Ep 70: Eating Disorders and Weight Stigma: Why Health Doesn’t Look the Same for Everyone with Dr. Erin Knopf

In this episode, we sit down with psychiatrist and eating disorder specialist Dr. Erin Knopf for a deeply thoughtful conversation about the realities of eating disorders, diet culture, and our relationship with food.

We discuss why you cannot tell by looking at someone whether they have an eating disorder and how these conditions affect people of all genders, body sizes, and backgrounds. Dr. Knopf explains how restriction and a scarcity mindset can drive binge eating behaviors, and why healing often involves rebuilding trust with ourselves around food and letting go of shame.

We also explore anorexia, bulimia, and orthorexia — an obsession with the health or purity of food that has become increasingly normalized in today’s culture. The conversation dives into how social media can reinforce disordered behaviors by surrounding people with like-minded messaging that makes harmful habits appear healthy or acceptable.

We also discuss GLP-1 medications and concerns about how they may contribute to long-term disordered eating patterns for some individuals. Throughout the episode, we challenge cultural beliefs around weight and health, discussing why true health does not require everyone to look the same or fit into a single body size.

Finally, we talk about how parents can help children develop a healthier relationship with food, body image, and movement in a world filled with conflicting messages.

This episode may challenge long-held beliefs about weight, food, and health — and encourage listeners to take a closer look at their own relationship with eating and body image.

Find Dr. Erin Knopf  and multiple resources At VERY: Virtual Eating Recovery for You

thestartinggatepodcast.com

Email us with questions and topics you want us to cover at
contact@thestartinggatepodcast.com

Follow us on social media @thestartinggatepodcast




The content in this podcast is for general reference and educational purposes only.  It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition.   No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment.  This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment.  Please do not rely on this podcast for emergency medical treatment.  Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Ep 70: Eating Disorders and Weight Stigma: Why Health Doesn’t Look the Same for Everyone with Dr. Erin Knopf

[00:00:00] Welcome back to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz So today's episode is one we've really been looking forward to doing for a long time, and it's because it touches on something that so many people experience but often really don't feel comfortable talking about, and that is their relationship with food.

So we're gonna be taking an honest look at what the landscape of eating disorders looks like today and how much it's changed over the last several years. We'll talk about how social media, wellness, culture, and even some of the messaging around healthy living can blur the lines between health and harm.

When it comes to eating, we'll go everywhere from restriction to binge eating, emotional eating, and really the importance of how GLP One medications and this new world of weight loss medicine is impacting how people have a relationship with food. After this show, we really wanna help you understand when to be concerned, [00:01:00] whether it's about yourself or even just someone you love, and recognize some of those early warning signs of eating disorders, and also give you some ideas of where to turn for support.

And we had to bring a specialist in, of course. And we have a phenomenal guest. Psychiatrist, Dr. Erin Knopf. Who an expert in eating disorders is the founder of Very Health, a virtual practice dedicated to helping individuals heal their relationship with food and their bodies. Welcome. We're so excited to have you.

And to get us started, can you just tell our listeners a little bit about yourself and what got you interested in becoming a specialist in this?

Absolutely. Thank you so much for having me. I like to describe myself as a socially acceptable nerd. I wanted to be a physician, you know, from age six and fell in love with eating disorders. Actually accidentally. I was in undergrad and working in Dallas, Texas at the Children's Medical Center. And all of the patients on the inpatient psych unit at the time had [00:02:00] an eating disorder.

And seeing this overlap of biology and psychology and how many systems it kind of hijacked, you know, even though it was an individual disease, if you will, it still affected family, social life future planning even. I knew this is what I wanted to do. So when I went to med school, thought let me be a child psychiatrist and work with kids with eating disorders. then I found out about the triple board program and for those that are unfamiliar, this is a combo, pediatric medicine, adult psychiatry and child psychiatry residency. And I thought. It's perfect. I can holistically create mind, body, soul, for kiddos. And that was it. The, my fate was sealed and I like to joke, you know, that was 2007, I think when I first knew I wanted to work with eating disorders.

And here we are 19 years later. So after doing my training at the University of Kentucky, I joined an incredible group of physicians at the Eating Recovery Center in Denver, Colorado, and served as a unit psychiatrist [00:03:00] there. Worked at the only eating disorder ICU in the country. Acute health at Denver Health. And I was there during the pandemic. So you can imagine that was a thing. It was a, I was the only psychiatrist there for a 30 bed unit, and I'll admit between COVID and having two babies, I really burnt out. So that's how very came to exist. My husband is a business attorney. That's really useful to have, by the way, when you're gonna do have a startup. It was one of those, it was actually his idea and I absolutely said, are you kidding me? I did not go into medicine to be an entrepreneur, but I guess I can call myself that now. But we started very, we really wanted to close that gap and bring expert clinicians , that really people could only access at higher level of care to the outpatient everyday care. So all of my clinicians are career clinicians working with eating disorders, and we serve patients 10 and up virtually for [00:04:00] psychiatry therapy, dietary services across. A lot of states now, but we say mainly 10, but you can check our website for more. We can offer almost two services actually in 42 states nowadays. Wild gives me the goosebumps.

That's incredible.

Thank you. Thank you. Blood, sweat, tears, I swear. But what's cool is we are here to collaborate with community providers. We are not looking to take someone away from one of the supports they have, especially if they're in an area where they did find an eating disorder informed provider.

That's perfect. We just want to compliment and fill out that multidisciplinary team. So we work really closely with other community clinicians and building that community together. 'cause this work is hard. It's really hard to do, and the only way through it is together Truly.

Well, let's get started on some of our questions. Yes. when we talk about eating disorders, it's such a broad thing and it can be from one side to the other, either not eating enough or eating too much. I guess, what do you just wish the general [00:05:00] person understood about eating disorders in general?

Oh my goodness. One, I think first thing is to understand who's affected by an eating disorder. It used to be seen as something only happening in white cis, he affluent females, you know? But really that was a skewed data point or statistic. That was just who was getting care. So really, eating disorders don't discriminate. They exist in all cultural backgrounds and across socioeconomic levels. They affect. Men, they affect women. They really affect L-G-B-T-Q community, and if anything, eating disorders cannot be diagnosed with your eyeballs alone. Actually, only 6% of people with an eating disorder are classified as underweight if we are using the BMI scale.

Yeah, I know that that is something that so many people even have a hard time. Understanding they have a problem because that's what's been communicated to them. Not just healthcare professionals [00:06:00] identifying about individuals. It's like, there's no way I can have an eating disorder. I, because I have a normal weight, or I'm overweight.

You know? And it's, we've really just made it only about a number on a scale, trying to think about it, that diagnos.

I love how you mentioned that because it really isn't part of the criteria to have it be part of or a stale number. It is behaviors, thought, feelings, and beliefs. That is what makes this a mental health diagnosis. I think it is more complicated by the fact that it has so many biological and physiological complications that follow. But this is something that more often I think people are struggling with and even specialists don't know to look for it. I mean, we talk about constipation. You know, in a GI clinic people think, oh no big deal. Or maybe this is just I-B-S-I-B-D related, but constipation from slowed gut motility from intentional weight loss is almost ubiquitous across the board.

Anyone who is dieting and yo-yoing through caloric restriction, caloric [00:07:00] excess is going to have slowed gut motility with constipation. So that's just one example of, you know, the chief complaint may not be weight loss in clinic. If you're a general practitioner, it could be a lot of other things.

 Let's start on one at the end. On the, the spectrum. Why don't we start with overeating or can we start with like binge eating and emotional eating? What are these and what are the differences between them?

I think there's a difference between clinical language, you know, in the diagnostic manuals cultural language. And then when you're doing this clinical work with individuals, you see it a little differently. So from my perspective, the root of binge eating is actually restriction. these are individuals who are trying to limit either certain types of foods. maybe it's the treats or the chips, fried food, baked goods, all the things that they're moralized to feel are bad for them they shouldn't eat. And [00:08:00] even if there's just mental restriction and not actual restriction. still does something in the body. If I told you, don't think about pink elephants. You're thinking about pink elephants now. There's no way around that. So if you tell yourself, don't eat candy, all you're gonna think about is candy. And even if you don't buy it, 'cause you say, I can't have it in my house because I'll go too far. The moment you're around candy, your brain will have a scarcity mindset, will think just one piece, and then that one piece reminds you how much you love candy.

And now you're thinking just this one time, you know I'll have as much as I want. And then never again. It becomes this feast or famine. You make promises with yourself. You, you get into this cycle where now you've ended up overeating candy, you've had more than the portion. Maybe it wasn't a true binge, you know more than what someone else would eat and you're having physical from it.

That is possible, but it's still, nonetheless, that cycle of now you feel guilt and shame because you went and [00:09:00] you did ingest more than was. Potentially an, you know, the right amount for you. So I really like to point out for people, you know, hey, if you're having binge eating issues or night eating issues, at what's happening before What does the previous day look like? How have you been thinking about food options? How have you been macros as far as making sure you are getting fat, protein, carbohydrates, fiber daily. This isn't just, you know, stock up on protein and your body's content. You do need carbohydrates. You, you need that glucose. It is real. You know, I know there's a lot of debate about added sugar and whatnot. I think there's so much more nuance in individualized care that there's really no way to give one blanket rule to everybody. So if anything, emotional eating makes sense too. You have this desire to feel and that's actually part of our wiring.

It's what makes us different than animals. We're not just eating. To fuel our bodies. [00:10:00] We're eating socially, we're eating emotionally, and we don't need to demonize that. It's just a matter of knowing it's okay to seek comfort from food, but how do you teach yourself that you can always have more later, you know, and build that abundance mindset.

The scarcity mindset again, is what makes risk of quantity if you will, when you're eating in those scenarios. But you do not have to pride yourself of, comfort and support . You are allowed to feel soothing and relief from eating a meal you really enjoy.

, I find this hard when working with patients and trying to help them develop a healthier eating behaviors and lifestyle. How do you really counsel people to learn how to decrease ultra processed foods that sometimes can almost feel addictive to you, but also not develop that scarcity mindset?

It, it, it's a hard balance. So how, [00:11:00] like, how, how do we do that?

I think it starts with you know, kind of relearning. We have to unlearn and relearn how we look at food. So foods, you know, became very popular post World War ii. Everyone was using these quick, you know, Campbell soup meals and recipes to get through the day, and it was a way of increasing, productivity, but also reducing strain on, you know, primarily women at home. That was, touted in all the advertisements. So I think there's a difference between, artificial ingredients and when we talk about processed foods and foods that are processed, I, I like to point out that even bread is a processed food.

We can't just eat wheat from the field. The wheat has to be ground down and filtered, and then that flour has to be used for something else. So it technically did undergo a process to be ingested so our bodies can digest it. I think there's, you know, other information to have. What makes digestion hard perhaps is some of these [00:12:00] foods, . If someone has an issue with processed bread, maybe it is because they need to have sourdough bread, for example, where the gluten is already broken down by the microbes that are in it. You know, that's another thing of when we look at history, that's what most humans were eating. They weren't eating the type of bread we eat today.

So, I know I'm jumping around here, but there's lots of different perspectives to look at here when it comes to the high processed foods like chips, candy, things that are always packaged on the go. I think it's more about moderation. Especially if you are someone who doesn't have access to fresh fruits and vegetables regularly. Or, , due to scheduling, you need something quick and easy. Something is still better than nothing, and it's a matter of can we still pair processed foods with other options? And so I'm thinking of. This is where I talked about the nuance, what you and I might be buying for our families and how we're structuring our meals for, I have a four and a 6-year-old and [00:13:00] my husband and I is different than what a single parent in a more urban environment might be forced to buy and feed their children. So I think there's just so many nuances of, hey, you do the best you can and you empower the person to know you're still making a good choice by feeding yourself and feeding your family and not having your kiddos go through experience of starvation. And, you know, is there any of creating more diversity here of where you get your nutrition?

I think that's different. You know, calories when we're talking about just. General meeting of body's needs It doesn't actually matter as much where it comes from, but ultimately the body always functions better and feels better and can manage itself better. When you have your macrobalance and you are giving it all of the micronutrients it needs, and these processed foods are often lacking in the micronutrients.

So that's why we don't want someone to rely a hundred percent of their meal [00:14:00] intake through that.

 is that something if, when patients are struggling with this, I know I've seen it. I know I've experienced. I did myself is when you are having this restrictive mindset, a lot of times if you're not balancing your food, that's some of where those cravings go, that drive the binge 'cause you went all day and you didn't get what you needed and your body's like, hello, please give me more.

And, and kind of drive some of that cycle. And not everyone realizes necessarily that's the driver of it. They just have that, like you mentioned, that shame game that starts happening. It's like, oh, it's me. It's the willpower, I'm the problem. When truly, like you had mentioned, if you reflected earlier in your day, you're like, ugh, if I had, you know, had not restricted all day and ate a balanced meal for breakfast and lunch, I wouldn't be here right before bed just eating everything in sight.

Exactly. And also, you know, that anxiety, the cellular levels, [00:15:00] having from, experiencing nutritional deficits during the day is also what drives insomnia and the difficulty to falling asleep and the racing thoughts. And so when people say, I get in bed, I'm trying to fall asleep, and I'm so hungry, I have to get up and go.

I mean, this is where there's both a combination of consciousness and unconsciousness driving. Binge eating or overeating in the evening time especially there is a biological pull to eat. I think it's interesting, you know, I get a little nerdy here. Everyone talks about one of the mechanisms for quote unquote obesity would be leptin resistance.

So leptin, you know, people have heard leptin and ghrelin these are hormones that help just monitor, maintain our hunger satiety cues. What's interesting with leptin, it's an opposite reaction or an opposite direction to hunger. So when leptin is lower, hunger is higher. And as you are eating more regularly and consistently, leptin will kind of be in the more of a medium range. When you are binge eating, leptin can actually get quite high. And [00:16:00] so that's supposed to tamper down your hunger cues, if you will. But in some people it's not. If anything, when we look deeper into those cases, for example, we actually find they were always going through some sort of weight cycling where they were dieting, rebounding, dieting, rebounding, dieting, rebounding.

And this is where the adaptive physiology that wanted to protect them from that starvation mode just. Was working in the wrong direction from what society wanted, what modern medicine wanted. They wanted the person to lose weight. The body said why are we in famine mode? Where's the lack of resources coming from?

I don't know. And it just changes the entire processing of the brain. But if you do that long enough, we know this model exists in other forms of medicine. If you are not listening to the internal cues, your body stops responding. It's like, well, nevermind. There's no point. isn't what we do.

Other things happen. So leptin resistance may be part of the issue, [00:17:00] but really again, who caused the issue, you know? And especially when you're talking to people who were big kids and put on weight loss diets and pursuits from a very young age. I could get into that too. I have a whole soapbox, I'll admit, as a pediatrician of, oh my gosh, we never should have started trying to shrink kids' bodies.

We are messing with their development way too much and setting them up for a lifetime health consequences and potentially eating disorders. But that just a pin in that for now.

So I've had patients that this is, they've had this experience, they've had the yo-yo dieting experience since they were a teenager and they come to you as an adult in, you know, in their thirties or forties and they're just like, this is always the way I've been, but I always feel hungry no matter what I do.

Is there a way for them to actually improve their leptin sensitivity again, or is that something that is likely going to be a struggle for lifelong [00:18:00] at that point?

I think when you take the emotional healing on first. Then, you know, especially if it's an older human with a developed frontal lobe. But that's when you can start integrating that frontal lobe, executive functioning, deeper understanding to quiet the amygdala and the deeper brain that is our survival brain.

Right? That when you have that integration, then someone can learn through lived experience, that they can trust themselves around food, they can trust their bodies. I think what's so hard is we have pathologize body size and body weight, rather than recognizing we have body diversity for a reason. Not everyone's the same height, not everyone is the same shoe size, and yet we try to confine weight to be in this very small range that, again, is defined by an equation everyone's using.

BMI, I mean, in our training years is when it really got implemented that you couldn't even bill and have your reimbursement from an insurance company unless you marked something about [00:19:00] BMI. So this was forced onto physicians. For the last, can we say two decades? I'll say two decades. Maybe it's more like one, but it's been a while. was arbitrary. At the end of the day, we have a mixing pot of humans in the United States especially, but not everyone comes from the same genetic background and size. Diversity mattered and was necessary depending on cultural background. There's also epigenetics, so we know that trauma experience in one generation can still show up in development of someone many generations later.

And that trend absolutely has been seen where a generation that experienced extreme starvation generations later, they are insatiable. Again, that may not be a leptin mechanism in this case. It could be something different altogether. It's just complicated. You know, if this was a Facebook status back in the day, that's what we would [00:20:00] say.

And I think what's so hard is we see population health information and guidance given that really overly harms the individual. So this is where it really comes down to what someone's weight is. And their health assessment is really between that person and their physician, who hopefully is, know, looking at so much more than just the scale number and the BMI, you know, what are your thoughts and beliefs around food?

How do you move your body? How do you keep your sleep consistent? We know that inconsistent sleep increases cortisol, high cortisol. What does that do to the body? Causes weight gain. So oversimplify a. Our recommendations based off of population level information and, it potentially misses what's going on for that person in the context of their life.

 And so for someone that's struggled with this and maybe BMI is not the best thing for them to monitor, what, what do you recommend they use as a [00:21:00] metric to kind of see how they're doing? And I would like to hear your perspective on that from , like a child versus an adult as well.

 So weight inclusive medicine is not brand new. It's been around for a while. But some of the more objective metrics, 'cause again, we are all. Especially acceptable nerds in the medical field. Truly to some degree we want something concrete we can rely on, we wanna see progress or at least sustaining a new norm. I would say again, it's more of feel and function. Are you able to, be in your life? Do you feel strong? Are you working on skeletal muscle development? 'Cause actually there's a lot more to that than. Weight number as far as someone's health and wellbeing. Are you feeding yourself regularly?

Are you making sure your body is never deprived? You know, some people really do need to eat every three hours, four hours to not experience a big dip. Are hunger cues. You know, you're not supposed to wait till you're starving to go eat something, much like you [00:22:00] don't wait till you're super thirsty to drink water.

That's a sign you're already dehydrated. The same thing when you say, I, I'm starving. I've never been this hungry before. not the normal cue to go eat. Lower or softer cues for hunger actually be bad breath. A little bit of nausea. Some people misinterpret that and then they feel like they can't eat. But any pregnant woman could tell you, well, if I ate when I was nauseous, then the nausea went away. It's a similar mechanism, y'all, for everybody. If you notice nausea and it may be a mealtime, don't wait. Go ahead and go eat something. So other things to look at when you're trying to help with position is really actually make it individually focused.

What are your health goals? I think this is one thing we all in medicine, because we value health, of assume everyone values health. We also wanna make sure that people don't get unhealthy and then overuse the system. You know, there's all these concerns of later stage issues. It's not that [00:23:00] we want to impose values on someone else, but we know that if they do get unwell, they're gonna show up to hospitals and, you know what I mean?

Like, we're trying to interrupt that. We, we can admit that that's also a motivation of ours. but at the same time, not everybody's health has to look the same. So, you know, labs I think are great. It's very important to look at labs and even important too, to better understand mechanisms. You know, we talk about visceral fat. visceral fat is not this terrible thing at all of the organs need to have a protective fat layer, and there's a lot to be said about why fat will show up in certain places we don't know the answer to yet. That's the other thing. As physicians, we are giving advice and guidance on things that are so complicated, and we've only begun to scratch the surface of the mechanisms at play.

So it's where we really have to be honest of, don't know, you know why you might have. This finding, and let's go do things that are easier to obtain. It is easier to give [00:24:00] recommendations on moving more, improving the nutritional balance and consistency of your daily intake, you know, and also making sure you're caring for your soul.

Because the social determinants of health and the domains of health matter here, your emotional health is as important as your physical health. Because the two are related, you know, the same wiring is there for both. We just don't really know how to follow the processes of the nervous tissue from a gross anatomy perspective to an emotional perspective yet. Right. And how it's all wired together. We know about the gut brain connection and yet we can't map it always, and we can't intervene exactly the same way because we don't have the ability to. So I think it's a matter of just taking in a lot more than just, okay, I see your weight. It's too high for your age and sex, and now we have to treat that.

No, no. Let's look at the context too. If someone was always 95th percentile, they're gonna be 95th percentile. The 50th [00:25:00] percentile is not the gold standard. That's just the middle. Not even the a mean an average or a mode. The most people are at the 50th percentile. No, that's just the middle. If you had a a hundred people and you line them up in wait order, that's 50th.

You know what I mean? But for some reason, I think I got a little confused what I see when I talk to other physicians. They think, oh, well I thought I needed to wait. Restore them to the 50th percentile. If they're coming up or I thought I needed to have them lose weight to the 50th percentile, said, oh, no, no, no. not their body. That's someone else's body. one of the important things to remember.

I'm glad you brought that up. 'cause I do find that it's very challenging. 'cause for kids specifically, there's not a lot of labs. many times when you are going for your well child checks with your children, you don't have as much data. Sometimes we as adult doctors.

Receive, and you only have these growth charts as you just mentioned.

Mm-hmm. Yeah.

and so for our listeners, if we have parents listening, and maybe [00:26:00] this is some, a discussion that they've had with their pediatrician, what are some of pieces of advice on how parents can try to advocate as well as take information in from healthcare providers to truly feel like they're doing what's best for their kid?

I think it's knowing that yes, historically we would recommend weight loss to children. The truth is that's not the best mechanism. Truly, I like to use the metaphor, you know, kids are a ball of Play-Doh and you have to roll it into a ball before you can roll it out to a snake. So kids are always gonna have a period of chubbiness, of looking bigger. You know, and again, we can talk about extreme cases and I'll get there, but I'm talking about the average kid's experience. And too often people say, well, let's take away some of that Play-Doh. It's too much. Well then when you try to roll it out, you're not gonna get the same length snake at this point because you've removed. of the building blocks, if you will, for growth. When a child's [00:27:00] weight is impacted, the protective evolution based mechanism of starvation mode puts development on hold. This is why kids look so much younger when they've had a restrictive eating disorder, but it's also the same for kids that have been forced to go on a weight loss diet. It delays how they progress through puberty. It can cause height suppression that's permanent. it's not benign, is what I wanna say. We talk about weight loss as if it's a benign process or benign recommendation. Absolutely not for any age individual, but especially the kiddos. If anything, what advice do I have?

It's a matter of first. Don't focus on the weight and body size and body shape. If anything, it's time to really use language. Like you can say fat 'cause they're thin and fat. We don't need to have the word fat be so, you know. Mm. Don't say that, don't say that. That's insulting. We need to take back the fact that this is just a descriptor word. kids are tall, some kids are [00:28:00] short, some kids are round, some kids are really skinny. Everyone has their own trajectory for development. And I mean, you look at a room full of 14 year olds nowadays, it is insane. Some of them look like they

Is.

17 col year old college students almost. And the others are prepubescent and they are teeny tiny little humans. There's no way to compare. They all have their own timeframe of when they will go through puberty, when they will reach their full adult development, which is usually not until college. And the last thing we wanna do is mess with their biological signaling internally. So rather than focusing on weight loss, look at again. Additive option. So like, again, moving more getting outside more. How are they doing emotionally? What, you know, what's their background? I mean, there might be trauma there and a lot more to unfold than just treating a weight number and a body size and pathologizing that it has to be holistic. And you know, if anything teaching [00:29:00] self-love starts there.

When we tell a kid there's something wrong with their body, they are too concrete of thinkers to take that just as a superficial thing, it becomes everything to them about their worth and their wellbeing, you know, and it reinforces the discrimination they experience at school. I mean, kids are mean these days and they don't mean to be, but they're learning, right?

They still don't know necessarily how to treat other people that are different from them. So all they know is different. Is that okay? I'm gonna start off kind of. Skeptical, and that might lead to some indifference at a low level or downright, you know, in your face. Like, why are you like this? You know what I mean? that feels personal. That feels like a personal choice to be different for these kiddos when it's not. It's genetics, it's environment, it's again, epigenetics too. There's so many layers there. So I'm sorry if I'm kind of going all over the place here, but it is overall complicated. [00:30:00] And if anything, we know that weight stigma discrimination for, for being in a larger body is harmful, just period, it's harmful.

And if anything, it's really no different than racism. You're talking about a snap implicit judgment of someone just from a physical characteristic. In this case, it's not skin color, it's body size. And there's this assumption of you did this yourself. You must be lazy fat because you you don't take care of yourself, you don't value yourself. When , that couldn't be farther from the truth. Truly. And it's interesting how weight stigma is even in the medical field I'm so grateful for organizations like students for size, inclusivity, and the Association for Weight inclusive Medicine and Weight and Size Inclusive Medicine because it's providing educational content for students, you know, who are in medical school or pre-medical school, and then residents as well as, seasoned clinicians of how do we unlearn this assumption. I [00:31:00] mean, we were taught to walk into a room and try to diagnose someone with our eyeballs automatically and. oversimplified and honestly dehumanizing for the person in the room. So there's lots of layers there. So for, again, to your question of for the parents listening, just know that your physician has good intentions. like to give the benefit of the doubt to all of my physician colleagues out there that you went into this because you care. And that's why you're giving healthcare specifically. And it's a matter of just leaning in more to the emotionality. But this is where we have systems working against us. You don't have time to connect and really get under the surface sometimes in your well child checks, in your annual visits. And that's unfortunate, you know? So if anything, I have a lot more. Wishes for improving the overall system of how we provide care and meet patients where they are. But at a minimum, just again, if someone tells you your kid needs to lose weight, you can say Thank you for caring. And I will have [00:32:00] some follow up questions and comments for you later.

But in the meantime, let's not talk about weight like that in front of my child. They are growing on their own,

 And I think what I'm hearing from you too is that instead of focusing on outcomes and metrics and specific numbers, really focusing on consistency with certain behaviors would be the best thing. And that's something that we really just do not get trained on in medical school or residency, is behavior.

And being consistent with healthy behaviors. But really that makes sense. You know, if you're consistently exercising your body and consistently doing things to improve your mental health and consistently eating nutritious food in general, that will likely lead to health as opposed to, you know, just.

Worrying about what that number on the scale is, or your waist or, you know, those, those other specific metrics.

exactly, 

okay. So, we're bringing up all these things and these concerns about how [00:33:00] interactions can happen in healthcare because we're worried about triggering an eating disorder.

And when we say the word eating disorder, honestly the majority of people automatically think of anorexia. So let's, let's talk about that one first. That diagnosis. What are some of those things that are happening to patients that are fueling that diagnosis and are things that we can do better to help protect our children?

So again, thinking about its thoughts, feelings, behaviors are what make a diagnostic, you know, criteria met. this case it's fear of weight gain. know, true fear, like they cannot do anything else. If there is a, a potential of weight gain, the desire to be thinner. So always thinking, you know, even if they have a weight goal of one number, that's not gonna be the end.

They will continue to push that goal further and further down. And then of course, the fact that it causes [00:34:00] dysfunction in their life. In the DSM, you know, anorexia nervosa is distinguished from atypical. I'm quoting that anorexia is under the other specified feeding and eating disorders.

There's actually no difference between them except in this case. Weight stigma between the two. You know, one, someone is underweight from where they should be and they are, are lower than the BMI 18. The other group, they're still in normal body weight, but that doesn't mean they're at the right weight for themselves.

They actually have the same medical complications and the same potential devastating outcomes. As far as what happens to the body in starvation mode. So I always like to remind people some statistics of, there's like 50% of the people in the country are trying to lose weight at any one time.

Maybe even 60%, 35% of people who pursue intentional weight loss will develop disordered eating or pathological dieting, which means they do overly think [00:35:00] about time-wise, when am I eating, what am I eating, what am I doing to compensate for my food? I eat with this person? Am I clean eating? I mean, even when we get into, there's this non formalized term, but we all use it in the field called orthorexia.

That's the over obsession with the quality of food. You know, are, are these pure, you know, whole foods, clean eating, et cetera. If someone's whole life is around that and it's leading to interference with how they socialize, how they plan their day, the time their brain is spending on food that's disordered, truly of the pathological dieting or disordered eating.

20 to 25% of those individuals will progress to a full diagnostic diagnostically met pathology in the eating disorder world. and that has more to do with the biological click in the brain. We don't know why some people have it in this paradoxical way. It's opposite what you think. You think if the body was experiencing starvation, it would. Want to remedy that by asking [00:36:00] the individual to eat more. But there are certain individuals with certain neuro wiring, the perfectionistic, high achieving, anxious, successful. Let's be honest, they're also very successful people who are more at risk for developing anorexia nervosa they can get really good at something really rigid and really constrained, and they feel this immense reward from it because the reward pathway got hijacked.

It's no longer about surviving through famine. It's more of, oh, I, I can starve more. But they don't realize that that's what their brain is actually asking them to do. It's wild. I mean, starvation too will a lot of the physical symptoms that we would expect them to have it when they're starving.

And patients will actually tell me that they did feel them. They just ignored it. So again, the type of GI distress. They have when they're withholding food, headaches, dizziness, cold intolerance. These are things that they may [00:37:00] not actually be feeling even when you ask them about it. But if they've lost more than 10% of their body weight in three months or less, they meet criteria for protein caloric malnutrition by default. And so, you know, it doesn't take actually much to get there. What's wild is the Minnesota semi starvation study in the 1940s was done by Ansel Keys, and he's the one who actually demonstrated just how profound intentional weight loss and starvation impacts the human being. It was only done with male participants.

And they were put on an initial diet of 1500 calories, 1800 calories, which by today's standard sounds like a pretty average number on MyFitnessPal of what to reduce your calories to. And they were starved for a period of time until they lost 25%. their ideal body weight. they showed all the same symptoms of someone with anorexia nervosa, food preoccupation, social [00:38:00] isolation, withdrawal mood dysregulation, meaning their mood was all over the place.

Super mercurial, poor sleep or sexual function, low libido. all the physical issues I mentioned before. And of course, you can get into low blood pressure, low blood glucose, low heart rate, those are the components that we worry that someone's medical fragility is now truly medically unstable. And that's why we're looking at hospitalization when patients do have those objective findings. but again, those same things happen in the atypical anorexic as well. So if someone was, you know, I'm making these numbers up right now, 250 pounds, put on a diet of, you know, don't eat more than 1200, 1500. Calories to lose more than a pound a week, they're gonna get to a point where they will start having physical complications if they are following through with that. And they may need to be hospitalized for hypotension or low blood pressure, bradycardia, 'cause [00:39:00] their body is breaking down itself in order to survive the famine it's experiencing. So that's one of those things where, yes, people think about the anorexia nervosa patients as being the chacectic, you know, emaciated individuals, but it may not be.

We're gonna pause at this moment, and I have to bring up this topic because we're seeing it today with GLP-1s. Yeah. Many patients meet exactly what you just said. When they have that rapid weight loss, what should we be doing? Because it's happening to so many people. Yeah. And only probably going to be happening to more as we continue to, to prescribe these.

Y'all. It is so scary. I mean, the eating disorder professionals world has been, you know, banging on chest and ringing bells and posting these things. I'm like, how? What's happening in healthcare? You know, this is not right. What is this, you know, district one of the Hunger Games, [00:40:00] you know, oh, the only thing that matters is to be as thin.

You know, maybe they don't say thin as possible, but be thinner and everything will be better for your health. Ignoring all of the longer term data that shows intentional weight loss isn't sustainable because adaptive physiology always takes over. Again, not a willpower thing. It's called biology. We all learned it in medicine.

Right. It's terrifying. I mean, they are having symptoms of, you know, low appetite, which. That's even in the criteria for depression, right? You know, anorexia is just the loss of appetite. It doesn't have to be anorexia nervosa, the clinical condition. But they're having this low appetite and nausea, which is an aversive experience, you know, that helps 'em avoid eating and makes it hard to eat when they try to eat at normal times.

And yeah, they're going without incredible amounts of nutrition subsequently. And again, the people prescribing it, usually, [00:41:00] I, it'd be one thing if it was just physicians, but the fact that now all these other disciplines out there are also prescribing it, you know, and, wellness clinics and spas, chiropractors can prescribe it.

I mean, it's just too widely available now. You can get it on Amazon, even you can get it anywhere. And so that means it's even more unregulated, unsupervised undirected and the risks with that. Far and wide, but let's say we're talking about someone who is getting prescribed by someone who is monitoring at the end of the day, what are they monitoring?

They're monitoring the weight loss, truly they're monitoring how much weight someone has lost to get to, again, some weight number ideal. That has been determined to be healthier for them. They're not paying attention to bone density. They might be checking labs, but even then the body compensates so well. It doesn't necessarily mean anything. Most patients have completely normal labs when they have anorexia until they are truly [00:42:00] medically unstable. waiting until that point, that's not healthcare either, you know, to before you intervene nutritionally. So the goals are just all wrong. And also think about, you know, the A a p, even instead, a GLP one could be used for children. think, oh my gosh, do you not know what it's already like to be an 8-year-old in the world or a 10-year-old in the world Now you add on nausea difficulty eating, what kind of behavior and mood is that kiddo gonna have? I mean, my four and 6-year-old are barrel hangry monsters when they haven't eaten enough and if they feel even remotely unwell, oh my gosh, watch out.

Like they all they wanna do is lay around and be held. Kids don't know how to reconcile that type of physical discomfort in the way that an adult who consented to it can say, I can muster through this. I can muster through this. But also, is that, again, your healthcare to constantly be battling that feeling every day? I think [00:43:00] so. And what really worries me. We know skeletal muscle loss sarcopenia is happening in these individuals. what's gonna happen when they're in their last quarter of life where their body doesn't make skeletal muscle in the way it used to in their adolescent young adult, middle aged adult lives? gonna happen to their stability, their balance, their capacity to carry themselves? I mean, we all know that someone falling and breaking their hip , in their eighties can be a death sentence. You know, people don't often do well after that. What happens if you've now lost that muscle? How many more people are going to have mobility issues and strength issues in their seventies and eighties because of what they're doing now in their thirties to sixties? I mean, the long-term issues are far and wide. Also, to go on another one, other soapbox with GLP ones, we have no way of consenting them appropriately, The data that's being used is looking at five [00:44:00] years of long-term data. Yes, we have data from Diabetes World, which GLP one for diabetes care. Amazing. It really does phenomenal work with lowering that hemoglobin A1C and reducing all of the complications of I like to say, sugaring the organs. You know, when someone has diabetes, beautiful outcomes, but the weight component, looking just at weight, all studies show you will gain the weight the moment you stop this medication. Why? Because, again, you're not suppressing your body's normal desire to eat and function, so to what end? in the same way that diets don't work, we're chasing the wrong holy grail here. We keep chasing smaller bodies, but that's again, not health and not sustainable, and frankly, of everyone's time and actually furthering their health devastation because weight cycling. Is what is likely causing inflammation in the body that leads to atherosclerosis, liver disease, cardiovascular issues. It is the [00:45:00] inflammation process of the body going through different metabolic bits so rapidly that is more damaging. And that's what a lot of other data shows, but that's not part of our daily practice.

The medicine either.

So for someone who's listening and may be taking a GLP one right now, what is something that you, some questions you would just have them reflect on to be like, okay, this is great. I think I'm using this medication in a health safe way. Or, you know, depending on how they're reflecting to be like, okay, maybe I need to talk to my prescriber or find a more involved provider to help me make sure I'm not using this as something that's setting me up for a brand new problem.

I think you put, you touched on something really beautiful that is also important for all of us physicians. It's agency and autonomy. So there is, again, real truth to wanting to escape weight discrimination. sense. People always talk about, [00:46:00] man, I get treated better when I'm in a smaller body. I feel more beautiful.

I can date again. I mean, there's so many layers there. So I never wanna sit here and fear monger someone out of a GLP one. Necessarily, that's not the aim, but I do wanna say, Hey, your overall health isn't just a weight number and a body size, you know? So what are your health goals? What are you hoping to achieve from this? What are the negative impacts? And can you think about how that would play out with these negative impacts that are likely, you know, your, you might have constipation and slowed, gut motility. 'cause that's exactly how the GLP one works, is to slow gut movement. What will that do? How well do you tolerate the nausea?

Is there a way to titrate the dose down so that maybe you feel a little more of a reduction in your fear of being out of control? Because now you have an external support with you. And not to say that it's placebo effect, but let's be real, that does help people when they are trying to [00:47:00] relearn something completely different, to just have some way of quieting the noise they have around themselves. says it's food noise, but. food noise is honestly still probably created by diet culture and this constant of low self-worth and failure by not being able to, quote unquote, have that healthy body and ideal physical appearance. I actually made a five day email course just about this because I just have a, well, not, it's not just me.

This is not just a unique idea I have, but in the eating disorder world, we just see food noise very differently. We see food noise as hunger. It has been the hunger cue misconstrued into a different narrative. And so how do you reduce food noise? You start again by behaviors, feeding yourself consistently and having micro and macro nutrition met daily, weekly, you know, on average the body. Likes to work on [00:48:00] trends, not day-to-day changes. So really, are you doing this whole behavior change and sustaining it for three to six months? If so? I think from that alone, people actually, I know people would feel completely different they just give it that time, but instead, there's also so much fear and immediate gratification needs and But what about right now?

I'm unhappy. Now it's again, very complicated. So to the person already on a GLP one, it's just a matter of knowing you don't have to increase your dose. Every time your provider says, oh, it's, you've been on this dose for four weeks. Time to go up. We'll ask why. You know, what? Are you following a protocol?

Are you following a protocol from the drug manufacturer? That's another thing to ask about. Versus if you're already feeling like you've had the improvement you're seeking, you don't need to go up on the dose. And then also remembering, you don't want to be chasing the. Weight loss on the scale is your only metric for success on being, on it being much more conservative. you're looking [00:49:00] to not have your adaptive physiology activate is key. The body doesn't like big changes period for anything. So if someone is pursuing a weight loss journey, just make sure you're doing it in a way that doesn't hurt your body, is the only thing I can say. But ultimately, I can't recommend intentional weight loss to anybody.

It does. It just feels too too risky, and again, not necessarily what's ideal for someone's health and wellbeing. Truly.

 I wanna make sure I'm hearing you correctly too. So, if someone is obese, and let's say their, A1C is getting close to diabetes, their blood pressure is trending up, we're looking at, if something doesn't change, I can foresee we're gonna have four new medications in the next three years.

'cause that's a, a common scenario we see with the patient. So that patient and, and we know, let's say if they could lose significant weight. From a healthy manner. I mean, really it comes down to those behaviors. Again. If they can start eating for [00:50:00] nutrition purposes, moving their body sleeping, taking care of the mental health, all the values of lifestyle medicine, then we could probably avoid a lot of those things.

But I'm kind of hearing you say we shouldn't say it is lose weight. To avoid those things, just maybe just say you need to start some healthy behaviors. Is that kind of what I'm hearing?

Well, here's the thing. know, what does obese mean? Are we looking at A BMI calculation alone? And also do we understand the ranges of it? 'Cause actually overweight individuals by the BMI standards actually live longer, is the interesting paradox.

I think it, oh, it's again, not what I think, what been told and talked about is that makes sense. From an anthropological perspective, you have more reserves on your body when your body's breaking down so you can sustain supporting yourself longer in that last part of life. In that scenario, I, I am imagining the person you are thinking of in this scenario [00:51:00] physically fat.

By that mechanism, it's still following the old data of it's because of that body size that they have these medical issues. When I'm actually saying it may not have anything to do with the body size trending up that caused those issues it's a lot more complicated than that. And if anything, why is the weight trending up?

What caused weight to increase in a way that seemed abnormal? Yes, we're all supposed to gain five to 10 pounds every decade of life. That's normal human physiology. But if it's exceeding that rate, why? And you know, what about this family or this individual's family history needs to be considered is the whole family, you know, genetically larger. I find it interesting to go off on a side tangent here. We know that connective tissue disorders exist, you know, where you've got hyper proliferation of collagen, cartilage, bone, et cetera. But we don't look at fat and we know the term lipedema. The only solution to it [00:52:00] is liposuction versus why is fat over proliferating?

Perhaps in that individual, know, someone who has obesity by weight and BMI calculation alone, what is their body composition, you know, what is their bone density, muscularity, et cetera. There's just a lot more nuance there, and I know you're not thinking of the bodybuilder coming into your office and then having the same question.

So I I do get that. Think ultimately someone in that size body, it truly, it's hard to not give this example, but to some degree it's kind of like fat bastard in Austin Powers. I eat because I'm unhappy and I'm unhappy because I eat. I'm over simplifying it. But that individual already has been told you should feel bad about yourself. Period. And if they got better emotional support, you know, which is a privilege for a lot of people to be able to access mental health care. I can't, [00:53:00] you know, ignore that enough. It would be completely different. If they start healing their stress, their cortisol levels will come down.

And honestly I would say the high cortisol level is likely what's leading to that excessive weight gain and all the health complications you're talking about stressing out the pancreas, making the body have more insulin resistance, affecting the blood pressure. I mean, hello, cortisol always increases blood pressure and heart rate.

We just never had that included in our metrics for what to do when someone's showing up with hypertension or pre-diabetes. Hemoglobin A1C levels. So I think that's really my bigger question is rather than changing how we tell someone to make weight changes or healthy changes in their life, it's more. Can we think broader, could their weight gain be a symptom of something else, and if so, weight loss couldn't be necessarily the answer to it. It's changing other parts of the system and weight loss will follow naturally if it [00:54:00] is at an inappropriate point for that Does that make sense?

I mean, I think that's what we, we talked about this all the time, so you're speaking our language. We're just making sure our listeners Yeah, because I think understand what's fair, and I'd like to say, and we've said this before, we've had multiple guests on the show that said this before too. If you can think about what you're eating as a way to treat certain things, like eating fruits and vegetables is going to help your heart and your vascular system in the.

It's many other, and your poop and your gut microbiome and, and everything else and in your brain and moving your body is going to help your vascular system and your brain and your musculoskeletal system and all these things. And if, I guess if we can think about it like that. So then again, you're just developing healthy behaviors, which are helping all of these systems in your body.

And eventually a side effect of that is weight loss. those healthy behaviors and managing stress and things as a way to treat your heart, [00:55:00] your brain, all these other things, then we're getting there without dwelling on it as lose weight to help your heart and brain. And so really we need to think how we phrase it.

We all need to, we all need a rebranding in the medical field, I guess.

all do. We do. We need to unlearn and relearn. And the other thing too is the weight loss that is anticipated isn't some dramatic change in appearance. That's not the goal here. It is simply more of allowing the body to biologically reset itself to a different homeostasis, you know, if it chooses to do so.

And again, adaptive physiology being what it was, a lot of indication to show an average person will experience that. But we're also not out here in healthcare just trying to change fat bodies. You know, fat bodies can also exist with perfect labs and perfect heart rate, blood pressure rates.

Again, we don't need to talk about lifestyle [00:56:00] changes if the person already. Abides by that they just are a fat person and that is okay too. Better than, okay. That's their body. so I think there's so much nuance still. There's the assumption that fat body will be unhealthy when there's plenty of data to show fat body totally healthy on their own already. And so to your question, yeah, it's about asking more of this person appropriately living their life as they need to want to, in a way that optimizes things without overly asserting the value of health on them. Overly making it, it's your personal choice and responsibility to be in charge of your health. Sometimes people just get bad, you know, cards dealt their way. It just comes with genetics, truly. it's again, peeling back all of those layers of nuance to be with that person in that appointment.

I think it's hard for the, the patient to, if, if there is a patient that is overweight or obese and they don't want to be, [00:57:00] and then we're telling them, but you're healthy.

why,

And, and you're doing things right and your A one C's good and your blood pressure's good, then it's almost like then they could feel bad for not wanting to be the way, the way they are.

I'm just thinking of the flip side too, and then that's hard for them too.

That's where I, you know, why do they wanna be thinner? Because of what they're taught, because of discrimination, because of how bad other people make them feel about themselves how much their worth is tied into being more socially appealing and acceptable. I mean, so unfair, but also so real. And that's where, you know, autonomy and agency exists. And if they are gonna pursue it, they. They need to do it in a supervised way, in a protective way, to really watch for those small changes that might show that they're creeping into eating disorder territory.

You know, just because they can do it doesn't mean they should do it.

Because with more [00:58:00] G GLP ones, I feel like society's probably gonna become even less accepting of overweight.

because it's overly simplified. Yeah. I mean, it's wild how many things are put into a black and white dichotomous across, again, public health population health, becomes the new norm

You're giving me some new perspectives on things. I'm soaking every little bit of this up. I know. I know we had kind of talked about not kind of, we had talked about binge eating. We've talked a little about, about anorexia. What about specifically bulimia? Do we see that more often now?

Is that something that we don't see as more commonly now because of GLP one access? where is that diagnosis?

So it's so interesting you bring that up. 'cause I feel like in the 1990s, early two thousands bulimia was on the rise. Interestingly, just looking at, you know, our 300 [00:59:00] patients, bulimia is not a high prevalence right now. It's interesting when you actually dig in more. It does still feel more like atypical anorexia with binge purge. Features than it is bulimia by itself. The bulimia specifically, what makes it different? Yes, historically was they're normal weighted usually. But it is the, a compensatory response to eating. And, you know, that means it could be intentional vomiting, it could be intentional laxative, overuse or abuse, excessive exercise.

There are multiple versions of compensating for eating. And it has to be tied to every single time someone eats. So yes, who does intentional vomiting, it might be an actual binge of eating, but a bulimic individual doesn't have to overeat necessarily as their only mode. They could be eating normally, but still after every meal. Find some way to compensate. so if anything, it's not that it's gone. I think it's [01:00:00] more fluid in the world of the diagnostic labels. I think individuals, especially with lifelong eating disorders, they even say I, you know, adds back and forth between, you know, restriction as being my one and only mechanism for weight loss. Then other times I wasn't losing weight, but I was still wanting it desperately. But I was more bulimic then. 'cause again, my weight wasn't dropping. And I was eating, but I compensated every time I ate with x and y behavior. not that it's not prevalent, it's just blurs into other things a little bit more now.

Labels are helpful, but labels are not always definitive.

 you've already mentioned this, the other diagnosis of Orthorexia. Can you explain to our audience, may be out there and they're just like, I'm trying to become healthier. So I do think about it all the time. When do I know that it's a problem and when do I know that it's just me [01:01:00] trying to be proactive in my health because it's gray.

This is hard.

So great. an Orthorexia isn't a formal diagnosis yet. I hope it'll be in the DSM six. But really, I mean, it's under the umbrella, I would say, of anorexia and restrictive eating disorders. So it is this over obsession, truly obsessional with the cleanliness and purity of what someone's eating. and what makes it a disorder, you know, more likely is when it's dysfunctional.

Again, people avoiding social events because that gets in the way of their gym time and then what they want to eat and prefer to eat. You know, they don't want to order something at that restaurant that's taking them out of their life. This obsessional need for control and calculation of macros and micros and quantities and the timing of everything.

Oh my gosh. The obsession with timing of like, I cannot eat past 3:00 PM Okay. Who taught you [01:02:00] that? Why'd you decide that? It's usually from a wellness influencer. YouTube, there's lots of information out there with talks about intermittent fasting and keto dieting and this elimination of full food groups that microbiome hates that and leads to lots of issues, like it's not good for the body.

But again, everyone's looking at it as this physical improvement goal, and I have like, people really do feel better initially, but not sustained, truly. I think what's interesting about Orthorexia is most people never find it to be a problem. Because of that exact reason you named culturally, it's everywhere.

There are huge million dollar businesses that are profiting from someone buying certain supplements and following certain protocols and being in the groups where we hold everyone accountable together. I mean, you're talking about villages of [01:03:00] people with shared perspectives. And so someone's not gonna see it as a problem until someone else in their life says, I miss you.

I don't see you anymore. You're different. You're not around. You aren't engaged with us at our family meals. Or, you know, you didn't even come to the kids' birthday party 'cause you had, that was your gym time instead. You know, those types of things are when it really shows that it's more of a problem.

The philosophy of an orthorexic person is a little harder . It first has to be seen as, what are you missing because of your belief pattern right now? And they need help seeing that insight before they're willing to change things usually.

And you said villages, I guess it could be. Harder because you, you can end up surrounding yourself with other like-minded people so much.

Echo chambers everywhere.

Yeah. And, and social media allows that even more than when we were just communicating with those physically around us. 

Mm-hmm.

so I, I imagine that just [01:04:00] makes it even harder to recognize, I guess, for somebody.

And you know, now with social media, it's not just posting pictures with small filters on it. I mean, I forget the term that just came out, but you can completely renovate your appearance, if you will, before you present it on social media and change every physical characteristics. So people don't even know if who they're getting influenced by, if they're real and if their journey is as bonafide as they're claiming it is. I mean, it's hard. We, we don't wanna distrust each other more. But I think as we keep expanding our community access, we do have to sometimes remember, I don't know this person. I am not directly attached to this person, you know, or engaged with this person. This is a parasocial relationship. This is not an actual, intimate, authentic relationship.

And I think that gets a little twisted. ANet actually came out with the most [01:05:00] amazing, short film called The Wrestler, and it actually, it focuses more on an adolescent girls experience on social media, but just showing how toxic it can be and is for so many people, it may not lead always to an eating disorder, but certainly lots of reasons why it would, you know, the maladaptive coping strategy to stress a way to numb out intolerable feelings.

A way to change and control things that otherwise feel out of control, to be more socially acceptable, to meet a beauty ideal. so much, and I think it's hard even for adults to really parse through that. It's not just kids that need protection on the internet, adults need it too. It's just too easy to have our pathways and what sounds familiar to be trustworthy versus, you know, verified and truly at with more scrutiny. So much seriousness, y'all. I'm sorry. This is like some heavy stuff here. I'm

Know,

paradigm

like,

all over the

take a break and just, [01:06:00] I'm gonna process myself. 

We can all do some butterfly taps. It's like, okay, we still wanna enjoy our lives. We wanna stay connected to our people. Do not just be an anarchist y'all and throw out all the systems. It's just no, the systems a little better.

I think one of the biggest things you've said today, and it's something I do feel good that we're doing, we all need to realize, we need to come back to our personal relationships. We need to come back to our personal goals. We need to come back to our own personal health and, and looking at each individual as who they are.

Because so much of what has gone wrong has been just trying to do the same care for everyone. Yeah.

Yes,

And,

protocolization, whatever we wanna call it.

and so if the, a takeaway, a big takeaway from all this discussion, , that's probably where I would start is like, we, we just have made everything too generalized and not giving [01:07:00] that personalized touch to each individual with what they need. Yeah. And it's caused a lot of problems because of it.

Honestly, I feel like the majority of the patients I work with, half of their journey to recovery is healing from, you know, experience in the physician's office, in a healthcare system, in an er. You know, they're constant feeling of being dismissed and validated because they were, were in a larger body instead of being treated for the malady they actually had.

I mean, it is wild how many patients, when we really dig in, we do find medical issues that need to be addressed and likely under, or explain better the symptoms they had that they were dealing with. But instead, weight was always the forefront of the discussion. It's just so interesting seeing just how that. Feeling though really does lead to freedom and reconnection and trust for self and trust for [01:08:00] other clinicians. You know, not all clinicians are gonna cause harm. And even if there're are clinicians out there thinking, oh, I've never caused harm, we actually can be a little more honest with ourselves.

We don't know. We don't know how someone heard our words and took it a different direction. And we can be humbled if someone says, man, I didn't like how you said that to me. Fair. Thank you for that feedback. Like, you know, let me thank you for the opportunity too to maybe re-explain or learn from your lived experience on the other side of that conversation.

I think when we get back to the goal of personal health, it also reminds us that we're in. A privileged position to have a personal relationship with our patients. You know, we're being granted access to their health journey Wow. Like what an opportunity to really know someone beyond labs, beyond weight numbers, you know what I mean?

So I think what I love, I don't get to practice pediatrics every day, but why I love being a [01:09:00] pediatrician at my heart and soul is even when I'm working with adults, there's still little children. I can see their inner child in them wanting to heal. And so I feel like we can have that reconciliation in our sessions and people are getting better because of that, and they're having experiences in life that are more robust and full and rewarding. Weight hasn't changed. It's amazing.

And for our parent listeners that are, that are out there, if you could just give any. Simple advice. 'cause I, I, I do think this is common that there are many parents that worry about this for their kids today. It's like, oh, I don't, I don't wanna cause this. I don't wanna be the cause of this. what would you tell a parent of how they can best support their children and kind of decrease that, their risk of having this lifelong battle with food?

Oh well, if anything, the other complicated component is, you know, we didn't even talk about our fit today. Avoidant, [01:10:00] restrictive food intake disorder. It's not just picky eating, which again happens in so many kids leading to nutrient deficiencies. But in this, to answer your question, I'm gonna keep it on point, not get too a DD myself. It really is a matter of teaching them that their body changes. The body they have in this moment of time you know, their three yearold body, their five-year-old body, their 10-year-old body. And help them start feeling comfortable with the fact that aren't you glad you don't look like a 3-year-old anymore?

Think of all the things you can do in this 10-year-old body, you know? And if you're feeling unsatisfied with your body right now, you just gotta keep waiting. Your body will keep developing and if there's something you want to be able to do, let's figure out what you want to do and make it less about their worth being tied to their physicality and physical capacity. 'cause again, everyone develops their gross motor, fine motor skills on different timelines. We have the Denver Developmental Scale, so we know that there's like a range of normal, but once we get above, you know, [01:11:00] basic stuff, it's not really watched anymore. And not every kid is going to be star. again, they're not gonna be tall enough. Perhaps not every kid is going to be a rock star either. They may not be able to sing or play an instrument, you know, and it's how do you have kids connect with themselves versus what they want to be their only guideline in life? And I think knowing that our bodies are meant to change and change is good, is so important to start instilling early.

Because we know the number one fear of our human species is change. People have different degrees of, accepting it or not. But really we all hate change on some level, period. If you say you don't hate change, please gimme a call. 'cause I'd love to know how you accept all change in your life. But truly body change is part of that. Dissatisfaction is taught, but it can be untaught too. And how you talk to your kids about [01:12:00] other people's bodies can also help. If you are saying, shh, don't be rude. You're actually teaching them. There's something wrong there that I need to know more about. But instead, at least this is what I do with my four and 6-year-old.

We actually ran into a mother and her daughter in the bathroom of a DJJ Maxx the other day, and they both had and my kids had never seen someone with a cholas before. And I said, mommy, why were they so short? And I said, were born that way. They actually have a condition that makes 'em short like that. And they said, what? How do they drive a car? I said, there's probably, adaptations in the car to help the mommy drive the car. He said, is she always gonna be that size? Yeah, absolutely. And I know it, it's different. I'm a pediatrician. I can, you know, get into this conversation, but I actually wanna inspire other parents. To say, like, we can talk about this, we can talk about when we notice differences and we can explain that is actually normal and healthy for them. That's who they are. And just like we would, brown hair, blonde hair, curly, straight, dark skin, light skin. We have [01:13:00] to do the same thing for body sizes too. , My 6-year-old even has a kid in her class who, he is like a foot and a half taller than everybody.

He looks like he is nine years old and he does get made fun of for being bigger. Ugh. I mean, he didn't ask to develop early all and noise or anything wrong with his size at all. it starts young, right? And so it's just naming that this is actually something that's possible. Some kids look very similar to their peers.

Some kids are ahead, some kids are behind, but they're all themselves. feel like that's the better core message when we're trying to instill body acceptance and being detached from body instead of totally engrossed in body size and appearance. But to ask me in like 10, 15 years how my kids are doing.

I don't

Yes. Well, I like that thought. Just your body is always changing and then just connecting more to, you know, what do you want out of life as far as if [01:14:00] they need to change a habit or something.

Right. I mean, even we as adults, and I'm sure, I know I can raise my hand and say, whoa, there were so many things that I didn't know to like know until I knew it. You know? And experiencing it as life being a mom and having babies and having your body change and not really knowing exactly how your body would sort out.

And it's not the same as someone else. Even if they also had a vaginal delivery or a C-section. I had both. Yay. It's so interesting seeing it from the lived experience angle versus medical professional angle exclusively. And so I think that's where some does come with our own lived experiences too, and reminding our kids that it's okay if you don't fully get it and you don't have the same experience someone else has. It certainly though, is acceptable.

If someone is listening today and thinking. I probably need to address some things for myself. Where should they go [01:15:00] to look for help?

I would say going to the very website is the a great first step. We actually have a lot of resources that people can access. So you don't have to start care today. It can just be, I wanna learn more. We have blogs we have a whole YouTube channel too with lots of paradigm shifting information, harm reduction information.

So you can browse through that library, but calling us also is a great way. Just consult, ask some questions. what I noticed the most is historically in the eating disorder world, it was always, I'm not sick enough for care. I'm not sick enough for care. We're outpatient. We're actually asking people not to wait until they're sick enough.

We want to help you make changes to how you see yourself. Eat food now now is, there is no better time than now truly to finally heal and better understand. Why do I think the way I think? How do I feel, the way I feel? How do I find food freedom? How do I find less [01:16:00] moralization and more self-acceptance and just more joy in life as a whole? Or at least acceptance of the nuance and the highs and lows of a human life because we're not always happy. That's not the goal. The goal is not to live your life with only happiness. It's about resilience. It's about knowing you have tools to solve problems or unexpected scenarios that come your way not to have this perfect, you know, photo life. So going to our website, submitting a referral, if you are a provider out there and think that your patient would benefit from eating disorder informed care, is also a great way. Or caller number 8 4 4 9 8 8. Very. Yeah, we're just here to try to help as many people as we can, even as a small startup company. Although I guess I can say we're, slowly bridging out of that startup world, but we are still small.

I'll have links to all of those in our show notes. If, if you're someone listening and want to. Find out more. This has been very informative and we [01:17:00] appreciate your time and your expertise and I really feel like our listeners probably learned a lot all of us have lots of reflection questions to walk away with after this show, so we greatly appreciate that and look forward to our next show.