Beyond Food & Weight: Navigating Eating Disorders in Teens

What if eating disorders don’t look the way you think they do?

In this episode of Hormones and Hope, Dr. Chhaya Makhija interviews adolescent medicine specialist Dr. Lauren Hartman to explore the rising prevalence and complexity of eating disorders in pediatric and adolescent populations.

With eating disorders presenting at younger ages and across diverse populations, this conversation highlights the urgent need for early recognition and intervention. 

Dr. Hartman provides a comprehensive overview of how eating disorders exist on a spectrum—from disordered eating behaviors to diagnosable clinical conditions and why waiting for full diagnostic criteria can delay care.

You’ll learn how to distinguish between disordered eating and a clinical eating disorder, what subtle signs to watch for, and why early intervention can dramatically change outcomes.

Whether you’re a clinician, parent, or someone wanting to better understand adolescent health, this episode offers a compassionate, practical, and hopeful perspective.

About Dr. Hartman:

Dr. Lauren Hartman is a double board-certified pediatrician and adolescent medicine specialist with nearly 20 years of experience treating children, adolescents, and young adults, with particular expertise in eating disorders across hospital and outpatient settings. Throughout her career, Dr. Hartman has held numerous leadership positions at regional and national levels.

Currently, she serves on the Eating Disorder Committee for the Society for Adolescent Health and Medicine (SAHM), the premier professional organization for adolescent health specialists. Dr. Hartman maintains a private practice in Berkeley, California Aspen Grove Adolescent & Young Adult Medicine where she specializes in eating disorders.

Her forthcoming book, Freeing Children and Young Adults from Shame, Scales and Stigma: A Practical Guide for Parents, Educators and Clinicians, will be published in Spring 2026 by Routledge.

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Disclaimer: This podcast is for educational, informational, and entertainment purposes only. It’s not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personalized guidance.

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Transcript

00:00
True or false? Eating disorders are only about food and weight. False.  Is this a myth or a fact? Eating disorders can occur in children and adolescents who  appear to have normal body weight. That is a myth.  Again, true or false? Disordered eating patterns are becoming more more common in adolescent age group. This is true.  Myth or fact?

00:28
usually recognize early signs of disordered eating right away. It's true and false.  How about the last one, number five, early intervention can significantly improve outcomes in adolescent age group with eating disorders.  Welcome to Hormones and Hope,  a podcast where we bridge science and wellness  to help transform your health.  I'm your host, Dr. Chhaya Makhija,  or you can call me Dr. Chhaya.

00:57
a triple board certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care.  Each week we dive into the powerful intersection of clinical medicine  and real life lifestyle strategies to help you feel stronger,  live longer  and show up as your most vibrant self inside and out.  So let's get empowered. Hello and welcome everyone. Welcome to Hormones and Hope,  another enlightening episode coming for you.

01:27
And our guest today is exclusive.  Now I've used the word special, I've used word excitement, but this is exclusive because it's a specialty that she works in, but also provides and serves her patients in a very  less talked about problem, but very much common.  I encountered this in my practice so often and it doesn't have to be a very  specific age group.

01:55
but it's quite diverse in humans and adults. So before  I talk about the topic, what it is and what is going to be discussed today, I wanted you to introduce you to Dr.  Hartman. She's a pediatrician. She's an adolescent medicine specialist.  And just recently I learned that 95 % of her practice  is focused on treating patients who are suffering from or who have a diagnosis of eating disorders. And that's going to be our topic.

02:25
This episode is also  exclusive because Dr. Hartman is an author  and she just released her book, is freeing children and young adults from shame, scales and stigma. I love the topic, Dr. Hartman. So welcome to our episode  and please share more about yourself  and justify the passion  as you express it with us.

02:51
Yeah, thank you for having me and thank you for that warm introduction. And I'm really excited to be here and to be talking with you and with your audience.  Most people have never heard of an adolescent medicine specialist. I'm sure most people listening are like, what is that? Because I get asked that question a lot.  And the reality is there's not that many of us. There are less than a thousand adolescent medicine specialists in the country. So there's there aren't that many of us.

03:18
but there's essentially three age-based medical specialties. So we have neonatology for young babies and gerontology for older adults. And so adolescent medicine is that spot between our pre-teens and teens and young adults. So we really have a unique lens where we're looking at the biological changes that happened at that time, but also really trained to look at the holistic picture of some of the social dynamics and the psychological changes that happened

03:47
during the time for adolescents.  And  as you said,  95 % of my practice  is taking care of young people with eating disorders. Even though I'm an adolescent medicine specialist, I'm first a pediatrician.  And I have had to  decrease my age range in my private practice because eating disorders have gotten younger and younger and younger. So I see as young as six years old of young kids who struggle with an eating disorder.

04:16
And so unfortunately, this is something that, you know, I just kept thinking it was going to go away  and we were going to know better and do better for young people. But unfortunately, you know, it just is incredibly prevalent and there aren't that many people from a medical specials who are trained to manage this. And so it's a real privilege that I get to do this and I get to work with young people and their families really closely as they get to.

04:42
So I'm guessing that once you completed your pediatric residency and that's where you shifted based on what clinical experience you were having to adolescent medicine, like more  specialization in that field or it didn't matter? Yeah, so I did my pediatric residency, did a chief residency year and then did the, it's a three-year adolescent medicine fellowship. So did my fellowship at UCSF in adolescent medicine and there it was

05:10
The department is adolescent young adults. So, you know, really kind of impatient and outpatient working with young people, a large part working with eating disorders. Okay. And you're located in Berkeley and your practice is in Berkeley, California. That's right. Yeah. And I also wanted to share with the audience that I met Dr. Hartman recently, a few months ago.  And as soon as I heard, as we were introducing  each other, I heard about  she

05:40
writing or releasing a book coming up soon.  And uh I was marvelled by the fact that you were working in this specific field also.  So please tell us, what is this book about? Like where, I'm pretty sure your clinical experience, your patient experience made this happen in terms of why I should write a book so that many more can really get this help or support that is being provided at your clinic.  But I'm just curious, what was that

06:10
fire in you that was like, need to sit, put in hours, write this book, make sure it gets published.  And uh why the topic that you picked? Why, why is it so special? Yeah. Well, thank you for that question. You know, I will tell you, I never intended to write a book. Like it was not a plan. It was not on a vision board. I  really love being a doctor and that  is and was enough.

06:38
I was just seeing patient after patient who was coming to me with an eating disorder. And there were so many themes when I would ask them what happened and tell me about where this began. And what I was hearing was from a lot of young people is, well, it started when my doctor told me I needed to lose weight.  Or it started when I learned this thing in health class about how sugar is really bad.

07:07
what my experience I had in P.E. or with my coach or something that happened at home. And so I know these doctors and I know these educators and I know these parents and they  all are so well intended.  And I know that  harm was not the the hope of what was happening with those words. But young people, they're just so vulnerable. And so the way in which those words landed.

07:34
You know, I've just appreciated, gosh, we just have to be so thoughtful in the way in which we're talking to young people about health, about bodies, about weight. And so really wanted to come out with a guide. It's really a practical guide for parents, for teachers, for clinicians of like, how do you have these conversations? What's the script? What are the tips? What are the strategies?

08:01
What do I do when my kid asks me this? So it really was intended to try to prevent harm and try to prevent weight stigma and eating disorders. Yeah. I'm going to learn so much from you today. I don't know about the audience. They will definitely, but I feel like, you know, we all have so much space to learn and understand. It's not just the empathy part of it,  but it's also, you know, every person is different.

08:29
And what words are coming out of  us as physicians in terms of recommendations or guidelines?  And there is this piece of us which is absolutely human, right? It should come from a place where, yes, there is no judgment, but watch what you speak because that's science and this is a human. And I think you're going to touch that core  in this episode and  I'm looking forward to what you're going to share.

08:58
So Dr. Hartman, this is going to be all about  the topic from your book, but also the eating disorders. And you're going to teach us on how,  clinicians who are also listening to this episode, but also people, parents,  our medical students  who listen to the podcast are going to get a lot of insights. We'll start with rapid fire and it could be a one-liner or a one word answer and then the deep dive questions. So you're ready? I'm ready.  All right, Dr. Hartman, you are false.

09:28
Eating disorders are only about food and weight. False. Thank you.  Is this a myth or a fact? Eating disorders can occur in children and adolescents who  appear to have normal body weight. That is a myth. Thank you. Again, true or false. Disordered eating patterns are becoming more and more common in adolescent age group. This is true. Myth or fact? Parents...

09:57
usually recognize early signs of disordered eating right away. It's true and false. Okay, all right, we can elaborate that on our deep dive. How about the last one, number five, early intervention can significantly improve outcomes in adolescent age group with eating disorders. True with many underlines and many exclamation points.  Okay, thank you. All right, Dr. Lauren.

10:25
As a pediatrician, as an adolescent medicine specialist, and I would also say a third category as an eating disorder specialist, because your clinical practice, the experience, the 20 years of experience really makes you  the specialist in that field. Is there a difference between  disordered eating patterns versus an actual clinical eating disorder, which is a medical diagnosis? And once you help us differentiate or define that,

10:54
you can get into, you know, the specific warning signs or how do you identify the signs? Sure. So, you know, when I think about disordered eating,  I think about a spectrum of problematic behaviors.  things like skipping meals, things like rigid food rules,  maybe using exercise as a way to burn off food that has been eaten.  And yet it jumps to what we would call a

11:22
clinical eating disorder and  is more severe  when it is more persistent and when there's impairment, functional impairment, psychological impairment.  I will say  two things that I think are important to say.  One is there are many different types of eating disorders. I think,  most people when they hear eating disorders, maybe they think of anorexia nervosa or bulimia nervosa, but there's a number of other types of eating disorders.

11:51
There's an eating disorder called ARFID or avoidant restrictive food intake disorder that actually has nothing to do with body image. There's a disorder binge eating disorder where people are feeling less control around food. And I would say the most important message for anybody listening is that you don't have to wait  to tick off all the diagnostic criteria to warrant help. Because it's just as you and I were saying,

12:20
Early intervention predicts a much better prognosis. It decreases mortality. It decreases morbidity. So if we can intervene early, I'll often say that to pediatricians, like, you don't have to wait to refer your patient to me. Like, if you're concerned, I'm concerned. Or I'll say that to parents all the time. You know, parents, I think, are often nervous to say something if they're concerned. And I'll say, if you're concerned, I'm concerned. And let's see what we can do to just shift the behaviors. Because

12:48
the longer they happen, the harder and harder and harder it is to recover from.  Do you think every human at some  stage or some point may have  a disordered eating pattern just because of the circumstances  or environment influences? Is that possible? Or most of the humans, how about that? I don't think  the majority of humans struggle. I think there are elements that feel

13:18
familiar.  Certainly we are all swimming in diet culture and we can't deny that. So, I think that is true.  And so we're our parents and so we're their parents.  There's a lot of intergenerational messages too that have been passed along.  And so some of what I  am aiming to do with this book, and I know it's a tall order, is to think about the messages that we've inherited that we would love to put down and not

13:47
pass on to the next generation? Well said, yes. Yeah, you're making me think a lot.  In  my clinical practice, or the endocrinology world, the complication that we see is more bone health related, or  amenorrhea, or I've had men who've had oh early low bone density. And then  as you're  interviewing them, it's like, oh, you're 25 right now, but this has been happening since age 16, 15.

14:16
in terms of the disorder eating pattern, because they're acknowledging it. They've never been hospitalized. They've never seen any counselor. It was not even probably discussed in their regular annual visits or not recognized. I wouldn't say discussed. And now we are looking at the complications because you pointed on certain morbidity and mortality risks. That's why the early intervention is needed. So can you help me  if I were, you know, as a clinician,  is  how do you oppose

14:45
the diagnosis from a medical standpoint. So this is where I'm getting into the early signs. And then we'll get into, you the follow-up question would be for a parent or even that individual or whoever is a caretaker  because we are talking about pediatrics and adolescent medicine uh or that specific age group. But as a clinician, what are the other signs that  you  are uh an expert  in?

15:15
recognizing or asking  or  even pinpointing like, yep, that is it. Let me ask further follow-up questions. So can you share  those insights to help clinicians?  Absolutely. And I think probably the first thing  is for us as clinicians to be aware of our own biases.  As you said that about the boys, it made me think

15:41
how important that message in and of itself is to get out, that boys are much less likely to be diagnosed. And at least a third of eating disorders is in boys, at least.  It's on the rise  for boys. And so  I think for clinicians, we have to have our eyes open that eating disorders affect all genders, eating disorders affect...

16:08
all races, eating  disorders affect all body sizes. You we have to kind of let go of the myths of what an eating disorder look like because what we know is that people who are non-white are much less likely to get diagnosed for having an eating disorder and therefore they're a lot less likely to have early intervention and to have great treatment. So, you know, we just first need to just be aware that

16:35
everybody have an eating disorder. And so we just have to be thoughtful about the screening first. In terms of the history, that's the probably biggest part of my work is  the listening and the history. So, you know, it's certainly doing a really thoughtful history, both with the patient and with the parent, you know, really to hear from them, but also hear from the parents in terms of what does eating look like? What changes have been, you know, parents know so well how their kids eat.

17:04
So they know, like my kid used to eat three pieces of pizza and now they're eating one. Or I remember when all of a sudden their lunches were coming home. So parents are a really important part of the history. The question I'll tell residents or trainees about what I think is the most useful question to ask a teen in your office, especially when you're seeing that teen at after school hours at three or four o'clock is, tell me what you ate today. Instead of like,

17:34
how are your eating habits? But like start with the morning and tell me everything you've eaten. Because if it's four o'clock and they have had an apple, like that's not enough for an adolescent who has such high metabolic needs. So it's really kind of understanding their behaviors and understanding the history. And then in terms of the physical, know, the growth charts are a really important tool when we're evaluating eating disorders.

17:58
Of course, as you know, like young people are supposed to be staying on their growth curve and are supposed to be growing. And so we're seeing plateaus or of course, if we're seeing weight loss, that's reason enough to have concern. We check their temperature because body temperature drops with malnutrition, their heart rate drops with malnutrition, their blood pressure drops with malnutrition. So thoughtful in terms of our physical exam. And then labs, again, as I tell,

18:26
residents and trainees is that an eating disorder is a diagnosis of exclusion. So we really have to make sure we're not missing anything. There are many other reasons why somebody may have lost weight or might be plateauing in their weight at a time when they're supposed to be growing. I do check labs. The two reasons why I'm checking labs is one, I want to make sure I'm not missing another reason why they've lost weight.

18:49
inflammatory bowel disease, thyroid disease, diabetes, cancer, know, something else that could be going on.  And I also want to evaluate to make sure that there's no  medical complications as a result of their malnutrition. But I do  give some anticipatory guidance for parents when I'm checking labs in that most of the time with gestural restrictive eating disorder,  very often the labs are normal. That does not mean that there's not a problem.

19:19
Sometimes I see people getting falsely reassured of like, oh, you're fine because your labs are okay. And so, you we don't have, we shouldn't stop there. We again need to look at the whole picture. And then certainly we do any KG because as I said, heart rate can drop with malnutrition. And then we also look at the bones, as you've said,  the bone health is that we really know them back and get impacted. And to your point, especially in the boys.

19:46
who have lesser-related estrogen, and I see osteopenia and osteoporosis often getting overlooked in the young boys as well. Yeah, you're right, you because when I did endocrinology, this was what, 13 years ago, like the fellowship, and when we had the section on eating disorders causing something called as functional hypothalamic amenorrhea, that is, know, absence of cycles because of this reason,  or something called as female athlete triad, you know, but not necessarily a eating disorder.

20:16
There was no section on what impact can that have on men because it was just that, oh, boys cannot have eating disorder. It wasn't stated that way, but there was no description about what are the complications that can happen. And now in clinical medicine, in the last five, six years, I've been seeing that I do get almost 50-50 % in terms of females or males getting impacted with skeletal health.

20:44
abnormalities, a thyroid disorder, like you said. Love the fact that you said about the generational gap, that leave it  as is, and let's learn what's happening now, what's needed now. So thank you for sharing these insights. Moving on from the clinician perspective now to actually what's happening at home, right?  What can a parent learn from you today in regards to is there a discipline in terms of what they could implement  or

21:13
a way to recognize so that they can get or seek early intervention. Like, why is this happening? Like, if I'm a parent, I'm questioning, like, why is this disordered eating or eating disorder so common in this age group? Am I doing something wrong in terms of my upbringing, or is it just social media, or this is how the culture has become? Can you just help me shine some light on that? So, you know, we  probably...

21:37
unsatisfying for the listeners is we don't have one singular cause that we can kind of point to of this is why people are having eating disorders. We know it's multifactorial. We know genetics plays a large role in that. We know social media does not help.  And  as you know, I see so often just parents getting blamed for this  and  particularly mothers often carry the blame and

22:05
I really have tried to  move away from that because what I see are first of all, parents are doing their best in what they've learned  and again, swimming in the same diet culture  and really trying to keep their kids safe. They're  often so well intended. And so I really tried to position this book to feel inclusive of like, yes, we've all.

22:32
probably said things that we wish we hadn't, I know I have. And so  one, there's ways in which we can repair some of those things. have an entire chapter on repair. But also there are things that parents can do at home just to help filter out the weight-centric messages that their kids are hearing to help  decrease  the  likelihood or just to shift this from potentially happening. And what

23:01
Research has found is that young people actually really want that of parents. They really want parents to help us throughout these messages. So  what I will say in terms of the most helpful thing parents can do at home  is, which is the hardest thing to do, is to model it themselves. Really model the way they are talking about their own body. And it is

23:27
So incredible when we just sort of have our eyes open to this of like how common it is and these subtle ways in which we all do it where we'll like see a picture of ourselves and like, ooh, I hate the way my stomach looks in that or I wish I didn't look like that or the way in which we comment on other people's bodies like, hey, you've lost weight, you look fabulous. know, we're really giving that message to our young people that the value is on a smaller body size.

23:56
And so, you the first thing is really to try to shift our words so we are commenting on character and talents and effort and not the body size or shape of somebody or their weight. You know, I really encourage families and  talk about this a lot in the book is how we shift our language around food, especially living in the Bay Area. You know, we have really kind of put this moral value on food.

24:24
And so really trying to shift that of not like good food, bad food, or I was bad today because I had a cookie, you know, instead of thinking about food as nourishment and joy and to try to have a relaxed, trusting relationship with food so it doesn't have to feel so tense and rigid. And then with movement, you know, I really encourage families again, starting with themselves of how we're talking about movement of like,

24:51
Oh, I've just had a stressful day. I'm going to go for a walk and blow out steam. Not,  ate this cookie, so I have to do this exercise. You know, make it transactional. There's a lovely study, if you don't mind me sharing, because I just  love it so much. And I think it just sort of puts a fine, like an underline on this point is they did this study in the 1970s called the rabbit study, where they wanted to see the impact of high saturated

25:20
fat diets on heart health, on cardiovascular health. So they fed this lab rabbit the same diet to then see, okay, what are the impact in terms of cholesterol and atherosclerosis? And what they found is there was one group of rabbits that was 60 % healthier, had 60 % less cardiovascular disease. And they were like, why? They were fed the exact same thing and they were genetically identical.

25:48
And what they found was that group of rabbits were actually assigned to a lab technician that was an animal lover. So when she was feeding the animals, when she was feeding the rabbits, she held them  and she pet them and she talked to them. And, you know, I just love that message in that like,  oh, so it's not just about what you eat, right? That there's so much more in terms of our health and that like kindness  and

26:17
Decreasing the stress  around food can be really, really helpful too. You touched a very deep, deep point here  in regards to a lot.  One was the parenting aspect. The deep point was it's multifactorial. It's not your parenting. So the blame and the shame and  specifically  letting the mothers also know because they do.  That's one deep point which I'm taking. The second one was

26:47
the language,  right? So you said that why aren't we like discussing about the character or commenting, complimenting about it rather than the outwardly appearance? You went back into the deeper aspects of who are the human being. The third one was it's  the interactions that we're having, right? The interaction. So it could be the interaction with me, myself, how I address myself versus with each other in that family atmosphere and that

27:16
the words that we use, the kindness that you touched on. But these are such basic foundation key concepts of any one of us. It doesn't have to be that we're talking about eating disorders or adolescent medicine or pediatrics. It's just basic concepts of how we could live our life, which could be more fulfilling. Love the rabbit study. Yeah, so thank you. That's why I say that, you I learned so much from my guest because it's so enlightening. It's not that...

27:45
There is this aim for perfection, but this is aimed for just grounding back to our originality of what we are made of in terms of just the human connection. I would really love you to end this episode with a few more things, Dr. Hartman.  One was you talked about early intervention.  If, someone has a diagnosis or you're identifying it as a specialist,

28:12
or say I'm seeing as a clinician that, this person needs more  support or I'm referring the patient  and they're in this group because they're with their parents, the adolescent and pediatric age group. What can be done or what are the outcomes that you see in your practice? So this is more of like a hopeful conversation. Absolutely, and I have a ton of hope. I believe in full recovery for every single patient.  I really, really do, and I really, really see it.

28:40
I used to feel when I first started like, oh, this is this terrible thing. But really, I just see young people get better all the time.  And I also will say I see families heal along this journey. You know, it is hard to have a kid struggle with an eating disorder. I haven't personally had my child have an eating disorder, but I will never forget the words that were said to me in the hospital one time  from a patient's mom.

29:10
The daughter had an eating disorder and a couple years prior she had had cancer, she had had leukemia. And the mom said to me, know, cancer was easier than this.  And I understand where she was coming from. She explained like, with cancer, had the meal train. You know, I had spoke community support. This was a really clear pathway. So this is hard, but what I'll see  parents all the time is like the beauty that I see emerge from the...

29:37
family and the lessons and the way in which they come together is incredible.  you know,  also just to give  people a lot of hope and a lot of ease is  most treatment can be done at home, can be done patient setting. As an adolescent medicine specialist, I really value trying to keep people in their school, in sports, in doing the things that they want to be doing and have it be as least disruptive as possible. What we do and what the most evidence-based approach is,

30:07
around eating disorders for young people is we actually help coach the parents to help support their eating. So parents are really the ones there with them, helping them  eat those three meals and these three snacks and helping them really get nourished. And so we really help to support the parents. And it's generally with a team of I'm the doctor and then we have a therapist and a dietician. So it tends to be like a pretty comprehensive multi

30:36
disciplinary team approach. But I'll say to parents all the time, parents do not cause eating disorders, they treat it. And it is hard, but they get through it.  yeah,  the best part of my job is when parents will say to me, my kid's back. Because as you know, when they're so malnourished, they like lose their self  and you know, they're like their spark is gone and therefore treated to their room. But then

31:04
when they get re-nourished, like the brain really appreciates that nutrition. And all of a sudden they're like, oh my gosh, my kid is back.  And that's the best. Beautiful. That was a lot of hope. So Dr. Hartman, if someone in California listening to  this podcast, if they had to seek your expertise, please let us know how they could reach for your practices. And the second is please let us know where we can get your book from. Thank you so much. So they could look up my name. It's Lauren Hartman, MD, or

31:33
My practice is called Aspen Grove Adolescent and Young Adult Medicine. I'm located in Berkeley, but I see people all over the Bay Area. I see young people,  all genders, age six to age 30, and again, work really closely with families as well.  And they can buy my book. Again, the title is Freeing Children and Young Adults from Shame, Scales, and Stigma.

31:55
It's a practical guide. It's for parents and teachers and clinicians, and they can get it on Amazon or they can get it through the publisher on Rootledge, and there should be a link on my website for that too. Sweet. Congratulations on the book, and thank you for your service, Dr. Hartman. Really had a lovely conversation today. Thank you so much for your thoughtful questions and your care. I really appreciate it.  Thanks for hanging out with me on Hormones and Hope.  If you've loved this episode,  me a favor, hit subscribe.

32:24
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