Kids Matter!

Our Daughters, Ourselves: Eating Disorder Education, Awareness and Prevention with Marcy Forta, EdD

• Alisa Minkin

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In this episode, Dr. Marcy Forta discusses body image, social media influences, how we talk to our kids about food and our bodies, and so much more.
Dr. Marcy Forta is the Founder and Director of Atzmi, a nonprofit dedicated to strengthening self-worth, self-compassion, emotional wellbeing, and healthy body image in Jewish orthodox adolescent girls, with the goal of preventing eating disorders before they begin. She is the creator of the My Best Self Project, a school-based prevention curriculum implemented in schools across the United States and internationally and supported by ongoing research evaluating its effectiveness.

Through student programming, parent education, and educator training, Dr. Forta helps communities better understand the cultural pressures girls face and equips them with practical, evidence-based tools to foster resilience, emotional regulation, and a healthier relationship with the body. She is a sought-after speaker who presents to schools, communities, and professional audiences on adolescent mental health, eating disorder prevention, parenting, and self-compassion.

Dr. Forta is the author of How Can I Help My Daughter? A Mother’s Guide to Nurturing Her Daughter’s Best Self and remains deeply committed to helping the next generation of girls grow into confident, emotionally healthy young women.
https://marcyforta.com/
https://atzmi.org/
https://www.nationaleatingdisorders.org/the-body-project/
https://www.nationaleatingdisorders.org/about-us/

https://podcasts.apple.com/nz/podcast/atzmi-my-body-is-not-my-self/id1500215343?i=1000567473562
Cover art by Charlotte Feldman 
Please note that while I am a pediatrician, I am not your child's pediatrician. This podcast is for informational purposes only and does not constitute medical advice. For any medical concerns or decisions, please reach out to your child’s health care professional.

Welcome to Kids Matter. I'm Dr. Elisa Minkin. As a pediatrician, mom and grandma, I understand how challenging it can be to help our kids grow into their best selves. We are so much more powerful together. Here I will be sharing the knowledge and wisdom of a wide range of people who understand and care deeply about children. I'm hoping for your input as well because kids really do matter. They are our future.

Alisa Minkin

Welcome back. Today, I'm here with Dr. Marcy Forta. Hi.

Marcy Fofta

Hello, how are you?

Alisa Minkin

Great. Thank you so much for being here. Dr. Marcy Forta is the founder and director of sme, a nonprofit dedicated to strengthening self-worth. Self-compassion, emotional wellbeing, and healthy body image in the Jewish Orthodox adolescent girls with the goal of preventing eating disorders before they begin. She's the creator of the My Best Self Project, a school-based prevention curriculum implemented in schools across the United States and internationally, and supported by ongoing research evaluating its effectiveness. Through student programming, parent education, and educator training, Dr. Forta helps communicate communities better, understand the cultural pressures girls face, and equips them with practical evidence-based tools to foster resilience, emotional regulation, and a healthier relationship with the body. She's a sought after speaker who presents to schools, communities, and professional audiences on adolescent mental health, eating disorder, prevention, parenting, and self-compassion. Dr. Forta is the author of How Can I Help My Daughter? A Mother's Guide to Nurturing Her Daughter's Best Self and Remains deeply committed to helping the next generation of girls grow into confident, emotionally healthy young woman. So it is such an honor and a pleasure to be interviewing you again. And I'm going to link to my interview that I did with you for my previous podcast, the Jewish Orthodox Women's Medical Association or JMA podcast. We're not going to be doing exactly the same things, in fact, because this podcast is not specifically for an Orthodox Jewish audience, it's for everyone. We're going to not focus on your work in that population, and we're gonna focus on the the larger issues which impact. Everyone everywhere. The work you're doing is so important and needs to be shared widely.

Marcy Fofta

Well, thank you. Thank you very much. It's always a pleasure to talk to you, Alyssa, so thank you. I'm very honored.

Alisa Minkin

Absolutely. So I want to start with talking about eating disorders and what we know about them. Let's put aside the Orthodox Jewish population and just talk about everywhere. I'd like an overview of how common are they and then the different types. Please.

Marcy Fofta

Absolutely. So eating disorders are a little more common I than people. Think right. We, we know that between nine and 12% of people in the United States will be diagnosed with an eating disorder in their lifetime. That is the equivalent of about 30 million Americans, or close to a half a billion people worldwide. And so, and this refers only to those who are diagnosed. Who have a diagnosable disorder. It's not indicative of how many people are struggling with food and eating in general. We know that about 95% of people who have eating disorders are diagnosed between the ages of 12 and 25. And in the last decade alone the number of preteens being treated for anorexia, which is one type of eating disorder, has really doubled. There's a lot of, there are a lot of statistics around eating disorders, but just the idea that. As, as, as young as age three, children are already starting to believe that thin is a positive thing and fat is something bad. And these are just adjectives. And already at that age, they're already starting to distinguish that factor. In fact, five year olds, 35% of five year olds are really already restraining their food intake in order to lose weight. and even 42% of first to third grade girls already wanna be thinner. So. know that 13 year olds are already attempting to lose weight and, and 10 year olds are afraid of being fat. This, this permeates so many aspects of our community, even if it's not an eating disorder level. and sadly the numbers show that people with eating disorders tend to be 11 times more likely to attempt suicide. 26% of people with eating disorders will attempt suicide some point throughout their illness which makes them. Not only dangerous but deadly of course, as well. so the types

Alisa Minkin

The types of.

Marcy Fofta

I will share with you. There are five types that are enumerated in the DSM five of course, which is our standard classification of mental disorders used by mental health professionals here in the us. and the first one is probably the most well-known one that's anorexia nervosa. but it's the least common eating disorder, believe it or not. I think a lot of people think that they can look at somebody and they can determine. You know if that person is struggling with an eating disorder because they look emaciated. But the reality is, is that less than 6% of the time when someone is diagnosed with an eating disorder, are they considered underweight. The vast majority of the time they're going to be in a regular sized body or a larger body, and so you can't look at someone and tell that they're struggling. But anorexia is that persistent restriction of food and that intense fear of gaining weight. People with anorexia nervosa tend to present with a body weight that is below. A minimally normal level for their age, for their gender, for their developmental trajectory, and even for their overall physical health. not always the case actually. But you simply can't determine if someone's struggling with anorexia based on their body appearance. And oftentimes people with anorexia have some type of dysmorphia, body dysmorphia with it, meaning they don't look, they look in the mirror and they don't see. Accurately what their body looks like. They see something different. The second kind of eating disorder is bulimia nervosa. And bulimia is recurrent episodes of binge eating. A binge is the intake of an excessively large amount of food, right? And it's a very specific period of time. They'll tell you two hours or less generally. It's not just like overeating or eating a big meal during this. This period of time the person

Alisa Minkin

Person feels.

Marcy Fofta

control over their eating. And they're not enjoying the food. They're not tasting the food, they're not realizing what they're eating. It's a very compulsive action that they're doing. And after they finish with their binge they feel a lot of guilt and shame around what happened. And so they follow that with some type of behavior to compensate for the binge. Things like self-induced vomiting, extreme exercise, might use

Alisa Minkin

Might use laxatives

Marcy Fofta

syrup, they might use enemas. Whatever they

Alisa Minkin

that they can use

Marcy Fofta

from what they just did. And there are

Alisa Minkin

and there are specific criteria for a

Marcy Fofta

How many

Alisa Minkin

many times a week, how long

Marcy Fofta

in order to

Alisa Minkin

in order to actually

Marcy Fofta

the official

Alisa Minkin

the official diagnosis

Marcy Fofta

and then we

Alisa Minkin

And

Marcy Fofta

called binge eating disorder. Binge eating disorder is actually the most common eating disorder in the United States. differs from bulimia and that. have no recurrent use of inappropriate behavior after the binge to compensate for it, but you do have the binges. so that's, that's kind of the difference between bulimia and binge eating disorder. And then there's something called arfid a I stands for avoidant Restrictive Food Intake Disorder. kind of describe this oftentimes as a feeding disorder versus an eating disorder. Ait. really extreme picky eating. People with AFA genuinely have a lack of interest in food and eating. I know it doesn't sound like a real thing to most of us, but they really have fears averse. They have a fear of aversive consequences if they eat certain foods, they don't like textures, tastes, smells, the temperature of the food. some people are born this way. Some people have this fear as a little child. And if that's the case generally. Occupational therapy is enough to help them. We introduce these textures, these foods, we show them that they're safe and that's enough to help them. But arfid can also be developed after a traumatic event. For instance, a mother shared with me, her 16-year-old daughter was babysitting and sh she was babysitting for the whole family, but they had a 3-year-old who choked pretty significantly. And so even though the, the, the child ended up being fine after that episode, she started feeling like her throat was closing or she couldn't swallow the food that was in her mouth or that something was gonna happen to her. And then it obviously has a psychological. Behind it and it requires different types of therapy. Occupational therapy wouldn't be enough'cause there's a mental component to it. then the final type of eating disorder that is enumerated is something called osted that stands for other specified feeding or eating disorder. People with OS Fed have extremely disturbed

Alisa Minkin

Disturbing.

Marcy Fofta

body image, an intense fear of gaining weight, but they don't fit neatly in any of the other categories. So some examples of os fed are something we call atypical anorexia, and that's when someone who is not underweight. They have all the other hallmarks of anorexia. So their BMI has not gotten to a lower category yet, but they're using all the behaviors of anorexia nervosa or there's something called purging disorder. And that is when somebody uses all those behaviors that we talked about after they have a binge in bulimia. The self-induced vomiting laxative use extreme exercise, but they didn't have a binge before they decided to purge. and then finally there's something called orthorexia nervosa. And this, while not considered an official diagnosis in the DSM five yet a lot of people are lobbying for it are. Obsessive behaviors around healthy foods. So it could be strict avoidance of a food that the person believes is impure, is unhealthful. Maybe they decide they're only eating organic food, or no preservatives or no manufactured food, whatever that looks like for each person. But ultimately even though the goal is to be as healthy as possible, the outcome is the same as in anorexia or in another eating disorder that they're malnourished because they're restricting their food intake so, so much, and the only other difference is that ASID is the most common eating disorder in the world, whereas binge eating disorder is the most common in the United States.

Alisa Minkin

It was an incredible breakdown. I really appreciate it. I have one more term to ask you about Big Auryxia.

Marcy Fofta

Big Auryxia, huh?

Alisa Minkin

Have you heard that one?

Marcy Fofta

I actually have not. That

Alisa Minkin

Oh.

Marcy Fofta

That could be that as somebody who has those anorexic behaviors, like that atypical anorexia, but they're still in a larger body.

Alisa Minkin

No, that big auryxia is a social media term. I think, and maybe that's why this is not an academic term and it's referring to the boys who are wanting to make their bodies bigger. It's also a kind of body dysmorphia, but it's more about bodybuilding. Maybe that's doesn't fall into the eating disorder category. I wanted to throw it out there and segue into the female male breakdown of this.

Marcy Fofta

Definitely males have different issues that they're struggling with and it is more muscular. Some males have anorexia and it's about weight loss for certain, but you're gonna see

Alisa Minkin

Gonna.

Marcy Fofta

Obsessions around, gaining muscle eating clean, making sure that you're working out a lot more ex compulsions around exercise. Right. But you do see that. Absolutely with girls as well, but it's not usually about bodying building their obsessions around exercise is usually about burning calories and losing weight and, you know, burning off the food that they ate. So while girls tend to be twice as likely as boys to struggle with eating disorders, we're definitely seeing an increase in boys who are struggling with eating disorders as well. But how we deal with that and, and where it's coming from, I agree with you, is, is not from the same place at all. Sometimes it is, but most of the time they have different issues, different things they're struggling with that might be contributing to it. But eating disorders are very complicated that way because there's no or two reasons why somebody has an eating disorder and somebody else who might have experienced something similar doesn't have an eating disorder. They're kind of an anomaly that way. They're biological, psychological environmental considerations. There's genetic considerations, so. We don't know why somebody has an eating disorder who experienced the same as somebody else.

Alisa Minkin

Right. I'm thinking right now about the old view of eating disorders being just anorexia, which I'm thinking of sort of, of the tip of the iceberg on a spectrum, and at the bottom of the spectrum would be disordered eating, which is not the same thing as an eating disorder. Can we talk about that for a few minutes please? Thanks.

Marcy Fofta

So disordered eating, so really. I like to, when I give presentations, I show this visual of a brain that's being filled with thoughts of weight and calories and dieting, and food, and shape and exercise when somebody's brain is completely preoccupied. Only with those thoughts. kind of one extreme. And that's the eating disorder, right? They don't have room for social life or even academics. They start off having energy for it. But ul ultimately when they're malnourished, their whole brain just turns over to thoughts about their body and their weight and their shape and what they're eating. And that, and that extreme is really the eating disorder. How much is it taking over your life? How much is of your energy is it taking, how much is it infiltrating Everything that you do. Whereas disordered eating might be some certain behaviors or habits or cultural norms in your, in your family, in, in the society that you live in that might not be healthy per se, but are

Alisa Minkin

Are not

Marcy Fofta

Disruptive to your life in a dangerous way

Alisa Minkin

way.

Marcy Fofta

that they, we would call them a disorder. They're just disordered habits. I like to think of eating on a spectrum, right? Where, let's say we have on one side of the spectrum, completely normal eating. On the other side of the spectrum, an eating disorder, I would say a, a disordered eating kind of individual might be at the 50 50 to

Alisa Minkin

To 75%

Marcy Fofta

on the spectrum. And that eating disorder from 75 to a hundred percent. So it's kind of how, how preoccupied are you with thoughts of weight

Alisa Minkin

weight

Marcy Fofta

in your

Alisa Minkin

and

Marcy Fofta

and eating and exercise. That kind of determines the difference and how it's affecting you. How are you

Alisa Minkin

Are you,

Marcy Fofta

Are you

Alisa Minkin

are you not suffering?

Marcy Fofta

From, from your

Alisa Minkin

From your illness, you know what I'm saying? Like, is your body

Marcy Fofta

do having to compensate for it in, in

Alisa Minkin

in certain ways?

Marcy Fofta

that's kind of the main difference.

Alisa Minkin

That's a really good explanation. I wanna talk about detection, but I really wanna talk about early detection and prevention, more than detection of when it's more obvious. And I'm going to link to the National Eating Disorder Association, so people who are thinking, I suspect my child or my friend, or whatever, has an eating disorder, will find plenty of resources there.

Marcy Fofta

Mm-hmm.

Alisa Minkin

there's plenty of good talks in this. What you do is prevention and as a pediatrician, oh, is my heart happy with that? We know that the earlier you pick up or even if you prevent something, it is so much better than when it already exists, right? The longer these things go on, the more and more recalcitrant they are to treatment, correct.

Marcy Fofta

Correct. Absolutely. Yes. Early treatment is much more successful treatment. The problem with an eating disorder that's kind of unique to other illnesses is that it has a physical and a mental basis right from the get go. So even though someone who struggles with depression might have physical That are linked to depression or somebody who struggles maybe with like a physical illness like Crohn's might also be depressed due to their illness. They're not part and parcel of the same issue necessarily with an eating disorder, right. The it, it's so complicated because it, it. It literally comes from both places. And so the longer somebody is starving themselves or binging and purging or whatever it is, the longer the malnourishment sense in the stronger the eating disorder voice becomes. And it is much, much, much harder to get the patient on the same page as you in wanting to recover because the eating disorder is serving a purpose for them. So earlier we help them, the better off they are in getting out of it.

Alisa Minkin

Excellent. Now, what about detection of early signs? You wanna go into that just a little bit before we go into prevention, which is what I really wanna focus on.

Marcy Fofta

Sure, sure, sure. You're saying some early signs and symptoms. So very kind of sad, interesting, whatever you wanna call it, is that eating disorders really do affect all organs and systems of our body. And so. There are a lot of signs and symptoms and just because someone displays a couple of them doesn't mean they have an eating disorder. That's first and foremost, but it is something to keep an eye out for. So things like understanding mentally there are pieces and physically, so mentally, does eating cause anxiety for them? Are they extremely unhappy with their body, not just, I'd like to, I'd like to be a little thinner. I, I'm a little unhappy. No extreme. Discontent. Do they control their weight by restricting, purging, or over exercising in, in an adolescent? This is, this is very

Alisa Minkin

Very dangerous behavior.

Marcy Fofta

and does it seem

Alisa Minkin

Doesn't seem like their entire life is dictated from

Marcy Fofta

about food and eating in their body? So those might be some mental pieces

Alisa Minkin

pieces to to recognize.

Marcy Fofta

but also of course that complete preoccupation around food and eating like we talked about. But you'll notice. All of a sudden they

Alisa Minkin

Sudden they might start

Marcy Fofta

eat certain foods. They might skip

Alisa Minkin

to refine meals

Marcy Fofta

might make

Alisa Minkin

they might make

Marcy Fofta

new rules around eating and

Alisa Minkin

eating.

Marcy Fofta

I don't eat before 11 o'clock ever, or I can't eat past 6:00 PM they start to be uncomfortable eating around other people. Maybe they have

Alisa Minkin

They have.

Marcy Fofta

or practices like cutting their food into very small pieces or chewing ex, you know, I have to chew. 30 times before I swallow or I can't have any fat on my food. Not just dabbing a piece of

Alisa Minkin

A piece of

Marcy Fofta

napkin

Alisa Minkin

nap.

Marcy Fofta

off a little fat, but like very compulsive. They're constantly dieting, talking about dieting. They might steal people not steal people. Sorry, steal food from other people's lunches. Or you'll notice that they're constantly needing to move. Their foot or their arm, or they're walking constantly because they wanna burn calories all the time, so they won't sit still. They might wear baggier clothing. Any extreme fluctuation in weight would be, would be a, a risk or a symptom. Over concerned with the weight of themselves or the weight of others would also be a symptom. they're, they tend to be withdrawn, have extreme mood swings. They, they feel disgusted with themselves overall. They also struggle to concentrate. They struggle to sleep well. They feel cold all the time, and they have a lot of gastrointestinal issues because they've altered the way that their body digests food, right? So eating can cause pain and bloating and heartburn nausea, things like that. Of course it's possible that they will stop menstruating or their menstrual cycle will change. That's definitely a possibility. It's not necessarily the hallmark like it used to be to diagnose an eating disorder, but it is a possibility. And then finally, somebody who has abnormal lab findings. Maybe you're seeing that they're a little anemic or their thyroid's very low, or their electrolytes are off balance, right? Or their red blood count or white blood count is low, or they're very dizzy. All the time, or they faint. You might notice sores on the back of their hand from self-induced vomiting or dental issues and lowered immunity. And I would also say frequent bathroom trips every time they eat, they go to the bathroom right afterwards would also possibly be a sign.

Alisa Minkin

What about restricting their diets, say becoming vegetarian? That's a little tricky, right?

Marcy Fofta

That's definitely tricky. I mean, so somebody who says they wanna be a vegetarian and their entire family is doing that and they decide like, you know, for they, they feel sensitive, they don't wanna eat animal products and their family cooks healthy and knows how to ins implement, put in the nutrients that they might be missing from animal products. That might be okay because that's a family value and they're doing that. But somebody who just decides all of a sudden out of the blue, you know what, I'm not, I'm not eating any animal products. We have to understand why are they doing that and what's underlying it. A lot of people will cut out gluten. That's a fashionable one without having Crohn's disease or a diagnosed gluten sensitivity. You know, I'm just gonna, I can't eat gluten'cause it really bothers me. Or you know, I have to do intermittent fasting is a big one. Because it gives them structure around their food and eating. But for a child, they need regular nourishment throughout the day. You can't only eat one or two meals. It's, it's, it's not healthy for a growing adolescent. What, what, what's okay for an adult? And I don't know that I'm, I'm, I'm not saying that it's okay for an adult, but I'm not judging it for an adult. What's okay for a kid? They're not the same thing.

Alisa Minkin

Right now I wanna go to prevention and I wanna not forget to mention the body project because what you're doing is specifically for the Orthodox community, but the body project is universal.

Marcy Fofta

Correct, and the body project is fantastic. How it works is by creating a cognitive dissonance, right? So the children hold one belief. That could have come from their culture, their family, their environment. And we are introducing a new belief and we're proving why this belief could be true. And the nature of the

Alisa Minkin

The nature of.

Marcy Fofta

that you can't hold two conflicting thoughts at the same time. So in order to reconcile this new information that you just learned and was proven to you, you have to create new pathways of thought, right? And so

Alisa Minkin

So

Marcy Fofta

project

Alisa Minkin

project

Marcy Fofta

very

Alisa Minkin

very strongly on body image,

Marcy Fofta

appearance

Alisa Minkin

appearance ideal.

Marcy Fofta

those things are not

Alisa Minkin

things are not necessarily

Marcy Fofta

Valuable. It doesn't create good health, just looking at your body and wanting to be thin and, and where those messages come from, and that's

Alisa Minkin

very.

Marcy Fofta

What we've kind of also added in our program is the piece of self-compassion. Kristen Neff and her concept of

Alisa Minkin

Concept of self

Marcy Fofta

how we speak to

Alisa Minkin

speak ourselves, our expectations,

Marcy Fofta

feeling like. We are part of a larger community

Alisa Minkin

community.

Marcy Fofta

struggles. What we have found and what the research is actually now showing, which is very interesting. We're doing a lot of research not only on our programs, but in general around self-compassion, that body image is a construct

Alisa Minkin

a

Marcy Fofta

can change

Alisa Minkin

that change

Marcy Fofta

because our bodies change. So we've made peace with ourselves

Alisa Minkin

ourselves right now,

Marcy Fofta

we're okay with that. But as our bodies change, especially

Alisa Minkin

especially.

Marcy Fofta

sometimes our bodies change more maybe than men because we have pregnancy. Menopause. We have different stages. Men do too. But you know, it's, it's a little different. It's a little harder to stay okay with our body image that changes. But if we can actually establish. for ourselves. The, the, the practice of self-compassion, not just self-compassion the way Kristen Neff has explained it. Then we've, we've created a framework that that helps us throughout our entire life. we, we kind of combine both in our program. So I think that that's very important in prevention is creating resilience because. It's like that old adage of, you know, giving a man a fish

Alisa Minkin

Fish

Marcy Fofta

teaching him how to fish

Alisa Minkin

fish.

Marcy Fofta

for life. So we, we don't wanna fix today's problem for them. We actually wanna help build a framework and a structure of resilience. Moving forward because in our lives we're always gonna have new, unique challenges. And so that's kind of where our framework from prevention comes from. And, but that's all built on the cognitive dissonance of the body project, which is the, the mother of how we do this, the most successful program. And it is very, that's very, very important program. Eric Stice, everything that they've done is, is really, the framework that we work in. but I think that in prevention there are some

Alisa Minkin

There are some factors that

Marcy Fofta

preventable factors that we can work with. And then there are things

Alisa Minkin

are

Marcy Fofta

that are just not preventable, right? things like weight stigma, weight bullying, messaging from die culture, they exist. But when we educate, when we educate

Alisa Minkin

parents.

Marcy Fofta

educate educators, when we make a noise about this, talk about it, we can. people how to kind of stop doing that, right. I don't think people always realize there's a lot of unconscious bias in schools, in healthcare against people who are in larger bodies and educating them around that bias and, and how negative that bias can be for somebody who experiences and, and the negative outcomes that are long term for them can actually help us change. You know, the outcomes and what and how people talk. So those things are things that we, we work to dispel. Diet culture. Diet culture. Meat is just, just to give you a context, diet, culture is just that belief that our body size is the most important thing that we will work to achieve. Being in a small body eating less food, exercising more. These are goals that are very praiseworthy, let's just say. So kind of. But diet culture also says that being in a smaller body is not only praiseworthy, but it's also healthier. It's the way we're meant to be. And we know that that's not necessarily the case. Not all people in smaller bodies are healthy, and not all people in larger bodies are unhealthy. So we have to, we look at a lot of different factors. BMI is one factor that actually isn't even an accurate. Factor, but we still kind of use it. But we have to look at blood pressure. We have to look at cholesterol. We have to look at joyful movement. Are they moving their

Alisa Minkin

They moving their bodies.

Marcy Fofta

well? What does their diet look like? There are

Alisa Minkin

There are other ways to.

Marcy Fofta

Health and health is not only physical, it's spiritual, it's emotional. And so if you're only focusing on your body to, to try to be healthy, you're, you're overlooking other aspects of health which can actually make you. unhealthy in the process. So we can, we can work on those. We can also work on some family influences, right? We can help moms be better role models for their kids. We don't always realize as parents, the the messaging, not just moms, I mean moms and dads. We don't always realize the messaging that we're giving our kids. the things we say about even our own food or that things we talk on the phone with our friends or the little comments that we make to our children. Did you really want to eat all that or don't you think you had enough? Certain comments and things that we say, how we approach certain things can have a big influence on our children. And it's not to say that some kids don't need to change their body size. I'm not saying that how we help them. Is, is is really very important in preventing an eating disorder or an issue with disordered eating or problems down the road. So I do think social media, is a big, big issue not only staying off social media, but being, oh. Allowing your children to feel comfortable to come to you about the messaging that they're seeing. We should be informed about what's on social media. We should also be informed how to, how to approach this with our children, right? Everything that they see on social media is doctored, altered. It's been modified in some way. It's everything on social media is. The value of it is only from the physicality of what you are seeing. The messaging can be very

Alisa Minkin

very.

Marcy Fofta

We are getting our information for serious things in our life off of an influencer is in a skinny body but know or do anything else. So we really need to help our kids evaluate the messaging that they're seeing. It's not realistic to think that our children will never be on social media. In this day and age. But we, we can definitely temper it and we can help with the

Alisa Minkin

Messaging.

Marcy Fofta

they see by being an open book with them and, and educating ourselves. Then this is found not only on social media, it's found in magazines, clothing, store mannequins, our peers, whatever our society dictates to be attractive and desirable. I think what was the other thing I wanted to tell you? Personality. So. Well, personality traits obviously are ingrained. might not be able to change somebody who's very perfectionistic, or who has like a negative emotionality where they're more fearful or sad or angry, I can address that, right? Because I know that that could be a risk for an eating disorder. So I can help them by helping them with the self-compassion piece like we talked about, emotion regulation, resilience things that are in my control and not in my control. So we're, we're, we're helping. Different

Alisa Minkin

Different personalities.

Marcy Fofta

that's both a preventable factor, it's also a non-preventable factor. So we have a little bit of both in there. and we can change the messaging that we choose to give our children. This is a very big one. In prevention, we tend to. No, we tell our kids and we, and we want them to know that their value as a human being does not come from what they look like on the outside, but we model that. That's actually what we value when we compliment everybody that we see. You look so good. Did you lose weight? I wish I had your, your willpower. You know, we, we, we compliment over and over again about, oh my gosh, I can't believe how skinny you are. Give me some of that. What did you do? Even if they're sick or they had. Traumatic situation in their life, and it was beyond their control that they lost this weight. We tend to compliment them on that, so we have to be very careful about the messaging. we give our children that it isn't a mixed message. And the same with our messaging around food, that can definitely be changed, right? We, we wanna talk about food as a tool for our nourishment and growth. We want our kids to learn to recognize hunger cues. What does hunger feel like to you? And what should we do when our body is hungry? And how do we recognize fullness cues? How do we know when we're full? What does that feel like? Because that's. Just like we teach our kids hygiene, we teach them when our bodies are signaling to go to the bathroom. We go to the bathroom. We want them to feel they really need to be in touch with their own bodies. sometimes when we're, our kids are little, we inadvertently might. Alter those cues, for instance. so as a pediatrician, you know this, right? You can't overfeed an infant. You can try, but they'll either throw it up or they'll pull away from the bottle, or they'll pull away from the breast because they're done. They know what it feels like and they're finished. we, our kids are growing up, we might say to them, oh, you didn't finish what's on your plate. You've gotta finish what's on your plate, or. have seconds or don't have any more, you ate enough. We kind of give them messaging around hunger and fullness and so now kind of subconsciously what happens is they're saying, oh, my mom says I'm full, so I must be full. It doesn't matter what I thought. This is what is happening. So somebody outside is telling them what their body should feel like, so we really wanna stay. Really careful in the messaging around eating and food and that, that's a whole big topic, but that's one of the ways that we can also help in prevention and. calling food good and bad and junk and garbage and whatever we call it. Because there's a lot of morality judgments around people who eat that food or the food itself. Yes, that food might not be nourishing food. That is correct, but it has a time and a place, right? Food is love. Food is celebration. People have special foods that their grandmother passed down to them. If we demonize food then, then that is another way in which it could become an eating disorder for a child because they become confused about the messaging. So we have to be really careful. But some things that are non-preventable, of course, are genetics. We have found that between 40 and 65% of your risk for an eating disorder is genetically based. So if you have that genetic predisposition, like you might have a genetic predisposition for Crohn's or. Diabetes, or I don't know, celiac disease, then you are at a higher likelihood of that happening or something could trigger the onset of it. So that's not a preventable factor. If you have family influences, maybe grandparents or extended family that you can't really change. they talk to your kids, you don't feel comfortable. That might not be a preventable kind of factor. Obviously messaging in the media, we can contextualize what our kids are seeing, but we can't change the messaging that is being put out there. That's not a preventable factor. And adolescents. That's, that's a risk for eating

Alisa Minkin

For eating disorder

Marcy Fofta

when we're in that

Alisa Minkin

that stage.

Marcy Fofta

a higher risk. That's just kind of the way that it is. So those are kind of some of the, the factors.

Alisa Minkin

It was amazing. You didn't even come up for air and you went through so many of the things I wanted to cover. I just sat back and let it flow. I didn't interrupt you for a reason, so thank you. That was phenomenal. I have a couple things. First of all, I wanna say that when we talk about preventative versus not preventative. We are not blaming the victim here. We are not blaming the parents. We are not blaming the kid. I wanna say that a million times over. These are very complex, multifactorial, complex conditions. It is not your fault that your child had. It is not your fault if you have it. It is just not. That's, I wanna say that loud and clear, but we're not gonna give up the idea of prevention because of that. I wanna point out, this is a tiny point, but maybe not so tiny, is that. When you're talking about sense of fullness, not everybody has that. Naturally there can be an interceptive problem, right? Where our sense of what's inside us is not typical. Like someone who may be on the autism or a DHD spectrum, for example, may not literally feel full like you are, you know, a a, a typical person would, and again, that's not a preventable thing but. That's still something to be be aware of. So you do what you can do and you don't do what's what's not good. That's really important. And you said so many things for a parent to do and not do, and I think that that is amazing. I'm just going to also underscore that the messaging that the parent gives is gonna come from where they're holding. Right, so I always say, put your oxygen mask on first. I say that in every single podcast because the parent is the leader. By the way, speaking of genetics, you should not feel that genetics is destiny because confusing genetics with heritability is a problem, meaning that there's other reasons for things to run in families besides genetic changes. There's epigenetics and there's environments. So if you have a family that is very focused on size and weight, that child's growing up in that. Disorder triggering environment.

Marcy Fofta

Absolutely. Absolutely. I agree with everything that you just said, and I, I, it's very important for me also to clarify that it isn't one thing that causes an eating disorder and it isn't somebody's fault that someone has an eating disorder. That, as you can see from what we've been talking about, there are just so, so, so many factors. And yes, it is more complicated when a child. It has issues with hunger and fullness. There might be a different way that we have to go about helping them with that. And that's when the parent might have to put more structure around that. But for a regular child, obviously, that's kind of what we're talking about, to help them recognize those cues and things like that.

Alisa Minkin

Right. And speaking of the neurodivergent population, I do believe they have a higher incidence of eating disorders if I am correct.

Marcy Fofta

Yes, that's true. And I, it's very interesting to me because most of the time people will assume that, you know, somebody tried to be skinny and then it turned into an eating disorder. And that's not really always the case, right? Sure. That is a part of the population. But interestingly, the actual act of. Losing weight, whether you did it purposefully or maybe you had a bad flu, or maybe you had an illness where you lost a lot of weight, or maybe you're taking GLP one medications and you, you physically can't eat whatever reason, actual act of losing weight can trigger. The onset of the eating disorder for some people. and I do think for the population, it could be they have food diversions, they have

Alisa Minkin

They have.

Marcy Fofta

whatever that looks like for each person. That's why it is so complicated. Like you said, there's no one reason or five reasons why someone gets an eating disorder. It's, it's a very biological, psychological, environmental illness. And there are some many, many factors. But yes, we are seeing more sometimes in the the neurodivergent population.

Alisa Minkin

It, it, it's super, super complex. And the other thing I wanna underscore that you did talk about is the focus on the external versus the internal. And I love your program that you do for the Orthodox community because part of that is teaching to focus on the internal. Right.

Marcy Fofta

Mm-hmm.

Alisa Minkin

I share some of that with us.

Marcy Fofta

So I, and I wish I remember their names. I think it's Lexi Lexi's. There's two sisters that are twins and they wrote this book and it, the, the, the gist of the book is that your body is an instrument not an ornament, right? It's an instrument in our, that we use in our life to get to do all the wonderful and amazing things that we're gonna be doing. And it isn't an ornament for people to look at or to shape or to do in a certain way. So. I like to make it clear. It's not that I'm telling you you should never care about what you look like. That's never something that we say, but it shouldn't be the primary way that we value ourselves via our physical appearance. And logically we know that that's not the case, but emotionally. Like you said, we've all grown up with this messaging. I feel like in a lot of ways we're in a fishbowl and we're swimming in the same water'cause we're all hearing the same messages and we so badly wanna step out of that water and give our children something different because we don't want them to suffer or struggle the same way that we did. Right. So many mothers will share with me women in their sixties, seventies you know, my mom took me Weight Watchers when I was eight. old, 7, 8, 9 years old. And to this day, I, I, I don't feel comfortable around food. I don't feel comfortable making food choices for myself. I, I'm always second guessing myself. And we don't want our kids to suffer through this. We wanna make different choices for them. So that's why it's so important to kind of shift the perspective to gratitude for the things that our body does for us every day. And in order to do that, it's not an easy thing to do. It sounds like it's very easy. We have to kind of push that for our children ourselves, us also having gratitude. So even if, let's say we had a really busy day and we ran around so crazily sitting down at the dinner table and saying, I am so appreciative of my legs. You cannot believe how hard they work today. Thank you legs. Or you know, I, I have this complex problem that I was solving and I figured it out. My brain worked so hard today by us. Mentioning

Alisa Minkin

Mention

Marcy Fofta

and have appreciating it and having gratitude for it. Our kids will also start to think in those terms and we can push that by sitting with them at night. You know, what's one thing your body did for you today that you

Alisa Minkin

that you didn't expect it to do.

Marcy Fofta

what's one thing you're appreciative of that you were able to do with your body? Or what's something your body's done for you that you don't even know that it's doing for you? Or you don't think about it every day? Right? Like breathing or our heart beating. more we can cultivate gratitude and awe. for just the normal use of our body and how it, how it performs. The better our kids are in, in recognizing that and in

Alisa Minkin

that using their body weight

Marcy Fofta

It's, a much better

Alisa Minkin

better,

Marcy Fofta

just the body positivity movement, which is just like, be big and

Alisa Minkin

big and happy. It's not,

Marcy Fofta

a,

Alisa Minkin

it's

Marcy Fofta

a different kind

Alisa Minkin

different. It's also the focus on what it does, the insight as opposed to what it looks like. I think we also have to think about what kind of language we use that our kids are hearing us say. Like you said, oh, you look so good. Did you lose weight? You look amazing. Look at that beautiful dress. You look amazing. Not that it's

Marcy Fofta

No,

Alisa Minkin

to appreciate a dress, it's not just saying the focus.

Marcy Fofta

for sure. And I think, you know, people will say to me, it don't, don't need their parents to tell them they're beautiful. But you know what? They need to know. The beauty is a construct that isn't just physical. A beautiful person is a kind person, is a, is a, is a responsible person, an honest person. So yes, you're beautiful because you're beautiful, but also this is what your beauty means to me. And, and, and we need to kind of reframe all that for the, for the child in order for them to look at their body in a different way.

Alisa Minkin

I love that. I'm just thinking about gymnastics and how the gymnastic body has changed. I don't know if you've noticed this, that I don't know if there's the same rate of eating disorders.'cause you can't tell by the body size or type. Right.

Marcy Fofta

Exactly.

Alisa Minkin

We should say that 10,000 times to all the physicians especially and other healthcare professionals out there. But if you're looking at the gymnastics participants now, they are more muscular. They have larger bodies, but they're able to do amazing things and it's no longer these frail little tiny, you know. Delicate

Marcy Fofta

Yeah,

Alisa Minkin

woman.

Marcy Fofta

agreed. One thing I wanna say is less than 6% of the time when someone presents with a eating disorder are they considered underweight. The vast majority of the time they're in a regular sized body or a larger body. So you're right, you cannot see it. And I wish I remembered the name of this person who's in the Olympics, and she did a comeback for ice skating, and one of the conditions she told her coaches for coming back was, she's going to control her own diet and she's going to eat. Whatever she wants she's gonna do this and she's been performing greatly and I'll, I'll try to find her name for you. do think that we're shifting, definitely we're seeing different types of bodies and, and in all honesty, we all are shaped differently.

Alisa Minkin

Right, right. But you could say to your daughter who's watching the Olympics, look at how powerful she is. Right.

Marcy Fofta

I love that.

Alisa Minkin

So that's what I was thinking of. Jordan Child. Go Jordan Child watching her 10 outta 10. How many times?

Marcy Fofta

I know

Alisa Minkin

Little bit of a tangent there.

Marcy Fofta

No, she's incredibly powerful. Yeah, it's beautiful. It's, it's, that's real beauty. Look at how they're moving their bodies in such graceful ways. That's beauty.

Alisa Minkin

These are messages you can give to your daughter and your son, right? And just be careful what what you're saying. I wanna talk for just a minute about healthcare professionals and. We already talked how they really need to be aware that kids with eating disorders come in all shapes and sizes, and it's not just about the weight, but I think that there are things that they can say and do that are helpful and not so helpful, and I just want to give you a chance to talk about that please.

Marcy Fofta

Yeah, so a lot of the time they haven't had a lot of training, to be honest with you in looking for. Issues eating disorder issues. So I'll hear in my line of work a ton of stories from moms who have gone to the doctor with their child and said, I'm concerned. I'm seeing this. I'm seeing that doctors are like, well, her BMI is still in the normal category and this could be a normal sign of puberty. Let's just wait. Let's just wait. And unfortunately, by the time they come back three or four times, it's become such a significant eating disorder that it requires hospitalization, much more intense treatment. I think. It's really important for doctors to listen to their, the patient's, mothers or father, whichever parent is bringing that child in. I think they're very in tune with their children. Most parents, not every parent, but most parents are pretty in tune. This is not normal for my child. I'm seeing a change or they're going through something and this doesn't seem normal. I think the doctors have to learn to listen better and hear what's going on. Number one. I think doctors also feel very comfortable, uncomfortable talking about body image. With, with children and I think that they need to learn how to have some language in approaching the child so that there's not. Weight stigma attached because a lot of times when a child might come in, in a larger body and the doctor says This child needs to lose weight. What, what we see and what the research shows is if you tell a child they need to change their body size, all they hear is they don't hear. They're trying to get me healthy. They love me, they care about me. They hear. I'm ugly. They think I'm disgusting. What's wrong with me? That's what they hear. So how we approach it, I'm not saying it's a conversation that you can't have. I'm saying we have to approach it very sensitively and a doctor needs to be aware of that. They can't just lay it out there in an insensitive way. A child is not the same as an adult. And how you talk to them about their body. Their body image and self-image are, are the same thing. So when you say their body needs changing, you're telling them they're not okay the way they are, and we have to be really sensitive to that. So I think sometimes I, I actually recommend to moms, to fathers to. Ask the doctor to have that conversation privately and not in front of their child. I'll have the

Alisa Minkin

Conversation

Marcy Fofta

to have it with me. Obviously, that's my job, please don't do it in front of my kid because it's, it's not good. Kids come out crying every time. They have to get on the scale every time they have to say

Alisa Minkin

have to say something to

Marcy Fofta

We need to find

Alisa Minkin

need to approach.

Marcy Fofta

that we shouldn't approach.

Alisa Minkin

Approach.

Marcy Fofta

Of course, but how do we do that in a way that will be very sensitive to the child? So those are the main things that I would say are really important. and, and really recognizing those signs and symptoms, like I talked about, hearing what the parent is saying and asking the right questions. Because just because a child may be, let's say they're withdrawn all of a sudden, doesn't mean they have an eating disorder, right? But if we're seeing that in conjunction with the fact that they had a big weight loss. For a child losing 10 pounds is a big percentage of weight. So that that means something is going on. Okay. Is it physical? Is it mental? That shouldn't happen without a reason, so let's figure out what's going on. Some of it's puberty. Of course kids tend to gain weight right before they have a growth spurt, sometimes it's really signaling something is wrong. the one other thing that I would like to say is, so we have what we call, let's say like a, a normal weight. You wanna say if someone's in a higher weight body and then we have somebody who's in a, a very large body, right? That that's. I know we don't like to use the term obesity, but some, a child who's in a very large category of weight, that's outside the norm. So we wanna understand what's, what's happening with that child, because that's not on their growth chart, right? They're not, they're not staying on their growth chart. All of a sudden they've gained a bunch of weight. So first we wanna understand, is there something physical going on with the child, right? Is there a thyroid issue? I don't know. There could be you, you know, more than me, what could be going on physically, and if everything's fine physically. What's happening emotionally, because we can take the food away from them, but if we don't address the underlying reason that they're using food, then they're gonna have another problem once we take the food away, which is part of the issue that we're seeing with GLP ones. can't just give GLP ones to a child without health help to understand why this child is in such a larger body. What, what are they using food for? If I, if I remove th that as their comfort? Then, and I didn't give them something else, then it's going to morph into another problem.

Alisa Minkin

Just

Marcy Fofta

just a lot of things to think about and be sensitive to.

Alisa Minkin

absolutely, and I'm gonna cry for just a minute here, that we don't have multidisciplinary programs in many places like we should have because there are so many components and so many different professionals that could be of help here. These situations tend to be complex. They tend to be, you know, a combination of mental health and physical and all these kind of things. So that's hard if, but the only way that you can handle it is to make your own team, build your medical, you know, therapeutic village as a parent, that, that's number one. And also to be that wall for your child to protect them against other professionals, whether it's in school or in the doctor's office or whatever, and unintentionally hurting them. I also wanna talk about asking permission to talk about weight because I think that's really, really important. I know doctors and other healthcare professionals, PAs, nps, everybody's out there. We are under the gun. We have very little time and we are expected to do that metric of that BMI, right? If we do nothing else it's really, really hard in limited time. It's really, really hard. So I, I think we need to have something for the, these healthcare professionals to, to guide them in ways to do this more sensitively without asking them to spend another 45 minutes.

Marcy Fofta

So I don't know what you think of this. This is something I've been thinking about. We have, you know, they started doing those mental health questionnaires and screening, right? If they see something that's wrong. why do we not have a dietician or a nutritionist on a staff in a pediatric office And that during your physical every year, you, you see, you talk to that person once a year. I think that we would catch a lot of these issues. It would also lighten up the doctor's load to be responsible for that. And it would really only benefit the practice and the child and the families. Hugely.

Alisa Minkin

I think we need to have integrated mental health and nutrition and all those things. That's where I get to the multidisciplinary. I'm putting my prayer hands up in the air. Maybe people can work on this for their child's practice. That would be amazing, but it's not the reality. At least now, and for many, many people. And so what, what I think about as a pediatrician, what I try to do is I try to be really sensitive and really careful. The vast majority of the time, everybody's aware that there's a weight issue, all right? You don't have to tell them, so don't tell them, right? If you're talking about a teenager, you're gonna see that teenager alone. You're supposed to

Marcy Fofta

Right. Yes.

Alisa Minkin

ask permission.

Marcy Fofta

Yeah.

Alisa Minkin

Can I speak to you about this? Would you like to talk about this? Do you have concerns about this? Let them lead the show rather than you come in there and you know, tell them

Marcy Fofta

I love that.

Alisa Minkin

so that That's one thing. One thing, and I think we do have to acknowledge that unfortunately, many of these stories of eating disorders seem to have a beginning where a child went to the doctor and the doctor told them they were too fat and had to lose weight.

Marcy Fofta

That is absolutely the case or a family member or somebody said that. And it, and it really, but especially a medical professional, I think sometimes we assume that if it comes from a medical professional, a child will take it better. But no, that's not necessarily the case. If, if they just don't realize how to talk to them or the sensitivities of your child, because every person is very different. You might say something to this child and they were frying with it, and then this other kid is crying for the next two weeks because you, you said this one comment. I think, I think we have to be so sensitive to the makeup of that child. you speak to the parent, is this something we should have a conversation with them about or are you comfortable if I have it, or would you like to have it separately? Or like you said, when it's a teen and they're seeing them privately, to have that, ask them, you know, is this, do you wanna talk about it? Is this something that you have concerns about? A lot of the studies show though, that even if they change their eating habits, they don't sustain weight loss in adolescence for an extended period. But if you,

Alisa Minkin

You

Marcy Fofta

if we kind of teach them how to, how to make better

Alisa Minkin

make better choices.

Marcy Fofta

Learn about food as nourishment versus calories in and calories out. How, how that process is in our bodies, what it does for our bodies, how we learn to feel, what we might be in the mood for. If we have an exam, let's say and we have to think for an extended period, maybe we want something that has a lot of protein in it. Maybe having eggs for breakfast might be a good choice for you. Or if you're gonna go outside and have a really race day or an outdoor day, or a big gym day or a a basketball game, you're gonna need some complex carbs to get you through. training. I think we need to change the way we also talk about food and the expectation about weight loss versus let's make some

Alisa Minkin

makes better choices. I love that. And even if you don't have an integrated nutritionist, you can still refer to one and you don't have to refer to one as a way to lose weight. In fact, there are non-diet dieticians out there

Marcy Fofta

Absolutely. Absolutely.

Alisa Minkin

that do not follow diet culture, and I think that especially with the adolescent population, you should try to find somebody that does not adhere to diet culture.

Marcy Fofta

A hundred percent. Yeah. It's not about eat this many grams of protein and this many grams of carbs and these many vegetables because that, that be very diet eating disorder esque because it's rules around eating versus the philosophy and how we feed our bodies and what's important in the essential nutrients and how we get those and how what they do for our bodies. So, so, so important.

Alisa Minkin

And if you have a patient that comes in and they, maybe they are still at in a bigger body, but they haven't gained weight and they've changed their eating habits and they're physically active, you clap for them. Right? Like you go girl,

Marcy Fofta

Exactly, and if they're sleeping well and they're

Alisa Minkin

right?

Marcy Fofta

things right, so sure they're doing things that are good for them. They're moving their body in healthy ways, they're doing all the good things, and all their other numbers are pretty, pretty good. let's say they're, let's say they were born at the 80th percentile for their weight and their whole life. They've stayed at the 80th percentile. Maybe that's where their set point is, and that's just the size of their body. Based on genetics, based on all the different parts to what, where our body is. It's not only about what we eat and how much we exercise.

Alisa Minkin

It shouldn't just be about the number it really shouldn't be. And, and, and we, we should be able to accept that. But it's also working with the child and working with the family to be healthier

Marcy Fofta

Yes.

Alisa Minkin

as the main goal. And again, not focusing on the external appearance, which includes the weight.

Marcy Fofta

Which includes the weight. Exactly.

Alisa Minkin

Right. So on that note, I'm gonna keep on time here and I'm gonna Thank you so, so much for doing this with me. This has been amazing. It's so important. I really appreciate it.

Marcy Fofta

Thank you. It's been I love, I always love talking to you, so thank you for the opportunity.

Alisa Minkin

Me too. Thank you.

Thank you for listening to Kids Matter. Raising Healthy, happy Children Takes a village, and I'm grateful you are part of ours. If today's conversation resonated with you, please share this episode with another parent, grandparent, teacher, or anyone who cares about kids. Together we can build a supportive community our children deserve. I'd love to hear from you. Share your thoughts, questions, or suggestions for future topics at Kids Matter podcast@gmail.com. With no explanation for your voice truly matters. Until next time, keep advocating for the children in your life because kids really do matter. They are our future. I'm Dr. Elisa Minkin and this has been Kids Matter. Please note that while I am a pediatrician, I am not your child's ped. This podcast is for informational purposes only and does not constitute medical. For any medical concerns or decisions. Reach out to your child's healthcare professional.