Exploring Eating Disorders in Teens: Impact of Social Media and Guidance for Parenting Support

Ever wondered how deeply eating disorders can impact teenagers and how social media plays a role in it? Do you find it challenging to navigate conversations about these complex issues with your children? Join us in our latest episode of Answer my Call. I have the pleasure of hosting Katie Cornwall, a renowned expert in the field of eating disorders. Together, we explore the intricate world of these disorders, shedding light on various subtypes and their grave seriousness.

Our discussion takes a special focus on teenagers. We explore how social pressures, body image concerns, and the added complexities of adolescence can trigger these disorders. We also delve into the issues parents face, offering valuable insights, and practical advice on supporting their teens. Moreover, we discuss the powerful impact of social media on the development and exacerbation of eating disorders, underscoring the importance of media literacy and mindful consumption.

Lastly, we turn our attention to younger children and the unique challenges they present. We navigate ways parents can lean into their fears and support their child's recovery journey. We also delve into the intricate relationship between eating disorders, trauma, and control, emphasizing the importance of a holistic approach to health. Our enlightening conversation rounds off with a focus on Avoidant/Restrictive Food Intake Disorder (ARFID) and its overlap with other eating conditions. So, gear up for a comprehensive exploration of eating disorders that promises to educate, inform, and support those navigating this challenging terrain.

Bio:
Katie  Cornwall is a Registered Dietitian Nutritionist and Certified ARFID Specialist with over a decade of experience in the mental health and nutrition fields. She has dual degrees in psychology and art from Albright College as well as a nutrition and dietetics degree from West Chester University. Katie works passionately in the realm of eating disorders and the anti-diet movement. Her main objectives in nutrition sessions include healing a clients’ relationship with food, working towards intuitive eating and movement, and providing a safe space to heal from nutrition myths and diet culture.  

 Katie is comfortable working with individuals, families, or partners in nutrition sessions. She has experience working with more general nutrition concerns as well as medical issues such as diabetes and PCOS. Her previous work experiences have brought her a great understanding of the importance of self-care, exercise, mindful eating, and working together with a team of health professionals to reach your health goals.

Transcript

Speaker 1: 0:02

Hi everyone. I'm Rajuta, host of Answer my Call. I'm a mental health therapist and owner of Mindful Group Practice, located in Pennsylvania. I work primarily with teenagers and women in my practice. I'm a mom to two teenagers, always waiting for them to answer my call. Hi, katie, hi, hi, how are you?

Speaker 1: 0:30

Welcome back to the podcast. I'm so excited that you are back on talking about eating disorders, which is such an important topic that I think doesn't get talked about a lot. I mean, there's a lot of bunch of stuff on social media, but for me, it's really about talking to an expert who has a lot of experience in this field, and you do a lot of outreach programs as well and reach out to different people, different experts in the field of eating disorders. So I'm really, really, really happy and excited to talk about this topic with you.

Speaker 2: 1:14

Yeah, and thank you so much for having me. I feel like over the years, I've realized that there's a lot that we kind of preconceived about eating disorders and what we see in social media and on TV and what we hear about from our parents and things like that. And as I've dived into this world it's been about 15 years since I really started my path into this world I've learned that there is always more to learn, and it's not what it seems, and there's no two eating disorders that are the same, and so I think it's so important to make sure that professionals aren't scared about learning more. There are many therapists and psychiatrists that won't touch eating disorders, and so just sharing all of this information, I think, is so helpful. So thank you for having me.

Speaker 1: 1:59

Thank you for that, and thank you for saying that, because this is also a topic. As a therapist, I haven't really delved into any of the eating disorders and as a parent, I'm always fearful of this area because it's so vast and it's so there's such a big spectrum to it as well and, like you said, there are no two eating disorders are similar or same, but also teenagers who are going through that, going through those struggles on the same. So there are so many different aspects to eating disorders and to the developmental stages within teenagers that I feel like this is a six-part series, but I feel like I could do a whole year worth of conversation. So let's start with sort of what are eating disorders? And sometimes I've heard that oh, it's not that serious or it kind of seek help when it's quote unquote serious. So if you could explain a little bit about what that means, what are these eating disorders and what that quote unquote seriousness around it means for parents and teens.

Speaker 2: 3:17

Sure, and I think it's good to kind of start, and I actually, when thinking about this question, I think it's good to start with the dictionary definition, right. So, because I think we often in our mind, someone says eating disorders and you picture something in your head whether, yes, I usually picture, and this is such a bizarre image.

Speaker 1: 3:40

Is girl interrupted For some reason? It just goes to that extreme of an image and that's why I said, as a parent, I'm fearful thinking about what could happen.

Speaker 2: 3:52

Yeah, no, and it's actually funny because whenever I explain this to parents, I actually use this kind of metaphor. So often we hear like mental health and eating disorder and I don't know what. I think we all from seeing that movie and reading that book, right, but everyone kind of goes to that picture. I use that reference a lot of like everyone sees like girl interrupted, like I'm going to be in a padded room and like all this crazy stuff. And if we look at that definition, right, it's a condition in which, like, there are persistent disturbances of eating behaviors, and whether that translates to physical or mental health, it could be either or both and so I think, if you think about that definition, it seems a lot less like girl interrupted in theory.

Speaker 2: 4:32

And I think we have to then from there kind of look at the different kinds of eating disorders, right. So yeah, so if we're seeing these conditions kind of develop with disturbing behaviors, it depends on what behavior is happening, it depends on how it's affecting your medical health and physical health and where we put the seriousness. So if we're talking eating disorders, what I usually am speaking of anorexia nervosa, bulimia, binge eating disorder and then other specified feeding or eating disorders which we can talk about more, and then we kind of have this other arphid, which is avoided, restrictive feeding intake disorder, which can be paired with arphid plus, which looks like feeding issues plus more of the eating disorder, classic body image stuff, but most specifically arphid is not including the body image and the weight concern piece as much. However, we see malnutrition, low weights because of the restricted eating.

Speaker 2: 5:34

So, we have all these different levels to this. But then within that, to be diagnosed with an eating disorder you need a doctor to be able to do like the physiological and the psychological assessment to determine what type and then like what subtype. So within, like anorexia, there's different subtypes. There's different kinds of binge eating disorder and osfet, all these other things. So I think that's why, again, there's no two that are the same is because we have all of these different subtypes within it. So you can be classically defined as anorexic but be purging type, or you can have binge eating disorder but still have restrictive tendencies.

Speaker 2: 6:16

And oftentimes I think people just think anorexia, very low body weight, we just think bulimia, just purging everywhere, and there's like all these other things in between. And so when we get into defining it, it really depends on what's going on for the person. And I think when we talk about seriousness, I kind of preface this with like I kind of take every eating disorder very seriously. There's obviously ones and behaviors that become more medically concerning. So, like as a practitioner, it's like okay, if I you know purging frequently, is it electrolyte abnormalities like heart rate issues, like all this sort of things like that become more medically alarming and more present maybe first, but it doesn't mean that that's more serious than someone who has been doing every single day multiple times a day. There's health implications across the board.

Speaker 2: 7:04

I think it's just a matter of figuring out the frequency of behaviors and how it's impacting someone's mental health a day to day.

Speaker 2: 7:12

So if someone is bulimic but they're really only purging once a week versus somebody who's purging 14 times a day, there's a level of like. How we handle that and I think that's what you're asking too is like where do we kind of step in as parents or providers? And a big part of my job at like an assessment is to be like okay, what is kind of going on? Like what are the behaviors? But then underneath that, how often are they happening? How is it impacting that person? And then that's where we can intervene with what level of support that that person might need. But I think within the eating disorder world it's helpful for parents to know that there is like a very competitive nature sometimes of like wanting to be defined as certain disorders, or like feeling better about being restrictive, and there's like more shame associated with binging than restricting. So we had to have to like tweak through all of these different behaviors, symptoms, mental health issues to figure out the level of seriousness in the way we treat it.

Speaker 1: 8:13

But I think they're all very equally serious, and I totally and completely understand that all of them are serious and we need to seek help. I think what I where I was also coming from is how do parents kind of figure it out? You know, I mean, purging is one thing that is kind of easier to see, but, for example, binge eating like as a teenager, a lot of times with boys will say they eat constantly, or my son ate a full pack of chips. You know things like that and I know I'm simplifying it tremendously. But what are some of the things that parents can tap into and say, okay, this is somewhere I think something is missing or I need to, you know, delve into it a little bit more.

Speaker 2: 9:09

Sure, and I think this helps to kind of speak it into languages here. So I think we have to then talk about the fact that, like, there's a difference between disordered eating and a full blown eating disorder, right, and so we see disordered eating everywhere, right? Like, most people have some level of disordered eating. So we grew up in a society that focuses on get everything done, get through the day, and then you're allowed to put your feet up and relax. So that kind of really breeds this over under mentality of like, just get what you need to get through the day. It tends to be more restrictive, like I just had a coffee and I missed breakfast, and I ate through lunch while I was working and then, like you know what, now all the kids are asleep and now I can put my feet up and eat. And it kind of breeds this over under restrict binge behavior. So I think it's really hard sometimes as a parent to figure out is this normal, is this something that I used to do, or is this a problem? And then throw in adolescence where, like, kids are growing and hunger is through the roof. Sometimes Some teenagers, especially athletes, really highly active kids, can need, you know, 3, 4,000, 5,000 calories just to maintain their growth, and sometimes when we live in a structured three meals a day kind of society, we don't get those needs met. As a teenager, how many kids come home from high school and say, like I had 10 am lunch today, I wasn't even hungry.

Speaker 2: 10:39

We have school schedules, we have sports schedules that aren't conducive to people taking care of themselves with food, and so that does breed some disordered eating. So I think it's helpful to look at a whole day, right, like look at your kids whole day of eating. Are they eating breakfast every day? Are they drinking a lot of coffee or soda or energy drinks? Are they eating lunch at school? Are they just having a snack at school? A lot of kids don't feel comfortable eating a full lunch in front of their peers or if they have one of those schedules where I feel like everybody's kid comes to me and says they have like 10 am lunch for some reason. So I feel like we have to look at that right, like they have a bizarre schedule sometimes and then they're expected to.

Speaker 2: 11:20

Then at 3 o'clock, you know, the bell rings and they have to go run all over the field for soccer. So I think we have to look at schedules what their intents actually are. Are their needs getting met? Because if your teenage boy is not getting his needs met today in terms of nutrition, he might not be skipping meals, but he might not be eating every food group or enough protein or whatever. And then going and running for three hours in the soccer field, you might see him come home from soccer and eat a whole bag of chips and is that a problem, I don't know right, like he probably just meeting his caloric needs and the behavior is a little disordered that he can't really slow down his hunger. He's so hungry it looks bingey, right, and I think paired with growth. You know, as a teenager's brain, they're not thinking that way. They're like I'm hungry, that's my favorite chips, we're done right.

Speaker 2: 12:10

So I think it's taking that data of like what are some things that we could do to help support that, that kids getting enough during the day? How do we normalize eating more during the day and moving away from this kind of focus and go culture into a space where it's like normal to pause and eat breakfast and lunch? Are we talking to our kids about like eating enough for sports, things like that? So I think, like looking at. The beginning of all of this is that, like we live in a very diet culture, heavy society, and so like we're going to see this sort of eating, like you probably will see disordered eating things within yourself as you reflect into this.

Speaker 2: 12:48

Many parents are like, oh my gosh, like I always work through lunch, I never eat lunch, or I always feed myself last, and like you know the kids first, and it's nine o'clock by the time I sit down and eat my dinner. So I think it's helpful to kind of like look at what is normal eating and within your household, as a parent, that can look different, right. Yeah, like what is normal eating in your house and where is that kid kind of falling within that. And then there's more obvious things, right, like the kids who are counting calories on their phones, talking a lot about body changes, talking a lot about diets or avoiding certain foods. I think there's some red flag stuff in there that like breeds from that disordered eating stuff. And then again we come back to frequency. So like to diagnose, needing a disorder, we often look at frequency of behaviors, right. So I think it's kind of looking at all those things and as a parent, I'm sure that you can speak to this, because it's really hard to figure out. Yeah, it is.

Speaker 1: 13:43

It is really hard to figure it out. But I also think that in many ways, if they are struggling, I would imagine, or hope, I guess, that they would come to us as parents and say, hey, I'm struggling, and that's a big, you know, intervention in itself. But if kids are not asking for help and they are struggling, then as parents I'm wondering if, again, like those red flags which is really helpful that you mentioned those red flags are something that we can look for and then, kind of going into different terminology like disordered eating and eating disorders are kind of, I think, kind of mainstream in terms of understanding where that spectrum lies. Are there any other terminologies that are out there that kind of are under the umbrella of eating disorders?

Speaker 2: 14:44

Well, I think it gets confused too, because oftentimes some of these words that we talk with eating disorders, so like behaviors like restricting is right, like intentional, like cleaning out calories or like missing things or skipping meals, right, purging is different from just vomiting because like there's an intention of a time purging, right. Like there are some people who binge and throw up and it's technically kind of like a purge, but others they maybe have thrown up because there's actually so much volume in their stomach, not with intention, right. So and then some people who don't eat a lot and then force themselves to throw up and that's like more violent and technically like a purge. So I think that there's all there's some understanding of like just what like different behaviors are, and so, beyond just the behaviors around food, we also like look at lack of use, diet pill use, any of the other kind of things, like I mentioned, calorie counting, food rituals, and I don't think that parents like or the general population knows what the term food ritual means. But right, like, so food rituals are sometimes things that like you can start to notice as parents too, individuals are behaviors that happened around foods or mealtimes that allow somebody with it and you just sort of like get through the meal. So say you have really high anxiety about sitting down to like the pasta dinner with your family and you don't want to eat the pasta and you're worried about the calories and the cheese and so on and so forth.

Speaker 2: 16:06

Sometimes we see clients struggle with eating really slowly or really quickly. Pushing food around the plate, counting out how many pasta noodles they're eating, separating foods on the plate, wiping off sauces onto their napkin, hiding food under their plate, feeding it to the dog on the table All of those kind of things can be considered food rituals. Some things are kind of normal and I always tell parents like right, like ripping up a piece of bread and dipping it in the pasta sauce is like not that weird to me, but like for some people, if they're ripping up tens and little pieces of bread and like spreading it across their plate and like rubbing it all into the sauce, like that's a little bit more of a problem. So there's like some things that could be categorized as a food ritual. That may not be, but I think it's helpful to look out.

Speaker 2: 16:52

Pacing is usually the first red flag that the Earth can see If someone is really taking a long time to eat or eating very quickly and leaving the table both can be symbolic of maybe something else going on Again with like nuance. You have to like look at everything. And then I think other terminology that comes up often for parents is just more around like the medical terminology and like things that we look out for, and I don't know if there's specific words, but I feel like just kind of understanding and talking more about all of the health implications and understanding a little bit more about like blood pressure and heart rates and things like that. And I think that's the stuff that comes up like once you're diagnosed and we can delve into that if you want later. But I feel like more of the terminology comes up post diagnosis for clients and parents than it does like previously. There's obviously, like within social media, some stuff that comes up of terms that people use, but I think it's like very dependent on the case in the person.

Speaker 1: 17:57

Do you see anything specific related to teens when it comes to eating disorders?

Speaker 2: 18:05

I think the biggest comorbidity with teens is the social and body image implications because it's so amplified, like think about just being a teenager without a disorder You're worried about. There's some normalcy right, like there's some disordered stuff happening. There's confusion sometimes about like gender sexuality. Sometimes there's confusion about like what's actually happening through puberty and depends on like your culture and like what you were taught or not. So I think there's some stuff that kind of amplifies a lot of this. As a teenager, the biggest thing is probably the parallel between identity and transformation in general at that age. If you're already struggling with who am I as a person and then throw in an eating disorder and the eating disorder becomes your identity and then an adult says, take that away, that can be really difficult.

Speaker 1: 18:57

So that's sort of because I'm thinking developmentally. There are so many things happening in teenage years and then you're right, with the eating disorder. It's really kind of a whole new ball game, I would assume. Do we see sort of in your practice or in your research? Have you seen an increase in eating disorders due to sort of social media exposure or media in general? And I say this reluctantly because media has always been there, but the way social media has sort of come up is a whole different game that I am still learning but because I've heard so much that of sort of there are sites and people that teens follow where there's a lot of talk about how to work through your eating disorders or how to manage I don't know negatively, positively how to manage your eating disorders. There's so much information out there. What are your thoughts on sort of social media and eating disorders?

Speaker 2: 20:07

So, tia, answering your first question, there's 100% post pandemic. We've seen a huge increase in eating disorders, which makes sense because eating disorders are really avoidance of emotion underneath all of it, regardless of eating disorder. So, with the anxiety and fear and changes in the pandemic, mental health suffered for many people beyond teenagers. So I can't imagine I always tell parents I can't imagine being a teenager going through puberty and hormone changes, plus having to not be around friends physically yes, there's phones and FaceTime and all that stuff but to not have the social experience of going through some of those together in person and seeing things and then to then go back to school and so think about all the kids who were 12, 13 and then going back to school as a 15, 16 year old. Your body's different, people haven't seen you person, people make comments about them, that people have body changes, like all these things. That like Piled up, it makes a lot of sense and that kind of translates to social media. So we see More people talking about mental health on social media, which is a good thing. But I think a lot of times clients, and specifically teenagers, say to me Comparing is one of the number one issues that they struggle with, and so a lot of times we encourage people to take breaks, to kind of restructure their algorithms, if you will. A lot of times, if you're kind of as we know, you know you say one thing and then all of a sudden it's the ad on your Instagram. So, like, even that's happening for them too. So if they're talking about hating their bodies with their friends and then, like, they're seeing ads on their Instagram for Diet pills, body types, like all this kind of stuff, um, that's not helping either. So I think you know, with the social media, the good and the bad go together and I think it's me that we're still navigating.

Speaker 2: 22:01

I struggle with this, like with my social media sometimes, of like, is this helpful or is this like contributing to confusion or Is this gonna be a triggering for someone else? And I think it's hard because some people really everyone's needs are different around that. Like, some people can see someone's story and and posting pictures with it can be really not helpful. Before and after pictures in any capacity, whether it's for Health reasons or recovery reasons or anything, there's just like no good scenario to post a before and after picture. So I always tell people like those are usually a red flag Because even if this it's a good story and they're like someone's recovered, putting an idea out about like what a recovered body looks like is never a good, a good thing, because everyone should be different and I so.

Speaker 2: 22:49

I think we're still navigating that as a In disorder community of like what's okay and not okay and you know, with with all of the Bad things, there are a handful of good. You know there's good advice. People find supports, people see stories of people who they've never seen before or feel like heard or seen, because the news owner is very isolating and so like it is helpful from a community standpoint. So I think with that we often work with our teenagers with like how can we like make social media work for you in recovery? And like are you in a place where you can have it, not have it? Do we need to like follow new accounts? Do we need to delete people, block people, mute people? It's really individualized at that point, but I think it's making it more challenging for parents and it's making it more challenging for for kids in recovery.

Speaker 1: 23:38

No, this is so helpful because, I mean, you so beautifully kind of laid out social media, because a lot of times now we are of the opinion that, yes, social media is bad, but there's good stuff on social media and how do we kind of manage those expectations right, and that it is individual, even within the eating disorder spectrum that, like you mentioned, who do you follow, who do you block Things like that?

Speaker 1: 24:05

And I love the fact that you talked about the recovered body, because it is true, like with celebrities and I don't mean that they have, may or may not have, eating disorders but when we look at celebrities, we look at these bodies that are so beyond when we are, at times, even as adults, like when I view certain bodies, I'm like, wow, that they look amazing, although I know that there may may not have been work, they probably eat really well, things like that but there is that pinch of oh, my god, look at them right, and where am I? So that comparison again. So it's really helpful to kind of talk about Everybody is different and that it's okay to be in that body and to be different. And I can just Maybe not even imagine how a teen feels Within that space of comparison all the time, so that's really helpful.

Speaker 2: 25:08

No, and I think you bring up a really good Conversation about like representation too right and so like, and I think, as we even an eating disorder treatment world there's. There's tons of discussion of this too, of like, how different modalities serve some people and don't serve other populations. There's always the conversation of access to care and different communities that aren't necessarily able to even like get care, and we have to, kind of on the always keep in mind that we need to be aware and inclusive of all these differences. But also, I Think the most important thing to do with your teenager in this space is to be talking about it, because if, even if we don't have the answer or have the perfect thing to say, how can we expect them to make the right choices around their feelings or their thoughts that they're having, if they think that those feelings or thoughts are like weird or not normal and so like what? What would it be like for us as parents to be like, yeah, I Compare myself sometimes, like I feel weird about food at times, like this is what I grew up with and like all this has changed, and I think like it's so important to just be talking about it, because I think that's the piece that was often missing for me. Is it like no one talked about it, right? Like I talked about this a lot with like parents in general and like motherhood of? Like I wish I'm a would have told me how Like hard it was To breastfeed or to like go through the body changes and stuff. Like Everyone kept it this big secret. And I feel like as a parent, just being like yeah, it's really crazy and it's like really hard to see a celebrity post a bikini pic three months after they had a baby and they look fantastic and I think it's like worth having the conversation of. Like they probably have a private chef and they have a nanny. They can like work out ten times a day, like all this other stuff and just like talking about it.

Speaker 2: 27:00

And I think the more as parents we talk about the feelings that we're having around bodies and food and then like how we're making our choices and what a definition of health really needs to be, the easier it will be for them to do that. We can't expect to like have the right answer, but we can expect that if we're being intentional and open and like Talking about these things in a conversational way with them and not like this is what you have to do. Okay, I think like it teaches them to do the same thing if I say, you know, my definition of health is X, y and Z, it gets them thinking about it too. And I think, as parents, it's good to think about your own definition of health, because often, as parents, that's distorted or like what we grew up with. And I think, at the end of the day, if you really sat down and said, like what is my definition of health? Mine has shaped to be.

Speaker 2: 27:55

Am I taking care of myself with food? Am I enjoying food too? Do I have enjoyable movement in my life? Am I moving enough? Am I feeling like I have good energy? Am I feeling strong? Am I sleeping well? How is my mood? How is my financial health? How is my?

Speaker 2: 28:13

Am I feeling like really satisfied from like an educational standpoint, like am I feeling like I'm learning? Am I feeling like work is really like beneficial and I'm like getting things out of it Not too stressful? All of these things is health to me, and I think the definition that we were, that I was taught anyway, I'm 36, so like I was taught growing up was health means that you're an ideal weight and that you exercised a lot and that you look a certain way and have a certain job. It was not this internal Mental health stuff. And so I think, if you talk about things in that way of like this person in your eyes might look healthy.

Speaker 2: 28:52

But is it healthy to go to the gym four times a day?

Speaker 2: 28:54

I don't know right like it maybe if you're like a crazy Olympic athlete, but like I don't know if, for if I went to the gym four times a day, I probably be like not a great mom, I'd probably be like really overtired. I probably wouldn't be able to like get in All the food that I need in the day and have time to like get through work. Like right like I think we have to figure out what that definition of health is and and Express that in a different way than we have in the last however many years. Right like I think you go to the doctor and the doctor says what's your weight? Well, that's what's important, and I think that that gets really blurry in this picture. And that's how can we expect our kids to change that definition if we're not talking about it being open about how much it does? It is confusing, it's confusing for me, it's confusing for you, it's confusing for them times a hundred at this point because of social media, and I think, like just having that conversation is so important.

Speaker 1: 29:47

You're absolutely right and you have made so many valid points and I want to touch on all of them, because this is a conversation that I think also Probably revolves around Shame. Right, like when you mentioned about people not really talking about oh, it's so hard to lose weight after You've given birth. I think there is kind of a stigma and shame attached to how can you not take care of yourself, for example, or how can you Think about yourself when you have a baby, like all your energy has to go towards the baby, and I think similarly in terms of when a Teen is going through what they're going through with eating disorders, I think parents kind of feel the shame, the Stigma, that what could I have done wrong or what did I miss, how did I miss something? The anxiety around, how is this going to affect my child? And is it like a lifelong thing that I cannot take care? You know, like I cannot basically fix it, and then that's one part, but the other part is also there's so much sort of shame around. Did I do something wrong and that's why my child has and eating disorder, and I think the conversation kind of stops there, and so as isolating as it is for our teens.

Speaker 1: 31:19

I think it also, to a large degree, is isolating for the parent as well. And then you kind of put in culture and different cultures, the way they react when it comes to eating disorders, right, like I come from a South Asian culture where eating is Everything, like how do you not eat, or how do you eat and how do you? You know there's such like an understanding of food culturally and it just sort of becomes, I think, an isolation for the whole family if there is that stigma Attached, right. So, yeah, I mean there needs to be more conversation, there needs to be education, there needs to be Sort of an understanding that yes, we do need help and so let's step out and get help. In your practice, have you, I mean, you have talked to parents, but what would you tell parents who's teens are struggling with eating disorders? How can parents support their teens in this struggle and, at the same time, go through their own ups and downs if they feel so?

Speaker 2: 32:39

No, and I'm glad. I'm actually glad you brought this up, because I think one of the things that we know about nutrition and like being dieticians that work in this is that myself, as a parent, when my daughter gets a cold or like it's the flu or whatever, right, right, the go-to is like okay, I got to call the doctor, I got met. Like you go through like this checklist right, and you're like, okay, I'm gonna fix it. You Can't fix the eating disorder as the parent for the kids, and I think it's so important to Acknowledge that you want to, and at times, because you want to, you might say the wrong thing, you might push in the wrong way or you might not be able to understand Mentally what they're going through. And I think that's one of the biggest things that I tell the parents is like you probably need to To either have your own space to work through the feelings that come up with us. So, whether that's individual therapy or also like working, a lot of times we just autopilot, give parents parent sessions to like educate and help you understand that. Like this is not a you did this and this happened thing, for the most part right. Like yes, everyone makes mistakes as parents and there's things that can happen and obviously this is I can't blanket this to everyone there's trauma that happens that we see eating is or a sprout up. There's, like you know, serious mental health disorders and things that they can sprout from like secondary. However, I think for the most part, just listening as a parent and Using that listening skill, paired with using professionals Together, is key. Talking first steps right, like if you say that you're just kind of like seeing some things and like are concerned, obviously trying to talk to your child about that, but also giving them a space for like is there more going on mental health wise, like is there already a therapist involved? Do we need to get a therapist involved? Therapists, dietitians who specialized and pediatricians that know about eating disorders. Like you do have to kind of bet for that, but like Finding some people in the field to just talk to and be open with can really help guide you along that path, because it's very hard as a parent not to default to fix it and Eating disorders are very different than other mental health struggles Around a behavior because it's not like right, like in substance use.

Speaker 2: 34:56

You can be like okay, you can't go to the bar like, or you can't, we can have alcohol in the house or whatever, or, like you know, we delete the dealer's number from the phone, like all this kind of stuff that you can do. That's very black and white. You have to be around food as a family and as a person, so it's. It's just a different journey and I think parents understanding that Just being supportive is enough Usually and then, paired with whatever kind of is going on behaviorally, be able to make decisions and use professionals as like a backup to that. But most of my, my teens and teens that I have worked with have said it's not about my parents saying the right thing, it's just that they're, they're hearing me, because usually we're not gonna sit like you're not gonna say the right thing, like we have to. I have to figure that out with clients, like Sometimes I say the wrong thing. The clients, if someone you never know what kind of some people love In terms of, like meal support, right, like some kids love a cheerleader and some people hate Talking about what they're eating in front of them. And like, as you're figuring that out with with your kid and their recovery process, it's helpful just to say like I'm just here. I'm here if you need.

Speaker 2: 36:06

A lot of times parents will have a, a journal that they will leave in their room or by their bed or in the kids room and they leave it as a space of like okay once a day. Like write down anything that you need to tell me or that you would like me To do differently, and sometimes having like that neutral space when it's not an argument or face-to-face, gives a kid the room to put down like okay, like please don't talk about how much pasta it on my plate. I'm gonna do the best I can tonight. Or please come with me to the bathroom after dinner and we'll just make sure I'm like okay together and not gonna purge. Sometimes like a text or a journal, something set like not face-to-face is more helpful for teenagers because they have a hard time sometimes With the the confrontation part.

Speaker 2: 36:48

But I think just showing up as a parent and asking questions is what most clients say is helpful and most of the time. Again, there's different circumstances obviously with with trauma and mental health, but most of the time if a parent is showing up and trying, the kid really just appreciates that and and if you're using professionals as backup, you should be able to figure out what your role will look like a little bit more and again, like there's so many, depends on age and depends on what else is going on. But I think parents always need the reminder of like you need your own support, like you need to work through your own stuff because Everything that you're doing is learned behavior. So, like you know, sometimes we do have to unpack our own History of eating and like how did I grow up with? What are my food rules? Like what did my parents say to me? And sometimes it helps you understand, like maybe, why you're doing some of the things that you're doing and maybe like where things could have Caused a problem, but there's usually not. Like this happened and this is what Ruin everything and and all of that.

Speaker 2: 37:47

And like giving parents space. Like we make mistakes as parents, like we've all done the wrong thing or something wrong, absolutely right. Right, so like Again, owning that. Like kind of like you know more modern parenting, right. Like if I get really frustrated and like yell and feel really bad about it. Right, like I feel like stop doing that and I'm like, oh my gosh, I'm the worst. I like yell and I'm not doing gentle parenting, like freak out. But I think the difference is like that I will apologize to my daughter and say like, oh my gosh, mommy shouldn't have yelled, I was getting really frustrated. Next time I'm gonna try and like feel my frustration and then talk to you.

Speaker 2: 38:20

I don't think I don't remember, you know, a parent kind of sitting down and being like I'm so sorry for yelling at you. Let me redo this and I think, like just again, just that was learned, though, like you know, I can't blame my parents because they were told not to do that right. So like it's looking at your behaviors, looking at learned experiences around food and around our bodies and trying to just have an open conversation, to grow together and, I think, holding a space separately with your own therapy or your own support groups. There's lots of good parents support groups to Learn about, maybe some of the ways that you can change your definition of health and support them at the same time. Some parents end up going on their own Healing journey with their relationship with food. It might not be a full-blown eating disorder, but, right, sometimes it is. Sometimes they say, like parents end up realizing that they have their own issues, but sometimes it's just more about Having their own space to like work through diet culture and learn more about what do I want from my nutrition?

Speaker 1: 39:19

Yeah, and again, beautifully said and so helpful because that, for parents, do it as a journey and trying to understand food in itself and relationship with food, especially within our culture. Again, there is so much information and there is Plethora of conflicting information with you can eat at a specific time, you Don't eat, you fast, you do this, you do that right, like this. So much information out there and so it's really hard to figure out what may work for you If you haven't put in that work in yourself. And I think it's like you said, it's great role modeling for our children as well, who are then looking at us and saying, okay, a, I'm safe in terms of trying to figure this out because we are doing that as a family as well. You mentioned something that kind of worked my interest in Kind of asking you this question, which is trauma. How does trauma kind of intersect with eating disorders, if there, I mean, I'm sure there is but sort of other ways of identifying that?

Speaker 2: 40:37

And I think this is a helpful question. I do want to hop back Just quickly and say like I completely forgot to touch on the cultural place, but it's so important within our practice and many others, like being sensitive to, like different cultures, food preferences and things and behaviors and Rituals, holidays that could impact the structure of eating, and like how to listen, recovery, and it's just so important to find practitioners that are sensitive to that and like willing to listen or learn if they don't know about your culture, and that does play like a huge role. I think that's so helpful. But looking, looking a little bit more into the trauma piece and I think, like in this day and age we use the word trauma really loosely and I think it's when we see it with eating. It's usually more around. It could be two things. It could be a specific event, right. So I think like being aware as a parent if someone's being bullied, if something like car accident, death in the family, like all you have those things that could be traumatic for anyone. Sometimes within that again like huge amounts of emotions and difficult emotions Sadness and anger and grief are very difficult for teenagers anyway and then throw in any kind of discomfort in their bodies, questioning any kind of like gender, sexuality stuff. All that stuff mixed in with it can really breed a space of like what's the easiest thing to control? Right, my food is a really easy thing to control as a teenager if you feel out of control in every other aspect. So any trauma that triggers some like lack of control or really high stress, high emotions. Sometimes and we can speak to this as an adult if you're really really sad or having really hard diet, it's hard to pick dinner, it's hard to sit down and eat lunch, right, like that's a normal reaction. So it's looking after these events sometimes to see, like how we're getting back to normal, and including food in that, because a lot of times we kind of brushed off of like oh, they had a break up and they didn't eat dinner, like, okay, I get it, like they're feeling sad, but if they didn't eat dinner and then they like realized that, you know, your brain starts to catch on like oh, you didn't feel that feeling. You've got to kind of like avoid that, we can really see the patterns of behaviors come out. So just being aware of like the same way you would with the stomach bug of like okay, it's been like 48 hours and they really haven't eaten. Right like, emphasizing, as a parent, you know you would. If they were sick, you would say, like you gotta have a Gatorade, you gotta have some soup, you gotta eat a cracker. Like you would be on top of that.

Speaker 2: 43:00

We also have to tend to nourishing ourselves through emotional stress and trauma and we often don't. Sometimes we do initially like right like after a funeral, having like the big food gathering, or like right like after difficult events, like coming together with family and friends and having like a potluck, like it really it's the things we do socially and culturally, but often it's only that immediate week after and not like the two, three months. And I think it's important to remind our teens and kids that your brain needs food and energy to be able to cope with heart emotions and so sometimes like pairing and looking for during stressful times, whether it's a stressful time for it. It doesn't have to be a huge trauma that it could just be a Move, a transition in the family someone getting a new job, right like changing schools, like the littler things that could be a trauma to somebody out, like to them.

Speaker 2: 43:56

So any kind of stressful time in life, emphasizing the importance of what taking care of yourself means and including food in that right. We often just forget after that first couple of days or or tend to look at the other things. But again, that goes into that holistic definition of health that we're looking at. How is stress coming like? Are they sleeping yet? Are they all these other things? But we're also looking to see like, like are they avoiding certain food situations? Are they able to finish dinner? Are they still saying that their stomach hurts from the thing that happened three weeks ago and that can also get a tip off that behaviors are stacking and like things are becoming more problematic.

Speaker 1: 44:32

No, again, that's really Really helpful in connecting any sort of trauma with, also, I think, control right, like what do I do to feel in control? And, like you said, it's really about kind of emotions that are underneath all of that. That requires our attention as well, just as sort of the eating disorder in itself needs treatment or attention. At the top of our conversation you had mentioned our fit, avoidant and restrictive eating. Can you talk a little bit to the relationship with eating disorders? Sure, sure.

Speaker 2: 45:17

So ARFID is almost in its own category. Sometimes we see it a lot within our practice because it depends and ARFID is so new to just clinicians in general and to, like the health world Not that it wasn't there before, but now that we're actually putting definitions and things with it. So sometimes we see ARFID present itself with an eating disorder, so what we call ARFID plus technically, so like, for example, I might have someone who was a quote unquote, like challenging eater or like really struggled with a variety of food. I don't like to use the term picky eating, but I think that's what most people socially understand. So, say, you have a 12 year old who only likes chicken fingers and french fries and like won't eat a vegetable, and it's like it's now becoming problematic, like we're getting into teenage years and they're not willing to try anything. They're like gagging on, like all the things right. They tend to present itself ARFID is more like that. There's not necessarily a body image component or a concern with how their body looks. We're missing that chunk of it. It's more and there's so many sub types of archvids as well of like whether or not it is something that's like an oral motor issue, like do they really have a hard time chewing, like they actually can't chew food normally and they feel like they're gagging. But there's also like texture issue, sensory issues. Are they neurodivergent? Like there's other things that could be happening there.

Speaker 2: 46:45

I, in my experience, I ran into it because I'm eating disorder world, because I've had people present to treatment before with anorexia, like low body weight and like really won't eat anything. But it's not about I don't want to eat the pizza because it's too many calories, right, like I don't want to eat the pizza because, like I can't do melted cheese and so, like when I first ran into it, probably about like six or seven years ago in like a treatment setting, it came to me as like oh, this is different, it's like it's not fully anorexia, like they're like we're seeing the body weight issues and the health complications, but there's like this malttrition underlying issue because they can't get their food variety up and a lot of these clients initially presented as like quote, unquote, picky eating that has like resulted in this. They used to get lumped in treatment settings with anorexia, straightforward eating disorder clients, and they would often be like well, I just like can't do it, like it's not, because I don't need to be in body image group, like I, like my, I'm fine with all of that, like that doesn't bother me, and so, like over the last few years, we've been seeing more research and more kind of specific points to kind of look through and how to treat these clients.

Speaker 2: 47:56

And so you could have someone who has the sensory texture issues or oral motor issue or really trouble with the feeding stuff, and also have eating disorder diagnosis. So whether whether they're actually like anorexic or believe it or other things with it, they can have that too. I see more people with both, and so it's like navigating, doing both. But we also, I mean, and as a practice, we all became, just became certified arphid specialists. So we're doing more of the straightforward arphid, of just like trying to work through adding variety, sake for health and nutrition and how to have more tolerated foods. It's a completely different ball game, it's a whole. It's a whole other whole, other episode for you.

Speaker 1: 48:42

Which it is.

Speaker 2: 48:43

Because it's a whole different. Yes, right, it's a whole other set of how to parent and how to deal with meals and foods. Exposures are key and frequency is key, but it might take 20 food exposures for them to be able to eat a bite of broccoli and that is like a huge win versus in getting through eating a whole breakfast. As someone with a straight more straightforward eating disorder, you know we could probably do that in a much shorter time. So it's it looks. It looks a lot different.

Speaker 1: 49:17

So, if I understand correctly, it is kind of a different for lack of better word issue in terms of sensory and food variety and quote unquote like picky eaters, but we do see a combination of both, so in other words, that there can be yeah, yes, it can.

Speaker 2: 49:40

It can express as both. So some parents that we work with have, like the straightforward condition which is like the person's avoiding certain types of foods and certain foods and their, their intakes are so restricted that they are having nutrition deficiencies, right, so like they are truly only eating maybe four or five foods and they're becoming deficient in, like iron or vitamin D, or like having bone health issues because they're truly not eating enough variety and it's impacting them socially right. Like if you're can't go to your friend's house and eat their dinner, you're not going to the friend's house and playing like right, like it does impact that. So there's different sub types of our fed and so like you can kind of get into all that in the episode. But like, depending on that subtype and depending on if they have the body image stuff too, if they have more of an RFN plus, that's how we determine how to treat it as a, as a dietitian, the core of all of this in terms of food, food exposures, family meals, the dynamics of the family, how we understand and treat all of these things.

Speaker 2: 50:47

It's important that the parents are involved.

Speaker 2: 50:50

It's important that we're all talking about our own food stuff and our relationships with food and that we depending on what diagnosis and what is going on mental health wise if you have the right team set up, so like dietitian, therapist, psychiatrist, if needed, pediatrician or PCP, and then sometimes an occupational therapist or speech therapist, depending on if there is arphid stuff going on and if you have all that behind you and we get a good, trusted experience team together, it's so much easier for parents to then figure out the route of treatment.

Speaker 2: 51:26

But because we kind of like circle back to the beginning here of like, because no two eating disorders are the same and our food stuff in particular is so different, it needs to be treated completely differently than a straightforward eating disorder. If we have all of that in place, a parent is going to be so much more successful and supported and it just takes the shame away, it takes away the confusion and it helps the whole family kind of grow and change into a space of like, having a better relationship with food and knowing how to handle when struggles come up, emotions come up, and being able to talk about feelings and food in a different way than we have maybe five, 10, 15, 20 years ago.

Speaker 1: 52:03

Yeah, this was a masterclass, Katie.

Speaker 2: 52:08

I feel like I need 24 episodes to get into each, but I think it's so helpful that we touched on a bunch of different things and I think, like it's always important, there's always another answer or route or way to kind of treat things or handle things. And I think the most important part of all of this you feel like you can trust your treatment team and you find the right kind of people to back you up as a parent and that you feel like you can work with, because if you don't have that, it's so hard to get lost in the mess of like shame and secrecy. That kind of stems from being disorders. Thank you so much. Thank you, thank you for letting me ramble on about all that. I just love to share and talk so much. I could go in a million directions, but I think what you're doing is so important for parents and family, so we appreciate you as professionals.

Speaker 1: 52:54

Thank you for saying that and I appreciate that too, and thank you for coming on the show and being so open and easy with your available, with all the information, all the questions that I asked you. So please come back and I would love to talk to you.

Speaker 2: 53:11

Absolutely yeah, and I'm always happy to answer questions for parents, families. I don't know the answer. I know so many helpful people in this community.

Speaker 1: 53:21

I'm always happy to put some of your information in the show notes so parents can reach out to you.

Speaker 2: 53:26

Perfect.

Speaker 1: 53:27

Thank you so much. Thank you. I truly hope that you enjoyed this conversation. My goal is to provide you with in-depth discussion on topics that concern us as parents of teenagers and young adults, and provide you with resources to get started. Have a beautiful week ahead. I would love to hear from you on our Instagram page for parents of teens underscore podcast. See you back here soon.