind of rather vividly. So there are some serious consequences. Could you talk about emotional consequences, not only to the person who has the eating disorder, but to their family and in their relationships?

SPEAKER_02:

Sure. So again, um, comorbid depression and anxiety, as well as trauma and post-traumatic stress disorder, can affect people with eating disorders. People with eating disorders sometimes feel a lot of shame or guilt over what is happening. And so that is also what can prevent people from getting the treatment in a timely manner. On families, you know, it can be feelings of guilt, certainly fear, helplessness, not knowing how to approach a loved one that they might suspect has an eating disorder. There can be feelings of blame toward oneself or toward the person with an eating disorder. Sometimes that can lead to family discord. And we know that the more kind of dysfunctional a family unit or the more discord there is in a family, sometimes that can be associated with more eating disorder symptoms.

SPEAKER_03:

Could you give us advice on when a parent or a partner or a good friend or the a person, him or herself, their self, uh, when should they be concerned enough to seek help?

SPEAKER_02:

So I like to think of warning signs in terms of categories. So if we think of the first category as being physical signs and symptoms, so drastic or rapid changes in weight can be one sign or symptom. Things like hair loss, brittle fingernails.

SPEAKER_03:

From from nutritional depression.

SPEAKER_02:

Absolutely, right. Yep. Perhaps changes in menstrual cycle, which might be less obvious to a family member. The second category in terms of warning signs would be emotions. So a lot of anxiety around food and eating, irritability, a lot of distress around eating, preoccupation with food, preoccupation with weight, sometimes even making comments on other people's appearance or weight could be a warning sign. And then the third category is behaviors. And so things like weighing food, excessively exercising, counting calories, missing family meals, missing social functions where food is involved. And what I want to emphasize is doing any of those things individually might not be a warning sign, but patterns of those kinds of behaviors and emotions and physical symptoms are probably more indicative that something is going on.

SPEAKER_03:

Any one of those things could be what your teenage kid is doing. Right. And you don't know about your kids' menstrual cycles, or you don't know they're just shy, or they're being a teenager, they don't want to go to grandma's house for dinner. So, but it sounds like maybe the pattern of those, or if if you're starting to see them more and more.

SPEAKER_02:

Absolutely.

SPEAKER_03:

What do you recommend a parent, a friend, a partner do? Because as you said, the the person experiencing these symptoms might not be very forthcoming about them. What should a person do?

SPEAKER_02:

Right. So if somebody is concerned, I always recommend that you find a time where both of you can have a conversation in a calm way. Approaching the person with your concerns and letting them know why you're concerned can be helpful. And so approaching it in a non-judgmental way, expressing that you're concerned. And then also you can give one or two examples about objective things that you are concerned about. So I'm concerned because I've noticed that you've been missing dinner with the family. And then also just knowing what to expect in terms of the person's emotional reaction to having that conversation. So it could be something like anger or denial, but it could also be a sense of relief that somebody has noticed and is bringing it up.

SPEAKER_03:

Well, that I hadn't thought of it that way. It always seems to me to be a that that conversation's gonna be a battle. Maybe it doesn't always have to be. No. Before we close the show, I want to ask you a little bit about uh people who have experienced eating disorders and then went on to live their lives. So is that the norm? I mean, do people get over this and then go live a relatively eating disorder-free life, or is this something that they struggle with long term? I get it. It's probably different from the various kinds.

SPEAKER_02:

It is. And so that's a really great question. So people can and do recover from eating disorder and eating disorder symptoms. You know, as with most mental health conditions, there can be periods of time where some of those behaviors or symptoms sort of come back, even if they're not meeting criteria for the disorder. And so times of stress, times of anxiety, times of transition in life or change might be examples of when people might see sort of a resurgence in some of those symptoms. People with eating disorders sometimes describe it as being ever-present in some ways in their lives, even though they have learned to cope with them and you know, eat a healthy diet and relate to themselves in a different way.

SPEAKER_03:

So we're talking with Melissa Eisenmanger. She is a doctor of psychology at Hennepin Healthcare. Melissa, what messages would you want people to know? If you had a minute to talk to the public about eating disorders, what would you like them to know?

SPEAKER_02:

So I think I think I would want people to know that eating disorders are treatable. Again, people can recover, can and do recover from them. And getting help as early as possible is really what is key to improving overall health, mental health, and quality of life.

SPEAKER_03:

It's a great message of hope for what you might be experiencing. There are teams of people to help you. Melissa, thank you.

SPEAKER_02:

You're welcome. It was so good to be here today.

SPEAKER_03:

It's been great having you on the show. I hope to get you back for a future episode. Listeners, if you need help with eating disorders, please do check out the National Eating Disorders Hotline. The link is in the show notes to this. And I thank you for listening to this episode, the first one of season five. And I hope you will join us for our next episode, which drops in two weeks. And in the meantime, be healthy and be well.

SPEAKER_01:

Thanks for listening to the Healthy Matters Podcast with Dr. David Hilden. To find out more about the Healthy Matters Podcast or browse the archive, visit healthymatters.org. Got a question or a comment for the show? Email us at healthymatters at hcmed.org. Or call 612-873-TALK. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas at Highball. Executive producers are Jonathan Comito and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.

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